Archive for August, 2009

If there were only one truth, you couldn’t paint a hundred canvases on the same theme

I saw this quote at an exhibition of the work of Picasso and Cezanne in Aix en Provence. You only need to think about Cezanne’s paintings of Mont St Victoire to understand this. Or think of Picasso’s re-working of the themes of other great painters…Manet, Goya, and so on.

I find this also extremely applicable in health care. A patient never has only one story to tell, because as human beings, life is not like that. Not only is every patient’s story fascinating, but I find every time I meet a patient there’s a new story to hear and explore. Truth is never single. And it’s never complete. It’s always worth taking another perspective, hearing another story, exploring from a different angle

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Chateau de Vauvenargues

Chateau de Vauvenargues

The Chateau de Vauvenargues has never been open to the public before, but for four months this summer it’s possible to visit. I went yesterday and it was wonderful. It really is in a beautiful location as I’m sure the photos above will show. It sits at the foot of Mont Saint Victoire, which Picasso never painted. He had a deeply respectful attitude towards “Monsieur Cezanne”, as he always refered to him, and that seems to have led him to steer clear of painting the mountain which not only provides the backdrop to the castle, but part of it was even included in the title deeds of the castle itself. I think that was one of the big surprises. After all, Picasso had no qualms about revisiting the works of Manet and others!

The main surprise though, was what the guide refered to as Picasso’s “spartan” choice for the interior. He left pretty much the whole interior as he found it – didn’t redecorate it (apart from painting the plaster in the bathroom with a woodland scene!) and only “upgraded” the place by installing a new bathroom and central heating. There is very little furniture in the house which certainly does give a feeling of simplicity, and the walls and ceilings are faded and peeling. I was also surprised to learn that he didn’t paint the views he could see from the windows, but that he said that when he painted here his painting became more green! You can see this is true. There’s a lot more green paint used in the works he produced here. However, the ancient links between Barcelona and Aix allowed him to explore his favourite reds and yellows and even led him to have a huge Catalan flag as the headboard for his simple double bed.

Picasso and Jacqueline are buried in front of the castle with a simple Picasso sculpture over the grave – no headstone, no words.

Sometimes it’s the simplest of experiences which are the most intense.

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Last week I stepped well out of my comfort zone. As you’ll know if you’ve browsed this blog, I am a keen photographer. However, that’s really the limit of my artistic endeavor. I have no sense of myself as an artist and drawing, painting and other creative arts feel as foreign to me as foreign languages I can’t even name do! So what led me to sign up for a two day workshop on photo-etching at the Gracefield Arts Centre in Dumfries? I think it was seeing some beautiful etchings for sale in the shop there and finding a leaflet advertising the course.

Well, whatever the reasons were, I signed up for it, and I thought I’d share a little bit of the experience with you so maybe you’ll be inspired to try something creative well out of your own comfort zone.

I took a few photos with me, but wasn’t at all sure what kind of photo was a good one for photo-etching. It turns out that the best prints are bitmapped ones that look very grainy or “dotty” when you look at them through a magnifying glass. Alfons, the workshop tutor, recommended I use one of my photos of rock carvings from Kilmartin. The first step was to lighten the image on a photocopier, then copy that image onto a transparency.

First etch
First etch

The copper plate to be etched is then prepared through a series of stages, involving applying a photosensitive polymer (like a thick oily bright blue paint) with a roller onto the prepared plate. The image on the transparency is then laid on the polymer-coated plate which is then exposed to UV light on a special machine (which looks like a giant photocopier!).
The exposed plate is then developed and etched through a series of soaks in different baths (there are several individual steps involved in this!), then the polymer is stripped off, and the plate polished to leave something like this …..

First etch

Then comes a VERY exciting part. The plate is inked, laid on dampened paper under woolen blankets in a printing press. A few turns of the big wheel to press the ink into the paper, and then it’s time to lift the blankets, and peel the paper off the plate to reveal the final print. (I can’t tell you just how thrilling it is to see the print emerge at the end of this process!)

First etch

It really did take a full two days to go from the photo to the print. There were nine of us in the workshop and the entire time felt fully engaged in the activity of making the print. I loved it.
I think I was very lucky to have such an enthusiastic, skilled and welcoming teacher as Alfons Bytautas from the Edinburgh Printmakers.

Not only has this workshop opened a new world to me, but I feel I’ve just discovered a part of myself I didn’t previously know existed! Seriously, you should try something creative, you’ve never done before.

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Atlantic lighting

If you want to build a ship, don’t drum up the men to gather wood, divide the work, and give orders. Instead, teach them to yearn for the vast and endless sea

Antoine de Saint-Exupery

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Penn Reading Project

The University of Pennsylvania usually sets a book for their new students to read over the summer before term begins. It’s a way of introducing their freshmen to academic life. This year, however, they’ve set a painting to be studied instead of a book.

They’ve chosen the local artist, Thomas Eakins and his 1875 painting “The Gross Clinic”. The university has another of Eakins’ paintings in its collection – the 1889 Agnew Clinic.

I think this is a very interesting development, and I’m not aware of any other universities which set a painting for everyone to study and discuss in this way.

Which painting would you choose for all the new students at your local university to study?

I’m pretty sure one of my first choices would “The Anatomy Lesson of Dr Tulp” (which happens to be one of my all time most viewed posts!)

Any suggestions?

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the need to belong

Everyone has to deal with this paradox – how can I preserve my individuality, yet not be isolated? I think of it as a spectrum, with individuality at one end of the line, and shared membership of a group at the other. Our immune systems are designed to recognise anything that is “not me” and reject it, so our prime defence mechanism is to reject anything that we don’t recognise as consistent with our individuality. We all need a coherent sense of an individual self. We create that through the stories we tell ourselves and others. At the other end of the scale, solitary confinement is one of the worst imaginable punishments, used to control prisoners since time began. We need to belong. We need to know we are not isolated, unrecognised or unloved. I think we all juggle that paradox throughout our whole lives. It’s a dynamic. Some of us hover mainly around the individuality end of the spectrum and others hover around the group end, but we all need to satisfy both needs in our lives.

It’s this photo I took in Japan earlier this year which got me thinking about this. See how almost all the turtles are trying to crowd onto the one little rock! They need to be together! I say “almost all”, because if you look closely you’ll see one little guy out there on the right happily paddling his own way.

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Whether its due to synchronicity or something about focus, attention and awareness, I find that I often have the experience that something I’ve been reading about crops up in all kinds of places. At the moment it’s pattern-spotting. In fact, this pattern-spotting theme is a fundamental one for me. I think it’s an important part of the way I work, but sometimes it just becomes a more conscious issue. Last week I had to conduct a training session for a junior doctor about consultation technique and one of the things I mentioned was how doctors are trained to spot patterns. We do that to make a diagnosis for example (“Oh, I know what this is. This is a thyroid problem”) In parallel with this I’m reading the novel “Popco” by Scarlett Thomas (and thoroughly enjoying it by the way!), and the part I’m reading just now is about the links between code-breaking, mathematics and music – the link being patterns and the ability to spot patterns. While I was driving at the weekend I caught the end of a discussion in a programme on Radio 4 about musical scales, and Pythagoras’ view of harmony. Didn’t hear enough of it to understand what it was about, but then, last night the chapter I read in the novel explained exactly the role of Pythagoras in the connection between music and mathematics (subject of another post I feel!). How strange, isn’t it?

Here’s a photo I took recently. What I noticed here was the pattern of the flowers. I thought it looked like a constellation of stars in the sky.

flower constellation

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The treatment of infectious diseases is often presented as one of the great success stories of modern medicine. There’s no doubt that antibiotics have the potential to kill many bacteria in life threatening situations and so have saved many lives. Antivirals don’t have as good a success rate as antibiotics (despite the strange current craze for dishing out Tamiflu). However, the story of infectious disease is not so simple. I came across a feature about this on the BBC site the other day, headed “Are we losing the war on bugs?” This is typical language about the issue of infection – it is presented as a war, which is about as helpful a metaphor as the “war on drugs” or the “war on terror”. If these are wars, then when could we reasonably expect them to be over? In fact, the BBC article is the most heavily war metaphor laden article on infectious disease I’ve read for a long time.

And indeed our battle to outwit the bacteria which have caused death and decimation down the centuries has revealed just what a formidable foe they can be.
It is a war of attrition. There have been points where we have been advancing, and points when we have had to beat a retreat.
In part is the ability to keep people alive for longer which has enabled some bugs to find a chink in our armour
Influenza is seen as the most wily of viruses, constantly adapting to thwart our attempts to combat it.
We will always be at war with microbes. Their genetic promiscuity is impressive, but we are learning more about them all the time. They are versatile and enduring – but so are we

Many of those phrases are direct quotes from scientists working in this area, so it isn’t only the journalist who has bought into this metaphor. Is this a helpful way to think about infection? I don’t think so. The clue lies in that last quote about microbes being “versatile and enduring” and the admission that it isn’t the kind of war which can be won.

Bacteria and viruses are part Nature, just as we are. We have a complex relationship with them. We couldn’t live without them and sometimes we can’t live with them. So what exactly is the situation? Having invented antibiotics have we discovered how to control infectious disease? Because that’s what the war metaphor is all about. It’s that dominant scientism belief that Man can conquer and control Nature. Scientifically, and philosophically, I think that’s a foolish stance.

I recently came across a research article from 2000, written by Mitchell Cohen, and published in Nature Insight (Volume 406(6797), 17 August 2000, pp 762-76). The article is entitled “Changing patterns of infectious disease” (no war metaphor, unlike the BBC piece)
Here’s the abstract

Despite a century of often successful prevention and control efforts, infectious diseases remain an important global problem in public health, causing over 13 million deaths each year. Changes in society, technology and the microorganisms themselves are contributing to the emergence of new diseases, the re-emergence of diseases once controlled, and to the development of antimicrobial resistance. Two areas of special concern in the twenty-first century are food-borne disease and antimicrobial resistance. The effective control of infectious diseases in the new millennium will require effective public health infrastructures that will rapidly recognize and respond to them and will prevent emerging problems

The author points out that at the beginning of the 20th century infectious diseases were the leading causes of death worldwide, and that average life expectancy was only 47 largely due to the number of children who died in infancy from infections. However, he then goes on to point out that from 1700 to 1900 life expectancy had risen in Britain from 17 to 52 and that the death rate from TB had fallen by 80%. Antibiotics hadn’t been invented yet.
The reasons for the change were “primarily decreases in host susceptibility and/or disease transmission.” After the invention of antibiotics infectious disease became even less of a cause of death “Between 1900 and 1980, mortality from infectious disease fell from 797 to 36 per 100,000” “By the end of the twentieth century, in most of the developed world, mortality from infectious diseases had been replaced by mortality from chronic illnesses such as heart disease, cancer and stroke” (war on chronic disease anyone?)
However, it’s a more complex picture, with new infections, and old infections now resistant to previously effective treatments. 13 million people died from infections in 1998, and the death rates from infectious disease have risen even in developed countries. Why? The conclusion reached by this particular author is interesting “The recurring theme throughout all of these factors that influence the emergence of infectious diseases is change”. What changes? Well, too many to cover here actually, but not least changes in demographics with increasing numbers of vulnerable people, from the elderly to the malnourished; changing patterns of human behaviour with more children being cared for in groups in nurseries, and more international travel; changes in the amount of ready-prepared foods being eaten placing food safety out of the hands of individuals and into industry and commerce; and the over-prescribing of antimicrobial drugs rises in resistance.

So the war metaphor doesn’t really work. The problem turns out to be more complex than beating the baddies. The best explanations for disease patterns emerge from understandings of how we live in this world. Yes, we do need drugs to treat life threatening infectious disease but the biggest advances will come from attending to our adaptability and our resilience. As a species we need to learn what influences these characteristics and to take measures to increase them. So here’s your challenge. What do you think can increase adaptability and resilience? At a personal level, and at a global level?

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I love the way landscape changes with shifting sunlight.
When I was walking around Jupiter Artland the other day, I noticed that through a gap in the forest I could see what’s known as The Three Sisters. These are the remains of “bings” from coal mining in West Lothian.
Look how the colour of the land changes as the sun breaks through the clouds….

light and land

light and land

light and land

I love to watch the changing light on the surface of water too, whether on a loch, or on the sea.

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I love the way the sunbeams sneaked through the leaves of the trees and lit up this web….

light and thread

light and thread

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