On one of our early morning ‘lock-down’ walks, Rohan and I met a neighbour walking his dog. After the usual greetings and the now standard enquiries about health, Andy asked if I could clarify a medical issue for him. He, as a worried husband, was keen to understand how blood tests are used to detect different cancers; I, as a former doctor and medical school teacher, was more than happy to help. After our two-meter chat he thanked me and they – he and his dog – went on their way.
As odd as this conversation might seem, offering explanations is something I have done for years. Explaining how the body works was part of my stock-in-trade and an important one at that – I have always seen being asked to explain as an honour and responding clearly and honestly as a duty. Most questions would come from patients and students but enquiries also came from others – MPs, journalists and, of course, family and friends.
Since my retirement the request for explanations have continued, and in one particular setting the provision of explanations has become almost formalised. For friends who come to stay it is now a tradition that when breakfast is over they can request an extra course – coffee with explanation. After a short break to clear the table, to brew some fresh coffee and to allow me to find a pen and paper, the morning’s question-and-answer session begins.
Guests are asked to suggest their topic the day before so as to give me time to gather my thoughts. Questions over the years have included ‘What is blood pressure, why does it matter if it is high or low?’, ‘Why do problems with my back give me pain down my leg?’, and ‘What is a heart attack?’ Sessions rarely last more than 20 minutes and, if we run out of time, topics can always be continued at breakfast the next day – or for more sensitive issues, over a chat in confidence.
Predictably, the coronavirus pandemic has not only caused a flurry of enquiries, but has also found me reminiscing; this time about a series of advisory sessions that occurred during a dream holiday in East Africa in 2012.
Word of my after breakfast tutorials had reached Lucy, a friend and keen mountain walker who organised a walking trip for us in the Mount Kenya National Park. Before our walk proper, we spent several days acclimatising in Nanyuki, a town 6400 feet above sea level. While there, Lucy surprised me by suggesting that each evening I might run some of my health sessions for her, our two mountain guides and our chef. In passing, she added that the sessions would have to be held by candlelight aided if needs be by hurricane lamps. In response to her request and by way of cementing my commitment, I bought a large flip-chart and a set of coloured, felt-tipped pens at Nanyuki’s general store.
Next day after a bumpy, climbing drive we arrived at our camp in a hill-top clearing. There, we installed ourselves in our log cabins; Lucy, Rohan and I in one, the two Johns and James in another. As it turned out, at nearly 10,000 feet, the lack of oxygen made hill walking difficult but the seminars each evening took place as planned.
I was soon given the topic for the first session – Mountain (Altitude) Sickness – and it became clear that a new set of considerations would have to be added to my preparation. Apart from checking details on the Web – there was internet reception in one tiny corner of the clearing – I had to ensure that James and the two Johns could follow what I said. Although all three spoke and understood English with ease, I sensed that conveying biological concepts might prove difficult. Explaining how ‘red cells in the blood carry oxygen to the brain and to other tissues’, and that at altitude the ‘provision of oxygen to these cells is reduced’, could pose problems. However, with the help of diagrams and carefully chosen analogies, explaining became manageable.
Judging by the questions I was asked, the ‘Mountain Sickness’ session went well, as did the next evening’s session on ‘Sugar Diabetes’ and one a day later on ‘Psychiatric disease, particularly depression’. And during all this, the candles and lamps added atmosphere rather than served to distract. Moreover, eight years later Lucy tells me that James and the two Johns still remember those evenings on the mountainside with warmth.
It has been interesting to discover how much people value and trust, open and honest explanations on matters relating to health. It is also clear that such ideals are so often ignored by our politicians.
The illustration shows Vitruvian Man, a diagram drawn by Leonardo da Vinci in around 1487 in which he tries to explain aspects of the human form.
For help with writing this blog, I would like to thank Lucy, Sarah, Rohan and Vivien.