Follow Graham on Twitter

Tuesday, August 25, 2015

Making of a Child Psychiatrist: (15) France 2

The Veyssieres kept chickens, and it was a new experience to have them follow you wherever you roamed in the garden. They always knew when it was feeding time, and gathered in a clucking mass shortly before. Oddly, they did not seem to be overly perturbed when Monsieur appeared with an axe, about once a week. Certainly, they scattered when he tried to catch one, but it seemed to be a game (with a rather unfortunate ending). I had never seen a chicken beheaded with one swift chop onto a large block of wood. Intrigued and revolted at the same time, I remember forcing myself to watch as the poor headless thing was released to run around in circles for a short while before falling over exsanguinated. The chicken was then hung up on a hook on the wall of the cool dark barn, just down two steps out the back door. The bikes were kept in this shed, so the evidence of death was there for me to see each day, until Madame decided it was time for a roast. I struggled. Not being a country boy, not understanding the basics of life really, I initially found it hard to approach the roast with relish. But..., welcome to the real world, pauvre petit Anglais!
To be truthful, there were few things that I could not eat. I am not sure whether Madame was being careful, or whether they just ate fairly simply, but there was only one time when I really had to decline – with very sincere apologies. Madame had organised a special treat – calf’s cheek – to be sautéed lightly. I just could not imagine myself eating this pure white fat, and had to ask for ‘un petit morseau de pain, et peutêtre votre confiture d’orange’ (ie bread and your (special) marmalade). She was crestfallen, I was embarrassed, but knew I would be even more so if I was to be sick.
Over the latter weeks, we attended a number of extended, and large, family events around the area, and because it was summer, and full of fête days, the food was in abundance, but with little that I felt I had to avoid. Mostly, I was a ravenous 15 year old, doing more exercise than I had ever done, beginning to become tanned, and beginning to sound very French – even if some words in an excited conversation escaped me. The grape harvest had led to new wines, presumably made on the property, or at least locally. So I began to develop a taste for the wines of Southern France (slightly watered down), much to the amusement of the Uncles and Aunts.
Summer also meant weekend fête days for towns, with a carnival atmosphere, roundabouts and sideshows. We toured from one to another. I am not sure where I had learned the basic skill (maybe at ‘Dreamland’, the amusement park in Margate), but I seemed to be quite good at shooting galleries, and often returned home with assorted dolls and French sweets. Jacques was better at cycling, but I seemed to a better shot. On occasion we went to these en famille, but mostly we cycled, often in a gang of cousins and cousins.
Because Jacques was that bit older and building towards a driving licence, and related to the fact that all his family members of the same age were riding motorized bicycles or Mopeds – called Mobylettes, Jacques (somewhat against his parents’ wishes) managed to gain access to one, and began to ride up and down our stretch of straight road. This was serious stuff. Sometimes I got to travel pillion with one of the cousins and, towards the end of my stay, I got to practice on this exquisite piece of machinery. Bliss. The feeling of power travelling at about 20Kms an hour was exhilarating, and I promised myself that at some stage in my life I would gain access to this mode of travel.
From then on we travelled to the next two fête days in style. In those days no-one thought to wear crash helmets, so we reveled in that feeling of the wind through our hair and clothes. I am sure Madame et Monsieur were very anxious, and after my bicycle accident, they must have wondered just how much of me they were going to be able to send home to my parents. But no harm was done, unless you count the implantation of the thirst for motorized transport. As an act of homage, in the summer of 1966, Jan and I, just over one year married, drove our Vespa 150cc down D940 on our way to the Pyrenees and Barcelona. We stopped to look over the old place, and bring back memories. It conjured a time of sun and freedom and happiness.
Just a small coda. Monsieur Veyssierre drove me back to Paris, sitting importantly in the front seat of his Peugot 403. As I remember it we chatted amicably for most of the trip, with my now fluent of somewhat simple French. He put me on the train for the Channel Ferry back home. On board, I had been under instructions to purchase a bottle of spirits and a carton of cigarettes for my mother. Sitting on a seat on the deck with case and my loot, I realized that the whole transaction was done in French. The pale tubby English boy with a residual depression and halting French had been transformed over six weeks into a happy, confidant, deeply bronzed, slightly grubby (and very smelly, it turned out) copy of a French adolescent.
Clearly, my perhaps slightly romanticized memories of that summer in France have stayed with me for over 50 years. I have a fondness for French food and wine, for the language, for the subtlety of French films. I have in my head what I call my Treasure Chest of French. Many words and phrases have disappeared, and I am sure my second language is now a bit arcane and my accent faded, but each time we have been back I have been able almost immediately to recall words and phrases sufficient to manage a daily routine. We have taken opportunities to go back to France on many occasions over the years, introduced our children to French culture, and encouraged at least one of them to have a long term French pen friend. I have a deep respect for French people and their maintenance of their language and culture in a modern world, a European Economic Community whose Lingua Franca is English, and an online community whose language is American.
I think I grew up that summer. Without knowing it, my time became an existential adventure. We were, we did, we enjoyed; my soul became a little bit country French. The result was not only a lifting of my depression, but a building of a particular form of strength. Sadly, I am not sure that I missed my family very much. Yes, I thought about them, and I wrote a series of letters to my mother (at least one of which has survived to the present, helping me to regain some sense of that time). I guess I was ready to go back to school, and had grown a maturity that allowed me to take on the mantle of being in the sixth form. I was much clearer about what I wanted in life, and this was despite my rather strange brush with French Medicine. I believe I began a life journey to gain an acceptance of things foreign, and different cultural norms, which has contributed to my being able to accept interpersonal and cultural difference in my psychiatric work, and put my feet into the shoes of ‘the other’. People are. They come from where they come from. They have their own peculiar forms of baggage, based in their developmental, family and cultural background. I may be able to join with them successfully for a brief time. I may be able to help them find a new path.

I think there was a downside to my holiday in France. I had always been a bit isolated and singular, gaining friends in ones and twos, but not necessarily relishing large groups or needing too much of a social life. I think France reinforced my ability to be comfortable in being alone. It was not so much that it taught me I could survive anything life could throw at me; rather, I was there, it was a fascinating adventure, we had fun, and I thrived.

Making of a Child Psychiatrist: (14) France

Once you got there, the flat was spacious, and having recovered from the climb, it was always a pleasure to be greeted by Madame, who seemed to view me as a figure of much amusement. I guess I was, with my protruding ears, ‘short back and sides’ haircut, my plumpness and always being out of breath. Every day she went to the local market, and tried to find things that might interest me, and seemed to scale the four flights of stairs with consummate ease; she was never out of breath.
So, I was introduced to French Onion Soup, and came to actually like thin slivers of horsemeat steak (without even knowing their origin). I came to like a cross between cheese and yoghurt called ‘Petit Suisse’ which duly appeared at the end of every meal, with a fresh fruit of some variety. The process of the meal, of course, was totally different with courses spread across an hour. Initially this was a bit alien, but I later came to enjoy the discussions (even if things had to be repeated or relayed for translation via Jacques). I must have listened carefully to the accent, and changed my own pronunciation, because in later years, when travelling through France, I was accused of being from Paris (a mammoth compliment of course). I also began a journey of appreciation of food with pauses and conversation between courses to allay indigestion.
Monsieur Veyssiere was a city policeman, and his beat seemed to be permanent night shift, and some naughty place with lots of petty crime called Place Pigalle (now famous from the film ‘Moulin Rouge’). The most exciting thing was the fact that he carried a revolver, the first thing to be shed when he got home. When emptied, I got to hold it on one occasion - a surprisingly heavy small object. I was intrigued, and slightly overawed. We were promised a tour of his beat at some later stage.
Jacques and I were to become firm friends. He was a year older, but keen to learn English, keen to teach me French words and pronunciation, and even happy to share his bedroom and his parents. He helped with my attempts at reading French, and would also translate bits from the black and white television, if something took my attention. He introduced me to Goscinny’s wonderful books about ‘Asterix the Gaul’ and, again, was happy to translate when I got stuck.
The flat was midway between the Metro stations of Porte de la Chapelle and Marx Dormoy, so it was easy to get around Paris and see a range of sights, and renew my acquaintance with dispensing machines.
We roamed. We went to markets (Les Halles) and to cafés where the scent of Gitanes was almost as thick as the coffee.
Jacques later came to England for a week, and an extra bed was put into my room. I think he struggled with the language even though his English was probably better than my French. But he settled in well, and we explored the delights of a Westgate that was in the full flood of the holiday season - which meant beach, and ogling as many girls in bikinis as possible. The small two storey semi-detached house must have been strange, as must the food and its presentation of course. But he was adaptable, friendly, never complained. We did picnics, and then a trip into Canterbury to visit Roman Pavement remains, and the Cathedral with its history reaching back to Thomas a Beckett. We visited Dreamland Amusement Park and tried out as many ‘shilling sickers’ as we could pack into a day.
I think overall it was fun. Certainly his parents seemed pleased with the whole process, and invited me back the following summer for the whole summer holiday to be spent on their small farm in Correze, in the Massif Centrale. Again, this was too good an opportunity to miss, and was to become a highlight of my young life.
My parents took me down to Dover, to board a ferry, but from there I travelled alone, which is a great achievement for a 15 year old. The train took me to Gare du Nord in Paris where Jacques and his mother met me. And then overnight in Rue de la Chapelle, that now familiar environment. The next morning, on a bright sunny day, we drove south out of Paris, stopping only for a loo stop along the road (slightly behind a tree), a common practice in those times, and something you cannot imagine in rule bound Britain or Australia.
We were not tourists, so Monsieur et Madame did not stop to show off the sights, or visit Chateaux or wineries. From memory the only stop was for baguette and jambon and cheese, accompanied by some vin ordinaire (a bit watered down for me). I think we tried conversation, but there were longish silences and occasional sleeps. Nonards, south of Tulle, is the kind of village you can miss, if you blink. It is more of an area than anything, covering 11square kilometres and with a mainly farming population of less than 400 souls, even these days. The Veyssiere property, a small walnut grove with an old house and attached barn, stretched back from a main route going south (D940). There was one farm with an enormous black barn almost across the road, but little else between us and Beaulieu-sur-Dordogne about 6Kms to the south. It was summer, so my memory is of long languid sunny days with temperatures in the 20s.
Jacques was a cycling wannabe with aspirations to do the Tour de France, so he had a setup in a cool corridor which allowed him to fix the frame of his new drop handlebar racing bike, the wheels rotating on rollers – all very cool. Understandably he was loath to let me try his fairly new machine, but the family had retained his previous bike, somewhat older, slightly beaten up with fewer gears, but serviceable for a tubby English boy.
We roamed the backroads, with me trailing way behind, much to Jacque’s delight. But I gradually improved over the weeks with rides to various towns, down to the river Dordogne, and races along the long flat shimmering, and almost always empty, main road. Towards the end of the stay we cycled to Rocamadour, a hilltop walled town, some 45 Kms away. Fabulous old place, and rich in its history with links back to the Knights Templar. Sadly, I am not sure this meant very much to a hot tired and out of breath 15 year old trying to keep up with his mad French pen friend. We toured the streets, admired the view, ate some lunch and headed for home relishing the steep downhill run. Sadly, relish turned to regret as I tried once more to keep up with proto-champ. Going round a curve at speed, even with the brakes partially on, I slid on accumulated gravel right across the road in front of a large tractor huffing up the hill. Lucky for me it was a tractor and not a fast car. The driver stopped to pick me up and investigate the damage – a grazed knee and quite severely grazed right elbow, but no broken bones. The bike had survived.

Jacques parents were contacted, and I was picked up by car and taken to the local doctor’s surgery, where the nurse cleaned up the wounds of competition and applied antiseptic and dressings. The doctor then decided I needed a preventative antibiotic. No, not an injection, or a tablet to be taken three times a day – a suppository inserted into my rectum with no ‘by your leave’. I was embarrassed in the extreme, but fascinated at the same time. “Why would you do that?” I thought. Presumably because it worked. Welcome to the world of French medicine, pauvre petit Anglais.

Sunday, August 23, 2015

Haiku on Couple/ Red/ Careless/ Awesome

Couple

Elderly couple
One walking hesitantly
Time and tide passing

A couple of thoughts
In marked contradistinction
Tumbling waterfall

A couple of forms
All your personal details
There for all to see

Red

Stop sign red lipstick
The warning message is clear
Do not cross this line

Red sky evening
Tomorrow will be so good
Let the dream unfold

Blood on desert sand
Old red smears of sacrifice
To the ancient gods

Careless

One careless miss step
Followed by seven tough years
In recovery

Seven samurai
Totally focussed tough men
Not ever careless

Seven young campers
Careless spark ignites a park
Life's tough learning curve

Awesome

On each ANZAC day
We remember our loved ones
And awesome courage

It's more than awe some
The worst you can imagine
It's really awe full

Low tide still water
A clear cerulean sky
Truly awesome day

Transverse Myelitis: Research on Diagnosis and Management

As an academic who has chronic residual (and slowly deteriorating) problems from an attack of Transverse Myelitis just before Christmas 2009, I am constantly on the lookout for updates in the international thinking about treatment and management. In particular, I have been keen to get high-level review articles. These ‘synthesize’ our knowledge and are constantly being updated when new research is published.
I have to come clean. I am a cheapskate. I am not into paying publishing companies exorbitant amounts of money just to access one article in full - which then may or may not meet my needs. I also have a philosophical belief that knowledge should be free – especially to those who really need to know what is going on; ie you and me. I tend to look for articles that are free to download. From ‘Google Scholar’ I have been able to find several articles that are fairly recent, are synthesizing the literature to date or synthesizing recent research, and are free to download.
Now let me be clear. You may find reading these very hard going, and may need a bit of help to interpret what they mean. But, if you download the articles and print them off, you may like to give them to your treating physician. They may be most relevant to someone who is new to having Transverse Myelitis, and you may like to ask your treating neurologist or other specialist whether they would be helpful.
Doctors are funny people. If you rush in and say: “This is how I expect you to treat my illness”, you will lose a friend. And those of us with TM will tell you that we need lots of friends. So be polite and respectful. Juts say you came across them, and wondered whether they would be helpful.

[PDF] Transverse myelitis: pathogenesis, diagnosis and treatment

   Chitra Krishnan, Adam I. Kaplin, Deepa M. Deshpande, Carlos A. Pardo and Douglas A. Kerr. Frontiers in Bioscience 9, 1483-1499, May 1, 2004     You should be able to download this from ([PDF] from researchgate.net)

Idiopathic transverse myelitis Corticosteroids, plasma exchange, or cyclophosphamide  BM Greenberg, KP Thomas, C Krishnan, AI Kaplin  et al.  Neurology, 2007   You should be able to download this from ([PDF] from myelitis.org)

[PDF] An approach to the diagnosis of acute transverse myelitis


 Anu Jacob and Brian G. Weinshenker   SEMINARS IN NEUROLOGY · MARCH 2008     2008;28:105–120.    You should be able to download this from ([PDF] from researchgate.net)

Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis Report of the Therapeutics and Technology Assessment Subcommittee of the …

 American Academy of Neurology T.F. Scott, E.M. Frohman, J. De Seze, et al. 
Neurology 2011;77;2128      You should be able to download this from ([PDF] from yimg.com)

Feedback, Comments and Discussion all welcome

Saturday, August 22, 2015

Haiku on Glance/ Drive/ Earlier/ Force

Glance

He glanced round the room
Trying not to miss the fun
She stood quietly

Miss Fierce stood out front
Needing to quell the class fun
One glance was enough

One glance was enough
He did not miss her slight smile
The fun could begin

Drive

The drive to survive
Innate in all living things
Just water the seed

Handicapped from birth
Saw the funny side of life
Had a joker's drive

Social animals
With a drive to touch others
Through lovewords and song

Earlier

An earlier thought
Keeps returning to my mind
Nagging me to smile

If she had arrived
A few minutes earlier
It was yesterday

Made up earlier
Now they are at it again
Repeated pattern

Force

She accepted him
No force was necessary
Except that of life

One drop of water
Each day for Millenia
Hole in rock not forced

Try to force the smile
Through teeth gritted with sharp pain
Everybody knows

Tuesday, August 18, 2015

Haiku on Beat/ Long/ Crush/ Score

Beat

Womb held infant heart
Mother's beat syncopated
Skipping together

Cannot win alone
Marriage a three legged race
You beat together

Pinball machined mind
No recognisable beat
ADHD brain

Long

Long and winding road
Halts and hills and barriers
Sadness overcome

Today is special
Fifty years long together
Anniversary

Longed to be with you
From those first dancing moments
In step ever since

Crush

Crush opposition
Grind the bastards into dust
Whoops, we're worse than them

Started with a crush
Deepened every year since then
Love tinged with respect

An underground crush
Subway train disgorges mass
Then sucks it back in

Score

Crunch up the grape pips
Keep a very private score
Or do a spit count

Keep a private score
And the partnership will end
In acrimony

In private moments
She nail raked his scarred up back
And kept her own score