Dr Garrett FitzGerald

At the next junction, Dr Garrett FitzGerald decided to turn left into North Tipp to get his Saxon-speaking sat nav fine tuned and recalibrated to a more local and lively dialect. 

They gave me the sat nav for Christmas and I had her working in no time — by Easter at the latest. No more, says I, on my previous safari turning right at Longford and ending up in Carrick-on-Shannon on my wrong way to Westport. The new machine was able to tell me how to make it to Raheen Cemetery in Ballyneety without losing eight hours wandering in the inback or coming upon the early signposts for Neidín. As an inveterate ingrate, I won’t put a tooth in it by saying straight out that I came to hate the bloody thing.

Saxon Sally was the cause of the distemper. She came with the infernal device. “Turn right at Brother Edmond Ignatius Rice Bridge,” she instructed, as we passed the memorial plaque for Meagher of the Sword at the Granville Hotel, in her Windsor tones and almost palpable to-hell-or-to-Connaught attitude.

I just knew she was taking the superior mickey. Her accent wasn’t Harrow enough to see her as one of my betters nor lower-classes enough to conjure up pictures of tattoo parlours, lues, little bit of crumpet and the merchant navy. No, it was some intermediate travel-guide patois designed by dark forces to induce rage, somnolence and systolic elevation. Here I was in me own little motor with this harridan telling me what to do in me own country. I’d never stick it out.

Luckily, I have friends at the interface of North Tipp and Biffoland who are expert microchippies. I told them about Sally and the way she might talk at you. Worse, I surprised even these guys by informing them that Sal was all transmit and no receive. The lads knew a few wans like that themselves — back to the Portumna side. They empathised that Sally didn’t even respond to the STFU command.

“Lave de ting wih uz for a few days and we’ll have her tickin over de finest for ya,” they advised kindly.

Biffoon speaker
On the day appointed I plotted, with setsquares and old almanacs, my way back to them via Thurles and Nenagh — and made it unscathed in under 20 hours. The boys told me the score. First, Sally had been disappeared. Next, they had made the device verbally interactive. Lastly, they had inserted a choice of three navigators who, respectively, spoke Biffoon, Buffaloon (the ‘on’ at the end is acronymic for ‘or nearby’) and Cloughjordanian. Naturally, I went for the Biffoon option.

Pic: Igor Mojzes/Getty

I switched it on at Shinrone and commanded it to guide me to Shannonbridge. After a polite pause, a gentle male voice asked, “What in de namajays d’ya want to go dayre for?” It chuckled a little, then said, “Did ya know tha a loh of fellas were drowned at Shannonbridge — escapin to de West?” I swear I could hear him rowlin around inside in de ting! “We’ll chance it,” I said courageously. “On your head be it den, sir. Don’t say I didn’t tell ya.”

We made it through and set sail for Ballinasloe. “D’ya mind me askin where yer headed now?” he blurted. Galway. “Hould on a minna till I puh in de teeh. I borrad dis set for de day off a lad in the County Home who haves no use for em. Me own are gone in for a service. Now boss, go ahead, de job is sound.”

Sunda Game
I loved it and him immediately. Along the enchanted way, he said that thoul matches were too wansided and didn’t he fall asleep during the Sunda Game last week. He gave a dissertation on the reasons why de ditches were replaced be de stone walls as we came closer to Galway. He had historico-philosophic observations to make about every village we passed. He knew shorter ways to get from wan place to anudder dan was ever on anny map. 

There was a downside; he didn’t hold any truck with motorways. “You see nohhin; no villages, no shops, no people. ‘Twould drive ya ouha yer mind.  Like I wouldna remembered to tell ya wha dey say abou Crauwell if we didn’t go tru ih!”

“What do they say?” He chuckled again. “They say dat Crauwell is de place where dey bates de pigs for bein hungry.” A mighty paroxysm of wheezing. Salty tears dripped down outa the device on to the dash. A few throat-clears later, he went back into receive mode.

Oranmore is the beginning of the live equivalent of computer games. “Did ya see dat pitcher, de Shinin wih Jack Nicholson? Well, didn’t he freeze to deh in de snow for a finish on account of he couldn’t geh back ouha de maze; d’ye remember dah?” Deed, I did. “We won’t feckin freeze here, buh we’ll wish ta hell we did before de day is ouh.” He paused in his meaningful way again. “Ya’d harly be on for turnin back, would ya?”

“You de man, Mahhy!” I agreed.

“Right Boss, turn rih here and give er de wellinton!”

High Cross of the Scriptures, Clonmacnoise.
Pic: Brian Kelly/Getty

Continuing where he left off last week with his modified sat nav, Dr Garrett FitzGerald visits the land of his mother’s people, and gets a lesson on history from his new friend Mahhy.

Pic: saintho/Getty

Dr Garrett FitzGerald laments the loss of open, free-flowing Rugby that allowed little guys like him to get involved, as well as worrying about the long-term risks of a more forceful style of play.

The day of the near-dwarf scrum-half is at an end. I played at ‘9’ for 22 years. To be honest about the thing, I was close enough to solid useless but enjoyed it greatly all the same. Two or three tackles in a match was about all that was expected of a player of average enthusiasm. The recipients were always bigger and heavier but they moved slowly and obesely as second-row men did in those times.

My last game was in Ballinasloe playing for Corinthians of Galway. For the first time ever, I got kicked in the head — because I was slowing up. They subsequently elevated the offending clergyman (whose dirty boot it was) to archbishop, but I doubt the two incidents were related. No concussion followed, but I chose not to play again. Since then, I have just watched the game.

In the 1990s, Rugby became professional. The game speeded up and became more watchable. Since then, the players have become bigger and fitter, the hits are much more frequent, the forces imparted are much more violent and the injuries more frequent and serious.

In the winter of 2010, one-third of all players in the Premiership in England were out with injury at the same time. Defensive strategies, many imported from Rugby League, have been implemented everywhere (including, depressingly, schools Rugby). The pitch has very few unmanned spaces these days.

All this change has led to the game becoming less watchable — if ‘open’ Rugby is what does it for you. Inside centres are huge and used as battering rams. There is no place for the ‘classy’ little fella any more.

Like in modern golf, the traditional course/pitch is now too small. Thirty superbly fit giants make the playing area too small. Bigger, more forceful and more frequent hits happen in this relatively small space. The very best players seem to suffer the most.

In the past couple of weeks, two of the most effective players of all time retired; Jonny Wilkinson and Brian O’Driscoll. Both were no strangers to serious skeletal injuries during their long playing careers.

Drico’s last two games were disappointing for him and for us as he had to go off injured in each —  his body lasted only eight minutes in his final game.

Stephen Ferris called it a day in the past week because of an ‘unfixable’ ankle. So many of our great talents seem to have suffered injuries way above the call of duty; Keith Earls, Sean O’Brien, Luke Fitzgerald, Barry Murphy, David Wallace to name a few. We have no idea what the long-term skeletal sequelae will be.

The skills and body-hardening regimes of the professionals offer a degree of protection against more serious skeletal injuries. Changes in scrummaging techniques and laws appear to have reduced the incidence of catastrophic spinal damage. There are, however, no magic techniques or fitness regimes to toughen the brain.

Although there is still some controversy (Brian O’Driscoll’s uncle Barry recently resigned in protest from the International Rugby Board’s medical committee) about ‘rules’ for concussion, at least some effort is being made to protect the players.

In the United States, the excreted stuff has hit the fan. Over the past decade, attention has dramatically focused on Chronic Traumatic Encephalopathy (CTE) ever since the death of ‘Iron Mike’ Webster of the Pittsburg Steelers (National Football League) team.

The NFL did everything in the ‘trick-book’ to discredit medical evidence for this dementing disorder in former players (who had repeated concussive injuries during their playing careers), but the number of cases just piled up until the evidence became overwhelming and irrefutable.

They are still splitting hairs on whether there is a proven linear causative relationship between football injury and the subsequent development of CTE. They have nevertheless agreed a compensatory package of circa US$750 million (€550m).

What is most worrying (in the American Football context) is the suggestion (and some confirmatory autopsy studies) that repeated mini-concussive or ‘sub-concussive’ hits can produce CTE.

There have also been some reports of CTE occurring in school/college players in their twenties. One cannot obviously translate the hits (with helmets, mind) of American football to rugby union. There is no longitudinal study showing CTE in former rugby union players. Yet, it is worth quoting two extracts from Graham Lawton in the New Scientist (March, 2014): “Neurologists have long suspected that other contact sports might also lead to CTE — particularly rugby union because of its emphasis on high-speed ‘hits’. Concussion is the fourth most common injury in the professional game.”

and . . . .

“At least one former rugby union player has been confirmed as having CTE. Barry ‘Tizza’ Taylor, who played for 19 years in Australia, died last year after a long battle with dementia. New Scientist understands that another deceased player’s brain has also recently been diagnosed in the UK.”

My biggest worry is about the sub-concussive guys!

With ‘Lanigan’s Ball’ ringing in his ears, Dr Garrett FitzGerald believes the outcome of HIQA’s report on UL Hospitals will be a big new ED terminal building in Limerick but no planes on the tarmac.

Should we change the country’s coat of arms to include a banana? It is demonstrably a banana republic already, so such a move seems right and just. It would truthfully rebrand the country. No longer the Island of Saints and Scholars of yore, we can honestly proclaim bananaland instead. The shamrock allusion is dead and gone and the harp that once hit the note isn’t likely to twice. Vive la banane.

In keeping with this appeal for rational change of symbols, it is obvious that our health services have been in the control of persons who are somewhat bananas. The hospital services are the prime example and reflect the wider national derangement.

The glaringly evident primary function of a public hospital nowadays is to prevent health professionals from doing the jobs they have been trained and employed to do. For instance, surgical theatres were originally designed to facilitate surgical operations. They are most ineffective in their primary purpose when they are closed or when there are no patients to operate upon. There are many other ways in which one can eliminate much of this operating nonsense. The latest move, straight from The Godfather or Goodfellas, is to call off all gastric bypass surgery in St Vincent’s University Hospital.

If there are no beds in which to care for post-operative patients, one can safely not bother having operations. If the nurses cannot be rostered for theatre work, it has proven best to cancel everything. If the surgeons and anaesthetists are in Canada and Australia, there is little point in scheduling operations here.

If the junior doctors won’t work 24 hours a day, you can shut down until after the next medical spailpín fánach round-up in India or Romania — and the bonus is that you can blame the doctors. If the budget has over-run, you can get it back into line by closing beds and theatres and dumping the nurses — and simultaneously, fix old scores.

‘Stay away from our ED’
While public hospitals primarily aspire to put a stop to clinical activity, the private hospitals are disposed to attract patients and carry out as many operations as possible. The private outfits vie with one another in oh-come-all-ye-faithful ads on TV and radio. In contrast, public service ads say, ‘Stay away from our Emergency Department!’

In summary, public hospitals are there to stop doctors from doing their jobs; private hospitals want them to do them even more. Does awareness of this not stimulate activation of your average banana-recognition neurons?

In the Midwest, bananity has been recently further fine-tuned. Now, there are opposing forces commanded by the same headman — like having Eisenhower in charge of both the Axis and the Allied forces on D-Day. It is now officially reported that our supreme commanders of health, through their generals, have made a balls-up of the public hospital services in the Limerick/Midwest area.

These generals had implemented the supreme headman’s orders to the letter. But the HIQA generals, on the orders of the same headman, say that the operation is ‘not fit for purpose’. Montgomery’s and Patton’s rivalry wouldn’t hold a candle to such a bananarama.

The updated combined orders for the area’s hospitals are as follows, “Close the beds in Limerick. Open the beds in Limerick.” Lanigan’s Ball, anyone?

If there is any consolation in this bananabacle, it must be in the idea that somebody is at last saying that an emergency department’s trolley problem cannot be solved without providing somewhere for the trolley-people to go. This logic had been officially excluded from all official planning equations for the past three decades. Every remedy was on the table except the obvious solution.

The HSE will have to formulate a meaningful response to HIQA. The bureaufest to be spawned by this head-to-head clash of generals of the same supreme headman will take off into orbit. The logistics of such response will make the simple matter of putting 170,000 men and war machinery on to the Normandy beaches a snip. It will take thousands of meetings, minutes, reports, feedsback, redeployments, goings forward, power-pointings, strategic statements, revisions, robustings, year on years, and non-terminating scapegoatings.

The exhausting burden of industrial-scale non-work will lead to serious consumption of time and resources. The rainforest will be diminished. At a remote of some moons and following a few oligo-compliant gestures, the HSE will be dissolved as planned. The new crowd (comprised of virgin bananamen) will take over mid-robusting going forward and as the song goes, “start all over again”.

The long-term outcome if it’s the usual pattern? A big new shiny ED terminal building in Limerick, thousands of passengers, one half-manned check-in desk and no airplanes on the tarmac.

The horticulturalists amongst the readers sadly know that a banana tree keeps on producing bananas — and only bananas.

Researchers at the Cortical Unit in Waterford carrying out their unusual brain experiments

It’s often strange what you’ll see watching a hologram from the various cortices being experimented on at our research lab, says Dr Garrett FitzGerald, but never boring.

Our research institute goes from strength to strengther. Only this morning, the sun warm in the clear skies over the Waterford Riviera, I visited my colleagues in the Cortical Unit. They were watching a halographic from Cortex 2910. The authentic voice of John the Baptist (from 0504, see below) could be clearly recognised in the feeding soundtrack.

In the resulting pictures, the crowd from Páirc Uí Caoimh could be seen heading barefooted and bareassed for the Lee. As they rushed along the holy ground, clothes were being fired off.

Already there was a massive pile of discarded Limerick jerseys, hats, dolls and colours on the lovely banks — these persons had obviously and shamefacedly left the grounds very early into the second half.

Saint Finbarr
Tens of thousands immersed themselves in the river; thousands were drowned, yet, somehow, the scene was joyful. Neither John himself nor the Bishop of Cloyne could be seen in the melee but there was no doubt that the fella with the hoe standing on a small punt was Saint Finbarr. Weesh resuscitated only those who wore red and white.

Cortex 2910 quivered in its bath. The surrounding walls of machinery — all developed at our facility — twinkled, winked, flashed and wobbled during the experiment. This particular study was manned by our retired husband/wife medical teams.

Although they are getting on in the years since retirement, they looked young again in front of our bank of thousands of cortices. My theory is proving right so far; brain activity prolongs active life.

The cortical ‘nurture’ room in my garage has been active for the past four years. Originally, we used brains cloned from our own stem cells’ DNA, but the process was too slow for us (with the notable exception of my own cells) to make significant progress in the short time left to us. Fortunately we have one of our own as chancellor of the local nearly-university.

He arranged a programmer — she has a helpful asparagus-spectrum disorder — who can ‘write’ electronic mutations of infinite variety. By the bye, she is a known expert in Wagner and, while listening, manages to resist strong urges to invade Poland.

Armed with this programming, we could call on my own advanced 3D cortical printers to spit out any class of a brain you might care to mention. This gave us the whole array of possible ‘natures’.

All that was needed was a properly functioning world-class ‘nurture’ set-up. The way we got our nurturing material was, to put it in humblest terms, ingenious. Had someone else come up with even a measly fraction of this inspiration, I would give them credit also — but such is not the case. I have to remind myself falsely and obsequiously that there is no ‘i’ in ‘team’!

Cortex 0504 gave me the idea. This brain came from the WIT lady’s selection. She had programmed for ‘speaking in tongues’ and we used the thought-word consponder to transaudiate the seeming near-gibberish that followed.

Heinrich Himmler
At first, I thought I was listening to a robust HSE strategic planning meeting about redeployment going forward year on year. But no; I was able to hear the dulcet tones of Heinrich Himmler in 16 extinct languages and German. He was great gas altogether. This cortex could ‘do’ anyone; Elvis, Osama bin Laden, Melvin Udall, George III; 0504 could do it dyslexically, in any language and none. You haven’t lived until you have experienced “We Mowed Pat Murphy’s Medda in the Sunny Long Ago” in Copto-Aramaic.

Our first venture in this regard was to connect Cortex 0504 to Cortex 1207. The latter had been pre-loaded with the 1690 deletion. Poor old 1207 was exposed to three months’ anti-popish bilirubinery in almost extinct Antrimese.

Heads on pikes
The resulting thought/word consponder gave us stuff that no human should hear. The halographics ensuing from its thoughts showed the most awful images, fit only for illustrating child-frightening literature such as the Old Testament; think Protestant infants’ heads on pikes.

But back to the baptism study. As far as we know, 2910 was standard issue (albeit very bright) cortex. Exposed to the voice of John, it quickly became a religious maniac in its thoughts.

The pictures switched quickly from Cork into the grounds of a Carthusian monastery near to home. PET scans showed the celestial neurons lighting up so much that there was a reddish glow from the solution in the bath. Audio and visual images revealed that there were impulses in train to convert the array of other cortices in the room to its way of thinking.

Some of our researchers had already come to believe that the Higgs-boson particle must have been present in the bathing fluid. We now plan to bring an expert down from Galway.

For WRH retirees, the show goes on — even at this late hour. Lizzie offered me a knighthood but I said “no thanks”.

We need modern computers, but are stuck with old adding machines.Pic: Ron Hohenhaus/Getty

Unlike professional rugby, our emergency departments are run by amateurs, our best players are sent to other leagues, and our team managers — believing us to be ‘world class’ — won’t even attend the matches, laments Dr Garrett FitzGerald.

The acutely ill patient is a great embarrassment for our health ‘system’ and for those who sail her. There is widespread fear in the community about what could happen next once a patient is advised to attend our emergency departments (EDs) — especially in the busier half of the year.

It is probably true to say that people are relatively satisfied with what happens in our hospital wards once they have negotiated the high hurdle of access on the most dangerous and terrifying days of their lives.

It should be a reasonable expectation, in a serious acute clinical situation, that one should receive rapid expert care delivered with reasonable humanity, effectiveness and efficiency.

If one were designing a health service, this would be the number one priority – primum inter alia. Regrettably, it is far from the current reality.

Our leaders do not seem to possess the ability to reimagine the existing model that currently militates against sick people. Governments and administrations, with the insensible collaboration of the medics, have missed the essence of the problem and have failed utterly to move with the times. These are the people who pride themselves on having their finger on the public pulse, yet they do not seem to have a clue.

Many errors
The mindset that has brought us to where we are now has many errors of thinking that have evolved over the past several decades. We persist with a system that foosters and stumbles from crisis to crisis while those in charge are under the illusion that ‘things are improving’. This is beyond understanding. This is truly ‘magical thinking’. The approach has been, in a word, amateur.

Our acute services are for another time, now long gone. Citizens live longer, have more illnesses cumulatively, encounter acute episodes that are more numerous and much more amenable to potentially successful, sophisticated and complicated care. We are talking many multiples in total numbers and complexities — a whole new ball game.

Yet our response is reason-defying. It is as if we have identified a need for advanced and powerful computers, yet are busily unwrapping 1960s adding machines.

Worse, we have a myriad of administrative structures to manage the adding machine adventure. Armies of agencies are busy discussing and rewriting the procedural manual.

School of thought
We seem to be trapped in a school of thought that asks, in response to the ever-increasing acute-illness workload: “Where are they coming out of?” Some have clearly discerned that the numbers are the problem. (People are having too many acute illnesses and this will have to change. There has been a huge investment in Emergency Departments but they keep coming! It’s nearly time to throw the hat at it, really, but we’ll keep doing our best. We live in a less than ideal world, etc.)

Relative failure
Decades down the road from the adoption of such a mindset, the highest achievement is relative failure. The failure-masters are in receipt of statistical feedback only. They do not really understand what the failure is. There is no real-life feedback. Such is the way of amateurs; distant though well meaning, and clearly unable to cut the mustard.

There are more things in heaven and earth than are dreamt of in their philosophy. As a parallel, look at Rugby in the professional era and contrast it with the amateur days. In the health services, we are in the professional era and run it like the amateurs.

Gestures such as building a new stadium or two, a grandstand here and there while having too few players, coaches and backroom teams — and driving the better ones out to other leagues — is not the way to get results. Employing five forwards and no half-backs won’t bring home the cup.

The team managers don’t even attend the matches! So, you get to stay at the foot of Division IV. Meantime the leaders dream longingly of the day when promotion to III comes about. Worse, they think they are barely short of ‘world class’.

By now – 30 years on – one must despair of a change in mindset. If they can’t see or believe that the set-up is failing, sloppy, often inhuman and frequently dangerous, where is the basis for change?

‘No room at the inn’
Perhaps a start could be made by rostering senior managers into the ED duty schedule, day and night. Real-time feedback would, no doubt, awaken them to reality. They could be given the task of explaining to the patients why it is policy to treat fellow citizens like livestock, why it is deemed acceptable for patients to lie on trolleys in corridors for days on end, and why there is ‘no room at the inn’.

The health administration is anxious to have a transparent and responsive complaints mechanism. What better way to achieve this than to be there live as the complaints come in? Perhaps the reality would stimulate some re-thinking.

Our inheritance is so much richer, whatever the flaws. Pic: LuckyBusiness/Getty Images

Dr Garrett FitzGerald examines the recent Enlightenment in medicine, religion and society as a whole, which has produced a country no longer indoctrinated from cradle to grave, but questioning the values coming from on high.

In the more formal days of medical school and hospital, I signed to the effect that I had “honour, sir to be your obedient servant”. This extract, from the last line of the application form to become an intern at my teaching hospital, went the way of all such nonsense a decade or two later. Perhaps the world was changing?

In my previous incarnation as defiant iconoclast, I signed — but I didn’t mean a word of it. This reflected failure on my part, having been exposed to 35 weeks per annum of intense residential character-moulding therapy by an all-male religious sect on whose vow of unquestioning obedience to the supreme pontiff Heinrich Himmler modelled the SS.

In those heady days in Ireland, the man (always a man, except when it was the reverend mother) with the highest position was always ‘right’.

His opinion was final and was best regarded as dogma.

During a teaching session for my year, a teacher-man who was about halfway up the medical hierarchy ladder explained in the presence of Herr professor the reality of medical life to us. ”I believe,” dixit, “that each of you students will make about 12 mistakes every day.

“The intern here will make six (Intern here humbly bows), I myself will make three mistakes, however trivial (reverential sniggering by a few wrong-vocation lads), and even the professor himself will make one mistake every day!”

The professor immediately responded: “Speak for yourself, Doctor!”

Loose notions
Expressing such loose notions could lead to uninformed persons actually questioning a professor’s edicts — or those of a nun, a bishop, a general, a prophet, or a government minister. Such a scenario was unthinkable then.

There would be anarchy. Loss of face was not permitted in those times. I resolved there and then, dysfunctionally, that I would make 30 per day but learn how to deny them to myself and others.

It was soon after this era that misguided medical people began to take increased note of scientific evidence. This regrettable development all but destroyed the noble profession in a decade or two. Some of what the top men had been dogmatising for years to generations could be tasted in horse-apple flavour.

That therapeutic practice of which Doctor X had boasted for 30 years was shown to be way inferior to poisoned placebos. Wonder auscultators in London stopped insisting that they could hear a splitting of the eighth heart sound.

Then the little guy, who should have been seen but not heard, began to speak up. They listened to his thoughts as they had listened to those of the masters. He was often right. And so, much of the world changed. Some parts did not. Religions particularly did every-thing and anything to hold the line. Governments banned free speech. Generals had dissenters executed. Dictators exterminated whole populations.

All of this change occurred in a two-/three-decade span. The question was raised amongst the fear-of-change fraternity, “Is nothing sacred any more?” Indoctrination from cradle to grave had us all thinking that there were many issues that lay beyond our capacity for understanding: “This is a mystery. If you could understand it, it wouldn’t be a mystery.” End of discussion.

Angelus avoidance
The foundations gradually crumbled. It became unnecessary for peons to kiss the archbishop’s ring or stop voiding to say the angelus more respectfully or whisper inflated peccadilloes to the man-in-the-box of a Saturday night or beat the breast in a pre-ordained spirit of inferiority and unworthiness.

Concepts of holiness, sacredness, undiscussability, falling to the knees, deference, mea culpaying, reverence for people-places-things — seen and especially unseen — and concession of personal control all visibly ebbed in the political, medical and religious domains. The Enlightenment had accelerated.

Spectres of sacredness
Not so in every aspect of life or in most parts of the globe. Tyrants, religious and secular, still call the shots in innumerable societies. Populations are consigned to a middle-ages future in countries across the globe where the air is dense with the incorporeal spectres of sacredness, deference, indoctrination, blasphemy, control and manipulation. Extraterrestrial wistfulness dominates visible reality. Fear is the key, the common denominator.

Chapeaux to the men and women who, over the centuries, felt the fear but faced it down in the scientific/medical world, ‘in spite of dungeon, fire and sword’ from establishments. Our inheritance is so much richer, whatever the flaws. We have come a middling good way along the road.

In order to get the graces and the cert (Compostela), you must do at least the last 100 kilometres

Garrett Fitzgerald on the ‘insights gained’ and the great good to be had from undertaking pilgrimages, and their key role in the protective response to ageing.

Elderly friends of mine have been looking out for their health lately. Gone is the longstanding certain conviction that the sooner they die, the earlier they make it to Heaven. Years ago, they couldn’t wait for the big day; now they wish to stick around and enjoy the known world. That man Dawkins will answer for this trickery in the finish.

When I say elderly, I speak only in terms of years — not condition. Eighty is the new 60. Twenty-year olds are still relatively in utero. Experts put this change down to a combination of apples and stents rather than angels and saints. Walking further than the length of oneself has become one of the new obsessions for those who are still naturally ambulant or who have already had the hips and knees replaced.

Unaided auto-salvation
Some have held on to the old ideas and, confidently and assuredly, wait for the thief in the night, as promised in the writings. The à la carte religious and the downright agnostic are now frequently seen to be engaged at not-so-formal refreshment of the spiritual tissues.

One of the most popular of such efforts at unaided auto-salvation is the big walk in Northern Spain to Compost Stella. Every second day, one runs into fellow wrinklies who are about to do the pilgrim route or who have survived it.

All, even those who have not yet set out, will try to convince you that no experience on this or other planet comes near. The returned pilgrims have not infrequently had occasion to double up on prostatectomy and laser halo excision — available only in the private sector.

In order to get the graces and the cert (Compostela), you must do at least the last 100 kilometres. If you wish to do the walk on your bicycle, you must do 200kms.

In 2008, approximately 130,000 registered pilgrims turned up; from my experience to date, I would estimate that most of them came from Waterford — many of these may also have been in the GPO in 1916.

July 25 is the feast of St James the Apostle (Santiago) who died in 44 AD at the ‘tender hands’ of Herod Agrippa and if you arrive on that day (different year of course), you are doing things properly. If it falls on a Sunday, you’ve really done the business.

Moor-slayer
Santiago is revered in Spain. He is the object of the pilgrimage. One of the 12 apostles, he was visited by an apparition of the Virgin Mary, and later personally beheaded with a sword by Herod Agrippa in Judea.

His body made its way to Spain with the help of angels in a rudderless boat. On arrival in Iberia, his relics were transferred to Compostela in Galicia and were swallowed up by a big rock. They were subsequently found during the reign of King Alfonso II. The pilgrimage dates from Alfie’s time sometime during the 9th Century.

James also reappeared miraculously at the never-even-happened imaginary Battle of Clavijo on the Christian side some centuries later and got the nickname Matamoros — the Moor-slayer — for his prowess in killing Muslims. Some CV for an apostle over a millennium and a bit!

I don’t go into the detail of which bits of the above my co-elderly friends actually believe while they are trudging the hills and dales of Galicia. Nearly all of them hope their next grandson will be named Jimmy.

One thing I have noticed is that several of them are big into the Paleo diet and will only partake of meat they have personally killed (many go lamping rabbits at night) or fruit and grubs that they have found on the forest floor or in Lidl.

They can also be seen on the Outer Ring Road at all hours in athletic costume, trailing indefatigable hybrid canines and laughing unto themselves. Tragically, some of them turn up weekly for the long-handicap competition.

You can take it from me that Rory’s drives wouldn’t be as impressive if he had to listen to stuff about Compostela on the tee.

Yet, the pilgrims will attest to the perceived benefits of their 100kms. Medical science, whose achievements pale in contrast to the deeds of St James, might suggest that there is great good to be had from exercise and dieting or that a break from routine may rejuvenate (marginally) the occasional wrinkly.

That is clearly not the answer. The pilgrims will tell you, without excreting any details, that their experience on The Way of St James has meant far, far more.

It’s very puzzling; this intangible human condition.

Rule one to survive oncoming winter: Move to Oz.
Pic: Getty Images

The rules are simple, says Dr Garrett FitzGerald, and you can apply them every year: very cold weather in winter plus respiratory pathogens equals chaotic trolley numbers. But he does have some survival tips for his readers.

This long summer of great weather may have induced a relaxation of the alertness neurons. One should beware. The cerebral cortex has shown itself to be fairly idiotic and feckless in the past — and such a state is likely to continue into the future. It is therefore highly advisable that one should engage the managing director services of the pre-frontal areas in order to avoid one having to tell oneself later that one told one so.

The winter will come. It will come more acutely than expected because of the false sense of security (unreality) consequent to the long summer. If you are deluded enough not to believe this, witness the fact that I am just coming out of next January’s ’flu. Getting the vaccine in October next does not prevent the illness in the previous September.

The man in New Zealand
The man below in New Zealand who can wrongly predict our weather here — from his observations on lunar cycles — hasn’t finalised his bets for the next eight months.

He’s quite busy at present possibly pissing up the proceeds of his last gamble where he bet we would have a mighty summer. He was in fact (according to some analyses) not nearly as good as a coin toss. He missed the storm of the century earlier in the year and had us frozen out of it last Christmas and New Year, whereas it was in reality grand and soft.

The DoH, like the HSE, is also in the winter-bluster business. It cites (in its recent epistle to Leo) 14,500 less trolley days in the first six months of 2014 compared to the same period in 2011, and presumably requires a buala bas for it, fair deuce for the excellent results lads kind of stuff. I was in the same predictive corridors myself for years.

The difference in my case is that I got it right every time and I don’t have to spend all my nights looking at the moon. And, for bonus points, my predictions do not change at all.

The rules are simple, and you can apply them every year: very cold weather in winter plus respiratory pathogens equals chaotic trolley numbers. Mild winter plus less bugs equals only usual trolley chaos.

Last winter was mild and there wasn’t a great deal of infection around.

This cold-bug combination was not the fault of the D0H or the HSE — or Ken Ring below in the antipodes. Perhaps none of them should claim credit for it?

When it comes to winter reality, none of them seem to know their ass from Coney Island.

Primary care
Now that our combined masters have managed to make our hospital services almost inaccessible, they all appear to be fixated on burying the only part of health that up until recently had been functioning reasonably well; primary care. They are well on their way.

The last minister was a particular one-man disaster area for primary care. The doctors have left in droves and the upcoming docs intend to get out as soon as possible.

We are dependent now on foreign missionaries, a state entered by our hospitals some years back. Some of our hospitals have no Paddies at all. This is success for our administration?

During the recent viral infection, I suffered — as is usual — with exquisite myositis and probable mild cerebritis. The dreams were only mighty, John of Patmos’s Apocalypse only in the ha’penny place.

M50 trolley tailback
I saw the day when it would take three weeks to get to see a GP, when all emergency departments were closed outside Dublin and Cork, when trolleys extended all the way down O’Connell Street, around the M50 and out into the sea off Howth Head, while shiploads of missionary health professionals and trolley-fabricators from Atlantis landed nearby on Ireland’s Eye.

There, a great slua of civil servants cheered to the echo the awarding of the Mission Accomplished Permanent and Pensionable trophy to themselves.

A proclamation addressing the ‘new’ mission was read to the great gathering whose punts stretched as far as Carlingford Lough. It was entitled ‘Health to the Healthy — The Sick Can Póg Mo Thóin.’

I woke up in a lather of blood and puke, gradually and gratefully realising that we are only two-thirds of the way there.

Rules for surviving
In the light afforded to the thinking person by the foregoing, there are obvious straightforward rules for surviving the oncoming winter:

1. Move to Oz (if impossible go to 2 below; a wildly inferior option).
2. Move to Dublin.
3. Wear a woolly hat, even in bed (maybe a bit jaunty when out of bed).
4. Avoid contact with bugs (if not possible, avoid the source of bugs — people).
5. Get the pike out of the thatch.

Dr Garrett FitzGerald

Dr Garrett FitzGerald examines the life of work of the great Dr Hunny O’Neill, who was ahead of his time in advocating an ‘upstanding’ existence, which is now recognised as a way of protecting ageing DNA and extending one’s lifespan.

Let us continue our recollections of the unsung heroes of Irish medicine. Today, the case of Dr Hunny O’Neill (b 1905).

His father Connie O’Neill named the boy for his brother Atilio and the school mates called him Hunny. The young lad seemed to have an innate sense of what was good for him.

From the age of eight months, when he first took to his bipedal calling, he showed a serious disinclination to sitting back down again. His mother was convinced that there was an equine streak in the father’s side as she daily woke him from the upright position for school.

He refused the sedentary disposition from his first day of primary education. The Brothers beat all seven shades out of him, the traditional method for getting a child’s mind right. He was attended to by healers, monsignors and exorcists to no avail. By the time young Hunny was 12, he was reluctantly allowed to stand at the back of the class throughout the learning day on condition that he never permitted his hands to stray
below his waist — a venial sin in those far-off days.

A ‘do-as-I-do’ man, Hunny never permitted his pet hybrid gadhar Darwin to sit. That K9 lived for 52 years, demising only when the complications of the foreshortened-legs syndrome finally overcame his steely will and the ever-present terror of the kick in the rear. By this time, in a process described below, Darwin had evolved into a strikingly perfect German sausage dog, tolerably versed in algebra and the classics.

As is often the case where strange lads from the country are concerned, Hunny enrolled in Trinity College to read Medicine. He soon led a student revolution which gained standing status for all of his classmates. By his third year, all the seating had been removed from the lecture halls and seminar rooms. Cadavers were dissected in the upright position.

Buttery, up
By his fourth, even the professors who wined in the Buttery did so with extended knees. Many of the teaching staff took to sleeping upright, though the change was not evident in some. Within a decade, the staff did not appear to be getting any older with the passage of time; actual rejuvenation in some led to overcrowding in Barbarella’s on Wednesday nights many decades on.

‘Funny’ Hunny O’Neill MB (the sobriquet added in recognition of some strange personal habits) is now 109 years old and still practising his unique brand of medicine. There is a village in East Clare — where he did a weekend locum in 1936 — in which the average age of the citizens is currently 93. He was recently honoured there with a presentation after an over-eighties hurling tournament for up-and-coming stars. Long hairs — which he has plaited — droop from his ears down to his clavicles.

He refuses to have them cut as he ‘feels’ they may reflect a stage of evolution not as yet understood; in any event, his barber is unable to reach them, the subject standing in the tonsorial chair.

What has been evident to O’Neill for over a century has now been confirmed in the Karolinska Institute in Sweden; sitting down may accelerate the ageing process. It’s all in the length of the telomeres — long telomeres mean long life, ultra-short telomeres suggest you should not purchase green bananas.

If you are sedentary for significant amounts in your day, you are all but goosed. Just look at the angles of the typeface in this essay and you will note that this masterpiece has been typed by a stand-up person (unless the editor has interfered with him).

Telomeres, when shortened, allow the chromosomes to fudge their functions and cease their replication. Dr Hunny believes that this latter handicap also stymies evolution and may actually reverse it. Conversely, unfudged chromosomes allow evolvers proceed to their programmed selves at an accelerated pace.
Hunny cites the glaring historical fact that the apes did not become ‘us’ until they stood up for themselves.

Naturally, one would expect a longer life-span in the more evolved. There are exceptions to the rule evident in some parts of the country where some can still be not seen crouching behind whins and scheach bushes.

O’Neill is currently promoting his ‘Seas Suas’ training device. It consists of specially fortified chains (Matt Talbot bungee) that hang from a reinforced-steel ceiling plate. The chains support a body harness with hypo-allergenic nipple guards and leg-openings in a fortified hygienic gusset. For the partners of private
patients, who may wish to ensure that there is no sitting down on the job, rawhide flagellae are an optional extra.

Only recently have I taken serious heed of Dr O’Neill’s advice. But, I should have done so from the age of five. I well recall that occasion when Kathleen in Nurse Hogan’s Nursing Home admonished me because I had given her ‘cheek’.

“I’ll redden your arse for you, boy, and you won’t be able to sit down till Christmas!” I should have stood my ground and taken it like a man. I’d be only about 23 now.

The HSE will never ‘up its game’ and provide a 21st-Century service until it is challenged to do so by breaking up its failed monopoly once and for all, argues Dr Garret FitzGerald.

Looks like the HSE is the future of our health services after all.

Dr James Reilly had a plan to get rid of it. Dr Leo Varadkar has apparently reversed that option. In essence, the latter decision suggests that we have arrived at the point where the HSE is now regarded as the best that the Irish can come up with in their philosophy. Small wonder that terms of yore such as ‘world class’ and ‘centres of excellence’ have been put aside.

The HSE is a monopoly. There is no competition. There is really no challenge for it to ‘up its game’ so fondly reminiscent of previously failed entities such as CIE or P agus T. It seems that there is little prospect of ever having a service that can get its act together in a 21st-Century way.

Outright failure
What other enterprise, business or service would survive outright failure over a period of three to four decades? This, of course, includes the period under the care of the Health Boards, the HSE by another name. I know of no retail outfit in the world where the customer is treated so inhumanely and yet the ‘firm’ manages to survive at the top of the market. Many of the key employees already have departed or are going to emigrate. Almost all of its key management personnel are unsackable. We have indeed a sad spectacle.

It is finally accurate to say that general practice, the only reasonably effective part of the health services, is deteriorating rapidly and is approaching the point of no return. With the hospitals and mental health services already in disaster territory, it’s now surely ‘game, set and match’.

What is most sad is that this is apparently the best we can come up with; we, a nation whose brains and industry are eagerly sought by the whizz-kid multinational companies that have flocked to our green and pleasant land.

In recent times, decent care of the acutely ill patient has been all but abandoned; a time when the dogs in the street could tell you that such care should have been moving in the opposite direction.

Under-sixes plot
Luckily, primary care has provided some semblance of providing an acute care facility. Yet, recent plans to overload the system with trivial visits (as in the under-sixes plot) threatened to produce first-time-ever waiting lists in general practice. Though such ill-thought plans have been taken off the boil by the new minister, the threat remains into the medium-term future.

We have Emergency Departments that cannot hope to do the job for which they are badly designed; care effectively, rapidly and humanely for very ill patients. For any health service, this is surely the ultimate priority.

In view of recent advances in diagnosis and treatments and an expanding (particularly elderly) population likely to develop an increasing load of medical emergencies, the service cries out for adjustment and flexibility — and perhaps a bit of lateral thinking.

It has received little apart from the old Titanic deck-chair switching ploy. For decades now, failure is the best we have come up with. Endless and seemingly eternal failure is a helluva formula for providing any service. The customer loses big-time; he/she will do anything — up to dangerous self-negligence — to avoid entering such a system at the time of most need.

Qualified personnel prefer to emigrate rather than be a part of it and, by their non-participation and non-availability, worsen the failure. Management’s response has been to pretend that they are not necessary and to scour exotic lands to the east for takers. Hardly the Bill Gates approach to doing business!

Monopolies require breaking up. Even a ‘pilot’ secession of one region or one hospital or part of the service might start the ball rolling. Such a HSE-free area would have to be guaranteed a no-interference status from the suffocating central control paradigm of the failure-meisters.

What should be obvious to politicians, departmental chiefs and HSE executives is that 40 years of continuing failure which continues to worsen is hardly optimal achievement. Failing with increasing confidence no longer fools the punter. Radical rethinking and innovation are badly needed. The acutely ill patient deserves a better deal than what is being delivered.

Tunnel vision
I was recently tested for new spectacles, which I am due to collect next week. I expect that they will fit me, not frighten the horses, and that I will be able to see for miles in all directions. I do not expect a set of opaque Guinness-bottle bottoms for lenses, 1950s contact-dermatitis-inducing wire handle-ends for wrapping around my ears, and my eyes having to look the two ways to Kenmare to get a glimpse of the blackboard.

In the extremely unlikely event of my worst dreams coming true, I would no doubt instigate a campaign to run a failure-optician out of town.

That is the reality of providing a customer service in the real world in 2014. Somehow, the health service is immune.

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Our correspondent in a cloudy Algarve, Dr Garrett FitzGerald recounts his run-in with some dubious looking floaters in the hotel swimming pool and wonders whether airlines should set a surcharge for obese holidaymakers’ ‘excess baggage’.

From the bedroom balcony there is a great view of the hotel’s swimming pool. Shaped in a kind of figure-of-eight, blue and shimmering in the sunlight, it looks inviting. On our second day here, we swam in its refreshing coolness in the afternoon.

We had not paid any real attention to the morning statement by one member of our party who had a mild CVA some time back and is still visited by minor episodes of dysphasia.

“The abaltrosses are clapping in the pool,” he said. We should have known him better than to conclude that he had already picked up the local Portuguese patois.

Later inspection from some distance allowed us full view of the evening plague of sea-birds on the water. Within a couple of days, the avian droppings were legion, impressive in texture, volume and colour variety; sufficient, one might think, to raise the high-water mark in the Archimedean tradition. The surrounding deck is a joy to behold. For some days afterwards, the guests swam in this slurry. A week later, the pool remains open. Fortunately for some, the weather has cooled a bit.

I can only think in broad terms when it comes to diseases transmitted by birds and their attendant parasites; viral, bacterial, rickettsial, fungal and protozoan. As a retiree, my knowledge becomes fuzzier and more archaic by the day.

Bird brains
In my student days, you could impress your honours credentials by asking your respiratory patient in the final clinical examination whether he kept budgies or (1st class honours) had a pigeon or two above in the loft. Allergic lungs among ‘fanciers’ and psittacosis were about the height of it back then. We didn’t know anything about domesticated ducks in China and the end of the world. We were somewhat primitively aware, on common sense grounds, that swimming in birdshite wouldn’t be all that great for the health.

My previous run-in (and runs) with Campylobacter (jejuni) happened following a meal in a golfing resort in the Sunny Southeast of Ireland; incidentally a five-star establishment. Should I get a dose of Campylobacter (lari) from the maritime harpies, I will claim some sort of record — if I survive again — as this place is also (dubiously) classed as ‘five star’. There are dangers galore, other than divorce, in the golfing way of life.

Rather than the pretentious designation ‘five star’, the management here should be encouraged to elect for ‘world class’. This term can cover a multitude of health service failures, as we have seen at home.

One of the great inequities in travelling to albatross countries can be found in airline company rules. The gentleman who sat in the next seat — and most of mine — on the trip can probably put away 7,000 calories for his brekkie without pausing for breath. My estimate came in at 135 kilograms. He was entitled to bring another 15 kg in the hold without punitive charge and perhaps another 7 kg in his cabin luggage. His ticket, same price as mine, brought 157 kg to Portugal. Mine sent only 91 kg (69 + 15 + 7). Yet, they wanted to put on a heavy (sic) surcharge on the slight excess on my bag. If I didn’t pay up I would have had to leave my space-suit, snorkel and diving bell behind at Cork Airport.

The war against the obesity epidemic is clearly being lost. Appeals that call on consideration of future health problems or self-image have not worked. Perhaps a tax on weight would help in some instances. Instead of a fixed fare for transport, tickets for trains, planes and automobiles could be sold on the basis of total weight transported and might be issued per kilogram, ascending precipitously at the higher levels. Taximen have long charged an excess premium for each bag in the boot.

Total conacreage
There might also be a case for a new bums-on-seats assessment in airline charges. Total conacreage covered (not counting ‘setaside’) or number of seats or parts thereof occupied could be considered in the fiscal deliberations. Each customer would have his/her own spreadsheet.

Coughing up cash — like hanging — tends to concentrate the mind. A London return fare of €700 could possibly change the attitude to one’s habitual number of fructose molecules? Any port in a storm. Tough love hasn’t gone away, you know. I will leave space here for comments from those who, on the occasion of my writing these suggestions, decide to make themselves feel offended.

Bon appétit till the next time!

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Also seen were many St Cecelias and any amount of long-haired lads with white frocks and wingy things.

A new arrival at their research lab in Waterford gives Dr Garrett FitzGerald and his colleagues the opportunity to gaze into the abyss of the world of sub-infinitesimal particles, and to have the surprising contents of the abyss gaze back.

The Cortical Institute in the garage was given an exciting Christmas present by one of our most prominent researchers.

Dr Isaac McSporran came to us originally from a chair of anecdotal neurology up north. Despite very small eyes, he has always been a scientific observer par excellence, or so he informed us. An occasional quirk in his CV did not deter us from taking him on to the team.

His stunning research has never been published. Editors of reputable and other journals have not relented in their bizarre refusals to print articles that omit the traditional ‘methodology’ information.

“I always inform them that my methods are mine to know and theirs to find out. These are secret and would not be secret any longer were I to share them with every Tom, Dick and Harry of whatever suspicious water,” he told us at interview. We’d have employed him even if there was a background of serial killing; we just had to get the use of his legendary invention, the kleinoneurotic viewer (KNV), which he brought in a valise chained to his drum, and which he promised to share with us in exchange for unfettered access to our banks of cortices.

The viewer allows the eye to behold particles of dimensions below decimals of infinitesimals. Dr Isaac assured us that the electron microscope was, in comparison, a scientific fossil, a ‘club foot’, a primordial-ooze-dwelling ancestor of the single-cell organisms of prehistoric days. Under the KNV’s gaze, carbon atoms are as herds of mammoths. We did not, however, believe him when he tried to convince us that he was well on the way to converting the viewer into a living organism by feeding it an ingredient from Tyrone peat.

For his current study, he has been using the viewer only on low power. When he called some of us over to see a receptor site on an astrocyte, I thought we were looking out on Botany Bay. His photographs of gnat spermatazoa bring tyrannosaurus rex to mind — the images taken before the machine was plugged in! At medium magnification setting, we saw bosons that exhibited a range of frightening facial grimaces.

The wonderful news he brought today concerned what he has termed ‘angels and demons’ after the fashion of Dan Brown, though Isaac does not really believe in the former; a demon man all the way, of Scots-Irish lineage himself. The ensuing row between the differing strands of belief amongst our team members required my intervention to restore the peace. The argument had to do with whether wings were visible or not.

It is well known at a primitive guessing level of science amongst paleo-thinkers that neurologic action is a matter of neurotransmitters meeting nerve-cell receptors.

What is not clear to that unevolved fraternity is why thousands of reactions may be elicited by just a few transmitters such as nor-epinephrine and serotonin. Hardly comes near to explaining the emotions suffered during Bubbles Dwyer’s last-puck free in the hurling final or phenomena such as true love.

The first of the new images seen sailing into neuronal receptor docks were middling smudgy enough. After Isaac charged up the battery, there was a definite suggestion of three-dimensional form. He then turned up the magnifier. Now, there was no doubt at all; there were identifiable ‘beings’ visible. They all had arms and legs, some had disputed wings, a few Irish-looking ‘saints’ wore top-of-the-morning hats or halos.

Angel delight
I recognised Saint Maria Goretti straight away, a martyr like myself; we had a photograph of her on the wall in Tipperary — glass front and passe partout. Dr von Graf of Ballyhale, our nucleolar specialist, whistled loudly when he saw Saint Anselm sitting on a distant amino acid. Also seen were hundreds of Aquinas-looking boyos, dozens of St Josephs of Cupertino, many St Cecelias with musical instruments, and any amount of long-haired lads with white frocks and wingy things.

My catalogue is long to date; angels and saints mainly, but in the criminally inclined cortices from the stores, we have since found thousands of demons. The artists were right after all — they really have little red horns which anchor their bearers on to the receptor landing pads and are almost impossible to displace.

Horny divils
Sporran’s secret ‘air extraction’ machine has since confirmed that the ‘angels’ are abundant in the air above. Ascending air from around the feet is full of the horny divils.

Our cloning lady in WIT is at present engineering further mutations and my 3D cortical printer is ready to issue her two new types of cortex — the sinful and the virtuous. It is planned to expose receptors in each to a sequence of a. angels and saints, b. demons and, c. all of the above — in various concentrations. The resulting holographs will be very interesting, sound recordings also planned.

Dr Sporran drops a new bombshell almost daily. Only this morning, he was able to demonstrate that both moieties of effector ‘transmitters’ (demons/ antidemons) are able to bypass the sealed reinforced-glass ‘skulls’ of the cortical baths.

“My view is that it’s all supernatural,” he announced at breakfast.

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To mark the traditional New Year detox diet craze, Dr Garrett FitzGerald believes all recent health-related food fads should be taken with a pinch of salt — particularly now that moderate salt intake is back on the menu.

Doctors must keep up with the fads, particularly when food related. Many of us lived through the time when fat was awfully bad for you and much of the population bought into low-fat this and low-cholesterol that.

Coffee could kill you long before your time for quite a period until they found some antioxidants in it and it can now have you challenging Methuselah for the long haul. Fish turned you into an apprentice (if mercury-sodden) Einstein, fibre destroyed the pile and varicose vein trade, and you could have all the tea in China so long as it was coloured green. All of these fashions should be taken with a pinch of salt — now that moderate salt intake gets the green light again.

Despite confident medical leadership in promoting vogues, the mortality has remained at a stubborn 100 per cent. There is more dietary advice than ever before and we have lots of dieticians, yet the streets are full of very fat people. The medical world is rapidly re-evolving food-wise. The fact that it is reverse evolution will not dampen the latest ardour. One should now put back one’s eating watch 20,000-40,000 years. Think paleo.

Egg static
My moment of doubt in our lifestyle führers came at a hypertensive meeting in Washington DC a few decades back. Breakfast was available at the conference venue. You could buy scrambled eggs but no other kind of egg. These were ‘low-cholesterol eggs’. The yolks had been removed and some sort of yellow stuff mixed in with the whites.

The American cardiologists washed down these ovoids with tumblers of fibreless fructose-rich orange juice and threw in a few doughnuts, rising then from the table with a sheen of ascorbic acid, virtue and superiority — possibly with a shortened long-term prognosis. They then rushed imperiously into the seminar rooms with saintly zeal to give an account of their latest dietary ‘certainties’ to save the world from itself before it was too late.

Out with the pyramids
Now, it’s the turn of the carbs. Already they are switching the deck chairs on the pyramid. The bottom and biggest layer (filled with bread and spaghetti and cereals) of the five in the ‘food pyramid’ is to be wiped almost clean and replaced by even more fruit and vegetables, the fourth layer. There is another message out there that now suggests you should eat pucks of meat — and little else; best served, of course, if you have killed it yourself.

There are other relatively new dietary trends abroad in the community — for the moment. It is difficult to say how long each will remain in vogue. The low-cholesterol dominance lasted half a century and may well have paradoxically contributed to the epidemics of obesity, diabetes and clotted arteries.

Instead of depriving yourself of cream on your porridge, you should now eschew sugar, try gluten-free and go hunter-gatherer. Bin the porridge and lash into the cream. Illustrations in future nursery-rhyme books will reveal a Mrs Spratt without a pick on her, and poor old Jack’s image will have to be ‘continued overleaf’.

‘Grain brain’
One of the new suggestions is that wheat is a big no-no. The argument goes further; the vaunted unrefined wheat may be even worse than the refined. Wheat, it goes, may give rise to all degrees of dementia — so-called ‘grain brain’, an idea that hasn’t yet met with general consensus. But what can we say for consensus in the light of what has gone before?

Other missionary-provided lifestyle advice comes under recent scrutiny; it seems that our elite athletes may be doomed. Persons aged 30 who take five hours or more per week of strenuous exercise have been found to be more likely to get atrial fibrillation in later life than your not-so-strenuous persons.

Perhaps the Kilkenny hurlers got wind of this, causing half of them to retire? Should good doctors pull up their cars on the highways and byways at night and offer the obsessive nocturnal joggers some scripts for prophylactic warfarin?

Group think
It is probably a wise tactic to regard everything we ever learned as erroneous. Think humbly of all the crap advice we gave out over the decades. We suffered from the ultimate in ‘group-think’ as we made the same mistakes with increasing confidence.

In our defence, let it be said defiantly that we were only following orders. The best approach now might be to advise exactly the opposite from here on in. Refresh the humility part of the mind with the comeback of the leeches.

My maternal grandmother (born 1877) left us short of her 99th birthday. She had walked at a slow pace most days of her span. Jogging or running was out of the question — it was considered un-ladylike for most of her life and the long dresses (to the floor) in her early days would not have permitted such extravagant hip movement. She never heard of lipids. She ate what was put on the table and appreciated the fact that food was available. She baked smashing apple tarts.

I am told that she was in sinus rhythm at the end. More important than all of this; we all loved her dearly.

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There is clear and irrefutable knowledge that there is no room at the inn. Pic: Getty Images

Reeling from the completely predictable chaos in the emergency departments this month, Dr Garrett FitzGerald believes the ‘make more room at the inn’ argument must finally prevail, and that those in charge must, like Elvis, leave the building.

It’s health service comedy season again. It gets funnier every year. As a result of a couple of mild winters, the jokes were damp enough in recent times. This year, they’re rolling in the aisles — many off their trolleys altogether.

The DoH-HSE Failure/A&E Abandonment of Patient and Responsibility Show is back on the road, bigger and better than ever. The line-up of comedians is world class. Here is a flavour of the hilarity. It’s quite preposterous, but that’s what comedy is all about.

There is no room at the inn (laughter).

(Background: it has not occurred to anyone that the inn might be too small. The problem of ‘no room at the inn’ began many years ago when the inn was downsized.

The current innkeepers are permitted almost any solution that does not include making more room at the inn. The inn needs a large annex that can be opened when the inn is full. This would ensure that there would always be room at the inn. Footnote: there is no such entity as winter, viruses are imaginary.)

Pigs and Dogs
There is a sign over the door: Pigs and Dogs Entrance (audience reminded that these were once known as ‘Patients’ — screams of hilarity).

INMO figures point to excess of 600 Pigs and Dogs in the vestibule of the inn (paradoxical laughter at the impossibility of this; unimaginable in a first-world country).

Head of HSE blames elderly and infirm “bed blockers” (many members of audience carried out — some taken to A&E for four days of waiting. Due to volume of laughter, audience does not catch the bit where he says ‘it’s not an issue of capacity’).

Next day, a senior HSE comedian says crisis is over, only 580 extra P and Ds (giggle-incontinence amongst some ladies in the front row).

Minister fresh from the holliers asks non-existent nurses and doctors to put shoulder to wheel (more punters wheeled out).

Minister says he ‘expected’ this crisis (oxygen masks drop down on to members of the audience, many of whom have apoplexy).

Fianna Fáil say the situation is a disgrace (several head injuries from falling on floor of the auditorium).

The ’infection’ word or the ‘virus’ word have not been yet used. (Hahahahahaha).

‘Winter’ not mentioned (silence, a joke too far).

At this stage, I switched off the show. One can only take so much short of pneumothorax. If you get this condition, you know where they’ll send you!

Thanks be to the heavens, none of this could be real. It would make you think of an imaginary doomsday scenario where much of it would be true.

Seriously, could you imagine a situation where 600-plus people were waiting on trolleys and chairs? Where decades of making the same mistakes with increasing confidence would be tolerated? Where the highest authorities in our health services would be shown to have absolutely no clue as to what they are on about? Where there is chronic denial of reality? Where patients are treated like animals? Where everything is on the table apart from the solution?

Where there would be such deliberate mistreatment and abandonment of patients to a level where the life of the patient is deliberately put at risk?

Is this what the real truth is? For millennia, people have been getting sick in the winter due to a combination of adverse weather and infection.

A system in which this essential truth is denied and consequently not acted upon responsibly could at best be a failed entity. The most charitable conclusion is that those in charge must have lost their way.

They have passed their sell-by/ usefulness date. It would be time that all of the top layers in health administration put the pens into the top pocket and, like Elvis, leave the building. Today would be best.

It would be, at least, morally wrong to subject our citizens to such maltreatment as has been demonstrated. The country was in uproar recently about a homeless man who died in a doorway in Dublin. Urgent measures to prevent further such tragedies were put in train. There is no parallel in our health service. None of the necessary, effective urgent measures (there is only one really) have been put in place to alleviate the conditions endured by our A&E brethren.

There was at least a perception that there was no room at the inn for the homeless man. There is clear and irrefutable knowledge that there is no room at the inn for our trolley/chair people.

The Government measure urgently implemented for the former was to make more room at the inn. For the latter, that solution, however obvious, is denied down to the last administrator. No pity at all.

If such a scenario really did occur in our little country’s health services, you would have to transmit to our health bigwigs a clear message; you have failed and there is no hope for you as evidenced by decades of failure by you and your kind. Do the decent thing. Pick up thy pen and walk. Close the door on the way out.

Ain’t nobody laughing.

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After almost 40 years of a worsening trolley crisis in our emergency departments, Dr Garrett FitzGerald believes the excuses from our politicians and health managers are as pathetic and inept as ever.

The blaming has been going on for more than 38 years. It is the Irish approach to any problem encountered.

One week there are, say, 260 chairs/trolleys (chollies) in the EDs nationally. The next there are 600. The response is to do the math; 600 on chollies minus 800 bed blockers equals minus 200 places in hospitals, no problem at all, QED.

Solution is simple: throw out the 800 and close more beds. In fact, if you (someone who is not me) had thrown out the 800 before the extra patients presented, there would have been no problem at all in the first instance.

Naturally, one can conclude from this that the guy (you) who was in charge before I came here is to blame.

Time and tide have waited for no man. Over the 38 years in question there has been a relentless increase in hospital emergency activity. This is caused by three main factors.

1. The population has increased, particularly elderly survivors of big conditions requiring hospitalisation. Outright success through expertise/advances, and relative success in ensuring their continuing survival — but with need for subsequent ongoing intensive therapies are the largest cohort of patients distinguishing today’s hospital achievements from times past. Cardiovascular, cancer and complicate multi-system disease treatments have evolved to a level unimaginable a few short decades ago.
2. Amongst these ‘half-successes’ survival has been achieved but frequently, ’instead’ produce consequent disabilities with need for ongoing and slow care. (Amongst these latter are a percentage of the group of criminal patients known as ‘bed blockers’.)
3. Attendances at EDs follow the normal patterns established decades ago: most patients are there because they obviously need to be there. Steadily increasing numbers are there because they have been referred from primary care, which does not have the simple facilities of urgent x-ray, scan and blood work necessary to come to a diagnosis that would be well within the compass of good GP care.
Added to these, you have over-anxious persons who are convinced they will receive proper care only at the ED, drunks and vagabonds. These we have always had with us and always will.

Worse to come
The bottom line is that we have more sick patients requiring more intensive treatments than ever before. As time, population numbers, and expertise advance, the future holds the prospect of an inevitable worsening of the same.

Let’s be very honest about what measures have been taken to date, perhaps using the analogy of the latest motorways.

The traffic has virtually come to a standstill because of the numbers of vehicles using the road compared with previously. From on high, an edict ensures closure of one lane on either side of the central barrier.

Naturally, less maintenance staff are needed (apart from managers, where more will be needed). It will now take two days rather than two hours to get from A to B.

Some cars can only do 30 miles per hour so these are shunted to the side of the road and gardaí with clipboards are called to have them removed (road-blockers).

Conditions of workers and expectations of them ensure that they are constantly pissed off and many will walk off the job. An All-Ireland Final will occur twice in September. Punters will be asked by management not to go to the match, unless ‘you are playing in it’. Following the game, a further lane on each side will be closed in line with overspending of announced budgetary restrictions. All solutions are on the table EXCEPT the opening of the closed lanes.

Then the ‘motorway flu’ hits the scene! (This is where all the cars crash into one another). Nobody in command has ever, ever, ever heard of the flu coming in that non-existent season ‘WINTER’ before. “It’s just not fair,” they all whine.

Flu excuse
This nonsense has being going on since the late 1970s in the hospital services. Some years, respiratory infection is mild, some years more severe. After flu has begun to abate some weeks after its appearance, the flu excuse can no longer be used; so you get really mean and vindictive with the ‘bed blockers’.

I have seen these misfortunates hounded out of hospitals by twisted healthcare workers who could ideally get a part in One Flew Over the Cuckoo’s Nest.

Too early discharge brings patients with chronic conditions back into hospital within a month with a worsening of their original condition.

The flu is only the trigger of a cascade of other disorders which lead to heart attacks and strokes some weeks down the line — keeping the hospitals as busy in May and June as in January. No HSE head has even noticed this after decades of its happening!

We’re now almost 40 years (commenced with bed cutbacks in 1977/8) into the same but worsening ED disaster scenario. The excuses remain pathetic, childlike and suffused with magical thinking.

Our masters, managerial and political, do not have a clue how to fix it. Not one single manager or politician who has overtly failed at the problem, many for decades, should be allowed through the door of the services again.

Decades on, the decent honest letter should be published soon:

Dear Citizen,
We have, to a man, made a total balls of the hospital services for almost 40 years. Please put us out of our misery immediately by accepting our unconditional resignations, and please get someone who can do the job.
Yours humbly — and FINALLY,
The Health Boards,
The Department of Health,
The HSE and Successive
National Governments.

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It’s difficult to think of many silver linings to the current ED overcrowding crisis, but Dr Garrett FitzGerald retells the tale of one elderly couple who contracted a multi-drug resistant love bug during their regular ‘dates’ in the local casualty department.

Julia’s story is by no means unusual these days, yet possibly a window into the essence of modern Irish life. Widowed for 12 years following the overdue dispatch of her partner’s well-pickled yellow body to the cold clay in Glasnevin, she had settled into a life of undying optimism of regaining her long-lost freedom.

Behind her now stretched the endless years of the trials, sufferings, weepings, gnashings and torments of the marital and maternal states. Gone at last from the family home out into this world of wonders were her five fine sturdy illiterate and useless sons, most of them now serving sentences for anger-related episodes.

One of her boyos had been hanged on a builder’s crane in Mesopotamia for western behaviour, following which she was persuaded to co-believe along with her neighbours that no great harm had been done.

Her daughter, she estimated, had to date given birth to six children by nine fathers. Some of the children sported treble-barrel surnames and all shared their first name — Miley.

Love studies
True love, the peer-reviewed amatory literature asserts, is hard to find, but Julia was not to be thwarted in her efforts. Her motto, often nocturnally expressed sotto voce to her two-bar electric fire, was taken from a formerly glorious sporting team; “to the brave and the faithful nothing is impossible”.

Possessed of a Free Travel Pass, she regularly frequented Sunday afternoon tea dances in hotels in dowdy towns in Kildare and Meath, making sure to avoid potential partners who gave off the smell of drink, were farmers, ex-priests or wore bicycle clips.

She was very close, she felt, to a good match on one occasion only, during her fourth year of searching. Her potential beau had a twinkle in the eye, a mannerly demeanour and a great but respectful sense of humour. He boasted that he could tell not just the temperature of the water but the depth of the River Liffey while standing naked on Butt’s Bridge with his eyes closed. He then spoiled the romance for her by pulling from his Sunday wellingtons two flat half bottles of Smirnoff.

Trolley nights
Thus almost ended her love crusade. She withdrew from the social scene as her health problems escalated in parallel with her consumption of Major cigarettes. On many occasions she was whisked by ambulance to various emergency departments in the capital city.

She hated Beaumont where, on the latest count, she had accumulated 234 trolley nights. The medical treatment, she felt, was reasonably good but the clientele was generally transient, with the result that she got to meet very few regulars.

The Mater was somewhat better in that regard and she spent many a night on trolleys contagious to those of men who were frequent over-weekers.

In a year or two she was on good terms with a lot of the Tallaght constituency and had many the good night on gurneys head-to-toe with the local acute and sub-acute clientage. Occasional dates emanated from these two- and three-night co-habitations but there were flaws, ranging from leakage to barking at every turn. Sometimes a blossoming of an ED hope was interrupted by the sudden demise or cruel admission of her prospect. One real louser for whom she had initial high hopes fecked her pillow during a mutual hypoxaemic episode.

Lourdes ED miracle
Yet, she stuck it out. The silver lining, which adorns fewer clouds than the experts would have one believe, manifested itself at last in Drogheda. On a will-writing trip to her sister in Duleek, she was caught for breath, anointed, and conveyed unknowingly to the Lourdes ED. Coming-to about two days later in a corridor, her eyes met his in the head-to-head opisthotonic position.

It was love at first bloodshot gander. The hiss from the oxygen was to her like the sixth symphony, encompassing, ethereal and eternal. The vibrations between them exceeded all the legendary competencies of the dorsolateral funiculi.

As the unexpected sometimes arrives at the least welcome moment, she was admitted after the next full moon and Tom made it to a different ward at the same time. Before they left the ED, they pledged that they would meet again, don’t know where, don’t know when.

Some sunny day soon afterwards, their paths crossed again in the same corridor and coincidentally on the same trolleys. They had a few wild days and nights before being cruelly separated again. But, true love’s path was not to be denied — they met over and over again in ‘blue heaven’, as Julia liked to think of it, making light of Tom’s — and her own — cyanosis.

Unfortunately, they were torn apart by her early discharge after only three days. They held on to Tom. The couple parted reluctantly.

“Don’t worry, my love. I’ll always be here for you,” said Tom.

Most of the time, he was. They were anointed and married in the corridor on the third day of their sixth next visit.

A tandem trolley was commissioned by the HSE only last month.

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Dr Garrett FitzGerald on the never-ending wait for someone to come up with a sensible — and workable — ‘great escape’  plan for the overcrowding crisis in our emergency departments.

Emergency departments (EDs) all over the Western World have been in trouble since the 1980s. Demand has increased and capacity decreased. Some day over the rainbow, it will occur to the medical administration mathematicians that, if the demand stays up, the capacity will need to adjust upwards to get a reasonable steady state. Meantime, billions of dollars, euros etc. will be spent on magical thinking and the rolling out of same. Possibly as much as it would cost to fix the thing properly.

Lanigan’s Ball
Great solutions to date have produced only a Lanigan’s Ball of a thing in a flooded dancehall where the best musicians refuse to play the venue and several patrons are regularly drowned. The bayfurs in charge are confident going forward, having identified the main culprit — the dancers themselves.

There is a new crime and new criminals. The felony of bed-blocking is at the root of all evils. Five or six hundred of these offenders absolutely refuse to go to non-existent nursing homes or to their homes for non-existent extended care.

The Minister for Health has identified this as the big problem and is to see to it that efforts to get many of these people out of the hospitals will become the main focus, going anteriorly.

The former exhortation to all staff to put shoulders to the wheel has not gone away, you know, but is not now the number one thrust.

All solutions to date, such as these old chestnuts, have achieved two common outcomes; an excuse to fail and failure. Everything is now on hold until the bed-blockers are sorted out. That this solution has been high on the list of excuses and ‘things-to-do’ for decades is neither here nor there. There can be an air of urgency again and targets identified and things rolled out in a fresh strategy.

When the winter pressures ease in July, pronouncements will be made about the success of the new dawn in the hospital services — same as every year for the past three decades. Yet, nothing will have changed.

EDs are not popular with patients, the public, managers, politicians, and many of the clinical staff (including many of those who work in EDs). In the perceptions of some, they are a destabilising influence on ‘inner’ hospitals, with whom they are in direct competition. They rock the boat unpredictably. They are the main cause of long waiting lists, deferred treatments, cancellations, chaos and the filling of emigrant planes with Irish healthcare graduates. All would be well if they did not exist at all.

The ‘main man’
But they won’t go away. EDs are disadvantaged in that they have a rather humble history, starting out as dressing stations and graduating to casualty rooms. Meantime the real work went on in the hospital ‘proper’ where the professor could have his team do the main work without untimely interruptions. Now they are proper life-and-death stations and acute investigative and care factories.

The ED is now the ‘main man’. But it has yet to achieve the overdue respect commensurate with its importance. The tail, it would seem, is not fully welcome to wag the dog. The shotgun marriage between the ED and the more ‘traditional’ (and more elective) services is not a happy one but the ED is now definitely the one with the trousers. The king is dead, long live the king.

The turnabout whereby the ED (with its acute assessment satellites) becomes the primus inter pares unit of the modern acute general hospital will be a slow and difficult process, but it is a very necessary next move. Old traditions and principalities must be done away with.

In the United States, many of the newer hospitals do not have an ED. Someone has obviously realised that two competing systems in the same building make for an unworkable situation. Hospitals that have an ED face continuation of their out-of-control existence or must take the necessary, if revolutionary, changes seriously.

In the bigger cities, it should be possible to designate one (or two) of several acute hospitals as the emergency hospital, a huge all-encompassing extended ED that does not have the restraints that bind it to a competing elective service. This hospital, including various bed classifications (medical, psychiatric, short-term observation, acute assessment etc) would carry the best: all the acute sub-specialty facilities and expertise and have priority in dispersal of appropriate cases to centres of excellence in the ‘feeding’ hospitals.

This move would provide the best of both worlds for everyone. Both divisions of ‘care’ (acute and elective) could get on with the work that they are designed to do. Of course, the capacity issue must be dealt with in whatever plans are drawn up. Without this, there is no possibility of success.

Unfortunately, it seems likely that we will stay trapped as we are, lurching from crisis to crisis as we have done for 30-plus years. No doubt, we could start by replacing the bayfurs.

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Despite our concerns, he told us irritably that he was ‘all rocking fight’

Dr Garrett FitzGerald recalls his stink in the Alpine clinic where the Chief of Medicine Günter Von Ryan was afflicted with the worst case of chronic spoonerism he has ‘sever eeen’.

Our chief of Medicine Günter Von Ryan, late of Vienna, could be recognised by his green befeathered yodelling hat, even in his bed. I like to think that it was my idea that he would take it off for ward rounds.

From the second month of my employ at the Alpine clinic, he tried leaving it for a couple of hours each morning with his analyst. I do not believe that the patients suffered because of his bare-headedness and perhaps many were less frightened than was customary until then. As further bonus, it helped him desist from yodelling in the wards.

What he did not eschew under my urging was his acting-out of the complete textbook of neurology.

Some days he came to the clinic with extrapyramidal manifestations, sometimes with apparent left-right agnosia, other times with spinal stenosis (in a wheel-chair) or nystagmus or opisthotonus or even a fugue-like state. Although a mere internist, his love at the time was the nervous system. Every evening, he repaired to his mountain eerie, and after a good feed of rerbs and hoots, took to reading the most detailed neurological texts until the wee hours.

‘Stot whaining’
It was our job as residents to allow for his disorder-of-the-day and to make wise observations on our interpretations of the possible malady at issue with nods to neuroanatomy and neuropathology. He was anxious to elicit our views on “stot whaining” we would use had we carried out a theoretical brain biopsy in the appropriate location for the exhibited syndrome.

You must understand at this point that he had also taken to spoonerism while mimicking fronto-temporal atrophy. This entity, he told us, was chronic and somewhat progressive over time, so it would have been disingenuous of him to be cured of it after a day. (Of course, by ‘stot whaining’ he meant ‘what staining’).

With time the syndromes became cumulative, each day’s new derangement being superimposed on those of the several days previous.

On Mondays he would appear with a single entity and by the end of the week he had to be seen and heard (unless global aphasia was present) to be believed. One of the biggest challenges I encountered was one Friday when he appeared fresh from his analyst with a left-sided CVA, restless leg syndrome, syringomyelia, uncinate fits and athetosis. Throw in the now-permanent word and letter transpositions and we had quite a puzzle on our hands.

On that occasion, we tried to put it gently to him that he didn’t need to go to such excesses of suffering himself, but he told us irritably that he was ‘all rocking fight’. I began to think that, should he persist in such extremes, he might be well advised to avoid buying breen gananas or plong laying records.

My own family too began to worry when they became aware of the catching nature of the paraphasic affliction. I was now sporadically and subconsciously slipping in stuff like asking them if they wished me to show to the gops to guy the broceries on my hay wome. They were not amused.

Dr Von Ryan himself was a kindly man despite his decapillos. He invited us all to his schloss one dight for ninner. He had boasted all day that we were to share a vaunch of henison which came from a sheer which he dot himself despite sudden-onset poliomyelitis.

Banny Doy
Sadly, the same evening, he had become afflicted with luetic general paralysis of the insane while on his mourney up the jountains and we found him swinging nollocks-baked from a chandelier, singing “Banny Doy” in the hain mall of his castle. Needless to say, we got feet swock-all to eat that night.

We were really concerned about him after that episode, bringing the matter to the attention of his analyst. She confidently urged us to leave the catter in her mare. It worried us somewhat that she had herself recently developed nine tacial fics, an alternating strabismus, and a couch of toprolalia.

Typhoid mornings
Von Ryan was changing over to the study of gastrointestinal diseases by the time my residency was up; his typhoid mornings were very sea poopy. He had, he belched, learned all there was to know about neurology, very little of it hic useful. His demeanour was much less alarming to his loyal patients, many of whom still retained ongoing tendencies to oral and written transpositions.

He came to the door of the clinic to wish me von boyage. I did my best to keep my formication under control during the ceremony. The analyst, who by then had obvious issues upstairs and who was looking mighty in Ron Vyan’s hodel yat, tished to whank me for all “ze wood gurks”, presenting me with a signed locks of byrica. The good doctor bade me au revoir with a fig bart.

I never booked lack since.

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He had a lot of deranged stuff on his mind — I can’t wait to get his cortex into one of our jars; the thought videos will be something else

Back at the Cortical Institute in the South-East, Dr Garrett FitzGerald recounts the team’s latest brain experiments aimed at ‘curing’ heterosexuality.

I was awoken by a very serious silence the other day. There was clearly something afoot but not ahead down in my garage. Usually, morning is the noisiest time of day in the Cortical Institute. Nocturia has seen to it that our researchers are up with the dawn chorus and raring to go at the day’s work in my converted garage. I employ only retired colleagues — who else would strictly adhere to the Institute’s motto, ‘Live as if this is your last day’? How right it was for some of our late brethren, Darwin be good to them.

The surviving colleagues sat around the central table, enclosed by the walls of cortical ‘jars’. The only sounds came from the purring of the feeding-bathing machines. The thought/word consponder, display units and scanners were all switched off. One of our scientists, wearing his trademark pink waistcoat, sat at a distance from the others and appeared to be in a near-catatonic sulk. My first thought was that we may have had a visit from the storm troopers of HIQA.

Deputy ‘Head’
My deputy ‘head’, a title most humorously devised, beckoned that I should come outside. A most impressive colleague who was said to have survived the Lusitania, she came straight to the point in the latest scientific jargon. “The lads aren’t puttin’ up wit it from that f*c*er Dwyer!” she said sweetly. Dwyer had read to them the blueprint for his proposed study, ‘Stereotactic microablation in sexual preference disorders’. I enquired gently as to the nature of the objections, like was she a member of Iona or a closet archbishop or whatever.

“Twas alright until he read the materials and methods bit. You didn’t have to be a genius to spot that he wants to cure heterosexuality. Couldn’t he just go on with his shite work to do with emptying the prisons with his laser beam? I never liked him or any of his breed, but he was on to something there. But he was after this all along. By the way, he was the worst dermatologist in history and ‘tis well known that he and all belongin’ to him are intellectual pygmies.”

I am a most tolerant boss with an inspired sense of destiny and eternal possibilities. They (and I) refer to me as ‘The Special One’. I felt obliged to ameliorate my deputy’s angor animi with lofty sentiment about our role as the chosen ones, the brave and the faithful, future history’s giants, and any amount of similar bull. I threw in a JFK for good measure at the finish — some people ask why, but we ask why not. I didn’t believe a word of it but it got the job done. Two Jägerbombs later and she was game to let the matter go.

Comical Ali
She agreed to talk the rest of the lads into it. I had promised her that I would have a word with comical Ali himself. I let him get a whole lot of very deranged stuff off his mind first (instant internal monologue: can’t wait to get his cortex into one of our jars; the thought videos will be something else when the time comes, maybe we can do it at a future office Christmas party, mightn’t be too long either — I’ve seen his carotids) then went to work on him.

He was slow to come round from his position of getting carried away with the excitement of the recent referendum. But, sure as shooting, against my famous soothing palliative molly-cuddling all-encompassing goose-down duvet plawmaus, he hadn’t a prayer. In fact, he was of the opinion that all bets were off. But there I was, beatific now, with the consolatory hand in firm extension. He cried like a babby until I was almost ready to throw up my hurried breakfast of blaas and red lead.

Our agreement settled the matter. By 11am, all our machines were at full throttle and all our rapidly and visibly decaying colleagues were giving the best of their ultimate or penultimate days. It would not go out from the Cortical Institute that we had classified heterosexuality as a new sexual disorder. Yet we would be suspicious of those who were anxious to engage in too-frequent manifestations of the orientation. Ali would confine his stereo-taxis to many cortices that had a history of male-female interactive overuse, and some fewer in the self-service constituency. Ablations would be geared towards attenuation rather than total cure.

Most days are great in the Institute. Today was rough at first, but exemplary management expertise carried the day once again. Only last week, a glowing tribute with effusive (almost lickspittle) gratitude from the governor of one of our major prisons. Of the first 100 subjects in Ali’s criminal ablations, all were immeasurably improved. Thirty-nine were planning to take holy orders on their release dates.

It is gratifying to be inspired. When one combines vision with know-how, the sky’s the limit.

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