Climate changes

BLOG CLIMATE

 

DURING THE 1980s, I lived and worked just over fifty miles south-east of central London in Gillingham, one of the Medway Towns in Kent. Usually, I drove to London on Saturday afternoons after my morning dental surgery session ended at 1 pm. Then, after buying innumerable gramophone records and later also CDs and seeing friends, I would spend the night at my father’s home before returning to Kent late on Sunday evening.

One winter Sunday evening, after visiting friends, who lived in South Hampstead close to the Royal Free Hospital, I began driving towards Kent. When I reached Lewisham in south-east London, snow began falling lightly. I thought nothing of it. By the time I arrived at the start of the M2 motorway, the situation had changed considerably. The motorway was under several inches of fresh snow. The few vehicles travelling at that late hour drove on a pair of groove-like tracks made in the snow by vehicles ahead of me. It was rather like the page in the song “Good King Wenceslas: ‘Mark my footsteps, my good page, Tread thou in them boldly … In his master’s steps he trod, Where the snow lay dinted’.

The snow continued to fall and by the time I reached the motorway exit west of the Medway Bridge, I decided that it might be better to drive through Strood, Rochester, and Chatham rather than along the motorway that by-passed these places along a hilly exposed rural route, which I believed might have been badly affected by the snow.

It was about 2am when I left the motorway. I joined a line of cars that was crawling slowly towards Rochester – a traffic jam at 2 am. Eventually, I drove across the River Medway on the bridge at Rochester. The traffic was slow moving and dense despite the time. I decided to leave the main road and follow a back road that wound around Rochester Castle and avoided the city centre. I drove about fifty yards upwards along a steep snow-covered lane and then the car would go no further. Its wheels were unable to grip the road and I slid down to the bottom of the hill where I had started. There was no choice. I had to re-join the slow procession of traffic crawling through the interlinked Medway towns.

When I reached Gillingham, it was long after 3 am. I turned off the main A2 road and drove, or rather slid, downhill along Nelson Road which was covered with deep snow. At my street, Napier Road, the snow was even deeper and had not been compressed by passing vehicles. I headed towards my house but could not reach it because my car became wedged in a drift of densely packed snow. It remained locked in the snow for over three weeks.

The following day, the Medway Towns were almost paralysed by the snow. However, the only stretch of railway that was still operating was between two neighbouring stations, Gillingham and Rainham, where my dental surgery was located.  I managed to reach my surgery by train in my Wellington boots and wore these whilst treating the few patients who decided not to cancel their appointments. The only patients who struggled through the snow that day were elderly people who considered that cancelling appointments was disrespectful to the professional. All those brave souls, who made it through the hazardous snow, were seeing me about false teeth.

Although the snow did not disappear from the Medway Towns for over three weeks, the rail service to London resumed quite quickly. So, I continued to make my weekly visits to the capital. Fifty miles from snow-covered Gillingham, London was free of snow. Exaggerating slightly, visiting London was like travelling from the Arctic to the Mediterranean. Few of my friends in London could believe that my home in Kent had sufficient snow to keep most skiers happy.

The spectacular change in climates that I experienced that winter when shuttling between London and Gillingham occurred long before the concept of ‘climate change’ became widespread in the public eye.

What? No gloves!

DENTISTS ARE FRONT-LINE workers, risking their lives for you. We put our fingers in people’s mouths and risk inhaling their expired breath and droplets of saliva and infected material. This has been the case ever since the start of human endeavours to resolve problems related to dental and oral pathology. I began hands-on dentistry in 1977 during the second year of my course in dental surgery undertaken at University College Hospital Dental School (‘UCHDS’). I qualified in early 1982 and worked in general practice until September 2017.

BLOG GLOVE Silvi_1024

At UCHDS we never wore gloves or masks while treating patients. The exception was for extractions that required minor oral surgery (cutting the gum etc.) when we were required to wear disposable latex gloves. For extraction that only needed forceps (‘dental pliers’) and elevators (wedge-like instruments), gloves were not required, but we did wash our hands between patients. When using the dental drill, we were required to wear safety googles over our eyes. What I have just described was what was considered correct practice at one of Britain’s leading dental schools. In those days, as in the future, any patient we treated was capable of harbouring nasty pathogens that could cause diseases such as tuberculosis, herpes, hepatitis B (and other forms of this virus), mycobacteria, fungi, and rarer diseases, all of which could have proved very detrimental to the clinician or his or her assistant.

The first practice I worked in was rightly considered to be one of the most ethical in the area. Once again, gloves and masks were not worn. Patients rinsed from a proper glass that was washed between appointments before being re-used. Instruments that had been used on a patient were placed in a bath of Savlon disinfectant for a while until they were needed again. All needles and local anaesthetic cartridges were single use only. At lunchtime and at the end of the day, all our metal instruments were sterilised in a hot air steriliser. It was not every practice that bothered to do this.  Horrified? Well, you might well be if you are old enough to have had dental treatment in the UK before the second half of the 1980s.

After I qualified, I subscribed to the New England Journal of Medicine with a vague idea of keeping up to date with medical science. Most of the articles were beyond my comprehension. However, in the mid-1980s, I began noticing many articles were being published about t-cells (a kind of white blood cell). What I only realised later was that these were being published because of the arrival and proliferation of a new threat to health: HIV (‘AIDS’). This epidemic prompted a dramatic change in how dentists operated. Almost overnight, we were required to wear gloves; advised to wear masks; commanded to sterilise instruments before re-using them; giving disposable single-use paper or plastic mugs for patients to use for rinsing.

What amazes me is that during the 35 years that I worked as a dentist, I never heard of or read about more than a handful of patients who were infected following dental procedures. There have been some newspaper reports of patients contracting HIV after seeing a dentist, but in some of these cases the mode of transmission was other than from clinical procedure. Over the years, I attended several lectures on the latest developments in cross-infection control. After each of these, I always asked the lecturer whether there was any scientific evidence that showed whether cross-infection controls in dentistry significantly affected patient mortality. Not one of these academic clinicians could provide an answer. One of them said to me:

“That would make a very good topic for a PhD.”

Whether they make a difference or not, modern cross-infection protocols make both the patient and the clinical team feel safer. I hope that everyone will feel sufficiently safe to be treated now that the atmosphere is infiltrated with particles of the Covid-19 virus. The nature of this highly contagious airborne pathogen justifies the many advances in cross-infection control that the profession has made since HIV appeared on the scene and will require further refinements especially in the field of air purification.

When I think back to my days of providing dental treatment with my bare hands and uncovered face, I am amazed that I and most of my colleagues never succumbed to anything much worse than fatigue and frustration caused by awkward patients.

 

 

Wake up call

RETIREMENT OFFERS MANY PLEASURES. One of these is waking up in the morning at whatever time one wishes. I do not want to sound slothful but waking up early rarely appeals to me.

black ring bell alarm clock

Photo by NEOSiAM 2020 on Pexels.com

While I was undertaking research for my PhD in physiology at University College London (‘UCL’), there were no daily time constraints. I could turn up at the laboratory whenever I felt like it and leave whenever I wanted. My timings were entirely up to me. I used to arrive at UCL at about 10 in the morning. At 11 o’clock, I went upstairs for coffee and biscuits in the Starling Room (a departmental meeting place for post-graduates and academic staff; named in honour of the physiologist Ernest Starling). By noon, I had returned to the lab. However, there was not much time to do anything because I liked to have lunch at just before 1 pm. And, after lunch, I often sat in the Ladies Common Room, chatting with Margaret, my supervisor’s wife who also worked in the lab. You can be sure that we never discussed scientific matters over our cups of sub-standard institutional coffee.

By just after 2 pm, I began getting down to work, setting up an experiment. However, everything stopped at 4 pm, when one of us would put the kettle on to boil, the heat being supplied by a gas flame from a Bunsen burner. Tea and biscuits involved me spending another hour chatting, mainly with Margaret. The other PhD students and workers in our lab took tea but were not distracted from their work. At 5 pm Margaret and my PhD supervisor, Robert, set off homewards, followed soon after by the rest of the lab. Between 5 and about 8.30 pm (and on some weekend days) is when I managed to do some ‘solid’ work. Miraculously with this lackadaisical schedule, I managed to do sufficient experimental research to be awarded a doctorate. Then, my life changed dramatically.

Soon after becoming ‘Dr Yamey’, I enrolled in the Dental School of UCL to train to become a dental surgeon (‘dentist’). Compared to my BSc and the PhD studies, this course leading to a Batchelor of Dental Surgery degree was far more demanding of my time. Five days a week, my presence was required at the Dental School at 9 am sharp. The day, which included a lunch break and two brief coffee breaks (if you were lucky), ended at about 5 pm. This seemed to me as bad as being sent back to junior school.

At first, I found this rigorous routine difficult after the relatively laxer times I had enjoyed during my BSc and PhD courses. I remember waking up at 7.00 am on dark autumn mornings and looking out of my bedroom window to see if there were lights on in any of my neighbours’ windows. Often, there were none. To arrive at the hospital by nine in the morning, I had to board the Underground at the peak of the morning rush hour. The tube trains were always crowded, standing room only, at that time. However, in those days in the late 1970s each train had two carriages in which smoking was allowed. Because many people were going off smoking or did not smoke, these carriages always had plenty of empty seats when they pulled into my station, Golders Green. Ignorant of secondary smoking, as I was then, I always travelled comfortably in the smelly, smoke filled carriages. However, by the time I had travelled the thirty minutes to Warren Street, I was always in great need of a quick coffee in the Dental Hospital’s basement canteen before classes began. After qualifying, the early morning routine continued. It lasted for thirty-five years until, at last, I retired.

Waking early in the morning was not confined to dental studies and practice. It is a feature of life that I have got used to in India. Many people in India wake early to take advantage of the cooler early hours of the day. I learned this very soon after arriving in Bangalore during my first visit to India in 1994. For the first few weeks, my wife and I stayed in my in-law’s home. On the second or third morning of our stay, I woke up in darkness. I could hear people rushing about in the house. I woke up my wife and said that I thought that the house was being burgled or attacked. She reassured me that all was okay and told me that the family liked to rise early. It was not quite 5 am. Day after day, my father-in-law tried to encourage me to join him on his early morning walk, to see the sun rise. Eventually, I gave in and we walked around a nearby open space in semi-darkness. It was only when we had returned to the house that we noticed the sun was beginning to rise.

Since those early days in India, I have just about got used to getting up incredibly early if there is a good reason to do so. Driving out of a city as large as Bangalore is one of these reasons. Before 7 am, there is hardly any traffic on the roads, which are usually choc-a-bloc during working hours. Flights to London are another good reason. They often leave India at early hours of the morning so that they can land in Western Europe at an hour that will not disturb those asleep in the UK, where late night/early morning passenger flights are forbidden. Although I can see the benefits of doing things early in the morning in India, I still miss being permitted to sleep until my built-in biological clock gives me its wake-up call. And for those of you who are by now thinking that sleep is all important to me, let me tell you that of late, despite not having any work or travel obligations, that clock of mine is waking me up much earlier than it used to years ago.

Long lasting

A bunch of flowers

Brings endless happiness

And plenty of  good cheer

 

Back in the early 1990s when I was practising as a dentist in Kent and owned a house in Gillingham, my future wife and I visited the local superstore, the Savacentre. Its name has nothing to do with the River Sava that meets the River Danube near Belgrade in Serbia. The shopping mall in Kent is pronounced “saver-centre”.

We wanted to buy some flowers and approached a florist within one of the wide corridors of the mall. He had some blooms of a kind we had never noticed before. We asked him what they were, and his answer sounded like “owlstromeriya”.

We bought a bunch of these attractive flowers and asked him how long we should expect them to survive in a vase. He answered:
“No worries there. They’re good lasters.”

And, he was right.

Alstroemeria, or Lily of the Incas, are native to South America but I guess many of those on sale in the UK are grown elsewhere.

Why I use an Android

android

A wise old friend of mine, Margaret, told me that once when holidaying in rural Greece, she developed an excrutiating toothache. Wary of trusting her teeth to ‘any old dentist’, she decided to go into the nearest town and visiting the local bank manager. She reasoned that the bank manager probably consulted one of the better dentists in the town. So, she visited the manager’s dentist, and was not disappointed.

Once, Margaret told me how she chose a new washing machine. She asked the repairman, who came to service her machine, which models he had to repair most and which caused least trouble. Based on this information, she chose her new appliance.

A decade or more later, I decided to acquire a ‘smart phone’ to replace my unsmart device. The choice was broadly between an iPhone and an Android phone, such as a Samsung model.

Remembering my old friend, who had been dead for several years, I consulted the man who ran a mobile telephone repair shop near where I used to work. I asked him which kind of ‘phone he had to repair most often. Quick as a flash, he said:

“iPhones.”

When I asked him why, he replied that the screens on Samsung models needed replacing less often than those on Androids.  That was enough for me to decide on buying a Samsung.

I have had several models of Samsung ‘smartphones’ since my first. Now, I am using an S8, which has a superb camera.

I am pleased I adopted Margaret’s method of decision making.

Annoying and rude

During the last few years that I practised dentistry, most of my patients brought mobile telephones into my surgery.

You would be surprised how many patients tried to answer their ‘phones when my fingers were in their mouths or their mouths were filled with impression (mold taking) material.

Worse still, were patients who were ‘texting’ constantly when I was trying to explain their treatment options to them.

Once, a patient arrived late, speaking on his mobile phone. He muttered to me that he was in the middle of a telephone job interview. I had no choice, but to let him continue. After half an hour, he told me he was ready for me. I told him that he had wasted my time and his appointment and had to book another one.

In the end, I put up a large sign in my surgery forbidding the use of mobile phones, which was rude and inconsiderate. This solved the problem because, to my surprise, most people obeyed it.

Espresso and extraction

lisb

 

Back in about 1995, I decided to leave the dental practice where I was working. I went to one or two job interviews, but did not feel that I would have been happy working in them had I been offered a job in any of them.

Then, I visited a dental practice next to the Portuguese Lisboa Patisserie in Golborne Road (near London’s famous Portobello Road). The owner of the practice, who has long since retired, knew me, but I could not remember him even though we had studied at the same dental school. 

The interview began well after my future boss had gone next door to get each of us an espresso coffee from the Lisboa. It was one of the best espresso coffees I had ever tasted in London. We got on well, speaking for hours, for so long that I was late for a pre-arranged dinner engagement. 

I took the job and worked in the practice for five interesting years, fixing and/or extracting many of the local’s teeth. I do not believe it was only the espresso coffee that persuaded me to join the practice, but it certainly helped. 

I have long since retired from that practice in Golborne Road and also from dentistry, but still visit the Lisboa Patisserie regularly. The quality of the coffee and Portuguese snacks, both sweet and savoury, has not faltered over the years, and some of the staff are those who were there back in the late 1990s.

I can strongly recommend a visit to Lisboa and its coffee, which was so perfect that it helped direct my career pathway.

 

57 Golborne Rd, London W10 5NR

Tooth powder

tooth powder

 

When I was a child, I brushed my teeth with toothpaste. My parents did not use paste. Instead they used Calox Tooth Powder. A small amount of this was sprinkled into the palm of one hand and then mixed into a paste using the wettened bristles of a toothbrush. The resulting gritty paste was then used to brush the teeth. I have no idea why my parents used the powder, but made us use toothpaste.

Many decades later, this year, I visited the Indian city of Pondicherry, which was a colony of France until 1954. We stopped at a tea stall that in addition to providing tea also sold small packets of paan and chewing tobacco (not very good for oral health) and packets of ‘Gopal Toothpowder’. Seeing the latter reminded my of my parents and their use of Calox. I asked the vendor how the tooth powder is used. He opened his mouth and rubbed his finger along his teeth. In his opinion, no brush is required. I bought a couple of packets, but have not yet been adventurous enough to try to use their contents.

Hard sell

clean mouth teeth dentist

 

An engraving of the Tower of Babel by Dolf Rieser (see: More about Dolf Rieser) used to hang overlooking the first landing of the staircase in our family home in north-west London.

In my thirties I worked as a dentist and lived in north Kent. Almost every weekend, I used to drive to visit my widowed father in our family home. On one of these visits I noticed a box lying on the landing beneath the Tower of Babel engraving. It was an unopened, sealed box containing a dental water pik. This is a device that can be used to pulse tiny jets of water between neighbouring teeth in order to dislodge deposits of dental plaque (bacterial debris). It has proved to be a far less effective method of removing plague than dental floss, which itself is less eggective than the use of  tiny interdental brushes. I was a bit surprised that my father had bought a water pik as he is not a lover of gadgets.

For several weeks after I first noticed the unopened package, I kept returning to my family home and seeing the unopened package, which was gradually becoming covered with dust. Eventually, I asked my father about it.

He told me that each time he visited his dentist, ‘D’, he was asked to purchase one of these water piks. After a series of visits, he paid out almost £100 to buy one. I asked him why he had wasted his money on something he was not going to use. He said:

“D kept on pestering me to buy one. He was getting on my nerves, so to shut him up I bought one. I have no intention of using it.”

No doubt profit was not the only motive for D wanting my father to own a water pik, and he might have been surprised by my father’s reason for buying one, namely to put an end to his ‘hard sell’.

 

To see the Tower of Babel engraving, click: HERE

Photo by Pixabay on Pexels.com

 

Bad hair day

hair

When I began practising as a dentist, I worked in a small town in north Kent. My working week stated on Monday afternoons. So, Monday morning was available for me to do whatever I wanted. I used to have my regular haircuts on Monday mornings at a barber shop owned by Dave. He often cut my hair and always did a good job.

One Monday morning, I entered Dave’s establishment and as Dave was not around I had my hair trimmed by a young lady. She did a good job but handled my head roughly. She knocked my head around as if it were one of those balls that boxers use for training. I am exaggerating a bit, but there is no denying that having this lady cutting my hair was a stressful experience.

Some hours later, I rang Dave to tell him about my recent visit to his shop. I wanted him to know that if his assistant persisted in treating customers the way she did to me, he would lose business. Dave apologised, and then told me that his young lady had had a bd weekend, a row with her boyfriend. 

I suppose that Monday was what people call a ‘bad hair day’ for me.

 

Bad hair day: a bad day a day with many problems, annoyances, etc. (https://www.merriam-webster.com/dictionary/bad%20hair%20day)