On Samuel Pepys, conversations with doctors, and Covid cases

This year I have further resolved to ask daft questions

On 1 January 1662 Samuel Pepys confided in his diary: “Waking this morning out of my sleep on a sudden, I did with my elbow hit my wife a great blow over her face and nose, which waked her with pain, at which I was sorry, and to sleep again.” So, not a great start to the new year for Elisabeth.

Perhaps the diarist had been woken “on a sudden” by a bout of epididymo-orchitis. Pepys first experienced this in October 1661 and, as Riches notes in Annals of the Royal College of Surgeons of England (I977, 59: 11–16), it “continued intermittently throughout 1662 and 1663”. Yet, Pepys records, with domestic harmony restored, he and Elisabeth celebrated the new year by seeing a play called The Spanish Curate, but only “after we had eat a barrel of oysters”. A barrel?

 Elisabeth tucking into a barrel of molluscs speaks volumes about her resilience. But a more impressive aspect of her nature was tolerance. After all, if I, waking “on a sudden… hit my wife a great blow over her face and nose, which waked her with pain”, there’s no chance I would have got “to sleep again”. So why, at the start of a new year, rather than aiming to be more tolerant, like Elisabeth, am I resolving to be less so? Or, to frame it more delicately, to be more discriminating in my elevation of tolerance as a necessarily guiding value.

Perhaps it’s because I’ve grown tired of tolerating empty phrases, whether written or spoken. For instance, one is often advised to “Have a chat with your doctor”. As that seldom-quoted philosopher – my granny – often observed: “Aye, right.” A few weeks ago, I accompanied a relative to see a hospital consultant, after a wait of several months. On the few occasions when he wasn’t scrutinising his computer screen and reciting test results, he made only fleeting eye contact with the patient; he failed to ask them if they had any questions; he instructed them to come back in two years; and he rose to open the door.

Such experiences are common, I suggest. For example, in Reclaiming Conversation: The Power of Talk in a Digital Age (2015, page 281), Sherry Turkle cites a senior physician who notes how some doctors “rely on the test culture”, they “don’t want to take responsibility for the things that might come up in a conversation… [and they] welcome the fact that the new medical records system almost forces them to turn away from the patients…”. That’s why I’ve resolved that in 2024 if I have, say, a sore stomach – perhaps after I “had eat a barrel of oysters” – I’ll see a psychiatrist. Apart from the possibility that I might get to stretch out on a comfy couch, I reckon they’re the specialists most likely to ask questions, establish eye contact, and engage in conversation, while being sensitive to nuance. Nuance is not a means through which the spirit world can be contacted, but a capacity for subtlety that tends to be ignored by the emoji-based yammering that is often central to what passes for conversation these days.

This year I have further resolved to ask daft questions. For example, what is meant by a “case” of infectious disease? I’m still annoyed with myself that throughout the Covid pandemic I read and listened to myriad references to “cases” that variously soared, plummeted, and gave “cause for concern”, yet I couldn’t be bothered to find out exactly what many so-called experts meant when they spoke of “cases”. But Spencer et al at Oxford University’s Centre for Evidence-Based Medicine were bothered. They asked in September 2020, ‘When is Covid, Covid?’, and found that the World Health Organisation, EU, US, China, UK, and Italy cited different definitions of what constituted a “case”. This left the authors to speculate that “[m]any more case definitions may be published globally, but these were enough to confuse us”.

Finally, another of my resolutions is to try and disentangle common sense from non-sense. For example, following the recent publication of a paper associating the risk of acquiring type 2 diabetes with the consumption of red meat, I came across this from naval surgeon and nutrition researcher Captain Thomas Cleave (1906–1983), who observed: “For a modern disease to be related to an old-fashioned food is one of the most ludicrous things I have ever heard in my life.”

Best wishes for 2024. Now… time for an oyster.