Not leaving without my cat…..

 

“Less is more. “I thought not for the first time and a change of scenery was what was required.

After the third morning lecture, I felt that I had updated myself sufficiently on the interpretation of abnormal liver test results in dogs and cats – at least until the next conference and presentation on the subject…..

Over the last few months, I had been at several congresses, but this one was special.

Partially because it was the first congress of the Egyptian Small Animal Veterinary Association, but mainly because of the venue.

The event was held at the newly opened Grand Egyptian Museum, generally referred to as the “GEM”.

The invitation I had received a few months earlier had included not only access to the conference rooms, but also to the museum’s collection and this was an opportunity not to be missed.

Like no other advanced culture, ancient Egyptians believed in the afterlife and they prepared for it extensively.

Life on Earth was considered to be nothing more than just a transitory stage, that was followed by an at least equally important afterlife, for which a body had to be preserved. Naturally, arrangements had to be made, to be well equipped and prepared for the next phase.

Preparations could take years and in the case of the pharaohs, it could last their whole lifetime. A lot of thought was given to what might be needed or what one might like to see again on the other side.

No surprise then, that this meant that treasured family pets were buried together with their former owners. This was a line of thought, that was not unfamiliar to me, as it reflected a desire also expressed by some of my clients in England, when I had to perform the euthanasia of a much-loved dog or cat.

An animal that was by the Egyptians considered to be able to cross naturally from one world to the other, was the scarabeus, the humble dung beetle, that lays its eggs into the waste products of other animals, which then becomes the substrate for new life.

Like this remarkable insect, I crossed the open hall of the museum, guarded by the giant statue of Ramses II in its centre, and passed from the world of veterinary medicine, where the aim is to preserve life, to the other side, where the afterlife had taken centre stage.

Rather than the extensive display of the items recovered from the tomb of Tutankhamun, indisputably the main attraction of the collection, two other areas of the main gallery had caught my interest.

One was an interactive reproduction of the tomb chapel of Khnumhotep II, an overseer of the Eastern Desert.

In the thousands of year-old murals of the tomb, birds, goats, and antelopes could be seen, receiving (early veterinary ?) care and large dogs were walked on leads in no way dissimilar from a dog been taken on a stroll today. There were vivid hunting scenes, and the wildlife of that time, including various sorts of sea fish, were depicted in great detail. With the help of modern technology, these scenes were brought back to life on the walls of the tomb.

Not far from this display, another section of the GEM was dedicated to the preservation of animal bodies. The same care and attention that was given to the mummification of human bodies, was used to protect from decay the bodies of falcons, ibises, fish, baboons and even crocodiles.

While some of these animals were found in tombs together with their owners, many of them were sacrificed to honour one of the deities that were associated with these animals.

Carefully wrapped ibises had their own wooden, painted coffins and sometimes even stone sarcophagi. They were buried in places like Hermopolis Magna to honour Thoth, the ibis or baboon headed God of wisdom, magic, writing and the moon.

Whole crocodiles were carefully prepared, their body cavities filled with bitumen and oil and then wrapped tightly in several layers of linen in places like Esna and near the impressive temple of Kom Ombo in Upper Egypt, in honour of Sobek, God of the Nile, of power and fertility.

But no animal was so often preserved for the afterlife than the cat. Honoured and highly respected as the nemesis of rodents and snakes, Egyptian felines were associated with Bastet, the Goddess of home, joy, fertility and motherly love. In virtually every necropolis elaborate sarcophagi and figures of deceased felines could be found and it comes as no surprise, that the land of the Nile is widely believed to be the birthplace of the never-ending love affair between mouser and man.

As so often though, there were two sides of the coin. As cats reproduced very fast and were easy to keep, they also made for convenient objects of sacrifice to the Goddess, resulting in mass burial sites for not seldom 100 000 and more feline mummies near the temples dedicated to Bastet. An ambivalence still found today, where modern society accommodates the treatment of cats in both the best as well as in the cruelest of ways.

For me it was time to leave again the world of the dead and to return to the other side of the museum, to improve particularly my knowledge of feline medicine.

Where murders (on the Nile) are made….

 

‘How much is the fare?’ I asked, and the boat owner set his starting price at 1000 EGP, which was about double the usual price.

The temperature had just surpassed 42 degrees, and I was standing in the sun.

‘Seven fifty’ I replied, to cut the matter short.

‘Come on man – it’s a long trip and fuel is expensive! Nine hundred! ‘

‘Seven fifty, or I’ll take a taxi.” I said and made a not very convincing attempt to walk away.

‘Ok, ok – seven fifty then!’ was the somewhat expected reply and a few moments later I was on my way, riding the waves down the Nile along the waters of the first and lowest former cataract of the river in Aswan, in Upper Egypt.

I am not a great negotiator, and I am always uneasy about haggling with people in less prosperous countries. While fighting over a price is part of the culture in Egypt and generally expected in most parts of North Africa, I do not get any joy out of squeezing people who are living just above the breadline, for a painfully low price.

Having knocked a bit off the top but having met somewhere in the middle felt about right to me and I could rest assured that the skipper was left with a decent profit as well.

Before the boat ride I had stepped out of my very basic dwelling in a Nubian village, ignoring the considerable accumulation of rubbish on the unfinished building site in front of my hotel, which had attracted a pack of stray dogs that had made it their temporary home and that had succeeded in keeping me awake at night.

Passing the local pharmacy, that had made no secret of the nature of its bestselling merchandise, I had walked down an unpaved desert road, that only camels, kids with their three-wheeled tuktuks and the most decrepit taxis dared to use. This was far from a “well off” place….

And yet, I was now about to immerse myself into a very different kind of environment, preparing myself to spend a considerably larger amount of money for a cup of coffee and a few sandwiches, that in line with the long established British institution of the “afternoon tea” had during a semi-surgical procedure been separated from its crust and cut in to easy manageable oblongs with precise 90 degree angles.

This was, providing that the simple linen suit I had purchased years ago in Nepal and the worn-out canvas espadrilles I was wearing (instead of my hiking boots…), would comply with the basic dress code.

The place had just changed hands and in the general confusion that comes along with a new management team, I was hoping that any new appearance standards had not yet been established.

The destination for my short boat trip was the river entrance of the Old Cataract Hotel, an exclusive, expensive, and well guarded address, and a watering hole for famous desert travellers right since its opening in 1900.

It was here, where Agatha Christie, who’s former house in Sunningdale I could have passed every day on my way to work, wrote one of her most famous novels : ‘Death on the Nile ‘.

For the main part of 1937, the author made the hotel her home while her second husband was working on the nearby archeological sites.

The fateful cruise that was taking Hercule Poirot and the other protagonists further up the Nile to the temple of Abu Simbel, was departing from the Hotel.

After agreeing to buy a restaurant voucher for 1500 EGP (roughly 30 Euros), I was allowed to settle into one of the comfortable chairs and enjoy the colonial atmosphere of the place.

The scarlet and white Moorish archways that got their inspiration from the Mamluk mosques in Cairo, the mahogany walled bar, that would not have looked out of place in Central London’s Clubland, or the delicately crafted lanterns with their cobalt blue glass protuberances, a material that had been manufactured and valued on the shores of the Nile already at the time of the pharaohs.

The shaded terrace, surrounded by palm trees and a well-maintained garden, where even in the middle of the day a gentle breeze, that was passing uninhibited through sand coloured canvas shades and delicately carved lattice panels, provided an ambient temperature.

    

Winston Churchill had walked these halls and enjoyed the terrace at several occasions and during his stay in 1937, he had shared the view on to the Nile and to the ancient ruins on Elephantine Island in the company of Agatha Christie.

A hidden orchestra had at the time provided the background music.

While many hotels today can easily rival the interior design, the luxury and the comfort of the furniture or the quality of the food (the sandwiches were actually not that great…..), no money in the world can substitude for the originality and the history of a place like the Old Cataract Hotel.

On the Nile

 

The Dahayiba is following the small tug at a steady, yet sedate pace upstream, as it has done many times before. The two boats, connected by a single rope, as by an umbilical cord, with no purpose without the other.

The Dahayiba, a traditional Egyptian sailing boat, is fitted with a couple of small sails – one at its bow, one at the stern – but even while making the best of the northernly tail wind coming from the Mediterranean coast, they are barely able to bush the heavy vessels against the strong current of the river. Without an engine, it took these vessels up to seven months to cover the whole distance from Cairo to Aswan.

You have to be much smaller and lighter, like the more elegant, single masted feluccas, if you want to travel against the stream, or you need the tough, diesel-fuelled heart of a tug to reach your destination in a reasonable time.

And yet, exactly because the vessel is progressing at a slow pace, it is providing you with ample time to follow the ongoings on the nearby shore, telling you one small oriental story after another.

There is the villager riding alongside the boat on his white donkey, the children waving and rolling themselves in the sand of a small beach near one of the few bridges that are crossing the river, or the grazing cattle on a water logged field, that are carefully guarded by an old man with a cane, sitting next to a banana plantation.

Whoever is travelling in this way, has brought with him a lot of time. Time to look, time to learn, time to study and to marvel at the miracle, the water of this river and its sediment has created in the middle of the desert.

Forests of palm trees, large fields of sugar cane, of barley and corn are reaching out into the fertile ground on both sides of the river, but only as far as the small pumping stations and irrigation trenches are able to carry the water. Just a few centimetres of elevation will make the difference between life and death, will make the difference between a Garden of Eden and a parched world of rocks and sands that sustains only the hardiest of plants and animals.

Meanwhile the banks of the river are a haven for large numbers of birds, and the water is full of fish.

Kingfishers, ibis, and different species of herons and of birds of prey are not difficult to spot and it is no surprise that these birds had a huge impact on the culture and the religion of Egyptian society already thousands of years ago.

But the same can not be said for hippos and for crocodiles. Once numerous in the river and the flooded fields as far north as to the river’s delta, hippos even known to have caused problems in the centre of Cairo, they have now been driven as far south beyond the Aswan Dam to Lake Nasser.  

  

It is easy to understand why this tranquil form of travelling on the Nile has helped to inspire so many books and films, regardless of the number of murders involved.

But while many authors have highlighted and detailed the uniqueness of this river, of this water way that like no other defines the entire existence of a whole nation, nothing can explain it better, than watching its shores while sitting underneath a canvas roof, sheltered from the desert sun, while being pulled along by a small tug steadily heading south.   

Four nights – The fourth and final night

 

I was on the finishing straight….

….and it felt like it…..

When I woke up again in the middle of the day, my head felt heavy and my face was puffed up. Not for the first time I was surprised that the facial recognition software of my smart phone had allowed me access to the device.

Shift work is not good for you. There were enough studies that had documented the impact it had on both your physical as well as on your mental health. Increased rates of cancer and heart disease, of depression and substance abuse were all well recognised problems associated with a frequent disruption of the circadian rhythm, of an irregular sleep and eating pattern. This morning though, I did not need any peer reviewed papers to confirm this.

And yet, there is a certain subgroup of society, not limited to the veterinary profession, that is drawn to emergency and to shift work, like moths to a source of light in the middle of the night. People who need the sharper contrast, the unpredictability, the extremes and who can not exist in the tedium of a nine to five job. Arguably the better pay and the lesser working hours might be additional factors.

Well, one more night – how bad could it be ?!…..

At least I had managed to find a few hours of sleep, and I was confident that I would be able to stay the course, whatever the last night would throw at me.

First though, I met Käthi, another friend and colleague, for some vital coffee and some home-made cake in her living room. Käthi was a true local, having grown up in the same street she lived in, and probably best described as the Grand Dame of companion animal veterinary medicine in Switzerland, known and liked by everyone inside and outside of the country.

With Käthi, whenever we meet, the dominating theme is travel.

Käthi had conquered the Silk Road, the jungles of South America, the deserts of Namibia as well as the Russian Taiga. Here was someone who was equally comfortable in a yurt in Inner Mongolia, in a hammock on a dahabiya on the Nil, as at a reception in an expensive mountain resort in Davos.

Always a traveller, but one with strong local roots.

What was a veterinary adventure for me, was the neighbourhood, embellished with a lot of stories and history, for Käthi. I followed her childhood memories as well as the episodes of her professional life in the region with great interest.

 

The night at the clinic started with the unwelcome news that another nurse had called in sick, which meant that by midnight, I would be the only German speaker at the clinic. In return this meant, that we would be able to look after English, Spanish, Portuguese and Polish clients in their native language.

The other change from the routine of the last few nights would be, that in stead of the morning handover to Audrey, I would face the whole clinical board, all specialists in their fields, returning from their Easter-break.

How fitting, I thought, this would be my personal 2.195 kms, the extra distance, that was added to all marathons after the 1908 London Olympics, when the race was extended to cover the exact distance between Windsor Castle and the Royal Box at the White City Stadium.  

My first patient that night was a small dog, that had started to shake all over its body. Questioning the owners, it became clear, that moldy food, scavenged from a rubbish bin at the local park was the most likely culprit.

Once an i/v line had been placed and a blood sample had been taken, I was heading for the safe with the restricted drugs to get a mild sedative, when I came across Jeanette, a member of the day team, who was still busy writing her reports and who suggested to use Methocarbamol, a muscle relaxant, instead.

It worked a treat – within a couple of hours the tremor was resolved, and the little dog was barking again and demanding more food. Another example I thought, where simple communication had paid off. You do not need to know everything if you communicate well.

The night turned then out as bad as expected.

The number of hospitalised patients had increased again, with some all but stabile. In addition to this, the waiting room refused to empty itself from announced as well as from patients that had just walked in without any prior notice. Now, the reduced nursing staff, came to bear heavy on the efficiency of the whole team.

A young couple turned up at 2 o’clock in the morning with a 10 kg terrier cross that had eaten a 50g milk chocolate egg.

The little dog looked at me, wagging his tail, uncertain why he was here in the middle of the night. The feeling was mutual… The Theobromine concentration in his blood stream could not have been much higher than 10 mg/kg bodyweight. At 30 mg/kg, the matter would become relevant for me. There was nothing I could do for this patient, other than sending him home, before his owners had even registered – this dog would be fine.

One of my feline patients was in a very bad way though, and with an advanced age and a neoplastic condition as the most likely differential diagnosis, I had to contact the owner with the recommendation to euthanise the cat. Understandably the owner wanted to be around her cat but did not have any means of transport. This further delayed the process and when the patient had finally been put to sleep, there was a need to talk. 15 years of an established human-animal bond should not be concluded within a five-minute consult. This is never easy, especially if you were never trained for this. This is never easy, if at the same time half a dozen other patients need your attention.

 

In the remaining hours before sunrise, when finally, the clinical situation was under control, time had to be spent on documentation. Licensed drugs had to be recorded, treatment plans be updated and prepared for the next day, reports sent to the referring colleagues and everything had to be priced up, as after all, the whole clinic operation was funded solely with the fees paid by pet owners.

Was all the recording and documentation necessary? I doubted it…

Was it tedious ? Definitely !

At least, with the unwavering support of the coffee machine, by now no longer been fed with any “lungo” varieties, there just wasn’t any opportunity for something called “rest” and the remaining hours, until the first members of the day team arrived, went by fast.

The final “council of colleagues”, the last few meters on the finishing line, went much smoother than I thought, but I could not help having the feeling, that some leniency was extended to a colleague who had enabled them to spend some precious time with their friends and families, before they themselves were putting their nose to the grind stone again.

When I exited the still very “cool” car elevator, I reminded myself to focus on staying on the right side of the road and not to fall asleep on the five-hour journey home, that was ahead of me….   

Four nights – The third night

 

It was a quarter to two, when I woke up, realising that I had been invited for 2 PM.

It was clear that I would not make it in time. Not something that was taken lightly in Switzerland… Thankfully I had very forgiving hosts.

While driving out of the city, I reflected, that I had made it to the halfway point of my assignment, to the 21-kilometre mark of a marathon.

It is vital to still feel good at this point, if you want to last the whole distance, and so I did. I had slept well and although the workload had been considerable in the first two nights, I had found brief periods of rest in the early hours, before the first patients that had not looked right at their morning walks, had turned up.

Nao and Patrick, who had invited me, were also veterinarians, but of a very different breed – veterinary dermatologists, and in fact some of the best in their field.

By now the sun had come out, we were sitting in their garden, and I took full advantage of the output of their high-end Italian espresso machine.

The whole atmosphere was a stark contrast to my nocturnal activities and while my friends were listening intently to my recollections of some of the events of the previous two nights, they could not imagine, putting themselves under the same sort of strain again.

For them, it was a matter of the past, something they had done during their training at university.

Running a very successful dermatology referral service had the indisputable advantage, that in their line of business, emergencies were extremely rare, if not unheard of.

There are not a lot of skin diseases, that develop into a life-threatening condition over night.

Reflecting on this and having to agree, I thought “….but you don’t know what you are missing…..”

 

Back at the clinic, I said hello to the nursing team, that had supported me so much over the previous two nights, but I noticed that the head nurse, who had not looked too well last night, appeared even worse now. Sure enough, she was already on some medication, but had dragged herself to work, as some of the other nurses had already called in sick.

The situation was not much improved by a first look into the critical care ward, where the oxygen generators were firing on all cylinders.

It turned out to be a night of mostly heart and lung patients, that were struggling with the warmer spring weather.

Radiographs confirmed the sad story of enlarged cardiac silhouettes and B-lines on the emergency ultrasound scans indicated the presence of water in the lungs. Some of these, predominantly small canine patients had arrived already with their own supplies of heart muscle stimulating, blood vessel dilating or fluid draining medication, others were first timers that despite their young age were already challenged by their narrow airways, deformed chests or genetically predisposed heart valves, that were “normal” features of their breed standard.

Regardless of their background, they all appreciated that extra bit of oxygen, that made their condition slightly more bearable, until – hopefully – the adjustments of their medication would improve the situation.

In the early hours of the morning the head nurse finally disappeared and I was not expecting to see her back again the following night.

Later, I handed my patients over to Audrey, the lead vet.

I instantly liked Audrey – calm, analytic, competent. In fact, a walking encyclopaedia.

“There are people that just talk and there are people that just talk… sense.” I thought to myself, and I was silently hoping that someone like Audry would look after me, if I myself would require any emergency treatment.

In a calm and efficient way, Audry took in my report, made the necessary notes and adjustments on the treatment plans and addressed any uncertainty with professional reasoning.

I was in no doubt that my patients were left in good hands.

(to be continued…)

Four nights – The second night

 

I woke at 12 pm, feeling a bit lightheaded, but it was nothing that a decent cup of coffee could not fix.

Earlier that day, I had written up and handed over all my cases to the the day team, had thanked the nurses for looking so well after me (in addition to the patients) and had made it back safely to the hotel, where most of the guests were enjoying their breakfast.

Before falling asleep, I had decided that the nihilism and the philosophic excursions of a brain damaged Sylvain Tesson crossing France on foot, had to give way to the somewhat more entertaining and light hearted recollections of an aging Paul Theroux, travelling through Turkmenistan in ‘Ghost Train to the Eastern Star’, as the better bed time reading. I managed not more than a couple of pages….  

With my circadian rhythm in disarray, and my personal morning now moved to the middle of the day, I started with a walk into town and a plate of bread and local cheeses at the Café of the local art museum. As it is custom in this part of the world, the newest issue of the local news paper was laid out, for guests arriving without company.

As important as especially the global news were these days, I found that today they did not interest me that much….

Probably an advantage of assignments like this – they focus your perspective.

For these four days, the whole purpose of my existence was condensed to looking after the animals in my care, to work, sleep, eat and just to repeat….

In a long-distance run, until your cross the finishing line, this is very much the same. Anything else must wait, has to be done later.

For once, there is a clear objective and there is no need to worry about anything else.

 

Well in time I arrived back at the clinic, where some of the in-patients were now familiar faces and most of them had improved throughout the day.

Time to take a closer look at another “first” for me at this clinic – the robotic pharmacy.

Here, all dispensable medication was in a sealed container, stored randomly, shifted according to available storage space rather than to treatment groups, and when required, removed by an artificial arm that was working in the centre of the cube.

While I appreciated the technological achievement, I took an instant dislike to it….

One of my first actions, when starting at a new clinic, is to walk into the practice pharmacy, to familiarise myself with the location of the most important drugs, to get an overview of what is stocked and to familiarise myself with any medication I had not seen or heard off so far. At times this requires a closer inspection of the packaging, of the size and the shape of some tablets or of the information leaflet inside the package.

All this was no longer possible, and I decided that the robot and I would not become friends.

Just after midnight, a typical customer in veterinary emergency clinics around the Globe arrived, not from Switzerland, but from the other side of the border in France, where all the clinics were closed until the next morning.

It was an elderly German Shepherd, that had been perfectly fine throughout the day, but had started to behave strangely in the evening, trying to vomit without much success, circling and trying to eat grass….

It was the classic presentation of a gastric torsion, a twisting of the stomach, that had the habit to occur nearly exclusively in the evening or at night in older, large breed dogs.

With the blood supply virtually cut off to some vital internal organs, this dog was in serious trouble and if its owners would have waited until the next morning, euthanasia would have been the only option left, if the dog would still have been alive by then….

Here aggressive fluid therapy and immediate surgery was the only sensible solution, and once treatment consent had been given by the distraught owners despite a guarded prognosis, the whole team focused on just this patient.

I/v lines where established and with the help of pressure cuffs, fluid was flooding into the veins of this patient. A few moments later the dog was asleep and out of pain and a couple of clippers prepared the abdomen for surgery.

If done in time, this can be an extremely rewarding procedure.

Once the abdominal cavity had been opened and a stomach tube passed to release gas and remaining stomach content, the stomach lining and the surrounding organs were inspected and found to be not too compromised, before the stomach was then attached in the correct position to the right chest wall.

Once that had been done, the wound was closed and the patient woke up from the anaesthesia. But even then, the battle was far from over, as a fair number of patients succumb in the following 24 hours due to complications caused by the disruption the condition had caused to the whole system.

But not so in this case – this Alsatian was able to return over the border to France the following day.  

(To be continued….)     

Four nights – The first night

 

“What have I done? What am I doing here?”

Any long-distance runner who says that he has never had this thought at the beginning of a marathon or a long race, is probably lying…….  

This sensation is not much different from that on a first day at a new veterinary clinic, even after years of experience. There will always be something that does not work, that can not be found, or that is done differently from the routine one is used to. In addition to this, you can bet, that upon your arrival, something will happen, that has never happened or seen before. In all of these situations, staying calm, not to panic and working through the problem is the best and the only solution – keep it steady and carry on running…..

The day had started quite well. Despite a journey of more than 400 kilometres, I had arrived early enough, that I had managed to check in at my hotel before reaching the clinic with an hour to spare, before the beginning of the night shift.

It was the first veterinary hospital I had worked at, with its own supermarket and its own petrol station and I do not think that there are many other clinics with the same amenities.

Adding to the list of novelties was an elevator just for cars, that provided a comfortable ride into the company car park. As cars could enter the lift from both sides, I could remain seated and operate the buttons, even with the steering wheel on the right side.

Once I had changed into scrubs and had introduced myself to everyone, I started by getting familiarised with the available hardware and tried, but failed, to access the clinic programme. The problem was that I had not received any log in details and I secretly cursed myself for not having checked on this in advance. At least, my early arrival paid now off and after a few phone calls, this issue was resolved, well before the first consultation.

And yet, I still could not access the system.

Typing in the security password, that very sensibly was taped on to the keyboard, three times and double checking my spelling, the beast still refused to budge.

Feeling already at this point absolutely useless, I had no choice but to ask the nurse again….

“Ah, that one…. nothing to worry – there is a typo in the password. Just omit the “i” and it should work!” was the short, but extremely helpful reply.

Another first…. a password with a spelling mistake!…. keep it steady, carry on running…..

Thankfully, the day team had done excellent work and only three patients had remained as in-patients in addition to a bird of prey that had been clipped by a car but was already recovering fast and visibly unimpressed being confined to a cage.

Then my first patients arrived – all cats – and after three consultations, I had already admitted another three patients to look after for the night. My luck was slowly fading …..

The role of the night team is primarily that of care takers. Look after the patients in your care and try to get them as stable and comfortable through the night, and unless seriously concerned, try to avoid interfering too much with the treatment plan, that had been set up by the far more numerous and often more qualified day team. In addition to this, attend to any new patients that are arriving and following a basic triage, provide advice and treatment and decide, if a patient would be ambulant (the preferred option for all sides involved), had to stay or – and here was the difference to our “human’’ colleagues – if euthanasia had to be considered.

Sadly, in emergency clinics, the last group is clearly overrepresented compared with the case load of general practitioners.

Following the first three admissions, the number of new cases started to drop and for the remaining patients, just ambulatory care was needed. Once the new admissions had been placed on fluids and stabilised, there was time to write up all the patients that had been seen and to update the local colleagues about the care our mutual patients had received. Not for the first time I thought that modern technology had made the writing of clinical notes so much easier, that progressively more information had to be recorded, which as a result, increased the time that was spend on this task. Somehow, I have my doubts that AI supported recording devices will be able to change this….

At about three in the morning, the waiting room was empty and all hospitalised patients including the raptor were looked after, so that there was the chance for some rest. Only now I realised, that I had survived the whole evening without a single cup of coffee, which was unusual, as so far, I had not found a veterinary practice in Switzerland without a high-end coffee machine, that provided midnight oil of a truly addictive quality.

Despite having a room to rest, I struggled to find any sleep and I was just about to start entertaining myself with the veterinary journals that had accumulated over the previous weeks, when the nurse informed me, that three dogs had arrived at the same time: one with breathing difficulties, one with a heart condition and one with bloody diarrhoea. The journals clearly had to wait….      

(to be continued…)

Four nights – Prelude

Yes, I had to admit to myself, that it would be a bit of a push, a bit of a shock to the system, but at the same time it would be a challenge and something that would take me a long way out of my comfort sone, but with the right focus and time management, it would be doable. After all, thousands of veterinary and human medical colleagues did it all the time, often for years, while it silently took its toll on their personal and social life and their physical and mental health…..

Earlier this year, I had been asked, if I would be interested to cover four straight nights, most of them in sole charge, at one of the busiest emergency clinics in Switzerland. To be precise, the whole Easter weekend – from Friday until Tuesday morning.

Four nights, fifty hours, three thousand minutes…..

It was not really a problem, that I had never worked at the clinic or even in the city before – over the years I had learned to adapt fast to new teams, frequently by just listening and relying on the nursing staff, who are both the body and the soul of many clinics and not to panic – everyone has had their first day somewhere.

It was not the surgical aspect of the work – I had over the last thirty years done a lot of emergency procedures and I secretly was looking forward to spending a few hours in the operating theatre.

It was not the fact that it was night work – I am naturally a night worker – always had been – and I am in the enviable position that I can function well, with limited hours of sleep.

It was not an issue, that it was exclusively emergency work – over the last few years, I had frequently done individual night and weekend shifts at veterinary emergency clinics in the commuter towns around London.

The problem was… the sum of all of the above….

While I was used to work in different places, to adapt to new teams and computer systems, to work nights and weekend shift and to treat emergency patients, it had never happened all at the same time, and it never lasted for four straight nights…

Spending a lot of my time these days with online consultations and writing, interrupted by emergency shifts and short blocks of first opinion clinical work in different parts of Central and Northern Europe, I felt a bit like someone, who had been living too much on junk food and not training enough, attempting to run a full size marathon…

Good for me then, that I knew a bit about marathon running…..

(to be continued….)

Just another Metro station…..

 

Ignoring the large array of souvenir and fashion shops, the street vendors and Italian food outlets along Via Toledo, Naples’ main shopping street, that separates the narrow lanes of Quartieri Spagnoli, from the banks and public buildings of San Giuseppe, I am descending into the local underground station to purchase a train ticket without any intention of using this form of public transport.

For the very reasonable price of 1 Euro and 50 cents, I have in fact entered one of Europe’s most unusual art installations.

The general idea, that underground stations could be more than just a functional assembly of escalators, platforms and tunnels, designed to ferry people to different parts of a city, is not new.

Whoever had the opportunity to visit the underground stations in Moscow or St Petersburg, and witnessed their grandeur, the opulence of decoration, the quality of the material used and the generous application of space and light, could understand what a great opportunity metro stations provide to convey a message or to interact with  the millions of travellers who are passing through them on a daily basis.

In stalinist Russia the intention was, to provide the working class with the illusion of their own palaces, to distract from the miserable existence they had anywhere else for the rest of the day.

The London Underground – with a few exceptions – compares as more functional, but at times claustrophobic. Here commerce and advertisement, predominantly promoting local entertainment or the benefits of various food supplements, appears to be the dominating theme.

At Toledo station, where advertisement is kept to a bare minimum, commuters are confronted with a playful and at times ingenious mixture of art and design, that in the opinion of some commentators have made it Europe’s most beautiful underground station.

Designed by Spanish architect Oscar Tusquets and featuring murals and installations of various artists, the station was opened in 2012, as the center piece of the Art Station Project.  A visit can best be summed up as an audiovisual combination of a psychedelic ride and a deep sea dive, with the difference that you do not have to take any drugs and you will not get wet….

My descend from the Via Toledo exit, made possible by the purchase of a single journey ticket, has started gentle and unspectacular enough with just the remnants of an ancient fire place reaching out of the wall on the right side of the entrance and a mosaic, with references to the history of Naples, to the left, as the only decoration at this level.

A short flight of stairs brings me past the gates and on this level, the walls are now kept in yellow and ochre, referring to the Neapolitan sun and soil, that is covering the fields and the hills around the city.

Getting on to the next escalator, the scheme changes again, from the rather plane yellow, to an irregular pattern of small, glazed white and blue tiles, that reflect any source of light, depending on the direction and the colour of the source.

This is used to great effect in the “Crater de Luz”, a large cone penetrating through nearly all the levels of the metro station, where a ray of daylight is blending with that emitted by green and blue LED lights inside the opening. This unusual, yet instantly eye-catching feature is indisputably the highlight of the metro station, creating constantly changing light effects at the bottom of the escalator, from where, divided by a tunnel, the platforms, kept in deep blue, can be reached. The tunnel itself has screens on both sides, reproducing the surface and the sound of the Mediterranean Sea.

Most visitors seem to be so in awe at this point, taken by the hallucinogenic effect of the Crater of Light and the tunnel, that lets you walk across the Sea, that they fail to venture even deeper into the structure, where a long corridor, crossing underneath the Spanish Quarter, with the photographs of two thousand different people along the wall on one side, is displaying the diversity of the citizens of Naples.

The corridor, now virtually devoid of travellers, is leading to a second exit at the Piazza Montecalvario, right in the center of Quartieri Spagnoli.

To get to the street level, I am again following several flights of escalators, this time in the reverse order of the colour scheme.

On each level, a different art installation is waiting for me.

At the ground level, life sized, black and white photographs of people in rage and despair make for a very engaging wall decoration. I am expecting that any minute, these characters might jump out of their pictures and shout at me.

I am moving on to the next escalator, where the walls feature again the ochre colour of the local tuff, but now there is a starless night sky.

Next, I am standing in-front of a large mural, that shows a naïve display of the city where the citizens are flying through the air, aided by simple contraptions that are pulled by birds, by hanging on to the wings of planes or floating completely unsupported, as if taken out of a Selma Lagerlöf narrative.

Eventually, another escalator delivers me to the barriers at the street level of the piazza.

This final level is decorated by a partially shredded, yellow band of traditional dancers, that have formed a long, undulating line through a rugged landscape.

At the end of this unexpected underground excursion, I am finding myself outside of the station, in the middle of a small and peaceful piazza, agreeing with myself that this was probably the cheapest and best invested underground ticket I had ever bought for a train ride I never took.             

To Naples….on the hunt for the perfect pizza

 

Benefiting from a window seat on the starboard side of an Airbus, I had a perfect view of Vesuvius, Capri and the city right below me and I immediately understood why Goethe had recited the famous quote:  “See Naples and die….”

A perfect composition of a colourful and vibrant Mediterranean seaside location, next to a capricious, but presently sedate volcano and some islands, out at sea, shrouded in a gentle mist, doused in a warm red light by the setting sun, was overpowering the frontal cortex.

And yet, my reason for being here wasn’t the scenery or any veterinary business, but a very humble dish – the Neapolitan pizza!

And to be more precise – the ultimate Neapolitan pizza!

Having witnessed and at times endured the obsession my Croatian friend Denis Novak had shown for this creation made of warm dough, tomatoes and mozzarella cheese, I had finally succeeded to employ him as my personal guide to visit the most famous outlets the city had to offer, for this globally recognised and celebrated kind of food. Joining us, while on a visit to Europe anyway, was Paulo Steagall, one of the overlords of veterinary anaesthesiology, who despite being a native of Sao Paulo, for the last few years resided in Hongkong.

When I entered our hotel at the spectacular Galleria Umberto, right in the centre of Naples, Denis was already waiting impatiently and I only had time to drop off my luggage, before we were heading off to our first stop.

Starting at the high end, we made straight for “Brandi”, officially the birthplace of the Margherita, the most basic version of a pizza. At “Brandi” only freshly produced Fior di Latte d’Agerola  was allowed to melt on the hot dough and a few basil leaves where added, less to enhance the taste, but more to reflect the colours of the Italian flag.

The beating heart of the place were two large, obligatory wood fired pizza ovens, indicating that not a lot of other culinary delights, other than the famous fare of the house were ordered here.

Sadly, I stumbled right at the first hurdle of our task, by ordering a “Quattro Stagioni”, which – while being extremely delicious – would make it very difficult to compare the dish with the versions we were hoping to enjoy at other restaurants.

From this point onwards, I refrained from committing this mistake again, but partially also to limit the calorific impact on my body, caused by the intake of two or even three pizzas within a 24 hour period…..

The next day, following a brief run along the seafront to burn off just a few calories, we started with the first pizza of the day at the very stylish and multi award winning pizzeria of Diego Vitagliano, where next to a wall of certificates and under the watchful eyes of an in Naples omnipresent Diego Maradona,

another three perfect examples of a Margherita where placed in front of us. With the tomatoes possibly a bit more intense in taste than last night, this was a real contender.

Following a long, digestive interlude in Naples’ Spanish quarter, where the city’s most famous adoptive son will surely be idealised for eternity,

our quest continued with a visit to L’antica Pizzeria Da Michele, where in green and white tiled, far more functional premises, pizzas have been served since 1870.

Only four varieties of pizzas, a small selection of soft drinks and bottled Peroni featured on their menu.

While not lacking in taste or the right ingredients, I had by now developed the necessary fussiness to notice, that the center of the pizza was slightly undercooked and that the grated cheese had not melted entirely.

Was I already developing into a pizza snob?……

Well, Julia Roberts seemingly had enjoyed her Margherita here in “Eat,Pray,Love”, and we considered ourselves lucky, for having been offered a table without the customary two-hour waiting time.  

That night, despite resting in an extremely comfortable bed, I struggled to find much sleep and I realised that the consumption of larger quantities of pizza, had a similar effect as a wine tasting that had ended in the destruction of whole bottles.

At lunch time the next day, we sensibly decided to walk a few kilometers to the West of the city, where “50 Kalo”, endorsed by my taxi driver (who had naturally charged me double the standard fare from the airport, despite me sharing the ride with another traveller…), was supposed to produce the city’s finest pizza.

The modern interior and the friendly waiters here were not necessary, to make us aware that this again were fine examples of exceptional pizzas, and the proudly presented Michelin Guide plaque at the entrance, stood in stark contrast to the extremely moderate 7 Euros that “50 Kalo” was expecting us to pay for their signature dish. A price that was much in line with all the famous pizzerias in Naples, something that kept a visit to these famous addresses affordable to both visitors and to the local residents.

Squeezing ourselves, a few hours later, around a small table, right next to the pizza oven at “Mattozzi” , we were presented with another excellent serving of this simple and yet so succulent dish, this time seasoned with the live coverage of the final world cup qualifier of the Italian football team against that of Bosnia-Herzegovina.

Was it due to a few rounds of Amaro Montenegro or to the disappointing performance of their National team, that in contrast to the pizza, at a price of 6 Euros each, a basic bottle of wine, that had been advertised with 30 Euros, was later charged with 80 Euros?….

Well, after a few heated words in Italian,English and Portuguese, the price was dropped to 50 Euros and our last night in Naples came after all to a peaceful end.

 

The next morning, now without my companions, I went on a final excursion….

Just ten minutes walk away from the hotel, right on the corner of Centro Storico, the old town centre, surrounded by numerous small book shops and working out of very confined premises right next to an old town gate, I found the grandmother of them all – the oldest pizzeria in the world.

The first pizza was served here in 1738 and now, as probably then, hungry customers were queuing in front of the door, waiting their turn.

At Pizzeria Port Alba, pizzas were served both inside its always crowded restaurant as well as outside, where they were swiftly wrapped in plain paper by a street vendor.

This was very much in the tradition of this simple meal, which was initially served right on the street to the Lazzaroni, the impoverished workers, who were passing through the gate.

And even today, the arguably finest of Naples’ pizzas was still served here, obtainable by everyone for just a couple of Euros…..