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…..      

 

 

   

Karlovy Vary

 

Most spa towns have centuries of history, long lists of famous visitors and endless anecdotes that just wait to be rediscovered. And this place of hot springs and mineral rich water is no exception.

Nestling in a small valley in the western most outcrop of Czechia, right in the middle of Europe, both the sick and those in need of recuperation, as well as the rich and famous, usually less sick or convalescing, have enjoyed this oasis of fresh air, unspoiled nature and healthy living, but probably more so this oasis of extravagant living, far removed from the politics and social issues of the industrial centres of the rest of the continent.

Here lavish hospitality, Michelin star cuisine, as well as exclusive outlets for Italian clothing, Swiss watches and opulent jewellery have found a home equal to the finest addresses in Knightsbridge, the Kurfürstendamm or the Champs-Élysées.

As always – to avoid the crowds, places like these are best explored with the help of a pair of running shoes, early in the morning.

It is the middle of March and while the reception of Grand Hotel Pupp is still deserted, I am exiting the building and cross the circular front court, which is covered with flag stones bearing the names of some more exceptional former guests.

Crossing the small bridge across the Teplá and running through a small park, I am looking at the Kaiserbad Spa, which together with the hotel provided 20 years ago a fitting background for Casino Royale, the first Bond movie featuring Daniel Craig.

Over a century before then, the building housed one of the world’s first fitness studios, kitted out with Swedish exercise machines in its Zander Hall.

While all of the machines have disappeared, the mural paintings, depicting ancient olympic scenes, have been preserved, providing for a few years, together with the dark wood panelling, a suitable backdrop for international chess tournaments and for a genuine casino.  

Crossing the Teplá again, I then continue my run on a narrow path, that is climbing in a zigzag pattern up the steep hill behind the hotel. With the town and the river slowly disappearing below me, my body is slowly adjusting to the cold morning temperatures which had caused a light ground frost.

Following the forest trail in a northerly direction, I am crossing the narrow tracks of a funicular. Turning left at a small station building, I realise that even more climbing is ahead of me.

Eventually I reach the end of the railway track and a look out tower, still deserted at this time of the day.

Descending now, I am heading further north along the ridge of the hill, passing the rather grand looking Myslivna hunting lodge to my left, with its tall windows and Art Nouveau features, another relict of Karlovy Vary’s Golden Era at the end of the 19th century.

Finally, I arrive at Jeleni skok, the “deer jump”, a small rocky outcrop ordained with the sculpture of a mountain goat. This place allows a generous view over the whole spa town, while the sun is rising above the crest of the hills to the East.

From here the path descends all the way back to the town and without much of an effort, I am finding myself standing between the old telegraph station and the Olympic Palace Hotel, another place with a famous former resident….

Following this road, I arrive at the Hot Spring Colonade, where a fountain of hot water is producing a permanent cloud of vapour, that is finding its way through the open roof of the building. After scolding my fingers at the small taps, where too late I notice a sign indicating that the water is exiting the ground with stable 72 degrees, I appreciate why most of the visitors had purchased small porcelain cups to taste the famed remedial liquid.

Now it is only a short distance along the river and past the “Elefant”, another renowned hotel with an excellent café and one of the town’s finest selections of both local and cosmopolitan pastries, before I find myself again in-front of the Grand Hotel.  

Just another way to cover 300 years of history in 35 minutes…..  

The straight line is godless

 

The Upper Palatinate is dull, nothing but dull….

Tucked away in the North of Bavaria, yet devoid of any mountains or other geographical features worth mentioning, resting its quiet and sedate existence somewhere between Munich and Southern Saxony, this area has always been overlooked, just been travelled through and generally been sidelined, if not avoided.

The strong regional dialect, even by Bavarian standards, as well as its proximity to the iron curtain during the time of the Cold War, didn’t help either.

Here, the straight line and the right-angle rule.

The house walls are straight, the windows are square, the doorbells feature the names of the residents in printed capitals. The lawns are straight, the gardens are well maintained and yet unimaginative. In this part of the world, no one wants to stand out.

Adventurous souls who live here, and happen to work in one of the local factories producing bathroom tiles, might decorate the outside of their houses with them, but only if they find enough tiles, to cover all surfaces in the same, monotonous shades of brown or green….

It was here, where I saw my first few days in practice as a qualified vet, taking care of the predominantly large animal patients of a colleague who had previously provided me with an internship at his small countryside clinic. Just a few days after my final exams, he had suffered a near fatal cardiac arrhythmia, so that without any prior warning, I had found myself on the yards and in the stables of the small local farms, where I required the help of the local trouble maker (who’s father had just been jailed for trying and failing to rob the village bank with a plastic gun….) riding shotgun, to translate for me and to make sure that I wasn’t chased off the premises as a foreign intruder….

These days were long gone and there was now little reason for me to stop here on my way to the more appealing countryside of nearby Bohemia. But just then, a sign next to the nearly empty motorway caught my attention…..

Like the bud of a single, yet hardy flower, rearing its head through brittle tarmac, something appeared to have changed since my last visit to the region.

In Abensberg, just a few miles away from the motorway, a golden sphere with a ring of portholes was dominating the skyline. Despite a weight of not less than 12 metric tons, balancing at a height of 35 meters on top of a colourful, yet fragile looking tower, this impossible looking structure, in a single instance, dashed all my preconceptions of the area.

This tower, part of the local brewery, was accompanied by a nearby building, that was anything, but neither straight nor plain or dull. Nearly devoid of right angles or any uniform areas of paint, with uneven walls and oval windows, it was featuring a spire, that was covered in a patchwork of dark and golden tiles while leaning in a precarious angle.

All corners and pointed elements were adorned with small globes in various colours and the whole structure was seemingly held together by a dendritic network of red and blue ceramic shards, that covered the whole building like a mesh of blood vessels or tropical ivy.

Unmistakably this building, as well as the brewery tower, showed the hand writing of the Austrian artist Friedensreich Hundertwasser. The gallery inside the art house provided a retrospective of the life of this colourful exponent of Central European art of the outgoing 20th century.

A tireless painter and beautifier of mostly urban buildings, Hundertwasser did not hesitate to apply his craft to power plants, to motorway service stations, to stamps, to kindergartens and even to public conveniences. Building one of the most unusual towers you will ever see, next to a traditional Bavarian brewery was not really an exception.

Producing most of his colourful paintings and construction plans in complete solitude in very basic, remote locations, that frequently lacked even the luxury of electricity or running water, it seemed natural, that by placing his works in areas where they were least expected , they generated the largest impact and transformation.

This neglected part of Germany not only provided the perfect canvas for his work, in return it presented the region and the local community with a steady stream of visitors for many years to come, and the imagination of one man is likely to inspire generations of future regional artists.

While Hundertwasser had the idea and had provided the initial drawings for the Kuchlbauer Tower, he sadly never saw the structure or the remarkable art house with his own eyes.

With the artist expiring in emblematic fashion on board of the QE 2 in the South Pacific at the turn of the century, it was left to his co-worker and friend Peter Pelikan to construct and to build this island of colour, curves and light in a Sea of straight lines….

 

Across the Tyrolean Plateau

 

It was during the night, that winter had returned to the Northern Alps.

What had started with icy rain, had turned into slush and then into thick, heavy flakes of snow, that started to cover the fields with a thin white blanket and burying the fragile buds of the first spring flowers with its cold embrace.

Then it just continued to snow, transforming once again the landscape in the valley, the trees in the forest and the rocky outcrops of the mountains into a canvas, fit for Gauguin’s ‘Winter Landscape’ or Monet’s ‘Magpie’.

With warmer weather and rain already forecasted, it was clear that this was to be just a short-lived interlude, yet it had replenished the downhill slopes on the mountain sides and the skiing tracks on the plains, as if quenching the thirst of a dying man and for a last time this winter, the opportunity had arisen, once again to enjoy the sensation of travelling on snow.

Following some time spent with friends in Seefeld, just a stone throw away from Innsbruck, I decided to travel North not through the Inn valley, but along the less busy roads across the Tyrolean plateau that connects Austria with Germany.

In the small town of Leutasch, comfortably 3000 ft above sea level, the temperature had remained below freezing and a well-prepared skiing track, that connected the small villages nestling at the foothills of the surrounding mountains, invited to another session of cross-country skiing.

With the back of the car stuffed with a wide selection of different skis, I picked my lightest and fastest pair of Norwegian skating skis. The moment was just right for it – wearing only a thin jacket, a cap, some light gloves and choosing a set of skis that didn’t need much more preparation than a thin layer of glide wax. Off I went, heading towards the border at the end of the plateau.

It felt so much lighter, than the alpine skiing equipment I had to wear the previous day. There was no need to queue at the lifts and today, with less speed and only a few other skiers on the track, less caution was required, when descending the few downhill sections.

While admittedly I had to make a continuous effort, I was gliding along in peace, enjoying a steady rhythm of breathing and pushing, just focusing on balancing on the skis and on the countryside around me. Occasionally I passed another skier or had to push just a little bit harder to climb a small hill, but then again I was rewarded with a gentle descend, that allowed me to let the skis just go.

Right in time, just when it was starting to snow again, I had reached the end of the plateau and the little ‘Café on the Bridge’, that offered not only shelter, but also a decent cappuccino as a just reward.

With heavy rain replacing the snowfall just a couple of hours later and continuing throughout the night, most of the tracks I had travelled on, had disappeared the following morning.