Across Electric Avenue for breakfast

 

Then I just saw sand and Darren’s legs in front of me, Ex-Army, chiseled chin, Afghan war veteran, seriously fit…..

This was the section I had not been looking forward to, but now it was only a question of pushing hard, hanging in there and reminding myself that this was Pembrokeshire and not the Brecon Beacons…..

At some point there would be an end to the deep sand and the uphill trail.

“I was soo looking forward to doing this run with you guys!” Catherine had said a least a couple of time since we had embarked on our sunrise outing at the National Trust compound in Stackpole and once again, we whole heartedly agreed that this was an exceptional way to start the day.

At first light, a forest track with hardly any elevation had led us along the west side of the estate’s large pond, that provided a haven of fresh water, shade and food to otters, fish and various kinds of waterfowl, just a few hundred meters away from the open sea, where the Bristol Channel met the Celtic Sea.   

This was Coastal Britain at its best. The Salt Path in a nutshell….

Crossing a small bridge, that was the temporary residence of a family of swans, with the cygnets still fast asleep, we headed south towards Broadhaven Beach, a large stretch of white sand with sheer rock cliffs on both sides and a church shaped rocky outcrop further out at sea.

The Beach was still deserted. The morning sun threw a warm light on to the sand and our bodies produced long, distorted shadows with endless legs and minute heads.

I had never seen the Welsh coast like this – the ground bone dry and parched by weeks without any rain, the grass burned and only the hardiest shrubs and fern providing a few islands of green in some sheltered pockets on the ground.

Still, it was an outstanding morning run.

Having survived (just) the steep section with the deep sand, we soon reached Saddle Point, an ideal spot to look at the Stackpole peninsula ahead of us and the calm and sun-drenched sea of the Channel to the South.

Here the track had levelled out and akin to running on the top of a table mountain, we were now following the coastline, with constantly new rock formations and stunning, yet inaccessible beaches appearing hundreds of feet below us.

We passed a deep hole in the ground and gave it a wide berth on its northern edge, when we noticed a narrow path that was running like the icy rim of a glacial crevasse just above its deepest point and the top of the cliff on its other side. Just for a moment we toyed with the idea to try it out, but thankfully dropped it.

Little did we know at the time, that just a couple of hours later, a young man, one of two brothers, would take a different decision, slip and had to be airlifted to the nearest hospital.

At the time of our run, he might still have had breakfast or might even have been asleep with not a single scratch on his body and a weekend of sea and sun to look forward to.

What a stark reminder to cease the day and to enjoy life while you can…..

Passing the narrow bay of Raming Hole and following the track along the rim of the peninsula, we headed north again and after a short while arrived at Barafundle Beach. Enjoying the first rays of sun light so early in the morning, sheltered landward by a row of dunes from the wind, it was not difficult to understand why this stretch of fine white sand was considered to be one of the best beaches in Wales.

Still devoid of any day trippers with their parasols, cool boxes and cyanotic French Bulldogs, and with a single sailing boat complementing the post card scenery, this truly was a coastal Arcadia.

Running across the beach along the thin blue line of firm ground, between deep dry sand to our left and the equally soft, sea water drenched ground to our right, teasing the waves to catch our shoes and soak or feet, we arrived at a long flight of stairs on the other side.

This time it was my turn to take the lead and to keep a steady pace all the way up to a small stone arch, that would not have looked out of place on an Aegean island.

Covering a final stretch of the coastal plateau, we arrived at an old boat house that had been converted to a sea front café.  Here hundreds of hummingbird moths had made the local bee population redundant and were busy pollinating the Red Valerian that was growing on top of the wall of the old cottage.

Crossing an empty car park, where in just a few hours urban holiday makers would start fighting over any empty space, we now found ourselves on a wide farm track that over the next two kilometres crossed a number of fields with large herds of Friesian cows on each side, separated by not more than 4 mm of steel wire and a regular charge of 4000 painful volts on each side.

Cruising along this electric avenue, we eventually arrived at the eight-arch bridge, that was crossing the pond where we had started our run. The canopied forest on the other side could have passed as a displaced bit of tropical rainforest and I would not have been surprised seeing a toucan or a couple of macaws flying over the treetops, as we crossed the pond.

Now it was just a final push up the uneven, dry-stone wall flanked road to the estate and to an English breakfast in the heart of Wales.

Six-hundred meters to a Swiss Rösti

 

Marianne was right – of course she was… – I did not make it in an hour. Not even after 1 ½ hours was I able to step into the small guest room of Berggasthaus Tierwies, a mountain cabin, that was resting precariously above the Schwägalp plateau in Appenzell.

With my last consultation finished right on time at 6 pm at the clinic in Nesslau, and with no emergency duties, I had changed and had picked up my backpack and my hiking boots for a sun set hike and dinner at the cabin.

Marianne was the clinic’s receptionist. The sort of absolute fitness nut that seem to grow somewhere on trees in the more remote regions of Scandinavia and the Alps, who outside of the clinic are only seen on a mountain bike, on various sorts of skis or dressed in long distance running gear for a few short moments before disappearing behind the next hill.

When telling her about my plan, she had frowned and doing some brief calculations, had summed up her verdict with a laconic: “It will be pitch dark before you are back at the plateau. Shall we prepare for no vet tomorrow morning ?….”

Despite all preparations, I did not reach the trailhead near the lift station, that was currently being repaired, before 7 pm. From there I could already see the cabin right on top of the steep rock face and just 600 altitude meters were between me and my dinner.

The first section was easy enough, a brisk hike along the last stretches of grazing pasture dotted with colourful alpine flowers, where grey Appenzeller cows were gathering the fuel, that made their milk and by that the resulting cheese so special.

Crossing a Bergschrund, I reached the rock face and when the first steel cables next to some exposed way sections came into view, I secretly congratulated myself for not having left behind my £ 1.99 DIY gloves.

While this was not a technical route, the extra security the cables provided, helped to lower my adrenaline level. Both Lake Constance to the north as well as Lake Zurich in the south-west came into view, while the sun was relentlessly nearing the horizon.

After an hour, just 450 altitude meters were covered, but I already felt, that I had earned my dinner. And yet, there was some more climbing to do, before the 2000m mark and with that the cabin was reached. Reassuringly there were still a few other hikers on the trail, even if most of them where already on their way back down to the valley.

It was getting close to 9 pm when I finally arrived at the cabin and I placed an order for a well-deserved beer and a quintessential Swiss “Rösti”.

The sun was about to set, and the first candles were lid, when my meal arrived.

Far too much and yet too good to let anything go to waste – so after eating half of it, the other half went into my backpack, the water bottle was refilled, and I started on the descend.

Now there was not much time left to admire the intense blue of the bellflowers and the purple of the thistles next to the trail in the fast-fading day light.

My luck though, that the path was running along the north-western face of the mountain, so that the red glow that followed the setting sun, continued to provide a warm light, while the mountains on the other side of the plateau were already shrouded in complete darkness.

Most of the exposed sections were behind me when I finally had to make use of my head torch. Although the lights of the hotel on the plateau looked so near, there were still a couple of hundred meters to descend, before reaching the pasture again. Holding on firmly to another steel cable while watching some smaller stones tumbling into the abyss, I faintly recalled some advice about “never walk alone in the mountains”, but I reasoned that at this point, it once again had been far too late for that.

Back on the pasture, with just the light of the torch illuminating the path, I cut through groups of cattle that had retreated to the etch of the forest. Their massive bodies appeared twice the size in the dark and their sizeable horns and the green light reflected from their eyes failed to make me feel more at ease. Thankfully, the damp grass had a larger appeal for them, than picking a fight with a visibly lost glow worm or related, oversized insect in the middle of the night, so that I managed to pass this final hurdle as well unscathed.

Standing next to the car shortly before midnight, I noticed the full moon moving slowly around the mountain site, saturating the rocks, the fields and the weatherbeaten trees of the plateau in an argent glow, while the bells of the cows, the music from the hotel’s terrace and the laughter of the remaining guests, enjoying their glasses of wine and Aperol, made for a magical midsummer night in the mountains.

Marianne was right – I did not make it to the cabin in time, but they would have a vet for the morning consults the next day. Slightly tired but happy……

Concrete, consulting rooms and the legacy of Le Corbusier

 

Summer had returned to the Northern Alps and I had taken on some locum work in Pfäffikon, a town with a small lake east of Zurich.

Not for the first time while working in Switzerland, I found myself in a spacious, ultramodern consulting room, where stainless steel, glass, plain or just white painted concrete and a composite floor, that despite of its dark oak pattern was devoid of any organic material, dominated the room.

A black and white photograph of a jumping kitten covered the whole wall on one side and provided the only irregular feature in the entire room.  

Why is it, I thought, that veterinary clinics in this part of the world differ so much from the practices in England, where I spent the main part of my professional life?

While both in the UK and in Switzerland traditional building features like Victorian, Edwardian or here Renaissance, Baroque or Art Nouveau elements are embraced and at times painstakingly preserved, they have not found their way into the veterinary waiting and consulting rooms of this Alpine nation.

While in Surrey, in London, in the West Country or in Yorkshire, asymmetrical facades, ornate fireplaces, bay windows (often with just single glazing) or wood paneling are preserved as character features,

while in British Columbia, in California or in Australia, wooden timber structures, plush fabric seating, walls with pictures and paintings with different styles of frames, and elements embracing a regional identity, are considered essential to provide clients (and their pets?) with a warm and calming environment,

Swiss clinics emit a rather cold, but then reassuringly sterile and probably more “clinical” environment.

For a country that features some of the most beautiful forest and mountain sceneries of the planet, and a country that has a long tradition of artisanal wood construction, this seems odd at first sight, but it has its reasons.

To get a better understanding of it, I found myself on a Saturday morning when the clinic was closed for the weekend, on the platform of the town’s railway station, expecting the local commuter train, as always in Switzerland, to arrive on time.

The journey along the fields and the gentle rolling hills of the valley east of Zurich, with the towering, snow capped mountains of Central Switzerland to the South as a constant backdrop, brought me in less than half an hour to the iconic Zurich-Stadelhofen station.

Located not more than a hundred meters from the Northern tip of Lake Zurich, designed by Santiago Calatrava, the busy station featured a flowing foot bridge spanning all platforms and a basement with a long row of organic looking concrete arcs, that reminded me of a rib cage or a row of tracheal rings. Somehow this unusual station contrasted in an appealing way with the Gründerzeit and Art Nouveau facades of the nearby multi-storey buildings that represented some of the Swiss Capital’s most desirable places of residence.

From here it was just a short stroll past the Opera building to the shore of Lake Zurich and from there along the tree lined promenade, that was complimented by a number of ice cream vendors, lake side bars and the entrance to Seebad Utoquai, that was offering a more refined swimming and dining experience to local residents since the end of the 19th century.

After passing Henry Moore’s Sheep Piece from 1972 to the left, I eventually arrived at my destination. Tugged away behind a large, historic lake side villa and hidden by a row of trees, stood the ‘Pavillon Le Corbusier’.

This colourful building, that appeared like a hybrid of a Lego house and a Minecraft construction, was the final project of one of the World’s most influential architect.

Born into an artisan family in 1887, Le Corbusier initially trained as a watch enameler before entering the art school in La-Chaux-de-Fonds. He never studied architecture. And yet his building and furniture designs, as well as his ideas of urban planning transformed both interior design as well as the appearance of whole cities around the world.

Representing a French-Swiss reply to the Bauhaus movement, Le Corbusier became one of the architects of the UN building in New York, the designer of Cité Radieuse, the vertical garden city of Marseille, and he was one of the leading brains behind the city of Chandigarh in Northern India, a project that had a great influence on the construction of the Brazilian capital a few years later. A large number of Le Corbusier’s works are today designated World Heritage sites.

In Le Corbusier’s buildings reinforced concrete, and floor to ceiling windows were widely utilised. Decorations were limited to single patches of paint or to just a vase with cut flowers or to a single green plant. Curtains were replaced by frosted glass and cushioned seating by functional steel and leather furniture. These elements were easier and faster to produce,  and easier to maintain and to clean. Le Corbusier’s ‘no frills’ mechanical approach was summed up by the notion, that residential buildings were supposed to be ‘machines for living’.

While this novel concept helped to provide organised housing and practical furniture to a large number of people, especially in developing countries or in cities that had to be re-build after the war, Le Corbusier’s ideas remained controversial and thankfully some of his plans, like the destruction of parts of the historic centre of Paris, to then being replaced by modern buildings, did not come to fruition.

In the medical world though, combined here with the orderly mindset of the Swiss, the concept worked extremely well. Looking at the small kitchen at the pavilion, features like uncluttered, easily maintainable stainless-steel surfaces, indirect lighting and a slightly structured, dark tiled floor showed a striking resemblance to elements of my local consulting room. The simple seating arrangement in the pavilion’s entrance hall would also have worked well in most veterinary waiting rooms.

 On my return to Pfäffikon, I noticed even more features of this style of modern architecture, like ribbon windows or whole residential blocks placed on concrete stilts for better energy efficiency. Walking down the High Street towards the late Gothic church, instead of an estate agent’s office, that would occupy a similar location in the UK, I found next to a traditional restaurant, a show room entirely dedicated to concrete.

Samples of the durable material with different textures and surfaces, in different shades of grey and even in different colours and with various levels of graffiti resistance were on display in the shop window.

May be there should be a limit to how far functionality should go …..

All my patients are under the bed

 

I love books – of course I do – but over the last years I have started losing interest in new releases, unless they are written by Jo Nesbø.

With the next Harry Hole adventure not due to be released before the middle of August, I started – not for the first time – having a look around for great reads that had been published years, if not decades ago.

The basic requirements for a book are that it has to be a paperback and that it should not exceed more than 400 pages, so that it will fit into my backpack when I go hiking. Sure, e-books do work as well, but I still prefer the feel of printed paper in my hands.

It was during some of these periods of idling between last minute emergency shifts in the UK, first opinion locum placements in Switzerland and regular online consultations wherever I was, that I stumbled upon a book with a somewhat unusual title, that I knew would be difficult to be understood by anyone outside the veterinary profession, while at the same time, it immediately caught my attention:

“All my patients are under the bed”

Having myself done many house calls over the last three decades, I was in no doubt that this book was all about cats, as this behaviour was just too typical. Unless a feline patient is on its last legs, it will go into hiding once the vet enters the house, if not – which is even worse – disappear through the cat flap or window the owner had forgotten to close, despite the prior advice to do so…..

On further investigation it turned out that the narrative involved indeed a colleague offering house calls, but the author was not just anyone.

What the strange title concealed, was the autobiography of “Count” Louis Camuti, an Italian born veterinarian, who became the world’s first veterinarian treating exclusively cats (and a few more unusual creatures, people tried to keep in their apartments….).

Three days later, the book arrived in the post.

The place was New York, the year was 1933 when it all began…..

Camuti preferred to do house calls, usually with his wife as the chauffeur who had to keep the car moving, as already then, it was impossible to find a parking spot.   

The dynamic duo did this for nearly fifty years and as Camuti soon became a household name among the rich and famous cat lovers residing in the Big Apple and its vast suburbs, there was enough material of likely and more unlikely things that happened between the call to the vet and the settling of the bill.

Despite the fact that over the last 100 years (!) treatment options have improved, that we have more diagnostic tools at our disposal and that today video calls are not only used widely but at times found to be superior to an in person house call, client’s expectations and the characteristic behaviour of our patients have remained the same.

In many of today’s urban households, life still revolves around the demands of the feline resident.

The diet and the wellbeing of the cat is frequently of greater importance than that of any other family member, including the occasional dog that might share the same apartment.

As much as typical cat behaviour like purring or just providing a quiet but reassuring presence, is appreciated and enjoyed, the shredding of expensive furniture or territorial marking is in equal measure misunderstood and – understandably – despised.

And yet, the cat has remained the preferred soulmate and companion of the urban dweller.

When Camuti combined this in his narrative with some memorable episodes with Broadway or Hollywood greats like James Mason or Marlene Dietrich, some entertaining reading hours on a peaceful mountain hut or in the busy departure hall of an airport while waiting for my next flight, were guaranteed.   

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….)