Friday, 11 January 2019

A page from the 'Book of Life'

No photo description available.

By my good friend, Susan Dustin

What a little contrast brings

Yesterday was my first day in 2019 of returning to walk with those in end of life. Standing outside of the hospital I lay my empty hands in front of my deliberately open heart and readied myself to receive and work with whatever would be presented to me. I prayed to offer those I encountered an empathetic grace-filled dignity even though I was feeling below par. 

People often comment to me that my walking with the dying is a laudable sacrificial endeavor. There may be aspects that are extremely emotionally taxing. Some situations also stretch my patience and ability to embrace others without bias. Occasionally there are passages so sacred that my failure to render them through any good account leaves me feeling isolated in the experience. Yet, even within my places of lack, great love and joy resound so profoundly that I am often transported into the divine. I am greatly enriched because I get to care for others in deep and intimate ways. The dying, through what great loss so clearly offers, often impart to me invaluable life perspectives. They, in all their broken frailty, teach me how to live fully! 
I suffer from reoccurring leptospirosis. The first year I contracted it, I had innumerable fevers, headaches, nausea, loss of appetite and hair, the threat of sight and organ damage, and deep exhaustion and depression plagued me. Throughout the past four years, it has randomly revisited for a month or two at a time. Because the symptoms are not as physical as the first bout, outside of extreme malaise, erratic thought and depression, I’m slow to realize that I am in the throes of it. Once I become aware, I fight furiously to heal and climb out of the pit in which it has cast me. It’s never easy. I eat well, rest when able and force myself to undertake exercises that produce but do not rob me of energy. I engage in positive, gentle thought as I bravely clear through a lot of emotional tears and frustrations. I do my best to keep humor and gratitude alive. Then usually, somewhere out of the blue, as mysteriously as it appeared and had me believing it would never leave, it disappears. Poof! 
Yesterday, several weeks into a Lepto Laze Phase, I was introduced to “Bertha”, a 66-year-old Thai hospital cleaner. Perched in her bed she was hooked up for her last round of a dozen chemo sessions for metastatic cancer. Bald but glowing, she happily greeted me. She informed me that she had intestinal cancer five-years-ago, had been operated on and had chemo, and had been clear until this new invasion showed itself. She chirpily said that the chemo had no side effects and that she’d not missed one day of her six-day-a-week work since she’d been sick save on chemo days. 
“No side effects. Without a tuft of hair on your head and face left and you feel you have no side effects. Wow!” I thought to myself. 
After a bit of chitchat, I ventured as to what she envisioned for her future once her treatments were over. Imagining a rather serious discussion to ensue, I was surprised when she strongly informed me that she was not worrying or even thinking about the future. “It’s a waste of time to worry about such things. I am living for today. Once I am off this bed, I am back to work.” 
Wondering if she was avoiding the harsh realities confronting her, I asked what her life has been like and what makes her happy at present. She merrily told me about her family, her work, and her beliefs. She felt she had a good life and even though suffering from an array of diseases such as diabetes, high blood pressure, and cholesterol she was at peace with her lot. 
She then laughed, “So, with all this illness, what’s one more disease? I may have them, but they do not have me. They may destroy my body, but they cannot destroy my way of thinking. I hate sitting around thinking too much; it’s pointless. I pray at times and guide my heart, but even that I am not too serious about. I have a good family who loves and visits me when they can. My two children have grown up and are successful, so I have no worries. I’ve lived well until now. I’ve had a full life and I am ready to go whenever it’s my time. Who knows when that day that will be? I cannot plan for it, so I live day by day, one hour at a time. I eat good food, love my family, and really enjoy the hard work of cleaning for others.” 
Running her hands over her plump, white pajama-clad body she smiled broadly adding, “I will be happy when I get to vacate this old residence in favor of a better one.” 
“You are amazing, and I really admire your way of accepting death and importantly living wholeheartedly until its time for you to ‘vacate your old residence’. I had a near death experience some years ago. Since then, when I remember to at least, I offer prayers of thanks at the end of the day! I ask forgiveness for the wrongs I have done (and promise to make amends when and where able), I acknowledge what I could have done better in order to clear my slate so that I am ready to go without unfinished business or regrets. Like you, realizing that life is tenuous, I embrace it by thanking the day and others for what they brought to me. I thank myself for the things I did well, and then ask if it is meant to be, that I will be blessed again with other such moments after I wake! I have not done this as well as I should have lately.” I wistfully responded. 
With a look of one who truly knew, Bertha took my hand in hers. I asked if I could give her a hug and a kiss. She nodded affirmatively. As I kissed her and told her that I loved and admired her, she mockingly complained, “That’s not fair! I can’t only receive a kiss, I have to give you one too!” 
Not waiting for my response, the humble cleaner of guru proportions, grabbed me in her big arms, embraced me generously, and added a loud smooch. 
Usually, when in a Lepto Laze Phase, I am forced to live on a day-by-day and at times an hour-by-hour basis as this dear soul does. I am in no way comparing my health situation to hers; rather it’s my attitude I am comparing. If we are able to honestly face our mortality, limitations, and vulnerabilities positively, we can appreciate our lives and health in ways we may have never envisioned when whole. Each meaningful, energetic, happy moment, has so much value and becomes great gain having been contrasted by deep loss. 
Bertha, like me, doesn’t possess a sophisticated voice to be able to express deep truths. However, her actions, presence, and way of being in the face of chronic illness and death spoke absolute volumes and gave me a well-needed reminder.
Seems to me that she’s mastered what she was here in this incarnation to learn and impart. She assuredly has a lovely new mansion by the beach with dolphins frolicking in the waves, waiting for her to occupy it. I think my eventual new model will be a small caravan—and I am okay with that. But for now, it’s time to use what little energy I have in the offering of gratitude.

I am, again, by contrast, feeling reasonably well, even when running at low battery. And the fullness of truly embracing life, which Bertha so eloquently modeled to me, begins with attitude.

Thursday, 10 January 2019

Protein found more in advanced prostate cancer could be key to preventing drug resistance

A cancer-driving protein is found in the tumours of men with advanced prostate cancer after treatment with hormone drugs but rarely found in early-stage disease, a new study shows.
The findings of the major study, published in the Journal of Clinical Investigation, confirm the importance of a protein called androgen receptor splice variant 7 (AR-V7) in resistance to hormone drugs in prostate cancer.
The research, led by scientists at the ICR in collaboration with researchers in the US led by the University of Washington, also suggests that researchers should look for new treatments that negate its activity.
In the study, the researchers examined biopsy samples from two groups of men treated for early and advanced prostate cancer.
They developed a new antibody to detect AR-V7 in prostate cancer cells, which allowed them to map its levels much more accurately than before.
AR-V7 was found in biopsy samples from three-quarters of men whose cancer progressed after treatment with hormone therapy, and expression increased further in men treated with the advanced hormone therapies abiraterone and enzalutamide.
But the scientists detected it in less than 1 percent of patients with early-stage prostate cancer, before treatment with hormone drugs.

Important role of AR-V7

Prostate cancers use the hormone testosterone to grow and develop. Abiraterone and similar drugs target the androgen receptor, which is found within cells and detects testosterone.
Despite the success of hormone therapies like abiraterone, resistance to treatment often occurs due to mutations and structural alterations which side-step androgen receptor blocking to keep signalling active.
The study highlights the important role of AR-V7 in this process and suggests that drugs developed to reduce its activity could make treatments like abiraterone more effective.
Men without AR-V7 survived nearly three times as long on average compared with men whose tumours tested positive for the protein, when treated with therapies targeting the androgen receptor before chemotherapy, the study showed. 
The researchers also identified a specific 59-gene ‘signature’ in men with high levels of the protein, which could identify drug targets for new treatments in advanced prostate cancer.

Novel therapeutic strategies

Leader of the study in the UK, Professor Johann de Bono said: 
“This is the biggest study to date of AR-V7 protein expression in tissue biopsies from men with early and advanced prostate cancer and shows that the emergence of the AR-V7 protein in cells is an important event in the development of resistance to hormone therapies like abiraterone, which was discovered at the ICR. 
“We saw that AR-V7 expression is rare in the early stages of prostate cancer, but emerges after hormone therapy alongside other mechanisms of resistance – highlighting its importance in the biology of advanced prostate cancer. 
“If novel therapeutic strategies could prevent AR-V7 expression during hormone therapy, it could improve outcomes for men with lethal prostate cancer.”
Source: The Institute of Cancer Research

Saturday, 5 January 2019

Promising news from Australia (Prostate Cancer Research)

Australian scientists have found a genetic marker that could identify which men are likely to develop deadly metastatic prostate cancer and may pave the way for effective treatments.
The federal government is investing almost $800,000 into researching how prostate cancers spread and become impervious to conventional treatment.
Roughly 3500 men died of prostate cancer in Australia in 2018, according to national data.
While localised prostate cancer has very good outcomes - the overall five-year prostate cancer survival rate is 95 per cent - patients with metastatic disease do very poorly.
The majority of these metastasised cancers are resistant to conventional treatments - androgen deprivation therapy - and become untreatable.
Just 30 per cent survive more than five years if the cancer spreads to other parts of the body.
Dr Philip Gregory at the University of South Australia will receive $782,078 from the National Health and Medical Research Council (NHMRC) to investigate a novel molecular pathway that could lead to new, effective treatments.
Dr Gregory’s team found the RNA-binding protein 'Quaking’ is switched on in prostate cancer cells that metastasise.
“Surprisingly we found levels of this [molecule with this specific protein] are strongly indicative of cancers becoming more aggressive and resistant to the therapies,” Dr Gregory said.
This finding was the springboard for the grant.
“We are trying to understand how this molecule functions in prostate cancer. It changes the way genes are spliced so we are hoping the molecule or gene splicing signature might be able to diagnose which prostate cancers will become aggressive,” Dr Gregory said.
“We can make better decisions in terms of treating patients if we can see which particular cancers look to have an aggressive phenotype. Maybe we would take out a tumour earlier or give them more aggressive treatment."
He hopes to eventually be able to design new therapies that would make the cancers less aggressive and more susceptible to hormonal treatments.
“One of the unique things about this molecule is that it works not by controlling levels of genes, but how the gene is spliced within cancer cells. It’s a new way of thinking about how cancer spreads,” Dr Gregory said.
Health Minister Greg Hunt said the research had the potential to save and protect lives.
“This critical research project is among NHMRC grants worth more than $526 million,” Mr Hunt said.
“Through the 2018–19 budget we provided a record total of $6 billion to Australia’s health and medical research sector."
Mr Hunt said since 2013 the government has contributed more $70 million towards prostate cancer research. In 2018 the government subsidised MRI scans for prostate cancer checks.
Kate Aubusson

Kate Aubusson of the Sydney Morning  Herald
January 2019

Wednesday, 12 December 2018

Do you live in New Zealand?

New Zealand is where we're heading this Christmas, and really looking forward to it. Only time to visit the North Island this time, do you live there? 

Monday, 10 December 2018

The Milk Boy Who Became a Soldier

When they left school, everyone remembers their ‘first job.’ I bet you can? By the time I’d left in 1966, I’d done fruit picking, potato picking, shoplifting and had two paper rounds, though I didn’t get paid for all those!
Daniel aged 14

My first real job was as a Co-op ‘Milk Boy.’ It was August 1966, and I’d left school in the July, aged fourteen and a half. England had just won the World Cup, and there was optimism around the country that I’ve hoped to, but never experienced since. I’d already applied to join the Army (see the world, learn a trade), and to the Australian Embassy to become a ‘£10 Pom’ but the real objective was to leave home as fast as possible, and I’d have fled with a travelling circus, such was the desire!

So, as I went for the interview that morning at the Co-op Milk Depot in Colchester, I knew it was temporary, but I had to convince them that this was indeed a career choice! I sailed through the 3-minute session, and the lady then gave me a math’s test paper. She went to get a pencil, but I spotted one on the windowsill, and when she returned I’d already completed all the questions. She was amazed, even more than my math’s teacher who’d always excluded me in mental arithmetic tests so as not to demoralise the rest.
Yes, I was in, but thanks to the math’s test, got offered a far better job as an apprentice in the Co-op Laboratories. It was twice as much money, more paid holidays, I could work indoors, wear smart clothes and get free dinner in the canteen, BUT I didn’t want a job for life, just a job until I could escape from Essex! I didn’t know what claustrophobia was, but I’d heard of people who were scared to stay inside, and this was the card I played, the card that led me to my alarm clock ringing at 2.30 a.m. the next Monday morning.

I’d never seen the clock at that time before, and when I looked from my bedroom window, the street lights were off, there was nobody to be seen! I dressed, threw cold water on my face, then crept from the house like a scared cat! My sister Jacqueline was only two, a ticking time bomb sleeping in my parent’s bedroom; if she woke, the whole house would! A 3-mile run (I ran everywhere) landed me at the depot, half an hour early. Wow! I’d seen milk floats on our street, but never this many, there must have been over a hundred! I was spotted quickly, the obvious ‘what the hell happens now’ face betraying me, and was taken over and introduced to Len; a lovely guy as it turned out. First, we had to check the stock put on the float by the night workers, making sure it tallied with Len’s book, a record of what each customer wanted. There were no calculators then, but there was me, and Len soon realised that he could forget his pencil and notepad, as he shouted string after string of numbers, and I just shouted back the total; he loved me! Twelve pence to the shilling, twenty shillings, ten florins, eight half-crowns or two ten-bob notes to the pound, and a guinea, a nice round twenty-one shillings; nothing easy in those days!

There were only a few different things on the packed float, mainly pints, half pints and third pints of milk, small jars of cream and bottles of orange juice, all which came in glass. The milk float was a relatively new thing, batteries the size of suitcases but drove along almost silently. However, you couldn’t appreciate that silence because with all that glass in metal crates, rattling along the bumpy road, you could hear us coming from three streets way; it was deafening!
By 4 am we were out on the delivery, and Len would make up the hand crates, about three houses at a time. He’d shout what to drop on each step, then off I’d go. Trouble was, every time you got to a step there was a note, ‘one extra pint’ ‘no milk today’ ‘don’t walk on my grass,’ it was as if they were all compelled to say something! I first witnessed why Len was a lovely guy when one morning he said, “Stop! Stand very still and look away from the float, Mrs. Jackson’s coming for her milk.” From the corner of my eye, I watched as this frail old lady sneaked from behind the hedge, tiptoed to our float in her slippers, and helped herself to half a pint. “But she’s nicked it,” I said. “It’s OK,” Len said, “I put it down as a breakage, she lost her husband last year and went a bit batty. What should I do, call the police?” He laughed, and we moved on.

As we walked up East Hill, Len told me he’d seen almost everything imaginable in his thirty years with the dairy. He’d bagged burglars coming out of houses, helped put fires out, saved a guy who’d had a heart attack and delivered two babies! “You wouldn’t see that much action if you joined the army,” he joked, as I blushed. At the end of the street, we looked back at the float, and Len seemed sad. “You know son, when I had Dobbin, I used to just whistle, and he’d trot along with the milk cart, he saved me a lot of walking, but that said, I suppose I’m fitter now.” Of course, I’d seen the horses only a few years before and knew what he meant. The coalman, rag-and-bone man, undertakers, everybody who carried anything bigger than a letter seemed to have a horse. “What happened to them all Len?” I asked. “They all ended up at the glue factory son, every one of them, young and old.” I guess at the time I was trying to imagine how you turn a horse into glue, would they be sticky enough? Who could possibly need that much glue anyway, but Len said it was called ‘progress,’ and we left it at that.

As the days turned to weeks, I got into the routine, and Len especially liked me on Fridays, because that’s when he collected the money. He would get his scruffy old book out,” Two pints, one cream, one juice and sixpence owing from last week,” to which I’d shout out, “Two and tuppence Len.” He’d knock on the door, the lady would pay, then he’d often show me off by making me calculate any obscure thing he could think of in front of her; it was fun, and for the first time in my life, I felt rather important. Friday was also pay day, and that little brown packet with fifteen shillings and sixpence in was a bag of gold to me. Over six weeks pocket money in one go! Looking back, I’ve never felt that wealthy since!

Very often, especially after 7 am, housewives would have tea and even biscuits waiting for us. We’d sit around the kitchen table, the grown-ups all dragging the last sliver of goodness from their cigs as I put my sugar in. “Three sugars!” they’d often shout, “It’ll rot your teeth.” I’d never drunk as much tea and was always needing to sneak into bushes for a wee! One lady, Val used to insist that Len had his tea upstairs because she wanted him to help her “lift some heavy things” in the bedroom. I had to look after her cat, who she said ‘got scared’ if it was left alone. Looking back years later, I can laugh and still see how happy Len was after all that lifting. Maybe it was a ‘perk of the job,’ everyone’s job had perks back then. The coalman got free coal, the dockers seemed to get free everything, the civilian workers at the Army stores dressed their entire family, rather conspicuously I thought! So, on Fridays, Len and I helped ourselves to a few bottles each, which he recorded as ‘breakages,’ and everyone was happy.

Winter soon arrived and getting up at 3 am with an inch of ice on the inside of the bedroom window and a foot of snow outside was a whole new game for the ‘Milk Boy.’ Our hands were so cold that we lost all feeling, and the chilblains were terrible, but still, we managed to have fun, though Len seemed to go through three times as many fags. Customers were complaining that the birds had pecked through the foil caps and drank the cream from their milk, others moaning that the milk and cream were frozen. What could we do? I was delighted that the birds were so clever, and at the posh looking houses, I’d pop my frozen little finger through the foil to give them a head start!

A big day at the depot was the introduction of ‘Yoghurt,’ and we were given a tasting sample because they were going to turn us into ‘salesmen.’ After one spoonful, Len and I looked at each other and grimaced; it was like sour milk, we knew it would never catch on! It came in four flavours and in ‘plastic tubs,’ and they would never replace glass! On my very first yoghurt delivery, on the way across the slippery path I went flying, and out popped six plastic tubs like mini-missiles. I thought, ‘thank God they’re not glass,’ until they hit the ground, the lids popped off and I’d painted a ‘Jackson Pollock’ in the snow. I shouted to Len, “Have we anymore Yoghurts?” to which he yelled back, “No son, why?” I paused, “It’s OK!” I then had to make sure it really was OK. There was a rusty spoon by the frozen fish pond; I remember seeing the fish still alive and moving under the ice, how bizarre! I scooped a mixture of yoghurt, snow, and perhaps a little muck, equal amounts to each tub, then pressed the lids back. Then I broke the thin ice on the pond, washing each carton in turn, drying them on my shirt tail. As I ran back to the float, Len said, “You were a long time?” “Needed a wee Len,” I said, more than relieved! That Friday, Len asked the lady at that house if she’d liked those new yoghurt things. I went red; it was a sure giveaway, I’m dead! “They were delicious, thank you,” she said, “Not sure about the flavours though. Did they have nuts in?”

Daniel aged 15

Before I knew it my time with Len was nearing an end, and I never would see him again. The Army wanted to interview me, and the Australian Embassy had offered me a ‘£10 Pom’ position, but I’d have to wait a further six months to sail. So, the British Army it was! The Milk Boy became a Soldier on 9th May 1967 and still smiles when he sees yoghurt, and enjoys it occasionally!

Monday, 26 November 2018

Saturday, 24 November 2018

Online tool can help men make prostate cancer treatment choices

A web-based tool can let a man with prostate cancer see how thousands of other men in his situation have chosen to be treated, which may help him better understand his own options, a US study suggests.
Early-stage prostate cancer may not need treatment right away, or ever, because these tumors often don't grow fast enough to cause symptoms. Because treatment can have side effects like impotence and incontinence, doctors sometimes advise men to put off surgery or radiation and instead get regular screenings to reassess whether the cancer warrants intervention.
"There is often no one correct treatment option because the choice of prostate cancer treatment depends on personal preferences around treatment benefits and risks," said senior author Dr Karandeep Singh of the University of Michigan in Ann Arbor.
"There are already a number of great resources available to the prostate cancer patient community to support this shared decision-making process," Singh said by email. "However, there are no tools that help patients discover what treatments similar men chose when faced with a similar decision."
Singh and colleagues set out to develop a tool that fit the bill. They used data on treatment choices made by 5,016 men diagnosed with prostate cancer to develop a web-based tool that predicts the most likely treatment choice based on what other men in similar circumstances have chosen.
Then, they asked another 2,527 men with prostate cancer to try out the tool and see how often the program predicted the treatment choice these men would pick for themselves. The tool, it turned out, was highly accurate.
"This tool is not meant to replace the shared decision-making process but rather to augment that process by helping patients focus their preparation on likely treatment options prior to meeting with their urologist," Singh said.
Patients and doctors can use the tool here:
It's only meant for men with early-stage tumors that haven't spread to other parts of the body. It won't predict treatment decisions for men with more complex cases.
For men who do have early-stage tumors, the tool focuses on aspects of the prostate cancer diagnosis, patients' age and weight, and any history of heart attack or diagnosis of diabetes.
When men are only 45 years old with lower-risk tumors, they will probably see that similar patients are pretty evenly divided between opting for radical prostatectomy surgery and choosing active surveillance, that is, skipping treatment in favor of periodic reassessments to see if cancer warrants intervention.
By age 55, men with low-risk tumors might see that more than half of similar patients choose active surveillance and less than 40 percent opt for a radical prostatectomy. And by 65, men with low-risk tumors might see that about two-thirds of similar patients pick active surveillance.
One limitation of the study is that it wasn't designed to prove whether or how the web-based tool might help men make treatment decisions or see how happy patients are afterward with the choices they made, the study authors note.
Even when men seem similar on paper in terms of their demographics and the particulars of their tumor, how well the web-based tool predicts what's best for them might vary from one man to the next, said Dr. Kari Tikkinen of the University of Helsinki and Helsinki University Hospital in Finland.
"Sure, this data can be reassuring to those whose own values and preferences concur with the option machine learning is suggesting as the most common choice," Tikkinen, who wasn't involved in the study, said by email.
"However, even in this kind of excellent situation it may not help patients," Tikkinen said.
A man who is very opposed to surgery because of the risk of incontinence or impotence, for example, may not want to choose surgery just because that's what the tool says most similar men would do, Tikkinen said.
But tools like the one tested in the study can still help men have more focused and nuanced conversations with their doctors about what treatment may be ideal for them, Tikkinen said.

SOURCE: European Urology, online October 11, 2018.


Saturday, 10 November 2018

Harry Patch - An amazing man

Pte HJ Patch, number 29295, C Company, 7th Battalion, Duke of Cornwall’s Light Infantry, took his place within the fighting force at the bottom of a long and complex chain of command that ended, by way of a regiment, company and platoon, in a section of some 14 men. 
Patch, who was called up in October 1916 at the age of 18, served as a private and became part of a Lewis machine-gun team when he arrived in France the following year. At this time, companies tended to be allotted four Lewis guns each. Gun crews were special, excused the everyday duties to which most rankers were subjected, and were expected instead to spend their time keeping their weapons in good working order. They operated as an individual unit under the command of the “No 1”, in Patch’s case a man called Bob Haynes. Patch always knew, and later could only remember, the three other members of the team by their nicknames. No 3 was known as Maudy (“There was an actress of that name. He had a good sense of humour,” Patch recalled), while Nos 4 and 5 were known as Jack and Jill. 
The bonds between Lewis gun team members were particularly strong. “We were just that little body alone and we shared everything,” Patch recalled. “You could talk to them about everything and anything. I mean, those boys were with you night and day, you shared everything with them and you talked about everything.” Such camaraderie helped men endure the harsh conditions at the front. 
The son of a master stonemason, Henry John Patch was born in the village of Combe Down, near Bath, on June 17 1898, and his family’s roots were buried deep in the Somerset soil. His father, whose family came from a village near Glastonbury on the other side of the county, had been born at Claverton, a mile or so from Combe Down, while his mother was from the neighbouring village of Monkton Combe. The Patches had thoroughly colonised this small corner of England, and by the outbreak of the war there were 14 different Patch families in Combe Down. Harry was 16 and an apprentice plumber when war broke out in 1914, and was anything but enthusiastic. 
“While a lot of the local lads went and joined up in the local regiment, the Somerset Light Infantry,” he recalled, “I never gave it a second thought. I never felt the need to get myself into khaki and go out there fighting before it was 'all over by Christmas’. I’m not saying I knew any different, but at my age I was keen to continue my apprenticeship.” 
By 1916, however, Britain could no longer rely on volunteers to fill the ranks. Conscription was introduced at the start of the year and Patch was drafted into the Duke of Cornwall’s Light Infantry (DCLI) in October. 
The following July, he and the other four members of his close-knit Lewis-gun team were pitched into the Third Battle of Ypres, otherwise known as Passchendaele, the last major battle of attrition fought on the Western Front. The offensive began on July 31 1917 in heavy rain – the heaviest for 30 summers – and they soon got bogged down in the Flanders mud. When it ended on November 6, with the capture of the ruined village of Passchendaele, Britain and her Empire had suffered some 310,000 casualties. 
During the four months, from June to September, that he spent in the trenches, Patch never had a bath or a change of clothes. Body-lice were a constant irritant, as were the rats, grown fat on the plentiful corpses, which gnawed their way through equipment, devoured rations, and ran across the faces of sleeping soldiers. “It doesn’t matter how much training you’ve had,” Patch recalled, “you can’t prepare for the reality, the noise, the filth, the uncertainty and the calls for stretcher-bearers. Anyone who tells you that in the trenches they weren’t scared, he’s a damned liar. You were scared all the time.” 
Patch first went into battle on August 16 in an action subsequently named the Battle of Langemarck, after the village that was its chief objective. “I’m told we attacked on August 16,” he remarked, “but the date doesn’t mean much to me. I know it was about six weeks before I was wounded, so I suppose the middle of August is about right. I remember the names – Pilckem Ridge was one and the other was Langemarck – but it is such a long time ago that I can’t quite connect them up in my head.” 
Patch may have forgotten the exact dates and places, but he knew what a battlefield was like. It was during his unsteady progress through a hellish landscape, ruptured by countless artillery shells, that he came across a young soldier from A Company of the 7th DCLI, which had led the attack. Of all the terrible sights he encountered, it was this that would remain with him throughout his extraordinarily long life. The soldier, Patch recalled, “was ripped open from his shoulder to his waist by shrapnel, and lying in a pool of blood”. Seeing men from his own battalion, he begged to be put out of his misery. In Patch’s terse but eloquent phrase, “he was beyond all human help”, and died before anyone could draw a revolver and comply with his desperate request. “It is an image that has haunted me all my life,” Patch said some 90 years later, “seared into my mind”. 
The battle was not over, however. At one point during the advance a German emerged from a trench, bayonet fixed, and ran towards Patch. The 19-year-old drew his service revolver and shot the German in the shoulder. Still he came on. 
The gun team had made an unusually humane and highly irregular pact that they would not shoot to kill unless absolutely necessary, and Patch remembered this code as he again took aim. “I couldn’t kill him. He was a man I never knew, I couldn’t talk to him. I shot him above the ankle, above the knee. He went down. He said something to me in German – God knows what it was – but for him the war was over.” 
When C Company reached the German trenches at around midday, they found them empty. By the harsh standards of Passchendaele, the attack had gone reasonably well. Patch and his comrades had emerged unscathed, but their luck would last only another month. On the night of September 22, the Lewis-gun team were making their way back into the reserve trenches, walking across open ground because there were no communication trenches in this area of the front line. They were waiting in a huddle while No 1 was “attending to the call of nature”, when a shell exploded above them in a flash of light. Patch was thrown to the ground, and lay there conscious but “incapable of anything” for a couple of minutes before realising that he had been hit in the groin by shrapnel. He applied the field dressing that all soldiers carried with them and waited for the stretcher-bearers. 
Taken to a casualty clearing station, he had his wound cleaned and dressed by a doctor, but the shell fragment that had caused it remained in place. The anaesthetising effects of shock were wearing off, and he began to feel acute pain. Since his injury was less serious than many of those at the clearing station, he was obliged to wait until the following evening before being seen by another doctor. 
He was told that the shrapnel could be removed but warned that no anaesthetic was available. Patch decided it was worth enduring two minutes of further pain, so four men held him down while the shell splinter was cut out of him and the wound stitched. Patch declined to accept the two-inch-long metal fragment as a souvenir, and was relieved to learn that his wound had been classed as “a Blighty one”, meaning he would be invalided back to Britain. 
He was taken initially to hospital in Liverpool, where he received a letter from Bob Haynes informing him that the three other members of the Lewis team had been killed by the shell that had wounded him. “There was nothing left, nothing left to bury. My reaction was terrible; it was like losing part of my life.” Patch’s physical wounds would heal, but the death of these men was something from which he never really recovered. 
Following his discharge from hospital he was sent to a convalescent camp at Sutton Coldfield, near Birmingham. There, he met his future wife, Ada Billington. 
It was not until August 1918 that he was deemed fit enough to resume training, at Tidworth camp in Wiltshire. He dreaded being sent back to the front, but an additional chest injury, suffered when he was shelled, had not healed and prevented him from carrying heavy equipment, so he was ordered back to hospital. This delay, lasting several weeks, may well have saved his life. When the guns fell silent on 11 November 1918, Patch was still in training on the Isle of Wight. 
“The war might have been over,” he recalled, “but its effects were never far away.” 
Like most of those who had survived the war, Harry Patch simply returned to his former life as a civilian and settled down to married life. But he returned to Combe Down “thoroughly disillusioned”: “I could never understand why my country could call me from my peacetime job and train me to go to France and try to kill a man I never knew. Why did we fight? I asked myself that, many times.” 
He never spoke about the war – not even to his wife of 57 years. In this regard, he was not unusual. As Dennis Goodwin, founder, along with his son, of the World War One Veterans’ Association, puts it, these men “simply retreated into their own shell hole of memories”. 
Patch was haunted, in particular, by the dreadfully wounded soldier who had begged to be finished off. The young man had cried out “Mother!” as he died, and Patch believed this cry was one of greeting rather than despair. “I’m positive that when he left this world, wherever he went, his mother was there,” Patch wrote towards the end of his life. “From that day I’ve always remembered that cry, and that death is not the end.” 
He left the Army with his faith in the Church of England “shattered”. In an attempt to revive it, he joined the church choir. “In the end, I went because I enjoyed the music and had friends there. But the belief? It didn’t come. I felt shattered, absolutely, and didn’t discuss the war with anyone from then on, and nobody brought it up if they could help it.” 
This attitude persisted well beyond the immediate aftermath of the war. Patch refused to join veterans’ associations, had no wish to revisit battlefields, never attended a regimental reunion and avoided all war films. He did, however, keep in touch with his old “No 1”, Bob Haynes, until he died in the 1970s. 
Patch did his best to repress all memories of the trenches. It was only at the age of 98, when he moved to Fletcher House, a residential care home in the Somerset city of Wells, that a minor incident brought those memories back. The door to his room was opposite a linen cupboard, and one night someone switched on the fluorescent light inside. Flashes of light came through the glass panel above the door to Patch’s room. Half asleep, he was transported in an instant back to Passchendaele. “It was the flash of a bomb,” he recalled. “That flash brought it all back.” He had been suffering from bad dreams about the war, and decided that the time had come to face his demons. 
In the autumn of 2004, aged 106, he was persuaded to travel to Flanders for a BBC documentary, The Last Tommy. He was filmed at Tyne Cot, the largest British war cemetery, containing almost 12,000 graves, many of them holding unidentified bodies. 
“Some of the boys buried here,” he remarked, “are the same age as me, killed on the same day I was fighting. Any one of them could have been me. Millions of men came to fight in this war, and I find it incredible that I am now the only one left. Just like them, when I went over the top I didn’t know whether I would last longer than five minutes. We were the PBI – the Poor Bloody Infantry – and we were expendable. What a waste. What a terrible waste.” 
The documentary makers also persuaded Patch to meet one of Germany’s last-surviving veterans on September 22, the anniversary of the loss of his three comrades in the Lewis-gun team. A year older than Patch, Charles Kuentz had also fought at Passchendaele. He, too, had suffered the loss of a close friend, killed by shrapnel beside him in a trench. Like Patch, Kuentz had never talked about his experiences until being asked to do so after reaching his centenary. When the veterans laid a wreath together, Patch leaned out of his wheel-chair to pick up an acorn, and presented it to Kuentz. The German died a few months later. 
Patch never courted publicity and occasionally complained that he was tired of talking about the war, but it was inevitable that he would attract attention as he became one of the very last survivors. Even towards the end of his 111-year-long life, when he was widely recognized as a spokesman for his generation, he was not in the least afraid to state his opinions. “For me, November 11 is just show business,” he once said of Armistice Day, and he rarely lost an opportunity to express his abhorrence of warfare. 
Last year, he returned to Flanders to unveil a stone plaque at the spot where he went into action for the first time. It would be the final visit to the Western Front by someone who had fought there. In recognition of his status as the last surviving soldier who had fought in defence of Belgium, he was appointed Knight of the Order of Leopold. He was also made an Officer of the L├ęgion d’honneur. 
“I greatly appreciate the way your people respect the memory of those who fell, irrespective of the uniform they wore,” Patch told the French ambassador. “I will wear this medal with great pride and when I eventually rejoin my mates it will be displayed in my regimental museum as a permanent reminder of the kindness of the people of France.” 
On June 17 this year Patch celebrated his 111th birthday with a party in the garden of Fletcher House. The following day, his portrait went on display at the National Portrait Gallery. 
At 9am on July 25, only a week after the death of Henry Allingham, aged 113, Harry Patch died. At the time of his death, Britain’s last veteran was also the oldest man in Europe and the third-oldest in the world. He remained alert and articulate until the end. 
Following his death, much was made of the example he set as a soldier, joining up “to defend the nation”; but this ignored the facts. “I didn’t want to go and fight anyone,” he wrote in his autobiography, “but it was a case of having to. When it came, army life didn’t appeal to me at all, and when I found out how rough-and-tumble it could be, I liked it even less. I had no inclination to fight anybody. I wasn’t at all patriotic. I went and did what was asked of me and no more.” 
When asked what he thought about the idea of a state funeral for the last veteran, Patch had replied: “Overall, the idea was all right, I suppose, wanting to honour the generation who fought, but I wasn’t interested. I want to be buried in Monkton Combe alongside my family in the churchyard.” After a public funeral at Wells Cathedral, this wish was granted. 
The poet Charles Hamilton Sorley, killed in the Battle of Loos in 1915, wrote of the “millions of the mouthless dead”, but until now those dead have always had a spokesman. Now that Last Post has sounded for the last veteran, there is no one left to say: “I know what it was like. I was there.” 
'The Last Veteran: Harry Patch and the Legacy of War’ by Peter Parker (Fourth Estate) is available from Telegraph Books for £12.99 + £1.25 p&p. To order, call 0844 871 1515 or visit

Friday, 26 October 2018

Tears in Heaven...

A post from my great friend Dusty's blog...
It’s late afternoon and I’ve just finished a haphazard first meal of the day and am sitting in front of my computer screen crying to Eric Clapton’s, “Would you know my name if I saw you in heaven? Would it be the same if I saw you in heaven?” His heartfelt lyrics make me wonder if anything would ever be the same again. If we would know each other over “there” and if it or we would finally be better when our tears were wiped away?
Today, however, my tears have not yet been wiped away and they flow freely from a deep well of groaning and grief that has no other way to express itself. I participated in the cremation of younger brother Nong Dton, our palliative care team’s 27-year-old sole male nurse. He was the same age as my daughter and the only child of parents similarly aged to me. He was cheekily playful, musical to the core, and an ethical hard worker when it came to caring for those in end of life. He tragically died last week in a midnight motorbike accident.
Hearing the news, the hospital staff collapsed on the floor, wept, and was unable to eat for a great while. “I’ll find my way through night and day…” Then bravely reaching outside of their loss, they rallied to ensure his religious ceremonies and cremation would be a success. They wanted to lift the family’s burden and show that their child was loved and appreciated. They worked tirelessly for many days with tears in their eyes and smiles on their faces. They tended to a myriad of details with the greatest dedication in order to send our brother off well.
“I must be strong and carry on…” Thais are experts at facing death. They have been actively involved in religious rites and sitting with the bodies of their dead relatives before they can even walk. They do so gracefully, tenderly, and kindly. They also contain an inherited sense of resolute acceptance that if you are born then you must suffer, and finally die. Today, I was deeply impressed by the number of attendees whose considerable difference in social standing meant little in contrast to the shared sense of love and loyalty. Yet no matter how used to dying any of us may have been, we all had to be very brave as we cried, sang, prayed, hugged each other, and sat for long stretches in painful silence. No matter how long you have worked in palliative care, imbibed a healthy death culture, practiced religious beliefs and forms of paying last respects, or given grieving processes there seems to be a timeless thread throughout our shared humanity. We all hurt deeply over our losses. We try to make sense of tragedy, even when there may none to be found. We often search out eternity from our narrow, earth-bound perspectives. We vehemently resist believing that birth, suffering, and death is all there is to our existence. We also come together in grief and prove that we are more alike than different!
The master of ceremonies, much like any traditional religious leader, instructed us that there was no death, just a change of apparel, or body and residence as she put it. She said we would miss Nong Dton, we would hurt and feel empty, yet he was not lost to us. She then cleared his karmic slate by asking for his forgiveness for any intentional or unintentional hurts or mistakes we’d made towards him and assured him that we’d forgiven him for any of his misdeeds. Older sisters P’ Dtuck and P’ Jim, the heads of palliative care reviewed his life and sang a Thai song of eternal love for him. P’Jim crooned just as soulfully as Eric Clapton had over the loss of his young son. She declared we’d never forget our younger brother, and asked him not to forget us. “Would you know my name if I saw you in heaven? Would it be the same if I saw you in heaven?…”
As we placed fragrant incense and sandalwood flowers and his nurse’s uniform and motorcycle gear under his coffin, we prayed we’d all know each other forever in a better place. A place where tears are wiped away and sorrow has been forgotten in the light of the joy and love we share. I knocked on his coffin and announced that it was Susan, his older sister visiting him, as Thais have taught me to do. I thanked him for being him in such a beautiful manner and wished him safe, good travels. P’Jim added as his coffin was being shuffled into the furnace, “Go well young brother. I love you. Do not forget us. We’ll follow you when it’s our time to go!”
“Beyond the door there’s peace I’m sure and I know there’ll be no more tears in heaven…” In the meanwhile brother Dton, “Would you hold my hand, would you help me stand…” so our sense of shared fragility and oneness would lift us from our knees in order to better navigate this messy thing called life, loss, and death.
Tears In Heaven
Would you know my name
If I saw you in heaven?
Would it be the same
If I saw you in heaven?
I must be strong and carry on
‘Cause I know I don’t belong here in heaven
Would you hold my hand
If I saw you in heaven?
Would you help me stand
If I saw you in heaven?
I’ll find my way through night and day
‘Cause I know I just can’t stay here in heaven
Time can bring you down, time can bend your knees
Time can break your heart, have you begging please, begging please
Beyond the door there’s peace I’m sure
And I know there’ll be no more tears in heaven
Would you know my name
If I saw you in heaven?
Would it be the same
If I saw you in heaven?
I must be strong and carry on
‘Cause I know I don’t belong here in heaven

Susan Dustin “Dusty”  Hattan (Aldous) – An Arsenal of Optimism

© Susan Dustin Hattan (nee Aldous) October 2018