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They always put me on hold. Thank You for Being Expendable

Years after I first returned from Iraq and started having thoughts and visions of killing myself, I’d call the Department of Veterans Affairs. They always put me on hold. 

NYT

Statisticians and the Colorado beetle

by reestheskin on 19/10/2020

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‘Statisticians have already overrun every branch of science with a rapidity of conquest rivalled only by Attila, Mohammed, and the Colorado beetle’

Maurice Kendall (1942): On the future of statistics. JRSA 105; 69-80.

Yes, that Maurice Kendall.

It seems to me that when it comes to statistics — and the powerful role of statistics in understanding both the natural and the unnatural world — that the old guys thought harder and deeper, understanding the world better than many of their more vocal successors. And that is without mentioning the barking of the medic-would-be-statistician brigade.

Coetzee on the last great man

by reestheskin on 18/10/2020

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“Like the rest of the leadership of the ANC, he was blindsided by the collapse of socialism worldwide; the party had no philosophical resistance to put up against a new, predatory economic rationalism. Mandela’s personal and political authority had its basis in his principled defense of armed resistance to apartheid and in the harsh punishment he suffered for that resistance. It was given further backbone by his aristocratic mien, which was not without a gracious common touch, and his old-fashioned education, which held before him Victorian ideals of personal integrity and devotion to public service…

… He was, and by the time of his death was universally held to be, a great man; he may well be the last of the great men, as the concept of greatness retires into the historical shadows.” 

JM Coetzee on Nelson Mandela in the NYT

Attacking the devil

by reestheskin on 17/10/2020

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On that day in 1981 when he first sat at the pinnacle of British journalism, the editor’s desk at the Times, and wrote his first policy editorial, Harold Evans heard Abraham Lincoln’s voice in his ear. In 1861 the president had said he knew of nothing more powerful than the Times, “except perhaps the Mississippi”.

Another wonderful obituary in the Economics — this one about a great man, whose life was changed by an evil one whom to this day continues to be dirt on humanity.

Fornicating through the mattress of organisational flow diagrams

by reestheskin on 15/10/2020

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I think1 the words are mine:

Every time I hear the term line-manager used about an academic, retirement gets a day closer

But the great JK Galbraith (senior) had some words of his own on line-management (Galbraith, a famous Harvard Professor of Economics, was ambassador to India for JFK)

Galbraith proved up to the task, in part, as Bruce Riedel writes in “JFK’s Forgotten Crisis”, because he had access to the president and his aides. Most ambassadors report to the State Department, but the blunt Galbraith told the president that going through those channels was “like trying to fornicate through a mattress”.

Economist.

  1. I think they are mine, but apologies if I have nicked them …

Timescales

by reestheskin on 12/10/2020

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A year ago, “TT [tenure track] or bust” was a common but ill-advised attitude toward the job market. That attitude should be unthinkable today. COVID-19 is an accelerant to a fire in academia that has been raging for at least a decade. When that fire is finally extinguished, the landscape of higher education will be unrecognizable at best and decimated at worst.

What I learned from leaving academic philosophy (Guest post by Samuel Kampa) — The Philosophers’ Cocoon

Think of it alongside a quote from Stephen Downes:

Educational providers will one day face an overnight crisis that was 20 years in the making. Link

Machiavelli on study habits (and passion).

by reestheskin on 12/10/2020

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After he had been dismissed from government, and implicated in the anti-Medici conspiracy, Machiavelli was imprisoned, tortured, before returning to the family farm. But his passions ran deep.

…Machiavelli was unable to turn his mind from politics. ‘I could not help but fill your head with castles in the air,’ he wrote to Vettori in 1513, ‘because since Fortune has seen to it that I do not know how to talk about either the silk or wool trade, profits or losses, I have to talk about politics.’ He spent the days chewing the fat with woodcutters on the farm and playing cricca in the tavern. But in the evening, he told Vettori,

I return home and enter my study; on the threshold I take off my workday clothes, covered with mud and dirt, and put on the garments of court and palace. Fitted out appropriately, I step inside the venerable court of the ancients, where, solicitously received by them, I nourish myself on that food that alone is mine and for which I was born; where I am unashamed to converse with them … and they, out of their human kindness, answer me. And for four hours at a time I feel no boredom, I forget all my troubles, I do not dread poverty, and I am not terrified by death. I absorb myself into them completely. And because Dante says that: no one understands anything unless he retains [it], I have jotted down what I have profited from in their conversation and composed a short study, De principatibus. [emphasis added]

Erin Maglaque · Free from Humbug: The Murdrous Machiavel · LRB 16 July 2020

Mindlessness

by reestheskin on 10/10/2020

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I cannot see the future, but like many, I have private models that I use to order the world, and for which I often have very little data. For instance, I think it obvious that the traditional middle-class professions (medicine, lay, veterinary medicine, architecture, dentistry, academia) are increasingly unattractive as careers1. I am not complaining about my choices — far from it; I benefited on the tailwinds of the dramatic social change that wars and other calamities bring. But my take on what has happened to school teachers and teaching is the model for what will happen to many others. I say this with no pleasure: there are few jobs more important. But the tragedy of schoolteaching — which is our tragedy — will continue to unfold as successive gangs of politicians of either armed with nothing more than some borrowed bullet points play to the gallery. Similarly, in higher education within a timescale of almost 40 years, I have seen at first-hand changes that would make me argue that not only are the days of Donnish Dominion(to use Halsey’s phrase2) well and truly over, but that most UK universities will be unable to recruit the brightest to their cause. I think we see that in clinical academia already — and not just in the UK. Amidst all those shiny new buildings moulded for student experience (and don’t forget the wellness centres…); the ennui of corporate mediocrity beckons. The bottom line is the mission statement.

As for medicine, a few quotes below from an FT article from late last year. I assume that without revolutionary change, we will see more and more medical students, and more and more doctors leaving mid-career. If you keep running to stand still, the motivation goes. And that is without all the non-COVID-19 effects of COVID-19.

One of the major factors for doctors is the electronic record system. It takes a physician 15 clicks to order a flu shot for a patient, says Tait. And instead of addressing this problem, healthcare companies end up offering physicians mindfulness sessions and healthy food options in the cafeteria, which only frustrates them further…[emphasis added]

Over the past few years, efforts have been made to increase the number of medical schools in the US to ensure that there is no shortage of doctors. “When you think about how much we’ve invested to create, roughly, 10 to 12 new medical schools in the last decade, at hundreds of millions of dollars per school, just to increase the pipeline of physicians being trained, we also need to think at the far end of the physicians who are leaving medicine because of burnout,” says Sinsky.

Take the case of a final-year resident doctor in New York, who spends a considerable part of his shift negotiating with insurance companies to justify why his patient needs the medicines he prescribed. “When I signed up to be a doctor, the goal was to treat patients, not negotiate with insurance providers,” he says.

According to Tait, 80 per cent of the challenge faced by doctors is down to the organisation where they work, and only 20 per cent could be attributed to personal resilience.

Re the final quote, 80:20 is being generous to the organisations.

Burnout rife among American doctors | Financial Times

  1. Richard and Daniel Susskind provide a good take on this theme. See The Future of the Professions OUP, 2015.
  2. Decline of Donnish Dominion : the British academic professions in the twentieth century, Halsey, A. H. OUP, Oxford, 1992.

The biomass of parasitism approaches unity.

by reestheskin on 09/10/2020

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Many years ago I was expressing exasperation at what I took to be the layers and layers of foolishness that meant that others couldn’t see the obvious — as defined by yours truly, of course. Did all those wise people in the year 2000 think that gene therapy for cancer was just around the corner, or that advance in genetics was synonymous with advance in medicine, or that the study of complex genetics would, by the force of some inchoate logic, lead to cures for psoriasis and eczema. How could any society function when so many of its parts were just free-riding on error, I asked? Worse still, these intellectual zombies starved the new young shoots of the necessary light of reason. How indeed!

William Bains, he of what I still think of as one of the most beautiful papers I have ever read1, put me right. William understood the world much better than me — or at least he understood the world I was blindly walking into, much better. He explained to me that it was quite possible to make money (both ‘real’ or in terms of ‘professional wealth’) out of ideas that you believed to be wrong as long as two linked conditions were met. First, do not tell other people you believe them to be wrong. On the contrary, talk about them as the next new thing. Second, find others who are behind the curve, and who were willing to buy from you at a price greater than you paid (technical term: fools). At the time, I did not even understand how pensions worked. Finally, William chided me for my sketchy knowledge of biology: he reminded me that in many ecosystems parasites account for much, if not most, of the biomass. He was right; and although my intellectual tastes have changed, the sermon still echoes.

The reason is that corporate tax burdens vary widely depending on where those profits are officially earned. These variations have been exploited by creative problem-solvers at accountancy firms and within large corporations. People who in previous eras might have written symphonies or designed cathedrals have instead saved companies hundreds of billions of dollars in taxes by shifting trillions of dollars of intangible assets across the world over the past two decades. One consequence is that many companies avoid paying any tax on their foreign sales. Another is that many countries’ trade figures are now unusable. [emphasis added].

Trade Wars Are Class Wars: How Rising Inequality Distorts the Global Economy and Threatens International by Matthew C. Klein, & Michael Pettis.

  1. William Bains. Should you Hire an Epistemologist. Nature Biotechnology, 1997.

Go west young man

by reestheskin on 08/10/2020

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But after completing medical training, Sacks fled the homophobic confines of his nation and family—his mother had called him “an abomination.” Paul Theroux tells Burns that Sacks’s “great luck” was ending up in Los Angeles in 1960, where he found ample “guys, weights, drugs, and hospitals.”

Advance requires those who can imagine new spaces, and medicine is even more hostile today than it was all those years ago. We pretend otherwise, thinking those tick-box courses will suffice, but real diversity of intellect is the touchstone of our future.

A case study of Oliver Sacks | Science

The History Men

by reestheskin on 07/10/2020

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I read Malcolm Bradbury’s satire The History Man many decades ago and loved it as a satire on university life (and which demonstrated to me why medical schools and universities were unlikely bedfellows).

The History Man is Malcolm Bradbury’s masterpiece, the definitive campus novel and one of the most influential novels of the 1970s. Funny, disconcerting and provocative, Bradbury brilliantly satirizes a world of academic power struggles as his anti-hero seduces his away around campus. (Amazon’s brief).

I have forgotten much of the detail, but not how fine a novel I thought it was, nor how funny I found it. But for every great thesis, there is an antithesis. Here is one:

Ignorance of history is a badge of honour in Silicon Valley. “The only thing that matters is the future,” self-driving-car engineer Anthony Levandowski told The New Yorker in 2018… I don’t even know why we study history,” Levandowski said in 2018.

Scientists use big data to sway elections and predict riots — welcome to the 1960s

I know which past — and future — I would prefer.

Human origins: just a little messy

by reestheskin on 06/10/2020

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Nice article in the Economist on how our ideas about speciation have been revised and updated. And not just for those animals but for humans too. In their words:

To be human, then, is to be a multispecies mongrel.

Medicine is awaiting its own Photoshop

by reestheskin on 05/10/2020

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My experience is limited, but everything I know suggests that much IT in healthcare diminishes medical care. It may serve certain administrative functions (who is attending what clinic and when etc), and, of course, there are certain particular use cases — such as repeat prescription control in primary care — but as a tool to support the active process of managing patients and improving medical decision making, healthcare has no Photoshop.

In the US it is said that an ER physician will click their mouse over 4000 times per shift, with frustration with IT being a major cause of physician burnout. Published data show that the ratio of patient-facing time to admin time has halved since the introduction of electronic medical records (i.e things are getting less efficient). We suffer slower and worse care: research shows that once you put a computer in the room eye contact between patient and physician drops by 20-30%. This is to ignore the crazy extremes: like the hospital that created PDFs of the old legacy paper notes, but then — wait for it — ordered them online not as a time-sequential series but randomly, expecting the doc to search each one. A new meaning for the term RAM.

There are many proximate reasons for this mess. There is little competition in the industry and a high degree of lock-in because of a failure to use open standards. Then there is the old AT&T problem of not allowing users to adapt and extend the software (AT&T famously refused to allow users to add answering machines to their handsets). But the ultimate causes are that reducing admin and support staff salaries is viewed as more important than allowing patients meaningful time with their doctor; and that those purchasing IT have no sympathy or insight into how doctors work.

The context is wildly different — it is an exchange on the OLPC project and how to use computers in schools, but here are two quotes from Alan Kay that made me smile.

As far as UI is concerned — I think this is what personal/interactive computing is about, and so I always start with how the synergies between the human and the system would go best. And this includes inventing/designing a programming language or any other kind of facility. i.e. the first word in “Personal Computing” is “Person”. Then I work my way back through everything that is needed, until I get to the power supply. Trying to tack on a UI to “something functional” pretty much doesn’t work well — it shares this with another prime mistake so many computer people make: trying to tack on security after the fact …[emphasis added]

I will say that I lost every large issue on which I had a firm opinion.

Helicopter parenting

by reestheskin on 02/10/2020

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The following is from Scot Galloway at NYU Stern. He shoots from the hip, and sometimes only thinks afterwards. But he is interesting, brave, and more often right than most. I think I would have hated what he said when I was ready (sic) to go to university. But now, I think I wasn’t, and for medicine in particular, allowing 17 year olds to fall into the clutches of the GMC and their ilk should be a crime against….

Gap years should be the norm, not the exception. An increasingly ugly secret of campus life is that a mix of helicopter parenting and social media has rendered many 18-year-olds unfit for college. Parents drop them off at school, where university administrators have become mental health counselors. The structure of the Corona Corps would give kids (and let’s be honest, they are still kids) a chance to marinate and mature. The data supports this. 90% of kids who defer and take a gap year return to college and are more likely to graduate, with better grades. The Corps should be an option for non-college-bound youth as well.

United States Corona Corps | No Mercy / No Malice

Alas poor Copernicus: when consultancy masquerades as expertise

by reestheskin on 01/10/2020

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“We’re going through a Copernican revolution of healthcare, where the patient is going to be at the centre. The gateway to healthcare is not going to be the physician. It’s going to be the smartphone.”…

and

“Christofer Toumazou, chief scientist at the Institute of Biomedical Engineering at Imperial College London, says there are “megabucks” to be saved by using technology and data to shift the focus of healthcare towards prevention.”

Ahem. I have been reading Seamus O’Mahony’s excellent Can Medicine be Cured in which he does a great job of following up on the crazy hype of big genetics from 20 year ago (and many other areas of sales masquerading as science). The above quotes are from only seven years ago. Still crazy after all these years, sings Paul Simon. Health care excels at adding tech as a new layer of complexity rather than replacing existing actors. And when will people start realising that prevention — which may indeed reduce suffering — will often increase costs. Life is a race against an army of exponential functions.

 In the FT

The function of higher learning

by reestheskin on 30/09/2020

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The task of a university is the creation of the future, so far as rational thought, and civilized modes of appreciation, can affect the issue. The future is big with every possibility of achievement and of tragedy.

Nobody then would have imagined how bad it would get. The final word was prescient.

Alfred North Whitehead, The Aim of Philosophy in Modes of Thought, 1938

The way Brenner sees the world

by reestheskin on 29/09/2020

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Alas, there will no more new ones of these, as arguably the greatest of modern biology’s experimentalists, Sydney Brenner, passed away last year. One of his earlier quotes — the source I cannot find at hand — was that it is important in science to be out of phase. You can be ahead of the curve of fashion or possibly, better still, be behind it. But stay out of phase. So, no apologies for being behind the curve on these ones which I have just come across.

Sydney Brenner remarked in 2008, “We don’t have to look for a model organism anymore. Because we are the model organisms.”

Sydney Brenner has said that systems biology is “low input, high throughput, no output” biology.

Quoted in The science and medicine of human immunology | Science

Image source and credits via WikiCommons

“At a certain age, there is only one subject.”

The fuller quote is:

She [Sigrid Nunez] was already well into her next novel by the time “The Friend” climbed bestseller lists. “What Are You Going Through”, out now, is not exactly a sequel, she says, but “these books belong together.” Both are “preoccupied with death”. And with ageing: “At a certain age, there is only one subject.”

The night must be drawing in.

The sudden success of Sigrid Nunez. Economist.

Words, dear boy…

Two quotes from Fintan O’Toole in the NYRB. The first, quoting Saki (H H Munro).

The people of Crete unfortunately make more history than they can consume locally.

The second, his own.

In this demented solipsism, the entire American past is shrink-fitted so that it hugs Trumps own ample figure, cleaving both to his greatness and his victimhood as an object of unparalleled persecution.

With more than one bound he was free

by reestheskin on 26/09/2020

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No certification, here.

As miserable in the job as he was smart, autodidactic, and headstrong, he managed to escape a soul-destroying future trapped behind a shop on the counter by persuading his Latin tutor to hire him as a student teacher, then convincing his mother to pay off the indenture and set him free.

The Future was His, Maya Jasanoff in the NYRB, reviewing Inventing Tomorrow: H.G. Wells and the Twentieth Century by Sarah Cole.

Skin trade

by reestheskin on 03/09/2020

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No, not that sort of skin trade, but inking1. This is from an article in the Economist, and sadly, although I cannot show them here, the images are remarkable. But some nice word lines too about the acquisition of high level skills and apprenticeship — vocation, if you will.

In China several prominent tattooists are taking a different approach. They have set up schools. In Wu Shang’s studio four students are hunched over flat pieces of silicon rubber—mimicking skin, just like his model arms—trying to recreate images that they first painted on paper.

That might seem inoffensive, but it goes against a widespread but unwritten code. Masters may take an apprentice or two under their wings, but only if they are truly committed to the craft. The idea that anyone can just show up, pay a tuition fee and after a few months apply ink to skin leaves purists aghast. Even in China some are critical. Mr Shen, the neo-traditionalist, says that he honed his technique over many years by wielding needles by hand. “You need to learn about the relationship between skin and needle. You can’t just get that overnight in school,” he says.

Many university staff would echo these thoughts.

The new ink masters – China makes its mark on the world of tattoos | Books & arts | The Economist

  1. Image of traditional Samoan tattoo via WikiP. Attribution CloudSurfer CC BY 3.0

Education is…

Mr Handy says this gave him the opportunity to learn from his mistakes in private. He argues that “education is an experience understood in tranquillity. You look back and see where you went wrong.”

Looking back over his career, he believes that teaching and writing is all about creating the “Aha!” moment. That occurs when people realise that an idea the teacher or writer has advanced is both useful and something they already knew but had not articulated.

No Excel or TEF here. The plain language belies the depth of the insight.

Charles Handy, Reflections of a business guru – Bartleby

Everybody wants growth but..

“Everyone wants growth but no one wants change.”

Paul Romer

Production functions: Those middle of the day blues

Every one of us has learned how to send emails on Sunday night. But how many of us know how to go to a movie at 2pm on Mondays? You’ve unbalanced your life without balancing it with something else.

Ricardo Semler

Via Status-Q. All too true. And now there is rugby on TV in the middle of the day on a weekday…

Those qualified need not apply

From a letter in last week’s Economist from Andrew Carroll, commenting on the Economist’s own description of Clement Atlee

He “lacks the conspicuous attributes of a leader” but “has undeniable ability, judgment and integrity” (“Mr Attlee and Sir A. Sinclair”, November 30th 1935)

Now I know where we have been going wrong.

As a follow up to the previous entry

“Keep the company of those who seek the truth; run from those who have found it.”

Vaclav Havel, quoted by Randy Sullivan via the Economist

We should worry more about righteousness

I am no fan of Henry Kissinger (an easy statement to make), but the quote below says something worthy of careful consideration.

‘the most fundamental problem of politics… is not the control of wickedness but the limitation of righteousness’.

I am not certain where I came across the phrase so beware. If I had made it up I would be even happier.

No marks out of ten

by reestheskin on 11/08/2020

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Q: If you had to rate your satisfaction with your life so far, out of 10, what would you score?

A: I would be very dissatisfied with my life if it was ruled by marks out of 10.

Lovely answer. Interview with Jennifer Pike: My ambition is to continue fighting for the future of classical music

Dear boy, I’d rather see you in your coffin.

by reestheskin on 10/08/2020

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I thought the above quote was going to be from an exchange between James Hunt and Niki Lauda. But no, it was some advice from a mother to her son (Richard Seaman) on the choice of his bride.

At a party earlier that year he had met Erika Popp, the daughter of a director of BMW. When they decided to get married his mother disinherited him. Her final words to him were: ‘Dear boy, I would rather see you lying in your coffin than that you should contract this disastrous marriage.’

Seaman was dead six months later in a crash on the track so his mother did not have to wait long. Even the spectators got in the spirit of things:

During a race on the Pescara circuit in Italy in 1937, a driver crashed into a marker stone and collided with another car before spinning off into the crowd. Four spectators were killed at the scene, others had their legs severed and five died later from their injuries. ‘The race continued,’ Williams reports, ‘as races always did.’ After the 1955 Le Mans disaster, in which 83 people were killed by flying debris, crowd safety was vastly improved, but in Seaman’s day spectators died almost as often as drivers.

Now attitudes are different: even our attitude to the nuts and bolts:

The [F1]regulations cover everything from engine size to aerodynamic shape, and part of the game is to work out how much you can get away with while still obeying them. Some innovations are modest. Before it was banned in 2012, teams used helium rather than compressed air to power the guns used to remove wheel nuts during pit stops. The helium’s lower density made the guns spin faster, allowing them to get the nuts off fractionally quicker. The incremental gains add up. When the F1 championship began in the 1950s the average pit stop took 67 seconds. Nowadays a decent one takes around two seconds.

The power of incremental change.

Jon Day · Dear boy, I’d rather see you in your coffin: Paid to Race · LRB 16 July 2020

The Great Unwashed

by reestheskin on 07/08/2020

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Two letters in the LRB on the now settled status of student hygiene.

The first from Otto Saumarez Smith:

Keith Thomas reminisces about his introduction to regular baths when at Oxford in the 1950s (LRB, 16 July). The architectural historian Gavin Stamp once told me that when George Frederick Bodley came to build new student accommodation at King’s College, Cambridge in 1888, he asked the fellows whether he should include a bathroom, but was told not to be ridiculous: as terms were only eight weeks long the undergraduates could bathe after they got home.

The second from Richard J Evans, in conversation with a porter at an Oxford college:

‘What’s the main difference between the old days and now?’ I once asked him. ‘Well, sir,’ he replied, after some thought, ‘in the old days the young gentlemen used to change their shirt every day and take a bath once a week. Nowadays they take a bath every day and change their shirt once a week.’ It was clear from the shaking of his head that he did not regard this as an improvement.

I was delighted to get out of university halls, to the luxury of a toilet and bathroom only shared with five fellow students (and their occasional guests). The downsides included rodents, and ice on the inside of the bathroom windows. My memory is that the rent in 1977 was £1.85 per person for a salubrious🤣 central location on the Westgate road (opposite the Harley-Davidson shop, and a house of dubious repute). I was in hospital for a few weeks (as a patient) during this period and, at discharge, my father picked me up at the hospital, and we drove to the house so that I could collect some more clothes before heading back to my parents home;  he knew better than to come in.