Being mortal – Atul Gawande

Just finished reading ‘Being Mortal’.  I guess in your 50s ‘being mortal’ seems to have some more immediate relevance than in your 20s!  Atul Gawande’s book is an excellent, thought provoking read.

Only learn through experience

Much of the book focuses on the options available as people get older or as their health deteriorates.  And for all of us it is difficult to anticipate how we may feel about these developments until we experience them on a personal level – most often firstly in context of relatives and friends and then, more directly, in person.

Gawande is a medic and a prolific writer.  And this is not the first of his books I have read.  He is keenly aware, as a doctor, of the approach taken by medics: analyse the symtoms and look to implement a fix.  But he shares his concerns about where this approach leads in the case of very ill or very old people.  He is not promoting euthanasia.  And he writes from a very personal perspective – patients he has looked after and his own father’s illness, treatments and death.

Quality of mortal life = independence?

Being Mortal asks questions about later life – how we all seek to maintain quality of life and how this requires the ability to think and act independently.  Right now as I write this I am contemplating whether I will watch a football match, watch the Open golf championship, go for a walk, go to the cinema, what I will cook for dinner, etc.  and all of these options are available to me (and I take this for granted).  But if illness means that I am dependent on others then I lose much of this independence and quality of life.  And in this context re reviews options around assisted living and nursing homes.  His comparison of living at home (supported by family), assisted living and nursing home living provides lots of food for thought.  And at this stage in my life I would have little appetite for the third option.  But statistically this seems where we are all headed.  So Being Mortal is suggesting we have not yet got this right.
The examples Gawande includes around complex, expensive, intrusive, limited benefit treatments provided to patients in the throes of advanced illnesses are challenging – for medics, family relatives of ill persons and the persons themselves – not to mind the insurers and health providers.  We are well familiar with the analyses of grater life expectancy, older populations, more instances of chronic illnesses, more options for treatment of same.  But they need to be understood in context of quality of life and independence.

I learned a lot about palliative care and its role through reading the detail of some of the examples in the book.  And its a much more broader science and engagement than I had appreciated.  I am not sure how well it is really understood.

All in all an excellent book – and good material for anyone.


Greystones to Bray or What can I do for you?

Yesterday morning (Sunday) I finally completed the Greystones to Bray cliff walk.  Drove to Greystones, parked there and walked back to Bray. Beautiful, cliff side walk -about 8km from centre of Greystones back up to the DART station in Bray.  Comfortable walk of approx. 90 minutes – no difficult climbs and lots of great views out to sea and up and down the East coast.

Because of some of the ongoing building work in Greystones it was not absolutely apparent where best to access the cliff walk – but one of the very friendly locals quickly sorted this out for me.  The path itself was quite muddy and wet under foot – not an issue so long as you were wearing reasonable walking shoes or runners.  And the view back to Greystones from the cliff walk was excellent.

Have now been living on south side of Dublin for over 20 years – and hard to believe had never done this walk.  And with the option to drive one way, walk the other and then take the DART back to collect the car – it all works very well.

Very much looking forward to doing the round trip later in the year – on a sunny, clear day, rather than yesterday’s overcast, damp day.

The DART

And the only hitch: the DART from Bray to Greystones seems to only run once per hour in a Sunday (at this time of year).  And no one seems to be on hand at the station to tell you to take the Rosslare train (sometimes) – because it stops in Greystones and there is no DART for another hour.  But as the helpful assistant at the DART stations said ‘what do you want me to do?;  All I could say was ‘I don’t want you to do anything.’

If you have not yet done the walk – get out and enjoy it.  And when you get back to Greystones lots of options for a coffee or something more substantial.

Day 5 M2M

Sitting here with rest of the gang in Innishowen Gateway Hotel in Buncrana, having had sandwiches and soup.

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About to head off at 1.30 for the last 40km to Main Head.

Joined by Prof. Hill for the last leg. Great sense of achievement for the group.

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And the beautiful weather has lasted the 5 days.

Thank you to all my M2M sponsors

Just wanted to use this post to thank all my sponsors for this week’s Mizen to Malin cycle..  Looks like we will be blessed with great weather – wish we were out cycling this morning!

A particular thanks to all my colleagues at Hermitage Medical Clinic who held a special breakfast this morning and have been very generous in their sponsorship and encouragement.

And, as always, for anyone else out there who would like to be a sponsor: my sponsorship page

Looking forward to loading up the bike tonight, packing the sun cream and off to the sunny south west (Mizen Head) with my fellow 51 cyclists at 5.30am tomorrow.

Mizen

 

 

Charity cycle: M2M: Mizen to Malin – Wed 1st June to Sunday 5th June

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Resting in Arklow
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M2M route for 2016

So, lots of training for M2M done since that spin in the rain on Christmas morning (when I still thought 25Km was a cycle).  And then the spins to Howth, to Rathnew, to the Sally Gap, to Arklow. Just three days now until we set out on our 690km venture from bottom of Ireland to top of Ireland (Mizen Head, Co. Cork to Malin Head, Co. Donegal), over 5 days (Wednesday 1st June to Sunday 5th June).

Our route

Looking forward to visiting Mizen, Killarney, Ennistymon, Ballina, Ballybofey and Malin – and lots of places in between.  And travelling with 51 fellow cyclists.

Breast Cancer Ireland

This cycle is in aid of Breast Cancer Ireland and Kilmacud Crokes Development Fund.  We expect to raise in excess of €100,000 to be split between both: that is a minimum of €50,000 for Breast Cancer Ireland. If you have not already supported us please contribute on-line by logging in to my M2M mycharity page – all contributions gratefully received.

Hoping to post each day from the road – perhaps with some gopro snippets.

 

 

The Book Thief by Markus Zuzak

Several themes running through the book – Liesel and her foster parents, poverty in world war two Germany, terror visited on the Jewish population, tragedy of war for families as they lose loved ones, beauty of books and learning to read (as the book thief accumulates books).

Liesel, a young German girl, is fostered out to a couple living just outside Munich. Liesel quickly builds a relationship with the father (Hans) and, over a longer period of time, also with the mother (Rosa). War time Germany and they live on the breadline. Liesel also develops a number of close friendships with other children in the neighbourhood.

Hans Hubermann teaches Liesel to read and over the years she steals several books (Hubermann also buys her a couple of books) which form a background to the story. Football in the street is one of the social outlets – and excels as a footballer.

The ugly advance of Nazism is to the fore. The Hubermanns shelter a Jew (Max) – and Zuzak describes beautifully the prison like existence of Max living in the basement of the Hubermann house. One of the tenser scenes describes the local Nazis coming to inspect the basement for its potential use as an air raid shelter.

Dachau is nearby and marches of Jewish prisoners through the town become a regular event. And Max eventually having left the Huvbermanns (to spare them the threat), ends up in Dachau.

Hans Hubermann is an interesting character. He has resisted all invitations to join up with the Nazis – and falls out with his son. Eventually he is required to join the army and the war.

Liesel develops a close (platonic) relationship with local boy Rudi. They play football in the street, they rob fruit from orchards and generally become best of friends.

The book is narrated by Death – as he gathers up the souls. At times Death tells us what will happen – almost to underline the futility of much of what humans spend their times worrying about.

In many respects the book took me back to Anne Frank and her hidden existence in Amsterdam. I listened to the book (via audible.co.uk) – found it absorbing, well paced and, in general, I thought it provided a different and worthwhile perspective on war torn Germany (and the struggle of ordinary people). Would definitely be looking to read another Zuzak book.

[schema type=”book” url=”http://en.wikipedia.org/wiki/The_Book_Thief” name=”The Book Thief” description=”Story set in Germany during second world war.” author=”Markus Zuzak” publisher=”Picador” isbn=”978-0-375-84220-7″ ebook=”yes” paperback=”yes” ]

Is rugby making progress?

Last Sunday I was privileged to attend the Ireland New Zealand (All Blacks) rugby international at the Aviva Stadium. Fantastic match, wonderful atmosphere, great standard and Ireland were pipped at the last minute by the World Champions.  One of the best sporting events I have attended – without question. And the occasion showed the Aviva off to its best – and no one could question the ‘atmosphere’ at the stadium – it was ‘electric’.

And there have been several fantastic days with Leinster, Munster and Ulster over the last number of years.

But then this morning I read about Blackrock Rugby Club and its problems.  And these are compared and contrasted with the growth and success of Cuala GAA (and reference to my own Club Kilmacud Crokes).

I think back to my playing rugby in Belvedere College, Trinity College and Old Belvedere.  I played schools rugby and, afterwards, junior rugby with TCD and OBRFC.  Great years – and many matches against Blackrock (not against the stars – Slattery, Duggan, etc., but against fellow junior rugby players, followed by lots of craic afterwards in Stradbrook, the Pav or Anglesea Road). I have fantastic memories of junior club rugby and the friendships formed over many years.  And when I played the guys who played on the first XV (or even at representative level) were just better than me.  But generally we felt part of the same organisation, sport, club.

Now my kids play football, camogie and hurling with Kilmacud Crokes – another set of friendships for them and for me.  Lots of the same type of endeavour – coaching, fundraising, àdmin, etc. I thought rugby was thriving also – with huge numbers playing mini rugby.  But I wonder.

Cuala and Crokes are examples of two clubs bulging at the seams – with massive intake of young boys and girls each year.  They are both looking for new and upgraded facilities.  There is huge demand for mid week, flood-lit training facilities – in order to enable teams to train through late autumn, winter and early spring.  There are only so many slots available between, say, 6.30 and 9.30 – Monday to Friday.  And during the winter all-weather or weather-proof pitches are critical to managing the logistics associated with bad weather.

And the current levels of growth are spurred on by Dublin’s current levels of achievement in Men’s senior football and hurling.  Significant growth in numbers of girls playing football and camogie is also driving demand for facilities – Ladies Football being one of the great success stories of the last 10/15 years.

Rugby has all the required success stories – Ulster, Munster and Leinster.  It has the stars – Brian O’Driscoll being the outstanding one.  It has the tradition of Schools Cup rugby.  Mini rugby and tag rugby have been great successes.  So what’s the problem – or is there one?

Om first examination the Dublin football team removes Club players from the fold in much the same way that Leinster removes players from the Club scene.  In GAA circles postponement of Club Championship matches until the county players return is a constant source of debate/ argument. But there is a difference – the GAA players return, they do not have employment contracts with Dublin and at all times remain part of the club.  Presumably there must be mixed emotions in a rugby club as they lose someone to the professional game – to return when?  Nowadays much of the top talent skips the club scene – joining elite squads from schools rugby or via third level scholarships.

I have no issue with professional sport.  In rugby this is what is producing the excitement (and the standard) of the Heineken Cup etc.  But how to maintain and sustain club rugby? This does not seem to have been resolved.  When Cuala and Kilmacud look to develop new facilities – they will first look to their members and their communities to assist with fundraising – but I have no doubt that the GAA itself will support these initiatives – the GAA recognises that development in the community, at club level, player development (at all levels) is the future of the organisation.  I would expect the IRFU to be in the same position – but I wonder whether it is.  It’s not a question about the merits of paying players. Presumably professional rugby should be capable of generating much greater TV revenues – given international coverage.  But it may be a question of looking to divert greater percentages of the cake to supporting and sustaining the amateur organisation that is club rugby.

If professional rugby is to be fed by the schools then does it need club rugby?  I think this is the nub of the question.  In spite of all the words used the reality is that club rugby is effectively in competition with professional rugby.  The Clubs play a role at mini rugby level and in offering playing opportunities to players not attending rugby playing schools.  But ultimately the professional sides are happy to talent spot and recruit at schools level (or via sponsored contacts at University level).

I have great memories of playing adult sport – rugby, cricket, hockey, golf (ongoing), indoor soccer. Sport is great for kids – for any number of reasons.  But I would be very keen to see more adults continue to play after school.  If rugby or GAA finds itself struggling on this front then this needs to be addressed – we need more people playing (whatever sport they choose) for longer.

Right now I wonder whether rugby is getting it right – in terms of the balance between Schools, Club and professional sides.  As a game it offers so much – it still accommodates people of different physical attributes more effectively than many other sports.

Perhaps ultimately amateur rugby will have to establish itself as a separate organisation – with its own objectives.  We have professional and amateur golf – and it seems to work.  Rugby is a great game – perhaps amateur rugby needs to find itself and reestablish its attractiveness and its own energy.  There may be new opportunities going forward for greater cooperation between clubs and schools – on the basis that schools may only have a limited appetite for sending their pupils into professional sport.

I am delighted to see Cuala, our local GAA rivals, expanding and developing their facilities.  I would also like to see Blackrock expanding and thriving (although obviously less so than Old Belvedere, given my own allegiances!).  And more facilities for all other sports – basketball, soccess, hockey, whatever.  For amateur rugby, I hope it finds a way forward quickly.  It may have to do this with less support than anticipated from the professional game.

 

 

 

 

 

 

 

 

 

The Hunger Games

Just finished listening to ‘The Hunger Games’ by Suzanne Collins (downloaded via www.audio.co.uk).  The book it reminded me of was WIlliam Golding’s ‘Lord of the Flies’.

I did not think it was nearly as good a book.  But I thought it created some of the same uneasiness/ tension about behaviour of young people in extraordinary situations.

I thought the plot was weak, the characterisation very limited and all in all found the book very disappointing – given the hype.  But perhaps that is the issue – the hype has taken over.  I look forward to watching the movie – but am not very optimistic.

 

 

 

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Football coaching sessions and meetings

Have been thinking recently about how we structure a one hour football coaching session as against we run many of our business meetings.

The coaching session – potentially 3 or 4 coaches working with 40 players.  In advance we agree session objectives and roles to be undertaken by each coach in the session.  Perhaps open with 15 mins of warm up and stretching, move to three or four bases – rotate the players through the bases and close out with two mini games – probably with rules/ scoring systems altered to emphasise a particular skill.

We seek to ensure that players enjoy the sessions, that skills are developed and/or tested, that we simulate match situations.  We promote fairness, safety, creativity.

For a meeting may have 4-8 participants, a pre circulated agenda and pre circulated minutes of previous meeting.  Probably also allocate one hour for the meeting.  We spend 15 mins working though previous minutes and action lists, leaving 45 minutes to address the items listed on the agenda.  In theory the meeting should be a lot easier – smaller numbers, advance communication of what will be happening.  But, in my experience the meetings are no where nearly as successful as the one hour coaching sessions.  Why?

Unfortunately many meetings are not focused – what is the objective (or are the objectives) of the meeting?  Why are we meeting?  Do we accomplish our objectives?

The football session will start on time and finish on time.  Players will be active and play many roles.  Players will be tested.  Players will learn.  Many meeting start late, run late, are dominated by longwinded contributions from those who ignore (possibly do not understand) the purpose of the meeting.  and there is no coach to ‘spot and fix’.

I think members of committees who meet on a regular basis have a lot to learn from well structured football (or other sport) coaching.  Meetings need to be born again in many orgnisations.