{"id":40938,"date":"2017-12-21T13:31:29","date_gmt":"2017-12-21T12:31:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40938"},"modified":"2017-12-21T13:32:56","modified_gmt":"2017-12-21T12:32:56","slug":"andrew-dana-hudson-mend-and-make-do","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/21\/andrew-dana-hudson-mend-and-make-do\/","title":{"rendered":"Andrew Dana Hudson: Mend and Make Do"},"content":{"rendered":"

\u201cAlright, Alfie, spit in the cup then, lad.\u201d<\/span><\/p>\n

Poppy was good at this, I could tell. The boy hocked up a rope of saliva, which she caught deftly in her tin. Then she took Alfie by the chin and turned his head about, shining her light in his eyes and ears and down his throat. Once she let him go, he plopped back in his seat and returned to shovelling spoonfuls of honey into his tea.<\/span><\/p>\n

\u201cAll\u2019s well, Millie?\u201d Poppy asked the mother, who nodded, eyes on her sewing.<\/span><\/p>\n

\u201cHow\u2019s everyone breathing?\u201d<\/span><\/p>\n

\u201cOh last week was bad, same as for everyone,\u201d Millie said. She coughed, then looked at her son. \u201c\u2018Cept this one. Swear, if he wasn\u2019t so determined to rot his teeth out, I\u2019d think I\u2019d actually raised a healthy boy.\u201d<\/span><\/p>\n

\u201cSaw the garden. That new chard comes up well, yeah? Any problems with yer stool this week?\u201d<\/span><\/p>\n

\u201cNo, miss, got it right by the door for you.\u201d Millie tilted her head at the sample thermos.<\/span><\/p>\n

\u201cRight. Last thing then.\u201d Poppy reluctantly gave me my cue.<\/span><\/p>\n

\u201cThis\u2019ll sting, Alfie,\u201d I said, \u201cbut keep your head and I\u2019ll give you a gummy, fair?\u201d I pulled a sharp from my case and stuck it into the boy\u2019s skinny bicep to draw a vial of blood. Poppy fastidiously cleaned and sealed the puncture.<\/span><\/p>\n

Outside Poppy rounded on me. \u201cThat needle better be proper sterile. I get enough infections from boys scraping up in St. John\u2019s skate park, which they won\u2019t tear down. I won\u2019t have you poking dirty holes in them as well.\u201d<\/span><\/p>\n

\u201cNeedles are sealed at the fabber in Swindon, same ones we use at the Trust labs,\u201d I said.<\/span><\/p>\n

This seemed to mollify her, but she still had to get the last word. \u201cRight, well my uncle knows the MP from Drownham, so don\u2019t think I can\u2019t get at yer bosses if yer wrong.\u201d<\/span><\/p>\n

I pursed my lips, and we moved on to the next house on Witchford Road. Down the way I could see where pavement gave way to pontoon, as the road slipped into the brown waters of the flood-fens. You could still see the occasional rooftop poking out of the low sea, and in the distance stood the windmills they\u2019d put up after The Wash levees broke.<\/span><\/p>\n

I didn\u2019t much like the Isle of Ely. It smelled of salt, marsh rot and the dead jellyfish that washed ashore. Hard to believe anything grew here in the sea-tainted soil, even Millie\u2019s chard. The whole place felt like it was just one good drenching away from going totally under.<\/span><\/p>\n

But the Eelies were another matter. There was a kettle on for us at every door on Poppy\u2019s rounds, and they talked excitedly about a scheme to use the flood-fens for eel farming, as they had 500 years ago. The Eelies had the strange grace of people who really had kept calm and carried on, even as rising seas had cut them off from the mainland, made their homes worthless, spilled sewage into their streets. The island\u2019s microbiome was still recovering from that last catastrophe, which I knew made Poppy\u2019s job much harder than that of the average NHS doc.<\/span><\/p>\n

\u201cToo much oil in those fry ups you like, George. I\u2019m switching you to oats this week,\u201d she said to one patient. \u201cNevermind what yer mum did, yer not to skin those carrots. I don\u2019t even want you washing them, you hear?\u201d she told another. And, \u201cfor God\u2019s sake, Neera, get out in the sun more. Yer pale as a ghost. I\u2019ll not waste vitamin D on someone with a porch that faces south.\u201d<\/span><\/p>\n

Cultivating healthy guts wasn\u2019t glamourous medicine. It meant an endless tedium of sampling and culturing, then cajoling people to make finicky dietary changes based on the results. Even with modern probiotics, it was more art than science.<\/span><\/p>\n

I told Poppy as much as I shadowed her rounds. I meant to flatter her, but of course I bungled it, and she took offense.<\/span><\/p>\n

\u201cYou think I\u2019m just balancing humours, eh? \u2018Take a sniff of this mercury, mate, that\u2019ll mend you right up.\u2019 That\u2019s what you think I do?\u201d<\/span><\/p>\n

\u201cNot at all!\u201d I protested. \u201cI think your work is really complicated, and, and\u2026 difficult.\u201d<\/span><\/p>\n

\u201cBloody right it is. And it\u2019s not made easier by you slowing me down. If the Trust wanted to help, they wouldn\u2019t saddle us with these nutty research schemes. They\u2019d hire more of me or send someone to rightsize our energy rations. I got families in the commons that are drinking dirty water in the winter. The new primary school lessons are all on video, but the algorithm doesn\u2019t take that into account, so they skimp on filtering to save juice for their screens.\u201d<\/span><\/p>\n

This was a common complaint, but hardly my department. I was only on Ely to do an environmental antibody survey, and I didn\u2019t know a thing about the clunky bureaucracy that administered the power grid, which had nothing to do with the National Trust. So I just said I\u2019d pass her comments on and did my best to avoid raising Poppy\u2019s ire for the rest of the day.<\/span><\/p>\n

Come sundown we each racked up our samples and peddled up the hill and across town to the Princess of Wales complex, where I\u2019d claimed some workspace. It was a grim place, even for Ely. Used to be a hospital, they told me, before antibiotic resistance made penning all the sick up together an untenable system \u2013 if tenable it ever was. Post-frailty, NHS had nominally split the complex with the Trust, which had wanted an outpost from which to study biomic effects of sea-level rise. \u2018Course like everything that project had taken an extra decade to get off the ground. By the time I arrived, Poppy and her crew had turned the empty buildings into their unofficial fermentation facility. They weren\u2019t happy to have me elbowing in on their squatter\u2019s rights.<\/span><\/p>\n

Still I\u2019d made them clear some shelves for me in the groundfridge \u2013 where I now deposited most of my samples \u2013 and a desk to set up my lab. A bee buzzed by my ear as I sat down. Even in a place that smelled as bad as Ely, the NHS was strict about its open air policies.<\/span><\/p>\n

I pulled a drop of blood (Alfie\u2019s), and asked the lab to put it through immune response paces overnight. I did the same with four other samples. There wasn\u2019t much point, since we\u2019d need reams more data to learn anything meaningful, but I hadn\u2019t slogged about with Poppy all day to not at least take a peek.<\/span><\/p>\n

Next morning Poppy picked me up from my lodgings, an ancient bed and breakfast by the even-more-ancient Ely Cathedral. We cycled up Prickwillow Road to the public towers overlooking the Roswell Pits. They were gorgeous granite buildings clad in iridescent solar panels, in the utopian style of the \u201830s \u2013 as our first patient was keen to tell me.<\/span><\/p>\n

\u201cLet the seas keep rising, I say,\u201d the nonagenarian exclaimed, waving his arms while Poppy tried to take his pulse. \u201cThese towers are rated to last 600 years!\u201d <\/span><\/p>\n

\u201cYou tell her, Fred,\u201d Poppy said, rolling her eyes. \u201cDon\u2019t build \u2018em like they used to, eh?\u201d<\/span><\/p>\n

\u201cIndeed no,\u201d Fred primmed. \u201cThey build them well enough now, but without ambition or grandiosity. Not like when I was your age. Of course, we had Jezza then\u2026\u201d<\/span><\/p>\n

He looked through me then, to distant days, and seemed to slump a little.<\/span><\/p>\n

\u201cYou going to the mingler, Fred?\u201d I asked, hoping to raise his spirits. I\u2019d heard these NHS-sponsored socials were big on Ely. Ostensibly there were health benefits to hanging around people with different and complementary immune fauna, but throwing exclusive parties also helped motivate the Eelies to give the NHS their faeces every week.<\/span><\/p>\n

\u201cHe better be,\u201d Poppy said. \u201cWe finalize invites based on this week\u2019s cultures, but I can tell you right now he\u2019ll be on the list. Our Fred has skipped the last four!\u201d<\/span><\/p>\n

\u201cThe minglers just aren\u2019t for me, dear.\u201d Fred looked guilty, and Poppy harrumphed.<\/span><\/p>\n

\u201cIt\u2019s in the cathedral, right?\u201d I asked. \u201cI\u2019m new in town and would love to learn about the building. Maybe you would be my date?\u201d<\/span><\/p>\n

He perked up. \u201cOur cathedral does have a fascinating history. I suppose I could\u2026\u201d<\/span><\/p>\n

When we finished securing Fred\u2019s word he would show at the mingler, Poppy looked me over, as if for the first time. She didn\u2019t say anything, but she refrained from snapping at me the rest of the rounds. At day\u2019s end, when we had racked up our cases of blood, spit and stool, Poppy stopped me before I turned my bicycle north.<\/span><\/p>\n

\u201cNot that way,\u201d she said. \u201cPub.\u201d<\/span><\/p>\n

The Cutter wasn\u2019t the oldest pub in town, but it had that defiant quality I admired in the Eelies. Propped up on stilts right at the edge of where the River Great Ouse used to be, it was already packed with boat people drifted in from the flood-fens, who enjoyed the now-ironic nautical theme. Poppy knew everyone, and glad-handed her way to the bar.<\/span><\/p>\n

\u201cOkay, tell me about yer project,\u201d she said, setting two pints of sour komby down on our booth table.<\/span><\/p>\n

\u201cWell, I don\u2019t know if you read the wikis\u2026\u201d Poppy glared. I started over.<\/span><\/p>\n

\u201cThey\u2019ve \u2013 we\u2019ve found a new class of pseudo-phytoncides that have complex immune effects. We knew plants produced them to fight off predatory organisms, but we now think they flow pretty dynamically through the biome. So my tests are part of an effort to get a bead on that, see how it links with the asthma question.\u201d<\/span><\/p>\n

\u201c\u2018The asthma question\u2019?\u201d Poppy seemed surprised.<\/span><\/p>\n

\u201cThink about it. Smog is gone. Those Californian drones finally got Europe\u2019s wildfires under control. By some metrics, air is cleaner than it\u2019s been in centuries. But respiratory illness is still on the rise. Why?\u201d<\/span><\/p>\n

\u201cMore heat. Less oxygen. More pollen \u2018cause of shorter winters. Dust blowing up from the equator. General frailty. It\u2019s obvious\u2026\u201d Poppy stopped then. \u201cIsn\u2019t it?\u201d<\/span><\/p>\n

\u201cWe\u2019re not so sure.\u201d I swirled my kombucha. It was strong stuff. \u201cThere\u2019s a lot of lumpiness to the data. Countries further south or in The Thaw, where the weather has changed the most, don\u2019t show the same impacts as places like Ely. In fact, it\u2019s worse here.\u201d<\/span><\/p>\n

I saw Poppy stiffen, so I held up my hand. \u201cNothing to do with your work. That\u2019s a trend we see all over the temperate New Coasts. So we have to look at deeper effects of searise, particularly on flora. Hence Ely.\u201d<\/span><\/p>\n

Poppy considered, gulping her pint. She burped. \u201cSure this isn\u2019t some goose chase to distract from the Trust\u2019s overly-optimistic drawdown projections?\u201d<\/span><\/p>\n

I didn\u2019t want to get sidetracked by politics, so I dodged the question. \u201cYou know as well as anyone how HVAC and antibiotics gave medicine some real bad ideas about how the body worked. Every few decades we discover a new layer of how our health connects to bigger systems. Germ theory. Allergens. Gut and mouth fauna. Japanese tree bathing. It\u2019s pointing to something. An ecological theory of health, maybe. You spend all day practically prescribing dirt, is it that much of a leap to take an interest in what grows in that dirt as well?\u201d I threw back my drink and, for the first time, glared back at Poppy. \u201cAnyway, that\u2019s my project.\u201d<\/span><\/p>\n

Poppy grinned then, and my jaw unclenched. \u201cThanks much for that rousing speech, missy. I surrender. You good-cop me with the Freds out there, I won\u2019t give you trouble.\u201d<\/span><\/p>\n

\u201cDeal,\u201d I said.<\/span><\/p>\n

When we got back to Princess of Wales, I showed Poppy what my lab had come up with. The projector needed to map the stained wall, and I had to shoo away a couple bees before it would take.<\/span><\/p>\n

\u201cWhat am I looking at?\u201d She squinted. \u201cIs this an LDL\/HDL sorta thing?\u201d<\/span><\/p>\n

\u201cIt\u2019s more subtle than that,\u201d I said, reformatting the visualization to something less technical. \u201cOur current theory is that it\u2019s about balancing four, maybe five factors, but there are multiple nodes of \u2018good\u2019 balance all across the chart space. Bit like Lagrange points, if you follow the counter-Kessler satellite cleanup.\u201d<\/span><\/p>\n

\u201cHow do you do the balancing?\u201d Poppy poked the data into a different shape.<\/span><\/p>\n

\u201cThat\u2019s what we want to find out. You can\u2019t just do supplements \u2013 the pathways of exposure matter a lot. And not just to the right flora, but to flora undergoing the right immune responses of their own. So soil salinity, pollinator shifts, diseases, floods sloshing the microbiome \u2013 all these can throw systems off-kilter for years.\u201d<\/span><\/p>\n

Poppy nodded. I was gratified she was taking an interest. The Trust worried that NHS rank-and-file would be resistant to findings that might radically expand their scope of work \u2013 or displace their authority.<\/span><\/p>\n

\u201cWho\u2019s this, then?\u201d Poppy pointed at a lonely dot and swiped its dataset into the foreground.<\/span><\/p>\n

\u201cThat\u2019s,\u201d I checked, \u201cAlfie, from Witchford Road \u2013 \u201d I stopped. I hadn\u2019t yet looked at the results. Alfie\u2019s chart was good. Really good. I pulled up the other four samples.<\/span><\/p>\n

They huddled together in a dank corner of the graph, like most of the flood-fens predictions I\u2019d seen. \u201cPoppy, is Alfie special?\u201d<\/span><\/p>\n

\u201cMillie\u2019s boy? He\u2019s a bit dim, honestly. Always skinning his knees and picking up jellies at the shore. Had to nurse him through some bad infections when he was a toddler. Quieted down lately, though, and he\u2019s been healthy as a house. I figured all that running around earned him a strong set of lungs. But sounds like you think there\u2019s more to it\u2026\u201d<\/span><\/p>\n

Poppy let me requisition a few NHS labs, and I dropped out all the samples from my first two days to run overnight. It was tedious work, and I was spent and hungry when I pedalled back into town. I\u2019d missed dinner, but the landlord had left me a covered bowl of soup. I ate it cold \u2013 exhausted, but giddy to be in Poppy\u2019s good graces.<\/span><\/p>\n

Next morning I went back to the compound early. Sure enough, compared to other Eelies, Alfie was an outlier. When Poppy arrived, I told her I wanted to return to Witchford Road. She grumbled at being thrown off her rounds, but I knew she was intrigued.<\/span><\/p>\n

Millie was surprised to see us so early, and so off schedule. \u201cNothing to fret, dear,\u201d Poppy said, \u201cJust want a chat with yer lad.\u201d<\/span><\/p>\n

Alfie plodded into the kitchen, and Millie set about fixing breakfast \u2013 cricket toast, which Alfie smeared with great gobs of honey. We spent the next hour gently interrogating the boy about where he played, if he ate anything unusual. I took notes, but nothing stood out. Defeated, we trudged back to Princess of Wales to pore over the data some more.<\/span><\/p>\n

\u201cIf these phyto-things are so important, why haven\u2019t we heard of them before?\u201d Poppy complained.<\/span><\/p>\n

\u201cComplex systems are hard,\u201d I offered. \u201cThey usually take many looks by many sets of eyes to figure out, and most of the time we have no way of knowing if our understanding is complete. It took centuries for biologists to figure out that lichens were three-player symbioses. Now we\u2019re learning that most organisms are really ecosystems themselves. Guts and brains connect to multiple communities of bacteria. Plants share microbiota with soil and pollinators \u2013 \u201d<\/span><\/p>\n

A bee buzzed in my face, and I started. I felt Poppy\u2019s eyes on me, then on the desk where the bee had set down.<\/span><\/p>\n

\u201cHow do pollinators feel about your phyto-things?\u201d she asked.<\/span><\/p>\n

Millie was doubly surprised to see us back again, but she hustled us in and opened up the pantry where the family kept liter-sized jars of the golden goo.<\/span><\/p>\n

\u201cBoys like their sweets, but never seen one take to honey like my Alfie,\u201d Millie said. \u201cThe cathedral apiarist helped us set up a hive in the backyard.\u201d<\/span><\/p>\n

The apiarist turned out to be my new boyfriend \u2013 elderly Fred. We found him on the cathedral\u2019s east lawn, bossing around a harried twenty-something enbie.<\/span><\/p>\n

\u201cNow try to get the whole swarm in the bucket in two or three good shakes,\u201d Fred shouted, as his assistant donned a beekeeper\u2019s hood. We watched them loose the mass of bees from a tree branch and deposit it into a cylindrical hive.<\/span><\/p>\n

\u201cOf course I know Alfie,\u201d Fred told us. \u201cSent Millie a jar of my best when he was sick a few years ago, right when the bees returned post-flood. He\u2019s been coming by ever since. Expect he\u2019ll make a good helper to Jude there, soon enough. We\u2019ll need the hands with the comeback these chaps have been making.\u201d<\/span><\/p>\n

\u201cFred, I could kiss you!\u201d Poppy said. I tried not to be jealous.<\/span><\/p>\n

It took a few days to test Alfie\u2019s bees, but the correlation was enough to bring to the Trust. Some health benefits of hyperlocal honey were known, but it might take years to find out why the honey had such a profound impact on Alfie\u2019s pseudo-phytoncide balances. Was it sheer volume? Proximity? Or perhaps something about the timing \u2013 an inflection in his immune system from exposure during his years of sickness.<\/span><\/p>\n

Poppy wasn\u2019t going to wait to learn for sure. She wanted to be ready to get hives for every house on the isle. She rallied the NHS docs to bring the compound bees under proper care. By the time I left Ely, they were building an apiary.<\/span><\/p>\n

\u201cWe\u2019ve got the works for fermentation,\u201d Poppy said, walking me to the Cambridge ferry. It was raining, and we huddled close under an umbrella. \u201cMight make some mead. The Cutter would serve it, I figure.\u201d<\/span><\/p>\n

\u201cThere\u2019ll be more to it than just honey,\u201d I said. \u201cIt\u2019s the conditions of the flora too, and the whole ecosystem.\u201d<\/span><\/p>\n

\u201cSure, I know that. I\u2019ll plant and weed this whole island if I have to. My Eelies been through enough. They deserve at least to live healthy.\u201d<\/span><\/p>\n

Poppy pecked me on the cheek as I stepped onto the ferry. Then she turned and walked back through the rain, towards her fragile garden.<\/span><\/p>\n

Andrew Dana Hudson<\/strong> is a speculative fiction writer living in Phoenix, Arizona, where he studies sustainability at Arizona State University. Previously he worked for the Center for Care Innovations in Oakland, California and as a community journalist in St. Louis, Missouri and in Sikkim, India. Andrew seeks to tell stories about what a sustainable world might look like, and how we might get there if we make good choices.<\/em><\/p>\n

This story was shortlisted for Writing the Future, the world’s largest health short story prize, which aims to bring together those working in health and healthcare with creative writers to think differently about the future and its implications for today. It’s run by Kaleidoscope<\/a>, a social enterprise set up to bring people together to improve health and care.<\/em><\/p>\n

Read about the judging process in this BMJ Opinion piece<\/a> by Richard Smith, one of the judges.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cAlright, Alfie, spit in the cup then, lad.\u201d Poppy was good at this, I could tell. The boy hocked up a rope of saliva, which she caught deftly in her […]<\/p>\n

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