Commentating

Yesterday, I was given the job of reviewing the subtitle template for Martin Scorsese’s Director’s Commentary of the film Raging Bull. On the whole, I find commentaries extremely tiresome, usually because – or so one gets the impression – they’ve just stuck someone in a cubicle with a videotape of the film, pressed play, switched on a microphone and left them to it. This means that you end up with two hours of inane rambling, incomplete sentences, lost trains of thought and generally unsubtitlable material. Most companies pay extra to translators working on commentary subtitles, and you can see why: utterances such as “So yeah, like, we, you know, uh… didn't really know what was goin' on, man, but he just, like, made... Oh, what was his name again?" don’t exactly flow well into 38 different languages.

If there’s more than one person recording the commentary, you’ll get the added bonus of them constantly interrupting each other and neither recalling what the other is talking about. "Hey, remember that day? You don’t? You don’t remember that? Where were you, dude? It was...” And what they do eventually dredge up from the far recesses of history is hardly enlightening stuff: on the commentary for Wicker Park, Josh Hartnett can only come up with one recurrent remark on their time spent filming in Montréal: “Man, it was cold that day.” The three feet of snow on the ground and ice particles in the air would never have given us the slightest inkling.

Actors are usually obsessed with how bad their hair looked in 1973, and how much weight they’ve put on since. Natasha Henstridge in her commentary on Species can barely talk about anything else. Americans also feel the need to gush ingratiatingly about how marvellously everybody else on the film did their jobs. On the worst commentary I have thus far encountered, three 15-year-old girls squealing their way through their excruciatingly nauseating teen-flick Sleepover, just count how many times they shout “Oh, he/she/it was AWESOME!” A shot of vodka with each, and you just might survive to the end of the film without hurling your DVD player out of the window.

This upcoming DVD release of Raging Bull will have no less than three – yes, three - commentaries. One with the cast and crew, one with the “storytellers”, i.e. Jake La Motta and script writers Mardik Martin and Paul Schrader, and finally the Martin Scorsese commentary mentioned above. To be fair, the Raging Bull commentaries have been rather better constructed than most: they’ve asked specific people to talk about specific parts of the movie. However, the “Cast and Crew” commentary somewhat conspicuously lacks the big name that begins with Bob and ends with Niro. In fact, many of the actors who appear on it had very minor roles and were not big names when the film was made. “This is ridiculous – I came here for this”, mutters John Tarturro, who appears as an extra in only one scene. But there is some interesting stuff from the cameraman, music director and soundman mixed in. Nonetheless, given that there’s also an hour of documentary footage elsewhere on the DVD which more or less covers the same material, the whole thing quickly gets mightily repetitive.

One has to wonder how many people actually watch commentaries all the way through aside from die-hard fanatics, of which, to be fair, Raging Bull probably has a fair few. The trouble with the medium of DVD and all the possibilities it creates is that no one has yet come up with the construct “Less is more.” Just one well-made, insightful documentary, with carefully edited interviews with key members of the cast and crew is all you need to show how much (or little) effort went into creating the various aspects of the feature and to highlight the clever little touches that unwitting audiences might otherwise miss. If there were only one extra, people then might actually have time to watch it before taking the DVD back to Blockbusters, instead of leaving all the hours of labouring of (amongst others) the subtitle translators and their stressed-out project managers entirely unread.

REBECCA

Diagnosis Murder

So Kylie has breast cancer. Shocking though it is that one so young and so famous can succumb so readily to this terrible disease, she’s not the first person I’ve encountered to develop it so young. I suspect, though, that Kylie will be lucky. She’ll have top medical teams surrounding her, a large amount of money to pay for superlative treatment and keep a roof over her head without needing to work, which in turn will give her time to cope with the gruelling side effects of chemotherapy and recuperate properly. Her tumour, it seems, has also been detected early, which is the key factor in determining cancer survival.

Her prompt diagnosis is the exact antithesis of what my mother endured when she became ill last summer. Even now, almost a year on, my blood seethes when I think how long it took the Princess Alexandra Health Care trust to find out what was wrong with her. The unnecessary delays and chaotic lack of organisation of the various hospitals involved can only have contributed to her poor prognosis of treatment and untimely death.

Mum had been experiencing hypertension for about a year and the doctor had tried prescribing various pills and potions and had stopped Mum’s HRT in a bid to lower her blood pressure. Apart from various nasty side effects from the medication, little change had occurred. Through all this time Mum claimed to be feeling relatively well. But at the beginning of June 2004, Mum caught a nasty fluey cold which she had real trouble shaking off. A particularly stressful and busy term at work and the death of one of my brother’s closest school friends left her feeling both physically and emotionally drained. Her GP took a few blood tests but Mum’s continuing high blood pressure remained the doctor’s top priority. Mum was getting headaches which she attributed to blocked sinuses and migraines and the various blood pressure medications she was on. She also at this time had to have hepatitis and typhoid vaccinations for an upcoming trip to Peru. She cancelled them once because she was feeling so unwell but then reached the cut-off point for them to be effective before her departure date, so went ahead with her rescheduled appointment.

Her vision in her left eye then, towards the end of the month, developed a blind spot. About this time, she had an eye test which showed that her vision had changed substantially in the past few months and she required new glasses. The optician claimed that she could see nothing wrong in the eye but that the new prescription would hopefully help alleviate some of the headaches and visual disturbances. Within a week, Mum’s vision through the new glasses was blurred and the blind spot was growing. She returned to the optician, who did not know how to use her practice’s retinal imaging camera but who examined the eye again and said she could see nothing wrong and that the visual problems could not be coming from the eye itself. By now it was mid-July. I saw Mum for her birthday and a theatre trip to London and she was clearly so distressed that I told her she should go directly to the eye clinic at Harlow hospital so that they could have a look. I hoped she was fussing about nothing, but she clearly was not going to rest until someone took her seriously.

So on the following Monday morning, Mum, uncertain she could do this, telephoned the eye clinic who said that she could turn up as an emergency patient and didn’t need a referral. After a long wait and a few chaotic trips to-ing and fro-ing between the eye emergency department and the main accident and emergency (it seemed you couldn’t go to the eye clinic without registering at A&E first), they put some drops in her eyes to dilate them (which meant that Mum was then unable to drive home for several hours until the dilatory effect of the drops had worn off) and examined the interior of her eye. They quickly determined that there was something pressing on her retina but they couldn’t make out what. They ordered an emergency angiogram, scheduled for two days’ time. It was when I heard this news that it finally hit me that there was something really major wrong, if not potentially life-threatening. My immediate thought was that she had a brain tumour or a leaking blood vessel building up the pressure on the back of the retina. And at this point, the carer-dependent relationship we shared changed forever, as I suddenly had to face my own mother’s mortality.

Mum returned as arranged for the angiogram and was injected with yellow fluoracil dye, only to have an allergic reaction and have to be pumped full of antihistamines. She went yellow from top to toe. After the X-rays were taken, she was given an appointment to get the results when the eye consultant got back from holiday the following week. When she got home, she had received a letter from the doctor’s surgery asking her to telephone to make a non-urgent appointment to see the GP about her blood test results. Mum decided that enough was going on by now to treat non-urgent as urgent and so she saw the GP the next day, who told her that the tests had indicated liver malfunction. The GP prescribed more blood tests and a liver ultrasound. The second set of blood tests revealed such high levels of ferritin (iron) in Mum’s blood that they were off the scale, 50 times the normal amount. The GP had no clue as to what could be causing all these various symptoms, particularly when combined with the eye, so wrote an urgent referral to the local gastro-enterologist, Dr Preston, at Bishop’s Stortford’s tiny, rundown hospital. He was of course on holiday, (never get ill in August) but thankfully his secretary, a friend of Mum’s, was able to arrange an appointment with his registrar, but unfortunately the only day this could be on was the same morning as Mum had to return to Harlow hospital to get the results of her angiogram. With some rescheduling and long waits on the telephone, eventually it was organised for Mum to go early to the Herts & Essex hospital and later to Harlow.

The gastro-enterology registrar suggested a diagnosis of haemochromatosis, a genetic condition which results in high levels of iron in the blood and which if left untreated (by the somewhat medieval-sounding method of blood-letting) leads to liver and or heart failure. He prescribed more tests to check the validity of his hypothesis. Mum then went on to Harlow where she saw the eye consultant, Miss Flay. The angiogram had revealed what seemed to be a blister on the retina of her left eye, of unknown origin. Blisters can be caused by high blood pressure or by periods of stress, but Miss Flay was also concerned that it might be a melanoma and that the liver problems could be a secondary growth from this. She then wanted Mum to see the Harlow hospital gastro-enterologist, who I seem to recall was actually her husband. Mum was then sent for a further liver scan at Harlow before this new appointment. One thing this whole experience taught me is that “emergency” never means “immediately” in the NHS. Though each individual appointment was prioritised as urgent, there was usually a week between each one, which meant that time was ticking ever further by. As it would turn out, we were still a million miles away from the final devastating diagnosis. It’s hard to write this from a vantage point of knowing what that diagnosis would be, and it’s too easy to direct the reader towards specific clues. For us at this stage it was an utterly baffling and frightening mystery.

Throughout all this drawn-out process, Mum’s health was deteriorating and despite it now being the school holidays, she felt permanently weak, exhausted and thirsty. She was getting a lot of back and shoulder pain but when her usual physiotherapist tried to massage her, Mum nearly passed out. The trip to Peru had long since been cancelled. The blind spot eye was also constantly growing. Liver scans require a period of fasting beforehand which is only made more difficult when the ultrasound departments are running hours behind time, as appears to be the norm in Harlow.

When Mum finally got to see the Harlow gastro-enterologist he informed her somewhat bluntly that shadows had shown up on the liver scan. These were potentially very serious areas of concern that required a CT scan and possibly a biopsy. We clutched at the hope that these shadows would turn out to be iron deposits from the high ferritin levels in Mum’s blood. We couldn’t see how Mum could have liver cancer as she didn’t have the right (alcoholic) history, and a melanoma in the eye just didn’t seem possible. Anyway, the CT scan followed the following week, and Mum was then summoned in for a liver biopsy.

By this point, as he had returned from his holiday, Mum had finally been able to get an appointment with Dr Preston in Bishop’s Stortford to get the results of all the tests his registrar had ordered. The genetic test for haemochromatosis proved negative. The ferritin tests were still ridiculously high, so it disproved our hypothesis that they had perhaps simply been thrown out of kilter by the yellow dye Mum had had in her blood after her angiogram at the time. Mum had not developed hepatitis as a result of having her vaccinations whilst in the throes of a virus. The only way forward was the biopsy.

The date of the biopsy appointment came round and Mum went to Harlow. But she was told that they could not go ahead as preliminary blood count tests taken a couple of days before had revealed that Mum did not have enough clotting agent for the test to be conducted safely. (The liver is very prone to bleeding.) They then had to arrange a biopsy as an in-patient in the Princess Alexandra Hospital so that Mum could have a platelets infusion beforehand.

A few days later, a Sunday night, a bed became available and Mum was summoned in to Harlow. She was then left in Harvey Ward for five days before anyone got around to arranging the biopsy. It seemed Dr Preston had ordered the bed without actually telling the ward what it was for. It quickly became apparent why we have such a shortage of hospital beds in this country, since wards are packed full of patients waiting to have tests that no one can manage to organise, for whatever reason, be it a shortage of equipment or just complete lack of communication between medical and administrative staff and their various departments. The lady in the bed opposite to Mum was waiting for a 24-hour heart monitoring test which didn’t happen for seven days, as it took that long for a machine to become available.

No one from the eye unit came to see Mum in this time either, despite a continual worsening of her symptoms. Mum quickly became institutionalised and passive, lacking the energy to kick up a fuss and we were unable to do this on her behalf as no doctor was ever present on the wards during visiting hours. The food was singularly disgusting and we took her in fresh fruit to try and keep up her vitamin intake. Mum was unable to sleep owing to the constant commotion in the ward and one particularly cantankerous lady in the corner bed with a chest-shattering cough, who weighed less than five stone and kept shouting at the nurses and falling out of bed. The doctors then started threatening to send Mum home immediately after the biopsy as they were going to need the bed – which was preposterous, considering that the reason she had been hospitalised was to ensure that she did not bleed to death once the samples had been removed, and that they’d kept Mum in that bed whilst doing absolutely nothing to her.

Eventually, the biopsy was organised for Friday lunchtime. Apart from Mum coming out in hives the moment she was injected with the platelets, which is apparently a common reaction, it proceeded without incident. Thankfully, Mum was not sent home and remained in hospital over the weekend. On the Monday afternoon the following week, the 1st of September, with Mum having felt ill since the middle of June, the doctors came to give her the results. And it was to be the worst possible diagnosis. However, instead of warning the nurses on the ward that they were going to give Mum extremely bad news, they just marched right up to her bed and told her that she had secondary cancer cells in her liver. Mum had no one with her to comfort her as she fell apart.

But it was secondary cells. The horrendous task then remained of trying to find out where the primary tumour was. As the biopsy indicated it was likely to be either a breast or bowel tumour, the eye was then decided to be a further secondary site or a possible result of the liver malfunction. A doctor came and examined Mum’s breasts and could find no discernible lump. Results from her last mammogram 2 years previously were unearthed and checked: they had been clear. A new mammogram was scheduled for the following week, at St Margaret’s Hospital in Epping. Mum had had a hysterectomy a few years previously which had revealed unusual but not cancerous or pre-cancerous cells in the lining of the uterus. The doctors wanted to double-check the lab reports done at the time, but of course these had been mislaid by the Princess Alexandra Hospital in the interim period. It was decided that Mum should have an endoscopy as soon as possible, and so she was kept in hospital. The endoscopy was booked for a couple of days later, but no one told the ward, so she was given breakfast on the morning on which it had been scheduled and so it had to be postponed for another two days. Mum had to have her digestive tract emptied and by the time of the test had a permanent migraine, with her eye flickering (still no sign of an eye doctor) and her head full of blinding lights. The endoscopy, with the added revulsion of having to wait for another doctor to finish using one of the necessary tubes on another patient before it could be carried out in full, was clear.

After her mammogram in Epping, Mum was finally allowed out of hospital (after three and a half weeks) and given an appointment with a general oncologist to discuss options. When Mum arrived at this appointment the following week on September 10th, she found it had been cancelled by Harvey Ward as they had sent Mum home and clearly had never heard of such a phenomenon as “outpatients”. The oncologist, Dr Bridgewater, an extremely kind and understanding doctor, thankfully fitted Mum in. They set a date to start a broad-ranging type of chemotherapy, proposing that the treatment would become more tailored if the primary tumour was traced. The mammogram results still had not wended their way over to Harlow from Epping so she was given another appointment to receive them. The oncologist also ordered an MRI scan of Mum’s eye and brain.

At the follow-up appointment, we found out that the MRI scan revealed that whatever was in Mum’s left eye had not spread outside of it. By the time Mum finally received radiotherapy on the eye five months later, once it had been confirmed as malignant, the cancer was found to have progressed on to the right eye and the brain as well. But - at last - the mammogram had shown up a small shadow: it was the first and only sign of the primary tumour. This then meant that Mum had to be referred to the breast cancer consultant, based in Epping. When she got to see him days later, her notes were still in transit from Harlow so he had no case history apart from the mammogram. He examined Mum and could find no trace of a breast tumour by hand. The shadow was so small that he had trouble believing that the cancer could have spread so far and wide through Mum’s body. He said he would start the process of arranging chemotherapy and would re-examine the results of the liver biopsy as this would indicate which drugs would be the most beneficial. He sent Mum home and encouraged her to try and build up her strength.

There was now the added complication that Dave and I were getting married on September 25th in the Lake District. We had had the worst build-up to our wedding imaginable and it just didn’t seem possible that Mum was going to actually be able to make the day itself. But she was determined to do so, and with some gallant efforts on the part of certain family members, she did. She looked so beautiful and radiant despite everything that had gone before. After the rector had declared Dave and I man and wife, I turned round to Mum, sitting in the front pew. She was beaming at me, a memory that is now one of my most treasured.

After Dave and I got back from honeymoon in the middle of October, Mum still had not started chemotherapy, but she was feeling fitter and stronger than she had for a good while. A preliminary meeting with a chemotherapy nurse had at least been booked at Galen House, Princess Alexandra Hospital’s new cancer centre. I went along with Mum to help her remember everything they told her and to try and keep her spirits up. Yet still Harlow’s staggering incompetence continued. The day before the appointment Galen House tried to cancel it as the head nurse had injured her back. Mum (rightly) got so hysterical (“I’m going to be dead before I get any treatment!”) that they rebooked it for her. The trouble is that the receptionist who made the call had no idea of the background to Mum’s case and the delays it had been plagued with – and she also didn’t explain that delaying this appointment would not have any knock-on effect to the start of Mum’s chemo itself. Anyway, to be fair, the nurse we spoke to at this appointment was calm, thorough and clear. For the first time, we no longer felt alone and at sea in the wasteland of the NHS. Mum’s first chemotherapy treatment was given to her in Epping the following week, nearly the end of October.

I fear it can be no coincidence that the breast cancer screening programme at St Margaret’s Hospital in Epping was recently suspended and 6,000 women’s results queried. With this background, something could well have escaped attention on Mum’s previous routine mammogram. This would have been the error that killed her. Whilst the shambolic process that Mum endured last summer is unforgivable and indicates the problems of the NHS when it has to deal with the unknown and make a diagnosis outside of the routine, the truth is that by the time Mum had started to feel unwell, it was too late to save her. Mum’s type of breast cancer was one of the most treatable – if it had manifested as a lump before it had spread, Mum could have had surgery, chemotherapy for six months and then radiotherapy for six weeks. All of this would have been awful enough but at the end of it she would hopefully have enjoyed a long period of remission, if not a permanent cure.

But now, for us, it is too late. I really do not know what can be done to make the NHS work if faced with a case like Mum’s again. No fault can be found with the individuals who cared for Mum. Dr Singer in particular, the breast cancer consultant, did his utmost to be both available, efficient and compassionate. But a system should not be allowed to nurture a health care trust that does not make its different departments communicate properly with each other, that tries to transfer trolley loads of paper notes between three different hospital sites, that keeps patients in hospital beds for days without treating or testing them, that makes patients chase up all their different appointments themselves, and that allows weeks to elapse before an “urgent” situation is dealt with. If only you could go from appointment to scan to blood test to results to appointment with second specialist within one hospital visit instead of having to spread each over a period of several weeks. If only consultants could be available for more than one afternoon a week for outpatients and one morning a week for in-patients.

In other parts of the UK, things may be better. In any case, I suspect Kylie will not have to cope with any of this crippling bureaucracy. But nonetheless, breast cancer is a foul, despicable disease and its treatment is debilitating and life-ruining for all who suffer from it. There are, thankfully, many happy stories too but so many women are not amongst the lucky ones. If the disease chooses to kill you, it will, and there is, at this current time, nothing we can do to stop it. I’ve seen the end, the hell breast cancer ravages on the human body before its soul is taken from it. It is barbaric. Sometimes no amount of courage or fight can be enough.

REBECCA

Smile, please

Recently my dear friend Minnie, on a visit back to her homeland from her adoptive city of Montreal, gave me a scrapbook that she wanted me to fill with thoughts, stories and photos of Mum. It's a helpful and constructive idea, particularly now as the numbness that swamped me immediately after Mum's death starts to subside and I find missing her utterly unbearable.

So thoughts there are aplenty, and many stories to record, but photos? When we were trying to find a picture of Mum to put on the order of service for her funeral, we realised how few truly nice shots of her we actually possess. In the end, we went for a passport photograph from ten years ago. It was a good choice technically as it was a clear image easily scanned. It also hailed from a time which, when it was taken, we thought would be only the middle of Mum's life, before she was plagued with any of the serious health problems that later struck: the sciatica that left her bed-ridden for weeks, and the menopausal imbalances that resulted in a hysterectomy and, more tragically, the years on hormone replacement therapy that would cause the breast carcinoma that killed her.

But why do we have so few normal, decent pictures, pictures that show her wonderful smile, or the essence of her personality, her wisdom? To be fair, Mum didn't especially like her photo being taken, but that's no wonder when you see some of the results of Dad's photographic "expertise" over the years. We have albums full of pictures of Christmas meals, with Mum bright red in the face from sitting near too many hot candles and downing an even greater quantity of sherries; of mountain landscapes with Mum just a dot at the foot of them, her face hidden under one of her collection of uncomplimentary sunhats; or of Mum's backside as she lumbers inelegantly out of a hotel swimming pool. And then of course that famous shot which prompted Mum to utter, on first viewing of the film fresh from the developers, "What the hell did you take a photo of that fat old bat for?"

We do have some lovely photos of her from our wedding, but by then she already had cancer and had been seriously ill for some weeks prior to the event. She'd lost weight and could no longer wear her trademark glasses, as she was partially blind in one eye from the tumour therein. Nonetheless, she looked so happy and radiant, so delighted that against all the odds she'd managed to get to the Lake District and see us married. And really, as it was prior to chemotherapy starting, it's the last time she looked at least something like herself - soon all her natural hair would be gone, and there was never a chance for it to grow back before she died. The photos from that day are to be treasured as they are the last we have of her. She was seldom outside thereafter, and camera flashes indoors made her left eye flicker, and, in any case, she simply didn't want to remember feeling quite so awful.

The actress Lynne Redgrave recently published a book of photos of her battling her way through breast cancer; to show that there can be beauty, strength and courage in images of great suffering. When Mum died, she weighed five stones less than she had a year ago. She was completely bald, bright yellow with jaundice from top to toe and covered in purple bruises, as her blood could no longer clot properly. But to me, she was still the loveliest, most beautiful woman in the world. She was the woman who had borne me, and the bond of love and gratitude that results from that is utterly unconditional.

Having no photos of her in the true thoes of her illness mean did mean at least that we quickly remembered Mum as she was when she was well. But if we could have her back, I would make the effort to record her presence on our earth with the grace and attention she deserved. I'd take a moment to sit her comfortably in a flattering pose, take off her sunhat and let her cool down, and then I would tell her the funniest story I could think of to light up her face with that wonderful, glorious smile that somehow I still feel shining down on us all.

REBECCA

Cinematics

One consequence of Lynne Choona Featherstone being elected as MP for Hornsey and Wood Green is that it pretty much scuppers any heavyweight political support for the Crouch End for the People (CEfP)'s bid to rescue Hornsey Town Hall from Haringey Council's sell-off. Choona has made it clear that she is not only a) extremely ill-informed on this issue, despite owning at least three properties in the area, one of which is almost directly behind the town hall itself, but also b) fully in support of the Lib Dem councillors' proposals for the sell-off and not the CEfP's plans to run the town hall as a community project, complete with an arts cinema. Barbara Roche (and, to be fair, the local Conservative candidate) had always given CEfP their full backing. Having participated in a free tour of Hornsey Town Hall last year, I can only confirm that it is a truly amazing art deco building, worthy of attention being lavished on it after years of neglect. However, it is immediately obvious that renovating it would prove a nightmare: its electric wiring lays hidden beneath impossible-to-remove marble panels, its main chamber is riddled with asbestos, its bannister railings are too low to satisfy health and safety officers' concerns for the welfare of hyperactive children, and its theatre has officially been relegated to the "deathtrap" category of fire service regulations and long since closed.

But when I heard that the marvellous PictureHouse chain were in discussions with CEfP, my heart filled with hope. I trusted them to somehow pull it off. It is my dearest wish that Crouch End get its own cinema. Film is how I make my livelihood and whilst the local Blockbusters contains various DVDs I have worked on (Wicker Park being the latest addition to its shelves), cinema is my number-one passion, the more obscure and foreign the better. It's the one facility that my beloved Crouch End lacks - you can while away hours reading the Guardian in a pavement cafe, get a decent German beer in at least two different bars, have long Tempranillo-fuelled lunches in tapas bars, buy excellent pesto in the Italian deli and delicious champagne in the wine merchants, and (just so I prove that I do think beyond the culinary from time to time) get your hair cut in at least ten different organic hair salons. But see a film? No chance. For that delight, you have to head up to Muswell Hill Odeon, which has to be the worst-run cinema in the universe. It has a skeleton staff of usually, well, one, who has to try to sell tickets, serve popcorn, clean the auditoria and let people into the screens all at the same time, meaning that most of these duties get neglected and all sorts of scum gets allowed in to hurl empty drinks cartons down into the disused pit that was once the ground floor of Screen One, sit in the expensive luxury seats when they've only paid for normal price tickets, rustle a cacophony of sweetwrappers and slurp on stinking hotdogs, and chat loudly on their mobile phones throughout the latter half of the film. And cleaning the toilets is just a dim and distant memory from when the ground floor probably still had seats.
Even if the town hall proposals are never realised (and the fact that McDonalds want to move into the empty PowerHouse store next door means that any idealistic vision of a European-style piazza in front of the town hall will probably vanish in a stench of Big Mac wrappers and potato-lacking fries), there must be an alternative site somewhere in Crouch End where a cinema could be born. After all, for years, City Screen in York had to make do with a lecture theatre in the Yorkshire Museum, but its staff's knowledge, expert programming and just plain old love of film still makes it rate as one of the best cinemas I've ever been to. We must be able to do the same here.

REBECCA

Elected Generals

Yesterday morning Rebecca and I strolled through Stationers Park to the Hornsey Vale Community Centre in order to cast our votes in the general election. Now a veteran of four general elections and countless other local and European polls, I still experience a striking frisson of excitement as I enter the polling station. Yesterday this excitement rapidly gave way to giggles when I noticed that Lynne Featherstone, the Liberal Democrat candidate, possesses the absurd middle name of Choona.

In the polling booth I regained sufficient composure to pencil a bold cross adjacent to the name of Barbara Roche, the sitting Labour MP who was defending a majority of around ten thousand. My decision to vote for the Labour Party yesterday was partly rational and partly tactical:

Rational in that as two young professionals, one of whom works in the public sector, and with a burdensome mortgage, Rebecca and I will benefit from further economic stability allied with continued investment in public services. If we start a family we will benefit from a support infrastructure including childcare, maternity and paternity entitlements, and various family-related benefits and credits. Mr Brown's record on domestic social and economic issues is impressive and I can endorse this agenda whilst being utterly repulsed by Mr Blair's arrogance and global swashbuckling.

Tactical in that I sought to prevent the Lynne Choona Featherstone bandwagon from sweeping into power in our Hornsey and Wood Green constituency. Given the result - a massive 14.6% swing gave Ms Featherstone a majority of over two thousand - my attempt to block her advance was even less successful than the efforts of Arthur Dent, our heroic pan-galactic hitchhiker, to prevent his earthly home being demolished.

No doubt several factors enabled Lynne Choona Featherstone to unseat a diligent and previously popular constituency MP. Certainly the Liberal Democrats’ opposition to the war in Iraq, allied with Ms Roche’s staunch support of it, had a major impact. In addition, this constituency, recently described by the Telegraph newspaper as ‘intelligent’, is home to thousands of middle-class, liberal-minded, Guardian-reading intellectual types, many of whom are disappointed in Labour, disgusted with Blair, and disdainful of the Conservatives.

Even before this general election the Liberal Democrats had enjoyed recent political success in this area, including a gargantuan swing in their favour in the Stroud Green ward by-election last year. Indeed, their apparently irresistible momentum could even sweep the Liberal Democrats into power in the Haringey borough elections next May. Esteemed BBC analysts Andrew Marr and Professor Anthony King were clearly oblivious to these events and possibilities, as both expressed astonishment that the Liberal Democrats had won the Hornsey and Wood Green seat.

However, perhaps most significant in Lynne Choona Featherstone’s success is a slick and ruthless public relations machine that ensures she enjoys an extremely high local profile. Anyone with even the remotest interest in local affairs cannot fail to notice Ms Featherstone, whose kitsch publicity photographs portray styled hair and shoulder pads redolent of American television shows like Dallas and Dynasty. Already an elected member of Haringey Council and the London Assembly, she has used these positions to good effect in boosting her standing in the constituency. Moreover, it seems Ms Featherstone has used her personal wealth to bankroll a relentless delivery of glossy leaflets and reasoned letters to local households. As a result of this lavish ‘blitzkreig’ of propaganda there could be few constituents who, upon surveying their ballot paper yesterday, did not recognize the name Lynne Featherstone, even with the distraction of ‘Choona’ sandwiched between forename and surname.

So, much to my chagrin, Lynne Choona Featherstone now represents me in Parliament. Elsewhere last night there were other pockets of personal disappointment. Two of my friends narrowly missed out in Swindon North and Harrow West respectively, and Rebecca’s aunt, Judith Blake, was unsuccessful in defending Leeds North West for the Labour Party. Judith, a successful local politician in Leeds, was a strong candidate chosen to replace the retiring Labour MP. The tension in our Denton Road flat became almost unbearable as the clock ticked on towards three o’clock without any news from the count. Every other Leeds constituency was declared long before finally we learned the terrible news that Leeds North West had fallen to the Liberal Democrats. Despite her personal opposition to the war in Iraq, Judith was the victim of an unprecedented swing from Labour to the Liberal Democrats which proved fatal in a three-way marginal.

Despite these personal disappointments I am content with the national outcome. A Labour government with a much reduced but workable majority should allow Mr Brown to pursue his successful social and economic policies whilst not enabling Mr Blair to ignore his party, shun Parliament, and strut around on the global stage. Indeed, the influence of an awkward squad of left-wingers should require Mr Blair to listen more closely to the concerns of his party, rather than those of Mr Bush, and to do more to achieve consensus both in Parliament and in the country as a whole. A return to traditional cabinet and parliamentary approaches to government, rather than the presidential approach that a massive majority allows, would be a welcome boost for democracy.


Dave

By Royal Appointment II

As NHS hospitals go, I'm a fan of the Royal Free. I've been going there regularly since last July about this swelling in my neck and I'm usually pretty impressed: I've always been seen within ten minutes of my scheduled appointment, the facilities and equipment are high-grade, the staff have always been kind, and, on a medical level, clearly at the top of their field. It's a bit of a trek over there from Crouch End - a 20 minute walk to Crouch Hill station for the half-hourly service to Gospel Oak, and a connecting service from there on to Hampstead Heath. Door to door, it takes an hour to travel a distance of just a few miles, though after a few weary years in the capital, I've grown to accept that as the norm getting around in London.

The auto-immune disease I have is not serious in the grand scale of things and it's supposed to just take care of itself, given a few years, and regular blood tests and scans. I usually feel perfectly OK while making those long journeys - an afternoon off work and the chance to catch up on some reading are the biggest disruptions. What I want to write about today is an extension of what Dave discussed yesterday and how the hospital appointments system operates if you are in fact suffering from the worst illness in the world.

My mother died of breast cancer on April 2nd, 2005. She was 58 years old. Her cancer wasn't detected until it had metastasised to her liver and her left eye, and was subsequently found to be in her bones as well. The delay and frustration of the process of even coming to this devastating diagnosis must still be written about; there's only so much you can mention in a single sitting and when it's all still so unbearably raw.

I'm thinking particularly of an incident in January this year. Mum's eye had shown little response to chemotherapy and a referral to the country's top eye oncologist at Bart's hospital in London had resulted in a course of radiotherapy being prescribed. I went with her to see the radiotherapy consultant for her preliminary appointment. My parents had to travel 30 miles into London from Bishop's Stortford. Dad took the day off work to drive her into town as Mum's loss of vision meant she was no longer able to drive, and after four sessions of chemotherapy she was simply too ill to cope with a train journey. Thankfully Mum had a disabled badge for her car so they were able to park directly outside the hospital.

But then we had to sit and wait no less than TWO HOURS in a hot, stuffy and massively overcrowded waiting room before Mum was seen by the doctor. Every person in there presumably had cancer needing drastic treatment and so it was impossible to kick up a fuss and demand to be seen any sooner. When she finally did see the doctor, he said that before starting the radiotherapy, she would have to have another MRI scan to see if the cancer had also spread to her brain. Statistically this was extremely likely as it had by this point reached both eyes, though was only visibly affecting one. Mum then had to walk from the outpatients department to the MRI unit to make an appointment for an "urgent" scan, the doctor wanting it done within a week. Mum was anaemic, weak, breathless and exhausted. Bart's is a big place. We had to stop twice for rests around its central quadrangle; thankfully it is bordered by benches. I have no idea why the receptionist in outpatients couldn't have phoned the MRI department on Mum's behalf to make the appointment.

Once we finally got to the MRI unit, it turned out that the first appointment available for an "urgent scan" was in three weeks' time. There was absolutely nobody in the waiting room - I wanted to scream at them to switch the bloody machine on and do it there and then. I would have operated it myself if I could. But I didn't, and Mum and Dad began their long journey home. Mum wanted to go to the bathroom before they set off - but as the nearest toilet was 200 metres away and down another flight of stairs, it was simply too far for her to walk to so she had to wait until they got home.

As a footnote to all of this, when the time of the scan finally came around, Mum received a telephone call from Bart's the day before to say that the scanner had broken and that all appointments had therefore been cancelled. It was a further ten days before the machine was repaired - and Mum's scan did show that, yes, by now, her brain was also showing a patch of cancerous activity. Three weeks later, her radiotherapy finally started. Daily journeys up to London for two weeks, often waiting for hours before a machine became available for her 15 minutes of treatment. It was now the middle of February, and she'd seen the eye oncologist the previous November. In fact, the day her treatment started was the day of her follow-up appointment with the eye oncologist - he'd planned on the radiotherapy being finished with long before then. By the time her new follow-up appointment was sent, Mum would be dead.

By Royal Appointment

Yesterday I accompanied Rebecca to an appointment at the Royal Free Hospital in Belsize Park, north London. Rebecca has a thyroid condition called Hashimoto's Thyroiditis which requires regular monitoring. After her consultation Rebecca had to arrange an ultrasound scan of her thyroid and a subsequent appointment at which to receive the results. Scheduling these two appointments required us to visit two separate departments and engage with two different administrators. This felt time-consuming and unnecessarily bureaucratic.

It seems inappropriate that patients - people who are often vulnerable and infirm - must trail around large hospitals in order to organise the next stage of their treatment. Perhaps one way to enhance the patient experience would be to establish a ‘one-stop shop’ approach to the scheduling of appointments.

Such a system would enable patients to arrange multiple appointments with different departments at a single point of contact without the need to visit each department separately. It would also be more efficient, because a system that empowers administrators to schedule several appointments with different departments is likely to require fewer staff than one which requires separate administrators to manage appointments for each individual department.

Good examples of this approach currently exist in local government. The London borough for which I work has a customer care unit that provides a single point of contact through which residents readily access a broad range of council services, from allotments to zebra crossings. This service is efficient, effective, user-friendly and popular with the public.

Establishing a single appointments service for an entire hospital sounds complicated and expensive, especially for a sizeable complex like the Royal Free. However, ultimately this would create a more effective service that delivers immediate improvements to the patient experience in addition to longer-term efficiency gains.

The recent Gershon Review requires public sector bodies to identify significant efficiency savings in order to redirect existing resources from administrative processes to frontline services. Certainly the NHS would benefit from fewer bureaucrats, more doctors and nurses, better facilities, and a more patient-friendly administration.

Reducing bureaucracy in the appointments system would be a first step towards freeing-up precious funding for frontline healthcare. Moreover, it would nurture a win-win scenario in which NHS patients enjoy smoother access to improved services.

Dave

Bank Holiday Monday

It's a Bank Holiday Monday and I'm procrastating work (playing the Kevin Bacon degrees-of-separation game, reviewing the subtitles for his 1988 film Criminal Law) with my first inane attempts at a blog.
I've just spoken to my aunt Judy, who is hurtling through the last few days of her election campaign to be the new Labour MP for Leeds Northwest, running on pure adrenalin and totally unable to predict the outcome on Thursday. Although her core vote is there, how many of them will actually bother to go out and put a cross on piece of paper next to her name is another issue entirely. Don't let Michael Howard in through the back door and all that. How I wish I could be as focused on something as all-consuming as that to help me through this difficult time. Today it is exactly one month since Mum died.
My husband is in the gym as I write; a sudden keep-fit drive he's been promising himself for weeks (he has to somehow recoup the 6 months' membership he's paid for but hasn't used). Yesterday he worked out next to Nigel Harman; good to know that the cast of EastEnders are alive, well, and still hanging out in Crouch End. This afternoon he's off to the exotic climes of Aldershot, where his beloved hometown team Carlisle United are in a thrilling promotion play off... On our wedding day, Carlisle beat Aldershot 5-0, so here's hoping the score is along similar lines.
I might go for a swim in a bit; someone's banging bongos in the park outside and it's starting to grate. Once again we have our crazy mass of emerald green outside our lounge window as the trees have exploded into life over the past few days. How many people who live in London have so much foliage in the view from their homes? Poplars, sycamores, willows, fruit blossoms - with of course Alexandra Palace gleaming down from the hilltop in the sunshine. I've craved nature so much in recent times; when you've watched death, you feel determined somehow to replace it with life.