Colonscopy and Liver Treats

 A sneak peek into How To Examine a Wolverine, which will be published by ECW Press on September 28, 2021. No, this peek does not involve wolverines. You'll have to buy the book for that. 

Colonscopy and Liver Treats

I'm sure you're wondering how colonoscopy and liver treats relate to each other, and if you've formulated a guess, I can almost guarantee you that it's wrong.

   

     Let's start with the liver treats. I've written before about how the rapid advancements in medical science and in the role of veterinary technologists have dramatically changed veterinary practice, but I'm here to tell you that nothing has had a greater impact on my day to day life as a small animal veterinarian than the advent of the freeze-dried liver treat.

    

    There are all sorts of good reasons for wanting my patients to like me. It makes my job more fun, it makes my job safer and it makes my patients dread seeing me less, which in turn means that my clients are more likely to bring them in when they should. And the best way to get them to like me is with food. This is trickier with cats, where less than half accept treats, regardless of the quality, but with dogs, if you have the right treat, 90% will take it and ask for more. We used to have terrible treats. They were the veterinary equivalent of the pediatrician handing out sticks of broccoli as a reward to the children coming to her office. Some dogs didn't care, but enough did that we decided to try and find something else. Something else that was at least respectably healthy. Fresh bacon would have been popular too, but there would have been... issues with that. Enter the freeze-dried liver treat. They are literally little chunks of dry liver. If you look carefully you can see the veins and stuff. I don't recommend you do. Dogs act as if they've just seen the face of God the first time they are given one of these. Dogs don't just like me now, they love me. I hand them out when I come in the room, I hand them out as I do things such as give needles and, most importantly, I hand them out at the end of the visit.

    Why "most importantly"? This is where colonoscopy comes in. Bear with me. In 1996 the Nobel prize-winning behavioural psychologist, Daniel Kahneman, and his colleague Ziv Carmon demonstrated what is called the "peak-end rule" using colonoscopy as an example. This rule states that people (and presumably animals) judge the quality of a remembered experience primarily by its peak, or most intense moment, and by how it ends, rather than by an aggregate or average of the entire experience. To demonstrate this they divided a group of human colonoscopy patients into two groups. The first group was subjected to the standard colonoscopy experience. The second group was given the identical colonoscopy with one key difference - at the end of the procedure the tip of the colonoscope was allowed to linger for three minutes longer and then slowly withdrawn. The second group subjectively evaluated their experience as significantly less unpleasant, even though it lasted longer. More colonoscopy was actually preferred! Why? It was less unpleasant because although the peak of the experience was the same, the end was better. Apparently, leaving the scope sit for a few minutes felt better than having it jostling around right up to the end. This has practical implications because the patients in the second group were more likely to agree to subsequent colonoscopies when recommended. (Incidentally, this experiment also begs important questions about sedation protocols wherever this was done, but never mind.)

    So, gentle readers, this is why the little mints and chocolates at the end of a restaurant meal are so important. Tips apparently increase on average by 14% when these are given. You may not even be conscious of it, but your feelings about the meal are most heavily influenced by the peak of it (most memorable moment) and by the last part. Just like colonoscopy. And I'm betting Rover feels the same way about his visit to my clinic. And even if he doesn't remember for next time, at least he's happier for that moment. That's worth something too.

Bas Cam!

This post is from my travel archives.

“Feelip, Feelip! Bas cam!”

A never-fail recipe for wholesale disorientation is to be awoken in the middle of the night by someone shouting incomprehensibly at you.

“Feelip, Feelip! Kwik! Da bas cam!!”

Arms, legs, blankets, backpacks, flashlights, bamboo mats, everything was in chaotic motion as Lorraine and I jumped up, thrashing about, trying to make some sense of the shouting.

It was Tapu.

Tapu was outside our hut and was hollering at us. I checked my watch. It was 2:30 in the morning. Neurons began to align. Tapu was trying to tell us that “the bus come”. The already objectionably early 5:00 a.m. bus to Apia was absurdly ahead of schedule.

We were on the remote and thinly populated south coast of Upolu, Western Samoa’s main island. Apia, the capital, was on the far side of the island. We had been staying with Tapu and his family for the last week and it was time to go to the airport. It was time to leave what had been a surreal cliché of South Seas living. Tall palms, empty beaches, sparkling water, thatched huts, happy people, seclusion, disconnection, peace... well, mostly peace.

Tapu had become frantic. “FEELIP!!! Da bas go! Da bas go!!!”

Sure enough, as we fell out of our hut, unzipped packs half slung over our shoulders, the thrashed yellow school bus began to inch forward.

“I need the bathroom!” Lorraine shouted, while running.

“No time!” I shouted back. This would prove to be a mistake.

We didn't want to leave. Of course we didn't want to leave. In part this was for the usual reasons people don't want to leave a beautiful place, but in part it was for other reasons. We were trying to come to terms with the fact that this could be the final leg of our eight month around the world vagabondage. The previous summer we had quit our jobs back in Winnipeg, put our possessions into precariously stacked boxes in Lorraine's parents basement, said goodbye to family and friends in an open-ended sort of way and then left without any actual plan for the eventual abstract “after”. Tanya and Byron, the tall guitar playing American couple who were also staying with Tapu were headed to Micronesia next and we wondered, could we stretch our funds just a little further?

We leapt onto the bus just as some advanced gear was engaged and it lurched forward from its slow roll into shuddering, swaying, flatulent propulsion. The driver flashed us a gappy grin and twisted the volume knob on the cassette deck bolted onto the ceiling. Bob Marley began to overpower the engine. We slid onto a small varnished wooden bench and stared in frank astonishment as Christmas lights festooned all around the inside of the front windshield, as well as an oversized Jesus nightlight on the dashboard, began to pulsate in perfect syncopation with “Buffalo Soldier”.

Not a single light was on anywhere outside and it was moonless and overcast, so the black surrounding our festively lit bus was otherworldly and dimensionless, creating the strong illusion of voyaging through outer space until suddenly the bus would slow and faces would materialize out of that void. These faces invariably belonged to colossal women in floral muumuus. Fat is beautiful to the Samoans, so if the vastness of the new passengers was anything to go by, the south coast was awash in hot women. The villages themselves were un-seeable in the black, but women kept appearing and kept climbing onto the bus, all of them full of remarkable good cheer given the hour. Through some trick of spatial geometry they managed to squeeze two abreast onto each little bench until all the benches were full.

The villages on the south shore had no shops, so the trip to Apia was primarily a shopping trip for most of them. Perhaps to pick up a few luxuries. Perhaps to stock up on Spam. Spam and corned beef had been introduced by the missionaries and were considered delicacies. In fact, as honoured guests we were served generously sized Spam chunks floating in ramen noodle soup (another store bought indulgence), while the family ate papayas and fresh greens and banana leaf steamed fish. Every garden was a rainbow riot of vegetables and chickens and fruit and cocoa trees that Sina, Tapu's wife, harvested, roasted, ground and made into hot cocoa for us every day. The sea was so thick with fish that they didn't bother with boats. A small group of men just waded out with sticks and beat the water, herding the fish into a net.

With some difficulty we persuaded them that we would prefer the local food too. Dinners became long delicious affairs in Tapu's open sided hut as we sat on the floor and ate the freshest most natural food imaginable while Byron strummed and Tanya sang softly. Eventually Tapu's family would start rolling over wherever they were sitting and fall asleep right there, starting with the grandmother and ending with Tapu himself. And then finally only the four foreigners were left awake, so we would quietly get up and wander back to our own huts in the starshine of a soft South Pacific night.

Eventually the bus entered another cluster of villages as again the faces appeared and again the aisle was filled with muumuus, smiles and a great deal of flesh. This was going to be interesting, I thought, as every bench was already occupied to an extent never dreamt of by the Blue Bird school bus manufacturers.

And it was interesting.

Friendly smiles were exchanged between sitters and would-be sitters and then the would-be sitters delicately clambered onto the sitters’ laps until there were four enormous women per bench. You may want to read that over again. Four. Per. Bench. Two above. Two below.

Finally Lorraine and I had the only remaining double occupancy bench. And then I was smiled at. I stared at the smiler. She smiled some more and began to swing her prodigious hind quarters around towards me. Zapped into action, I grabbed Lorraine, plunked her on my lap and slid to the window. Two women gracefully inserted themselves beside us. One above. One below.

Marley played on. Jesus pulsated. The bus lurched and farted deeper into the Samoan night.

You will recall that Lorraine needed the bathroom earlier. She still did. Even more so. Her brow was glossy with sweat and her mouth was set like a vice. With every lurch and bump she winced softly. This went on for almost two hours. How she didn’t succumb to a rupture, I honestly do not know. I suppose some of us just have inner sphincter strengths that we are unaware of until they are truly tested.

We finally sputtered into Apia’s main market at 5:30. I had assumed that the early start had been to allow everyone to get to the market for opening. But it didn’t open until 7:00. It was empty, save a handful of skeletal dogs scavenging through yesterday’s market’s remains.

It is so strange when I think back on this now, but when I calculate the time change, at that very moment back home my father was undergoing emergency brain surgery for a tumour that had suddenly declared itself with a storm of seizures. We had been a week without any communication with the outside world. There had been no way for anyone to reach us, although they were beside themselves with efforts to try. There in Apia, in the cool pre-dawn, looking out at the deserted market and trying to see the funny side of the bus situation, I had no idea that my life was being profoundly rearranged on the far side of the Pacific.

It was time to go home. The lack of a plan for after was no longer a problem, but a blessing.

We disembarked just as the eastern sky began to colour rose and saffron. Everyone else stayed on the bus and, including the driver, went immediately to sleep, their snores mixing with Bob Marley and the sounds of a small tropical city just coming to life.

The Coneheads

The official symbol of veterinary medicine is the letter V superimposed on the “Rod of Asclepius” (you know, that snake twining around an upright stick). The unofficial symbol, however, is the “Cone of Shame”. Before I go on to discuss the cone, I want to say a word about the official symbol. That word is “lame”. It’s a lame symbol because it’s derivative of the human medical symbol, making veterinarians look like a junior league version. If anyone is going to use a symbol with snakes, it should be us, and they should have to superimpose an H on it. We actually handle snakes, whereas most modern physicians run screaming from them. The symbol originated from an ancient Greek healing cult involving releasing snakes among the patients. Presumably, this frightened the patients into at least claiming that they were feeling better so that they could leave. As that’s no longer the standard of practice, I feel the physicians should get their own symbol now and then we can keep the plain rod and snake without the tacked-on V. Failing that, we could politely ask the veterinary surgical specialists to allow us to use their centaur logo for the whole profession. Centaurs are cool.

End of digression. On to the coneheads. Officially known as Elizabethan collars, or e-collars for short, these lampshade shaped items are as indispensable to the veterinarian as the stethoscope, the syringe, and the scalpel. It’s one of the things that distinguishes us from our human medical counterparts, although I’m told that a local vasectomy surgeon keeps a large e-collar in his office as a joke. What a card. Humans can be told not to lick their wounds and incisions and, generally speaking, they won’t. Dogs and cats on the other hand… Well, the point is obvious.

So why do they lick? And is it even a problem?

Second question first. I have had quite a few people declare that it is natural to lick a wound. Yes, it is. But it is also natural to poop indoors. And it is natural to die soon after our reproductive years. Natural behaviours work best in natural environments and when there are no better alternatives.

Dogs and cats lick for two main reasons. The first is to clean the area. If it’s an accidental wound, initially this can be helpful. By all means, get those bits of bark out the cut from that sharp branch you ran into. The problem is that they don’t know when to stop. In the wild, a wound would keep getting dirty, so it made sense to keep cleaning it, but our pets eventually come into a (hopefully) clean home. At that point they’re just introducing bacteria from their mouths. A version of the licking-is-natural myth holds that their oral bacterial is beneficial. People who say this have never looked inside the mouth of a middle-aged dog with dental disease (which is to say, most middle-aged dogs). It’s like peering through the fetid gates of bacterial Hades. There’s a reason why you are always prescribed antibiotics after a dog or cat bites you. I remember a colleague who didn’t bother, and her hand turned black. True story. But I’m veering into digression again.

The other problem with the licking instinct is that they cannot differentiate between a dirty accidental wound and a clean surgical incision. I imagine dogs and cats waking up after an operation and thinking, “What the heck? Those people were all so friendly and nice and petting me and saying how good I was, but then, bam, I had an instant nap and now I wake up and there’s this cut on my belly! Did they drop something sharp on me? Didn’t they even notice!? Losers. And it’s got these bits of string stuck to it. Groan. Oh well, I know what to do. It’s just like those bits of bark that were in that cut from the Evil Stick…”

The second reason that dogs and cats lick is for comfort. It likely, albeit subconsciously, reminds them of when they were small and their mothers licked them. It’s soothing to them the way thumb-sucking or hair-twiddling is for some people. This self-soothing can become addictive and tip into obsessive-compulsive behaviour. Anxious cats will lick their bellies until they’re bald, and anxious dogs will lick their paws until they turn rust coloured (by the way, that colour is due to a substance called porphyrin in the saliva reacting with the air). A note of caution – sometimes these behaviours are also due to itchiness from allergies, so don’t assume your pet is developing an OCD and just slap the cone of shame on him. That would be agonizing if there’s a legitimate itch. And there are excellent medicines these days for allergies. Even for true excessive self-soothing and anxiety, a cone is not the best solution. The necessary behavioural therapy for these guys is well beyond the scope of this story (now, that would be a digression!), so ask your veterinarian for advice on this please.

But for the wounds and incisions, the cones are still the way to go. Theoretically bad tasting sprays and ointments are possible alternatives, but many pets laugh at these. You’ve seen what they’re willing to eat, right? Fortunately, however, the cones have come a long way. When I first started in practice, we only had the rigid opaque plastic ones. Dogs crashed into things and cleared coffee tables with them, and cats got stuck under couches and in cat doors. The modern ones are clear, to improve peripheral vision, and a little more flexible. They’re still a nuisance though. Even better for some pets are the floppy cloth ones (true “Elizabethan” collars that Shakespeare wouldn’t be ashamed to be associated with) and inflatable doughnut-style ones. I say “for some pets” because these are more easily defeated by the agile, the determined, the Houdini-like. You may have to try a few different options and sizes and means of attachment before you hit on one that is a reasonable compromise between nuisance and effectiveness.

Maybe the best veterinary symbol would be to put an e-collar on the centaur. You could also put one on the Asclepius snake, but that would just be dumb as snakes can easily reach around any collar. But a centaur with a cone wouldn’t be dumb. Not at all. Right?

The Willow Wren - excerpt

This is the first chapter of my forthcoming novel, The Willow Wren, which will be published by ECW Press on March 23 of this year.

February 20, 1944

 

            This memory stands out above many others. A glinting nickel in a fistful of pennies. I can feel my mother’s hand gripping mine, a thin leather glove squeezing my thick woolen mitten, squeezing it maybe a little too tightly. And I can smell the smoke - sharp and somehow metallic - mixed with the dry smell of powdery cement dust and the tang of brown coal fires, and perhaps something else that I didn’t recognize at that age, something charred. I did not like the smells.

But this is principally a visual memory. The picture is detailed and clear in my mind’s eye, like a large format photograph taken by an expensive camera. The front of our three-story building had been neatly peeled off, as if by an enormous can opener wielded by a fairy-tale giant. The only evidence that there had ever been an outside wall was the still lightly smoking pile of debris on the street out front. But then debris was everywhere in the city, so it was difficult to connect this particular debris to the wall that had once defined the outer limit of our domestic life. It was more as if the wall had magically vanished or had been excised and carried off.

We stood and stared, wordlessly, just staring. Bomb damage was not surprising given the air raid the night before - we saw plenty enough of it as we hurried from the train station – but what was surprising was the precision. The wall was gone, but just a meter beyond it the interior was absolutely intact. Nothing was out of place. No chairs had been knocked over. Even the paintings on the walls still hung straight. We were looking into our living room as if into a life-sized doll’s house.

This doll’s house impression was so strong that it distorted my sense of perspective. I remember suddenly feeling very small, as if my mother and I had been shrunk to doll size. I longed to grow to my full ten-year-old boy size again so that I could reach into the living room and delicately pick up a wooden chair between my thumb and forefinger. I even made the pinching motion inside my mitten with my free hand.

“Where is Papa going to sleep now?” I asked, when I finally found a way to make words.

“Don’t worry. The Party will find something for him.”

I nodded solemnly in response, trying to visualize Papa sleeping on top of his desk, papers pushed aside, a blanket and pillow brought by an aide. He had one rigid leg, the result of tuberculosis in his knee when he was a child, so my mental picture showed that leg sticking out from the end of the desk while the other one was tucked up.

“He’s an important man, your Papa.” She said this flatly.

“Shall we go to his office now Mama? Is that where he is?”

“Yes, I suppose that makes sense. I’m sure he’s very busy dealing with this, but since we’ve come all this way.”

Just then an older teenager came rapidly peddling up the street on a bicycle, weaving amongst the piles of rubble. He was tall and very pale, with black hair slicked back to reveal a high acne pockmarked forehead. His dark grey uniform was slightly too small for his long thin arms and legs. I recognized him from Papa’s Ortsgruppe office (local Nazi headquarters), although I did not have reason to know his name yet. Later I would find out it was Erich. I remember being envious of his bicycle as it was a relatively new dark red Kalkhoff. But honestly, I would have been happy with any bicycle.

Erich waved to us frantically when he spotted us.

“Heil Hitler Frau Schott!” Erich’s right arm shot up as he rolled to a stop.

“Yes?” Mama’s arms remained at her side. My mother was a solid and serious looking woman. She was not large, but with her strong voice and her ability to wield an unblinking stare she certainly could be intimidating. That day she wore a very businesslike tan-coloured suit and had her hair pulled back severely into a tight bun.

Erich swallowed and blinked several times before continuing. “Ortsgruppenleiter Schott sends his regards and he also sends his regrets that he was unable to meet you at the train station or here at your home.” He paused for a response, but as there was none he went on, “As you can see the enemy attacked again with many bombers. It began at 3:15 this morning. Leipzig Connewitz was especially heavily hit. There are hundreds dead. Killed where they slept.” He stopped again, perhaps realizing that he was striking the wrong note. “But of course, our Luftwaffe shot most of them down before they could do even more damage. So, I am sure they have learned their lesson.”

“I’m sure they have,” Mama said dryly. “I suppose this means that Herr Ortsgruppenleiter will not be available to see his wife and son at any point today?”

“You are correct Frau Schott. I’m afraid that will not be possible. He has arranged train tickets for you on the 13:20. He is concerned there will be another attack. Please stay away from the city until you hear from him.” Erich reached into his satchel and pulled out two brown cardboard tickets that had red swastika priority stamps on them.

This was of course a disappointment. This was to be a special treat to mark my tenth birthday a few weeks prior. For the first time I was traveling without my irritating siblings. And for the first time Papa was going to spend time with me alone and show me some interesting things. I had obtained special leave from camp to do this. I was still going to have a day with Mama in Mellingen, but that was more afterthought than main event. Feeling only disappointment and not horror or sadness in the midst of all this destruction and apparent death may seem odd, but that is honestly all that I felt then. Sometimes small boys have small concerns.

And as it happened, Papa was right. The train was only a few minutes out of the station when the air raid sirens began to scream. I put my hands over my ears and began to rock as I could not tolerate loud noises. I squeezed my eyes shut as well. When I opened them again, I saw that Mama looked very upset. She was looking down at her lap, frowning, and her eyes were moist. She clutched an elaborately embroidered white handkerchief. The transformation to this from the tough woman who had spoken to Erich was unsettling. I remember wishing I could comfort her, but I had no idea how to go about it.

She noticed me looking at her. “I’m sorry Ludwig.”

“No, it’s okay Mama. I am scared of the bombs too.” I felt brave and grown-up admitting this.

“It’s not that. But I shouldn’t make you worry. We’ll be fine.” She wiped her eyes and nose and turned to the window. I had some inkling as to why she spoke that way but pushed it out of my mind. I was just happy that she looked a little less upset now.

The train began to accelerate. I wondered whether the speed of the train affected the chance that it would be hit by a bomb. I surmised that it probably would and willed the train to go even faster, but then I saw smoke rising far in the northeast. We were heading in the exact opposite direction, so I felt better and smiled at Mama, but she did not seem to notice.

I never saw our beautiful doll’s house home again.

Mr. Barky Barkerson

My own dog is a beautiful Shetland sheepdog named Orbit. In common with many dogs he also has a number of nicknames: Orbers, Orbie, Orbiedo, the Fluffmeister, Shithead and, more recently, Barky Barkerson because, in common with many Shetland sheepdogs, he has learned to bark. He didn’t bark much at first, but you could tell he was often thinking about it. Lorraine and I, both being veterinarians and knowing the breed, were very careful to discourage barking. Some people make the mistake of trying to train their dog only to bark when a stranger comes to the door. Perhaps they’ll succeed, but more often than not, once a dog is allowed to bark for one reason, they will find justifications for barking for a dozen reasons. “That leaf, it could have been a threat! Never trust a leaf.” Or, “Ok, now I know that that noise was just a figment of my imagination, but it could have been the start of a barbarian invasion!” We did not allow Orbit to bark for any reason, but this was like trying to keep the lid on a jar of nitroglycerin. You just know it’s going to blow someday. (Yes, yes, I know that nitroglycerin doesn’t come in jars and that if it did, keeping the lid on would be the least of your worries, but you get the picture.)

That someday was one evening when a group of four of my friends showed up, hammered loudly on our front door and then waltzed in before I could get to the door, startling Orbit and rearranging four of his five neurons (I said he was beautiful, I didn’t say he was smart). He began to bark furiously at them and since that day barks whenever there is a knock on the door. Not only does he bark whenever there is a knock on the door, but he also barks whenever he thinks there is a knock on the door. This encompasses a breathtakingly wide array of knock-like sounds associated with cooking, cleaning and just life in general. After years of counselling people to avoid letting their dogs bark, here I had a dog that barked like a deranged fool when I so much as accidentally hit the side of a saucepan with a wooden spoon.

So, the problem is clear, but what’s the solution? Dogs are like humans in that acquiring a bad habit is the easiest thing in the world to do, but unacquiring is an entirely different matter. It takes a lot of work and it takes a lot of time. At its most basic level you want to negatively reinforce the bad behavior and positively reinforce the good. Now, before I go on, I should emphasize that negative reinforcement is not the first choice for most behaviours. For example, when you're housetraining a puppy, you ignore the bad behaviour (and positively reinforce the good), and when you're trying to stop a dog from chewing your shoes, you redirect away from the bad behaviour (and reinforce the good). In most cases ignoring or redirecting is the way to go. But ignoring does not work for barking, and in Orbit's case, redirecting did not work either. He was that dedicated to his task. A workaholic barker.

In theory, this all sounds simple enough, but the real trick is that you have to do it consistently. For a barker, the positive is easy enough. If ever someone happens to knock on our door and Orbit doesn’t bark, he gets rewards and lavish praise. This doesn’t happen very often. The negative reinforcement is tougher though. I recommend a squirt gun or a plant mister accompanied by a firm no. Squirt him in the face each time he barks and say no in as gruff a tone as you can muster. The problem is the consistency. The barking is self-reinforcing, meaning each time he barks he feels even more like barking the next time, so if you only squirt him one out of three times, the barking is winning two to one. Practically speaking this means having squirt guns or bottles placed all around the house so that one is always at hand. Or I suppose you can keep one in a holster, but you might get funny looks. Regardless, you will have to do it a thousand times in row to be effective. It’s exhausting.

Incidentally, if your dog is one of those weirdos who likes being squirted in the face, you’ll have to find something else he doesn’t like, such as perhaps a blast from an athletic whistle. And I don’t recommend the bark collars, certainly not the shock ones. The ones that spray citronella had potential when they were first released, but I found that many dogs just learned to tolerate the citronella spritz. They have the advantage that you do not need to be home for it provide negative reinforcement, but if you can do the spraying with water you can control the dose, as it were, to get the desired effect. The first few times Orbit ended up with a dripping wet face before he stopped barking, but now we often just have to reach for the bottle and squints his eyes, lowers his head and, yes, stops barking.

I wish I could end the story there. Unambiguous success. Clever veterinarian triumphs over foolish barking dog. But life is rarely so simple. Recall that I said that consistency was key. Too often I can’t find a squirt bottle at that moment, or my hands are full, or I’m not near enough to where he is, or… insert a dozen other excuses. In short, we are not consistent. He barks less, but still too much. However, should the barbarian invasion actually come, we’ll have ample warning. There’s always an upside.

Yes, You Climb Volcano

I'll start this blog by exhuming a short travel story that was first published back in the '90s, and was read by Bill Richardson on CBC radio.

A number of years ago Lorraine and I were traveling in Southeast Asia when we ended up in a little flyspeck cluster of isles in eastern Indonesia named the Bandas. The Banda islands are each quite small and low and are arranged in a kind of loose bracelet around Gunung Api, an active volcano that rises in a perfect cone out of the sea in Banda harbour like a child's naive drawing of a South Sea's volcano. There is little to do in the Bandas other than snorkel and stroll and fully exercise one's passion for sloth, but after a week or so of staring up at that magnificent volcano I could sloth no more and began to think about climbing it.

The idea was, evidently, not original. Our host smiled and nodded vigorously - "Yes, you climb volcano!!" - and arranged for Bapa Saleh, the guide, to meet me at five the next morning. I say "me" and not "us" as Lorraine has an uncanny intuition for detecting when I'm being an idiot.

So Bapa Saleh and I set off across Banda harbour in a dugout canoe at five the next morning, with me in splendid anticipation of the magnificent view from the peak of Gunung Api that would be had of dawn breaking over the glittering Banda Sea.

This anticipation was almost immediately replaced by bewilderment and then ever-higher states of anxiety as it became painfully clear that this thing was actually going to be bloody difficult to ascend. The volcano was entirely covered by loose sharp rocks on a slope as utterly steep as gravity and the established principles of physics would allow a slope of loose sharp rocks to be. Consequently I was reduced to scrabbling up on all fours with three slips down for every four scrabbles up. In short order, despite the pre-dawn coolness, I was completely saturated in sweat, coated in grime (albeit exotic volcanic grime) and both my knees were bleeding.

At this point it probably bears mentioning that I am a (relatively) young and healthy man. Bapa Saleh was sixtyish, wearing only bathing shorts and a Kentucky Fried Chicken t-shirt and was in bare feet. Bare feet! Moreover, the man could move at an incredible clip and, perversely, his only English was "Slowly, slowly!" which he would periodically shout down to where I lay gasping and panting as he continued to skip up the mountain.

Then it began to rain. Hard.

I have few recollections of the rest of that climb other than that of a strong smell of sulphur and a hazy photo taken by the hugely smiling Bapa Saleh with me looking like something that might have been found in the trenches at the Somme, clutching an Indonesian phrasebook and sitting at the utterly socked-in summit.