Speech by the Mayor of Atlanta

email from Sunil Liyanage

May 30, 2020, 4:52 PM (14 hours ago)

to DonaldJTrump@wh.com

Have you EVER heard a speech like this?

 

https://www.fox5atlanta.com/video/689455

 

A Doctor's tale

Listening to ‘The Tales Patients Tell’

 

From the Blog - https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.cambridgeimmunology.org%2F%3Ffbclid%3DIwAR3JXgxOGILR0f8JJ3IitbCvCBg9K9fNW_-d9b0CixcrjDY9T9D1JOVd80g&h=AT1asdmsWLxtYY4PfkZt4Bik1-Qr8j0bnLyoJPlZtu1ZQXCDPUpO7_edy6YeEpDhKzqn60HZbT2NcskdugOH9lJt1MqSng3aI0cZAcnPCD_b-iFmLPbJi4OOBa8VJUmIjbh6aw

 

Listening to ‘The Tales Patients Tell’

Picture from:Abraham-leon-kroll-the-conversation-natl-academy-nyc-1920

When the ghost of a dissipated life appears at the stroke of midnight, and demands that I explain the most important lesson that I have learnt during my many years of clinical practice, the one I would wish to pass on to the next generation of doctors, I have only one answer: “First, last and always, listen to the patient”.

I myself have a chronic illness, and as an immunologist, I primarily look after patients with long-standing ill-health, due to rare, ‘orphan’ illnesses. Such patients become ‘experts’ on their condition and are more knowledgeable about their condition than most doctors and healthcare workers who look after them. From my perspective, the ‘expert patient’ is a joy to deal with. However. an all too common reaction to them, when ill, by doctors, and dare I say nurses, is to sigh and give them a look that conveys, “Now I’m the medical professional and I know what’s best for you, and you be a good boy or girl and pipe down.” Thus, many a medical ‘misadventure’ is born.

The importance of listening to the patient is one of the skills I learnt very early on, as a medical student and young doctor. I was deeply impressed by a lecture given at the end of his career by a physician par excellence, Professor Rajasuriya, called ‘The Tales that Patients Tell’, about the value of a carefully taken history. This lesson was seared into the medical toolbox within my brain, as a young intern doctor. 

I was working the professorial medical unit as a house officer, and my co-house officer was Sarath Gamini, who went on to become an eminent physician. The ward was located in a long rectangular building, with half parapet walls surrounding it; a design aimed at providing ventilation to mitigate tropical heat and humidity. At any one time, the ward housed about a hundred patients. Sarath Gamini and I were doing the early morning ward round one Sunday morning, following the intake of patients presenting at the hospital emergency department the previous night. On such ‘casualty intake’ days, about 50 patients were newly admitted during the night, to be dealt with by two rookie doctors. We were working systematically, to review the patients under a priority system based on the severity of their attending complaint, to get ready for the ‘post-take’ morning ward round, by the consultant on-call.

We were working at the head of the ward, reviewing the patients in the beds just inside the parapet wall. Those judged to be less ill were either standing or seated or lying on mats on the verandah outside the parapet wall. A young man in his early 20s kept complaining that he was feeling ill, and had chest pain, and insisting that he be seen first. My co-houseman told him that being a young man, he was unlikely to have a serious heart condition; there were many people who were older and sicker than he was, and he must wait his turn. The man kept complaining bitterly and then in slow motion collapsed to the floor. We thought he was malingering, but he had had a cardiac arrest and could not be resuscitated. A post-mortem was refused by his folk, so we never found out the cause of death. Every time I get ‘irritated’ by a ‘know -all’ patient, this incident flashes in front of my eyes.

Some of the most astute diagnoses and patient management decisions that I have made were as a result of listening to the patient before me. Recently, I was consulted by a 47 year old lady, who told me that she had an ‘immunodeficiency’ and developed serious repeated infections, but that no one believed her, as her blood inflammatory markers were never raised (CRP, ESR, CBC). She had a history of dental abscesses, skin infections after minor trauma, complicated typhoid fever when living in South Africa, urinary sepsis and lung infections, but her inflammatory marker called C-reactive protein (CRP), which is typically raised during bacterial infections, was never elevated. She showed me a graph of her CRP, which only reached 22 (normal <4 20="" a="" africa="" an="" and="" at="" bacterial="" been="" blinking.="" but="" can="" canada="" cell="" crp="" defect="" deficiency="" detecting="" diagnosed="" did="" div="" due="" during="" episode="" examples="" for="" genetic="" give="" go="" had="" her="" hundreds.="" i="" immune="" in="" innate="" into="" it="" nbsp="" not="" of="" patterns="" pneumonia.="" pneumonia="" proven="" rare="" receptors="" s="" seen="" she="" south="" specialists="" such="" the="" till="" to="" took="" uk="" usa="" wall="" when="" where="" without="" word.="" work.="" you="">

Another example is a lovely young lady, who had a long-standing rheumatic disease, which had been treated with drugs that suppress the immune system. These, in turn, made her unable to synthesize proteins called immunoglobulins, also known as antibodies, which are needed to protect her from bacterial infections. She was troubled by recurrent infections, until we initiated treatment by replacing the immunoglobulin that she lacked, by intravenous injection of concentrated immunoglobulin, prepared from the blood of healthy donors: a product called intravenous immunoglobulin. She used to attend the day case ward of our hospital, every 3 to 4 weeks, to receive an immunoglobulin infusion over 3 to 4 hours. This practice is resource intensive for the National Health Service and ties the patient to attend hospital every 3 to 4 weeks. This method is increasingly replaced by giving an alternative product called subcutaneous immunoglobulin, which the patient can be taught to self-administer, at home, by injecting it under the skin.

I saw this lady in my clinic for a routine review. She was doing well; the consultation was short and uncomplicated. At the end of it, I asked her whether she had anything else to discuss. She hesitated, but I encouraged her to continue. She explained that coming to the day case ward allowed her to meet other patients with similar conditions, to socialise, and to exchange notes about the tribulations and triumphs of people with conditions like hers. This lady is a writer and poet. While on the ward, she met another patient receiving the same treatment, who was an accomplished and eminent author in his seventies. They started to compare notes about each other’s condition. The senior author, a poet, sent her his most recent poems for perusal; she, in turn, shared her blog, her memoir and short stories. They had a tempestuous, although sometimes exhilarating synergy, and they synchronised their treatment dates to facilitate their social interaction. The only venue they met at was the day case ward.

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As a physician, you have to look after a patient’s mental well-being as well as their physical health. I told her that we could agree that intravenous immunoglobulin, administered as a day case, was essential for her wellbeing, and that we did not need to further discuss transferring her treatment to use subcutaneous immunoglobulin. The status quo continued until the elderly writer passed on to the Valhalla that the souls of departed authors inhabit.

Another antibody deficient patient, in her mid-60s, was also receiving subcutaneous immunoglobulin. The serum is given as an injection under the skin of the tummy, or the upper thigh, and this results in swelling around the injection site. The swellings subside within about 48 hours and is well tolerated by most patients; it is the standard of care around the world. This lady had come for a routine review of her progress, and was brought to me by our specialist nurses, who informed me that everything was going swimmingly. I talked to the patient and was pleased to note that she was no longer troubled by the recurrent infections that predated her being treated with subcutaneous immunoglobulin replacement therapy. Again, before she left, I asked her whether she had anything that she would like to discuss. She took a deep breath and said that she suffered immensely from the subcutaneous injections. Her tummy would swell, the swelling was large and painful, and would not go down for over a week. Now this is unusual, and therefore I delved further into her story. It turned out that from her teens, she had developed marked swelling of her legs. Examination confirmed that she had a condition called lymphoedema, due to an inherited condition called Milroy’s disease. Lymphoedema is a condition where the fluid that exudes from the blood to nourish the tissues is not reabsorbed. The so-called interstitial fluid is normally reabsorbed by tiny vessels called lymphatics, which take it back into the bloodstream. If the lymphatics are not developed or blocked, the fluid remains in the tissues, causing swelling, or lymphoedema. If you inject subcutaneous immunoglobulin under the skin, it is absorbed into the bloodstream gradually over a day or so via the lymphatics. If the lymphatics don’t work, the subcutaneous immunoglobulin will not be absorbed and will cause a painful persistent lump. Q. E. D. (quod erat demonstrandum).

I informed the patient that I understood the problem, and that as subcutaneous immunoglobulin was not suitable for her, we would proceed to treat her with intravenous injections of immunoglobulin instead. I ended up with a happy patient.

The immune system can affect most of the systems of the body, and when colleagues in other disciplines are faced with patients who are puzzling, they often end up being referred to an immunologist. “This person baffles me, let’s see what the Immunologists think!”. Thus, a 50-year-old lady was referred to me by a haematologist, who did not think she had a blood disorder -her complaint was of fatigue, and a slight reduction in her white blood cell count. I investigated her thoroughly but was similarly puzzled. I took her history again. Her main problem was fatigue, which fluctuated in intensity. Coinciding with the zenith of her fatigue intensity, she noticed that her eyes became pale yellow, and her urine became dark. I did some simple tests to check whether she was destroying her own red blood cells, a condition called haemolysis. She indeed was, and had an underlying disorder, called paroxysmal nocturnal haemoglobinuria, caused by the surface change of some red blood cells. This change makes them susceptible to be lysed by components of her own immune system, called the complement system. When red cells are destroyed en masse, the red pigment is broken down to bile, which makes the eyes tinge yellow and the urine dark. There is a biological agent that blocks the complement system that destroys red blood cells, and this lady was initiated on this treatment, by a national scheme. When I saw her six months later, she was a new woman; the enervating fatigue, which had plagued her for 10 years was no more, and there was a spring in her step.

Another lady in her 30s was referred to me to exclude an underlying immunodeficiency; she had been admitted to hospital about 30 times in the previous 18 months, with proven sepsis, and no one could find out the source of the sepsis or what underlay her serious condition. Again, careful attention to history revealed that she had been troubled for several years by joint and muscle aches, a condition called fibromyalgia. She mitigated this by taking handfuls of a painkiller, called an NSAID, a nonsteroidal anti-inflammatory agent, as though she were eating Smarties. I enquired whether she felt pain in the upper part of her abdomen, an area called the epigastrium. Indeed, she was troubled by prostrating abdominal pain from time to time. A gastroenterologist then examined her stomach by passing a camera into it and found a large ulcer in her stomach lining. This was most likely caused by her intake of nonsteroidal anti-inflammatory agents, and she was advised to stop taking them. She was treated with ulcer healing drugs. The episodes of sepsis were due to ‘bugs’ from her stomach ulcer getting into her blood stream. When I saw her a year later, she was completely well, and had been free from any more hospital admissions with sepsis.

I think the curse of medical practice are doctors and nurses who don’t listen to patients and take what they say seriously. This is not to say that I have not come across factitious illnesses by people injecting themselves with contaminated stuff giving rise to infections and serious abscesses, or Munchausen’s by proxy, where parents manufacture illnesses in children to get enhanced social security payments, and hypochondriacs who imagine a whole range of symptoms and abnormalities, called a somatization disorder. 

Despite these exceptions, the main lesson I would like to pass on to the next generation of doctors is, “First, last and always, listen to the patient.”
The art of listening : By Leon Zernitsky: https://en.wikipedia.org/wiki/Leon_Zernitsky

With grateful Thanks to Shaista Tayabali, Editor and Korrektorin.

Bailo from Goa

Philip G Veerasingam

Bailo from Goa - When my wife Ramya and myself went on a Cruise ship early last year we disembarked at a port in Goa. There was a musical band which sang songs at the pier, to welcome the tourists. I recognized the melody and beat as the same as a Sri Lankan Baila. When I asked them about the song they called it 'Bailo'. The Portuguese controlled Ceylon from 1505, their first accidental landfall, and later1597 to 1658 as part of their empire. Their headquarters was in Goa in India. They invaded Goa in 1510. They heavily influenced Goan culture, cuisine and architecture. Their control over Goa lasted till 1961 when India took over control. The music of the Baila, Bailo, is derived from the musical expertise of the Portuguese. Wally Bastian helped in the revival of this music in Ceylon, in the early 1950s.

 
Portuguese ‘Bailo’ from Goa

Please click on the web-link below, with your speakers on :-
 
https://www.facebook.com/100002568976224/posts/2918821298213474/?sfnsn=mo&d=n&vh=i

Interesting point of view, on COVID

Inbox

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Lakshman Karalliedde

May 18, 2020, 11:01 AM (18 hours ago)

to bcc: me

My mantra too.

Brilliant talk

x

Sunil Liyanage

Mon, May 18, 11:58 AM (17 hours ago)

to

This speech is brilliant & worth listening to.

 DR. RICK RIGSBY is a USA Today, Amazon, and The Wall Street Journal best-selling author. Rick is a former award-winning journalist who became an Internet sensation when his speech on hope was viewed by over 130 million people worldwide. Darrel

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Dr.C.S.Ratnatunge

Most of our batch would remember our VD  appointment. There was Dr. Ratnatunge and Dr. Ms Jayawardena - Lester Jayawardenas wife, Here is a write-up on Dr. Ratnatunge by Dr. Nihal Amerasekera.

Dr C S Ratnatunge - Remembered by Dr Nihal D Amerasekera

We are eminently fortunate to have been medical students during the golden era of medical education in Sri Lanka.

Dr C S Ratnatunge was the Superintendent of the Anti-Venereal Disease Campaign and Clinical Specialist in Charge of the VD Clinic. The Clinic was in a back street close to the GHC and remained a non-descript building without a name board. All those who entered and left the building (except the doctors) did so like frightened deer at Yala.  We all had  a 2 week appointment with CSR during which he taught all we needed to know and more. It was one of the best organized and comprehensive clinical teaching courses I have attended. What struck me most of his teaching was his ability to combine scientific detachment with sympathetic understanding of the mental and physical trauma of his patients. As a doctor he was meticulous and a superb clinician.

In 1964 whilst working in the VD Clinic CSR published the History of  Venereal Disease Control in Ceylon with Eunice D.C Pereira. This seminal work on the subject published in the British Journal of Venereal Disease brought him worldwide acclaim.

He proceeded to the UK in the early 1950’s where he obtained his MRCP(Edin) and qualified further in venereal diseases in London. On his return he took charge of the VD Clinic where he worked until 1966 when he retired to proceed to the UK. CSR was appointed Consultant in Genito-Urinary medicine at the Royal free Hospital in London where his expertise was greatly appreciated.  During his tenure he published many scientific papers that were published in the BMJ, Lancet and in the British Journal of Venereal Diseases. CSR also worked as a Consultant to the WHO. He retired in 1982 and the Royal Free hospital held a Symposium on Sexual Health in his honour.

As a Consultant at the Royal Free Hospital he was a visiting physician to the Prince of Wales Hospital in North London where I worked in 1975. Once I introduced myself  in a dark corridor in the bowels of that hospital. Since  then whenever we met he gave me friendly and helpful advice about my career. Even after I became a consultant although he was retired he continued to do several Locums in my hospital. We often met up at lunch in the hospital canteen where we discussed all topics from medicine to politics and mutual friends and acquaintances. He was a kind man generous in his praise for others and a gentleman in every sense of the word.

We thank him for his contribution to medical education and his tireless work in Sexual Health.

May he find Eternal Peace

Covid in the UK, blaming China.

Dinakantha Kumararatne

26 April at 12:06 ·

For those who are inclined to be apologists for the UK approach to deal with Covid: please read this article from the Financial Times:
When Dr Richard Horton turns up for our Zoom lunch, I feel a pang of disappointment. I am at home but attired for a real-life work meeting: black frock, inoffensive earrings and a dab of make-up. The editor-in-chief of The Lancet, the prestigious British medical journal founded in 1823, “arrives” in a black hoodie. He has apparently forgotten his light-hearted promise to wear a jacket, though happily remembered that we are dining together. “Look, I’ve got my lunch,” he says proudly, thrusting a brown paper bag towards the camera. He offers to wait until mine is delivered. I am not surprised that our loose sartorial agreement has crumbled in the face of his to-do list.

It was The Lancet that, in January, first published clinical reports of a mystery pneumonia from Wuhan. Since then, a trickle of papers on Covid-19 has become a torrent of crucial, freely accessible information helping to shape the public health response in real time. That has landed the 58-year-old with an arguably more important secondary role: critic-in-chief of the UK government’s handling of the Covid-19 outbreak. Since February, he has accused ministers and their advisers of failing to see the coming storm, keeping up a barrage of criticism in The Lancet, in newspapers and on television. The UK response to the pandemic, he told the BBC on March 26, is a “national scandal”. I go to the heart of the matter: does the government have blood on its hands? “I’m not going to use those words, but I do believe lives could have been saved had we acted earlier,” he says. “If we had used February to scale up capacity for testing and contact tracing, and to begin surge capacity for intensive-care bed use, it’s absolutely clear we would have saved lives and saved the NHS. Even if it wasn’t the extreme lockdown we see now, we should have been reducing social mixing and winding down economic activity, like promoting working from home and physical distancing, so that we started to cut the lines of transmission.” We are speaking against the backdrop of an increasingly rancorous debate over the UK’s response.

He has despaired at how the science and politics of this pandemic have been handled at every turn: from the lack of testing at the beginning to what he says is the “charade” of the daily press conferences and the “strategic failure” of the government to plan adequately. He, along with others, has demanded transparency on the opaque epidemiological models that shaped the UK’s originally laissez-faire response, which included floating the idea of “herd immunity”. I have delegated the catering at my end to my 17-year-old daughter Rosa. She settles on an Italian via Just Eat. The doorbell rings; a few minutes later, she serves me four slices of Hawaiian pizza and waves hello to my interviewee.

Horton and I briefly discuss how unsettling the pandemic is for children. Horton is sitting in a study with the obligatory bookshelf in the background. He unpacks his lunch and angles his camera down to flaunt a carefully arranged Mediterranean feast. His spicy meze platter comprises chicken, homemade tzatziki and hummus, baba ganoush and fresh chilli sauce. I can’t help feeling a little jealous. Horton has to be one of Britain’s longest-serving editors. He joined The Lancet in 1990 and was appointed editor-in-chief five years later, aged just 33.

He makes no apology for being overtly political. “Some of the great advances, like the 19th-century sanitary movement and the birth of the NHS, were not technical accomplishments but political struggles. The idea you can strip out politics from medicine or health is historically ignorant. The medical establishment should be much more politicised, not less, in attacking issues like health inequalities and poor access to care.” Notably, one of his idols is Michael Marmot, a London-based academic who has pioneered the study of how social inequality affects health. The idea you can strip out politics from medicine or health is historically ignorant It was studying physiology and medicine at the University of Birmingham that first opened Horton’s eyes to how other people lived. “I can remember as a student going into high-rise flats where the carpets were soaked with urine,” he says. “The bathrooms were completely unsanitary, the kitchens were loaded with unwashed dishes and cutlery, and everywhere was dirt. I’d never seen anything like it before.” After a middle-class upbringing he only discovered in his forties that he was adopted, that his birth father was Norwegian and that he had five half-siblings: “It was a shock. I went from being an only child to having this enormous family. Being half-English and half-Norwegian changed the centre of gravity of who I thought I was and I’ve been having a love affair with Norway ever since.”

Horton has been labelled a left-winger by his critics. He rejects the tag, saying he has voted Conservative, Labour, Liberal Democrat and Green. His philosophy is, however, faithful to the spirit of Lancet founder Thomas Wakley, a surgeon and social reformer once described as an “honest denouncer of invidious distinctions betwixt the rich and the poor”. Wakley named the journal after a surgical instrument and a type of window: it was meant to symbolise piercing corruption and letting the light in. Accordingly, Horton has shone the light of The Lancet on a range of political causes: he has praised the climate protest group Extinction Rebellion, urging healthcare workers to join non-violent protest; he published an emotively worded letter in support of the people of Gaza penned by a geneticist in Italy later accused of having anti-Semitic sympathies; and he ran a study claiming that civilian deaths related to the Iraq war had been undercounted. None has made him the most popular man in the room. Dr Michael Fitzpatrick, a GP and former Lancet columnist, described Horton to me as “very personable and easy to deal with, but a bit of a showboater and a pariah in the medical establishment”. In truth, Horton has never been forgiven for publishing a 1998 paper by Andrew Wakefield that raised unfounded doubts about the safety of the measles, mumps and rubella (MMR) childhood vaccine. Despite years of controversy, the paper wasn’t fully retracted until 2010, after the General Medical Council ruled Wakefield had been dishonest (he was later struck off). The uncertainty caused childhood vaccination rates to plummet and energised the anti-vaccination movement.

The MMR debacle became one of the biggest ongoing calamities in public health. “There’s no escaping the serious damage that was done,” Fitzpatrick tells me. “He [Horton] wasn’t apologetic enough about what happened.” Does Horton regret what happened with MMR? “I’d be mad not to, but I can’t simply retract papers I don’t like. There has to be due process [via the GMC tribunal].” Has he ever come close to being sacked? “I don’t know,” he smiles. “You’d have to ask my publishers. All good editors get fired eventually.” It is time to change the subject.

We have a pandemic to discuss. When we meet, the shortage of personal protective equipment among health workers is dominating media coverage. Hospital trusts have threatened whistleblowers with disciplinary action; Horton has offered to act as conduit for their dispatches from the pandemic front line: “Workers have been bullied and forced to see patients who clearly have or are suspected of having Covid-19 without PPE. When they raise concerns, they are belittled or threatened. It’s horrifying to see the lack of concern by some NHS management.” War zones, one doctor told him, are better prepared than the world’s sixth-largest economy.

The NHS was left playing catch-up, Horton says, because the government either ignored or did not act on information in a timely manner. The first paper suggesting the existence of a new contagious virus appeared in The Lancet on January 24. Horton now wants to know why that chilling assessment was seemingly passed over in Whitehall. “Why wasn’t that paper read by the Scientific Advisory Group for Emergencies, or the New and Emerging Respiratory Virus Threats Advisory Group, or NHS England, or the chief medical officer or the chief scientific adviser?” he asks. “We had all of these committees and all of these offices and all of these organisations, but somehow they didn’t connect. We’ve had the biggest science policy failure in a generation.”

He dismisses the idea that such a devastating outbreak could only have been predicted with hindsight: “How can it be hindsight? It’s there in black and white on January 24, written in a paper from China, telling people, ‘Please act now, this is urgent, there’s a crisis.’ ” A week later, another Lancet paper warned that, since the virus was no longer contained in Wuhan, and that “self-sustaining outbreaks in major cities globally could become inevitable . . . Preparedness plans and mitigation interventions should be readied for quick deployment globally.” Blue Kitchen Mediterranean Cuisine 177c Priory Road, London N8 8NB Hot and spicy marinated chicken meze platter (free-range chicken, fresh organic chilli sauce, tzatziki, baba ganoush, hummus) £9.50 Highland Spring water Wood Oven Pizza 391 Kilburn High Rd, London NW6 7QE, via Just Eat Tropicana pizza £7.99 Extra black olives 80p Service charge 50p Total £18.79 Horton’s combative public persona conceals a personal struggle: in 2018, he was diagnosed with advanced melanoma. His experience as an NHS patient adds to his sense of outrage at the pressures facing health workers. “I don’t think I’ve ever been in an institution where people have been so genuinely kind and thoughtful,” he says. “That’s why I’m so angry that we didn’t act sooner. I’m angry because I know how good the NHS can be. Politicians and policymakers and scientists let down the NHS and its staff. And that’s unforgivable.” The government is clearly rattled by such criticism.

A Sunday Times article entitled “Coronavirus: 38 days when Britain sleepwalked into disaster”, published last weekend, drew a lengthy rebuttal from the Department of Health and Social Care. The rebuttal includes a quote from Horton on January 23 calling for “caution” and accusing the media of “escalating anxiety by talking of a killer virus” to dismiss the idea that a scientific consensus around a coming pandemic was building in late January.

The quote originated, he clarifies, from a tweet urging caution on lurid coverage rather than government policy. Besides, the World Health Organization declared a public-health emergency on January 30. “I do think it’s a misrepresentation, absolutely,” he says. “Between January 24 and 31, there was daily mounting evidence and concern that this was tipping into a pandemic.” Meanwhile, the scientific community is desperate to second-guess what the virus will do next. “We are already seeing it’s got the potential to come back,” he says, noting China’s uptick in cases. “That’s very worrying indeed, and it’s why we need a vaccine as quickly as possible. “But there’s still a vast amount to learn. Why did the outbreak take off so dramatically in Italy but not Germany? Testing is one possibility, but we don’t know for sure. Testing is absolutely crucial, and if we’re going to get out of these lockdowns we definitely need to scale up our capacity.”
Western countries have fared poorly in their coronavirus response compared to Asian countries, he thinks, because they saw the threat through the lens of influenza. China and Hong Kong feared a rerun of Sars, a much deadlier illness, and clamped down quickly. The cognitive bias, he says, has cost us dearly. Horton also worries about complacency setting in once this pandemic has run its course: “It would be very dangerous to say this is our 1918 [Spanish flu pandemic], and to think these things only come around once a century. The conditions still exist in countries for zoonotic diseases [which jump the species barrier from animals to humans] to develop. We’ve had five or six of them in the last 20-30 years.

This is the big one for now but there might be an even bigger one to come.” I wake up and think I’ve got to make the most of every day, because I don’t know how many I will have Rosa brings a coffee cupcake, but we have moved on to talking about Horton’s cancer and it seems disrespectful to eat it. It was his 19-year-old daughter Isobel, from Horton’s marriage to paediatrician Ingrid Wolfe, who urged her father to get a mole on his right temple checked out. Since his diagnosis, Horton has undergone surgery three times and is left with scars and an uncertain prognosis. He is now on immunotherapy. Every day is “the toss of a coin”. Therapy soothed his darkest moments: “I thought I didn’t have very long to live, maybe weeks or months . . . It was extraordinarily helpful to be able to sit in a room with someone who is on your side and be able to say anything.” Solace now comes in the form of books — currently The Birth of Biopolitics by Michel Foucault, on how governments exercise power over the lives of their citizens — and a nightly glass of Lagavulin whisky. He is still nervous about touching his face because he fears to find cancer has returned.

But for now he feels — and looks — strong: “I wake up and think I’ve got to make the most of every day, because I don’t know how many I will have.” He will push for a public inquiry into the coronavirus pandemic, and for the WHO to be strengthened, not weakened. The inaction that followed the WHO’s emergency declaration, he clarifies, was down to member states and not to China, to whom he says the world should be grateful to for its warnings and containment efforts. That attitude might surprise those in the medical profession who criticised China’s initial response to the outbreak.

But the idea that China should pay reparations for the resulting economic losses is, he says, ridiculous, and he calls Donald Trump’s decision to suspend WHO funding a “crime against humanity”. He is now writing a book about why, despite the warning signs, the Covid-19 pandemic caught the world by surprise. Meanwhile, that formidable to-do list leaves no time to answer his critics: “You said earlier that people think I’m a pariah. Maybe in previous years that might have upset me. But now? I really don’t care what people think of me. If I’m not here in six months or a year . . . f*** them. Seriously.” Anjana Ahuja is an FT science commentator Follow @FTLifeArts on Twitter to find out about our latest stories first. Listen to our podcast, Culture Call, where FT editors and special guests discuss life and art in the time of coronavirus. Subscribe on Apple, Spotify, or wherever you listen.