In a moment of exuberance some weeks ago, I floated the idea of Fractal Friday. I got a bit self-conscious subsequently because Andrew Gelman in this post joked that fractals are so ’80s. I can’t have been paying attention in class.

Anyway, this picture fell out of its folder during a trawl for happy memories on the hard drive yesterday. It was taken last year in the Chamonix Valley, where fractals abound.

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Welcome to the Knackered Hack. If you're visiting in search of my paleo lunch with Black Swan author Nassim Taleb, you'll find it in three parts here. If you enjoy what you see don't forget to subscribe to the RSS feed. Alternatively, so you don't miss an important update and can more easily forward those salient posts to your friends and business contacts, sign up for my regular email service. You can follow me on Twitter by clicking here. Thanks for visiting!

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Among the reasons why blogs stop updating, bereavement is unlikely to be high up on the list. But that is why the Knackered Hack fell silent these past few weeks.

Spending an extended amount of time in limbo in hospital brings to the fore all sorts of extraneous thoughts about time and uncertainty, not to say the complexity of information that tired, exhausted relatives have to absorb and sometimes make important decisions from.

Hospitals are all about corridors, lifts, stairs, inadequate eating facilities, irregular food and drink, and not a lot of fresh air. That’s especially true if you are there for a long-term vigil and not just popping in during visiting hours. There was a moment when I realised that it had some of the hallmarks of the Opec meetings I was required to cover professionally in my early 20s. They involved endless days in hotels in Geneva or Vienna, chasing important-looking men speaking English with thick foreign accents, the majority of whom were under the mistaken impression that they were in control of things. Time was completely elastic. In fact we even called it “Opec Time” because nothing ever happened when it was meant to. When the Hotel Intercontinental in Geneva gave us watches with the Opec logo on them we all laughed.

But the business of how to manage your own expectations in hospital — and how your expectations are being managed by the medical authorities — is a serious one. There are definite differences between junior doctors and the more senior consultants. The key qualifier, in my recent experience, is frankness. Hope in a hopeless situation is very confusing, but I guess the younger you are as a medic, the more idealistic: the closer you are to your original motivations to help and do good. You are less used to death and less practised in the application of those heuristics that permit the cutting through all the possible treatments that a modern hospital has to offer to the more simple need for palliative care, which, where it involves ever larger doses of morphine, is itself terminal.

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