The Pitcairn Perspectives by Philip Spires - HTML preview

Medical assessment

Report on consultation with Professor Edward Pitcairn, annual health assessment prepared for Hackney Metro University, Personnel Department, Academic staff office.

I saw Professor Pitcairn on the morning of Tuesday 18 May 2021 at 9:45am in University College Hospital, London.

General notes

I have seen Professor Pitcairn almost every year for the last twelve years for the purpose of assessing whether he should, in his own interests, carry out further field work in a remote and isolated area of Indonesia. The exception was last year, 2020, when Professor Pitcairn was unable to fly to the United Kingdom because of restrictions on travel imposed by the Covid pandemic. I was advised that Professor Pitcairn would have an annual medical assessment as usual, but that it would be carried out at his local hospital in Yogyakarta. When I raised the issue of a lack of notes in his file from the assessment, Professor Pitcairn admitted that he, personally, had promised to make and keep such an appointment, but in fact never did. He blames pressure of work, lack of time and, above all, difficulties around travel. My own opinion is that he was probably already suffering some symptoms arising from his current condition during the last year and avoided the assessment because he did not want to risk having to undergo treatment, which would have disrupted his work, and precluded further field work.

In the field, he has to spend several weeks at a time under canvas in an area where minimum temperatures are around 26 Celsius. Though climatic conditions in the area where he works are drier and cooler than are generally found in the region, he himself spends much of his working day deep in damp, bat-inhabited limestone caves, hence the need for these annual health assessments. In general, Professor Pitcairn has remained in good health, and in the past I have had no reservations whatsoever in recommending his return for a further year of fieldwork. This year, however, I cannot offer that judgment. It is my suspicion that if Professor Pitcairn had pursued his annual assessment last year, then my current assessment of his condition might have been considerably less severe.

Edward Pitcairn is 1.82 meters tall and weighs 68 kilos, which is some 10 kilos less than last year. He does not smoke, drinks moderately, but, he says, never when working in the field. He is 73 years old and ostensibly fit, is sexually active when resident in his home in Yogyakarta, where he has a stable relationship with his long-term maid, who is over thirty years his junior. Though she has children from a previous relationship, they do not live with her, being permanently resident in the maternal parents’ household in the same city. Professor Pitcairn thus legally has neither dependants nor family responsibilities in Indonesia. There are thus no barriers to his not returning.

In London, he is in regular contact with his only daughter, Gemma and his granddaughter, Elsie. They are both financially secure and employed in professional roles, in academe for Gemma and media in Elsie’s case. Gemma and Edward Pitcairn jointly own a substantial house in Islington, a house whose part ownership Edward transferred to his daughter a decade ago. In the light of the following, it is my judgment that the house would provide a familiar and supportive environment for him. Gemma Pitcairn has offered her father long term residence, if it be required. Edward’s wife, Penny, died of breast cancer in 2004, an event which prompted Edward to embark upon fieldwork again after many years of tenure in a full-time post in Hackney Metro University in London. Professor Pitcairn spent the bulk of his academic life researching the archaeology of Australia before basing himself full time in London, during which time he cared for his wife during her illness. His desire to return to field work remained strong, and he undertook his current project in Indonesia with enthusiasm. This desire to place his practical study ahead of all other considerations is what led him, last year, to avoid reporting his symptoms and general ill health. I realize that much of this information has been included numerous times over the years, but I restate it here to provide a full picture of his current health status, given the changed circumstances to be described.

Health assessment and background

In previous years there has been little change in Edward Pitcairn’s general health. Over time, he has slowed down a little and put on some weight, but he has remained generally fit, largely as a result of activity related to his work. He has never taken extra exercise because he has never needed it. As noted above, Professor Pitcairn has recently suffered some unexplained weight loss, though how recently this began I am unable to assess as a result of last year’s missed evaluation. Edward Pitcairn, himself, cannot recall when it began or is unwilling to share his opinion.

He referred himself to his doctor in Yogyakarta about six months ago. He reported feeling more tired than usual and generally weaker. Unfortunately, this referral happened during a short visit from Sawu to lodge samples from the dig for analysis with the university labs. His doctor noted the reported changes in Professor Pitcairn’s health but recorded no other symptoms or observations. He prescribed general vitamins and minor dietary changes, which included more fresh food and no alcohol. Professor Pitcairn returned to the field two days after the consultation. I asked Professor Pitcairn if he had modified his behaviour after this advice, especially in relation to his diet. He replied that, in the field, the provision of food and eating were communal. There was simply no scope for special consideration, especially in the area of the purchase and storage of special diets.

Some five weeks after this medical assessment, Professor Pitcairn suffered what was described by his assistant as a ‘collapse’. They were together inside one of the network of caves they were exploring for evidence of prehistoric human remains. In medical records from his doctor in Yogyakarta, documents which also record the observations of his colleagues, Professor Pitcairn is described as having passed out and fallen into a small cavern, hitting his head on an earth bank on the way down. The assistant reported that Professor Pitcairn was unconscious for five minutes, and during that time lay half submerged in standing water, since the assistant did not have the strength or the manoeuvring space to haul the considerably bigger man clear of the crevice where he had become lodged.

After regaining consciousness, Professor Pitcairn is described as having suffered several minutes of severe confusion, during which he conversed only in unconnected, random phrases, many of which made no sense to his colleagues, indicating that they did not relate in any way to his immediate surroundings or concerns. Professor Pitcairn, it must be noted, has always been a focused and alert person, so much so that during this period of uncharacteristic confusion, several of his colleagues were convinced he was dying. An hour later, Professor Pitcairn seemed to have lost all knowledge of his incapacity and could not remember either the fall or the period of recovery. Throughout the subsequent days, almost for a week, he kept asking how he had managed to hit his head, because he developed a very significant black eye as well as a lesion on his scalp. Photos taken at the time are attached. Professor Pitcairn denies passing out and has his own explanation, an account that is not corroborated by any colleague. But if the account is at all accurate, it describes events that could not have been witnessed by anyone but Professor Pitcairn, himself, and the project co-director, who, for reasons revealed below, is unlikely to comment.

Worryingly, Professor Pitcairn seemed to invent, in the opinion of his colleagues, an altercation with Professor Sarnu, co-leader of the excavation, an argument during which, Professor Pitcairn claimed, he was punched in the eye. Unlike the fall in the cave, however, Professor Pitcairn claims he has precise recollections of where and when this happened, and indeed of the verbal argument that led up to it. In Edward Pitcairn’s description of events, the argument in question took place on the same day as his fall, earlier that morning, on a beach near the site where the two men had walked for a dawn swim. It is clear from all the material I have seen, and has been clear for some time, that the two excavation leaders have not shared what might be described as ‘friendship’ for the last twelve months, though of course they had worked together for about ten years. Their relationship had been ‘professional’ and largely polite, though they fundamentally differed on many aspects of their joint project. Professor Sarnu, of course, studied under Professor Pitcairn and at that time their relationship was at least cordial, friendly, indeed, in Edward Pitcairn’s own assessment. Things changed only some time after the two men began doing field work together.

Professor Pitcairn’s recollection tells of the two men having left the campsite, situated on a bluff above a wide sandy beach at about five thirty in the morning, before the sun was up. Apparently, this was not an uncommon practice, and thus was not noted as anything special by their colleagues. They were swimming by first light and had returned to the beach by six thirty, where they began a discussion about the findings that Professor Pitcairn was proposing to publish. It was apparently the revelation by Professor Pitcairn of the contents and conclusions of his paper that prompted the argument.

According to Professor Pitcairn, Sarnu had claimed that there existed an agreement between the two men that they would always publish all reports of their work under joint authorship. Sarnu had disagreed with Professor Pitcairn’s conclusions and had interpreted their publication in Professor Pitcairn’s name alone as undermining his declared ownership of the project. Sarnu has elsewhere claimed that joint publication of findings was a precondition of Professor Pitcairn’s participation in the project. Edward Pitcairn claims that no such document or even verbal agreement existed and that such conditions were never even suggested, let alone agreed. A text has come to light validating Professor Sarnu’s claims, but the authenticity of the document is questioned by the administrators of Professor Pitcairn’s own department and is described by Professor Pitcairn himself as “a convenient modern invention”.

The argument between the two men lasted at least an hour, but no corroboration of it having taken place was reported by any colleague on the site. The two men, it appears, remained alone on the beach throughout. Professor Sarnu claims this as vindication of his claim that there was no argument, while Professor Pitcairn cites the silence as evidence of the extreme intimidation suffered by the Indonesian staff on the dig. He claims they have been instructed to keep quiet and that they are too afraid to speak out.

Professor Pitcairn then went on to describe how Sarnu had accused him of deception and duplicity, while he had accused Sarnu of plagiarism and self-aggrandizement. For an academic, a charge of plagiarism is several degrees worse than one of murder, whereas self-aggrandizement is probably par for the course. At approximately seven-thirty, Professor Pitcairn claims, Sarnu threw a surprise punch, the full force of which connected near the left eye. According to Professor Pitcairn, the punch felled him, though he did not lose consciousness. Sarnu, it appears did nothing to help his colleague, but also did not leave the beach. Professor Pitcairn describes how he sat on the sand with Sarnu standing over him ‘looking threatening’. No further conversation between them was reported. After five minutes or so, Professor Pitcairn was able to stand, at which point he remembers Sarnu turning to leave. He offered his colleague no assistance. Professor Pitcairn says that Sarnu then went back to camp, while he, in order to avoid further contact with him, skipped breakfast and went straight up to the excavation site, taking a path that avoided crossing the campsite on the way.

I am not trained in any form of mental health procedure. I am neither a psychologist nor a psychiatrist. I make a clinical observation, however, that there exists a fundamental difference in Professor Pitcairn’s memories of the two events of the morning, indicating that there may be a pathological explanation. He seems to recall the argument with Sarnu in minute detail, even to the quotation of verbatim phrases. All memory of his collapse at the excavation site, however, seems to have been erased. He suggested that he may not even have suffered collapse but may have been felled by another blow to the head, delivered as he bent low over his site of interest in the dark. At the time of the reported collapse, it must be recorded, Professor Sarnu was certainly in his tent back at the camp, because there is a record of a telephone conversation between him and his department in Yogyakarta that lasted all morning. The content of that conversation is not on public record but seems to have involved an exploration of the legal consequences of expelling Professor Pitcairn from the site. It is certainly possible that the Professor’s collapse in the cave at the excavation site was a delayed response to the blow to the head on the beach from Sarnu’s punch. There now exists no clinical way of confirming or excluding this possibility.

After the collapse, Professor Pitcairn’s colleagues describe his mental state as ‘occasionally confused’ for the rest of that day. He did walk back to the campsite unaided, but he himself recalls that his progress was slow and ponderous along paths he knew perfectly well. He was sedated by a paramedic at the campsite and retired to his tent at around four in the afternoon and slept through until the next morning. The next day, he was told to stay in bed and was then transferred to a local hospital for observation and rest. He stayed there a further seven days until a helicopter could be arranged to airlift him to hospital in Yogyakarta. The staff on site indisputably followed the correct procedures in Professor Pitcairn’s treatment. It was essential that he be moved for observation from the excavation site to the nearby Pustu Menia hospital. It could certainly be the case that the actions of on-site staff may have saved his life.

After two days in hospital on Sawu, where he was described as ‘under observation’, he was again transferred by air to Yogyakarta and was again admitted to hospital, where he spent another five days under observation, before it was decided to run several clinical tests based on new symptoms he was reporting that had not been previously recorded on his file. Full and detailed records of his treatment after admission to hospital in Sawu and then in Yogyakarta have been made available to me and the care Professor Pitcairn received was exemplary. Professor Pitcairn, himself, has subsequently suggested that the entire episode of his collapse and hospitalization was a construct to get rid of him. I have seen no evidence to support this claim, but there were no witnesses to the morning encounter Professor Pitcairn has described and at the time of his collapse he was working with just one assistant, who has since left the team to seek employment elsewhere. His whereabouts are currently unknown. In Yogyakarta Edward Pitcairn received initial palliative care and was then under observation for a week, during which time tests were completed, before he was discharged to recuperate at home. The Yogyakarta hospital then readmitted Professor Pitcairn after three weeks. The consultant records that he wanted to repeat some of the tests he had done and at the same time carried out a thorough and professionally conducted check on his health followed by a more thorough series of tests. Professor Pitcairn had a blood test and an X-ray on his head. The blood test results were inconclusive and there was no skull fracture. Professor Pitcairn also had the usual chemical-based analysis, plus a full brain scan and later some magnetic resonance imaging of his body. The Professor was again discharged, being judged sufficiently recovered to embark on his annual leave, the date of which had been pre-arranged for some months. His doctors agreed to send the results of their analyses and tests directly to me, which they did. I received them on the Friday before Professor Pitcairn’s scheduled appointment with me this morning. I can state that all the procedures carried out in Yogyakarta were of the highest professional standard.

Test results, diagnosis and prognosis

The results as communicated to me are as follows. The lesion to the scalp ostensibly caused by the fall in the cave is judged to be superficial. There is, however, evidence of sub-cranial clotting above the left eye. The evidence described points to a small, highly specific trauma to the head, in line with what would be expected from a punch. The clotting, however, does show signs of having broken up and is cited as ‘dispersing’. It was assessed again after a few days and was then described as ‘non-threatening’.

More worryingly, however, is the finding that Professor Pitcairn does have advanced pancreatic cancer. The condition was suggested by analysis of blood and urine tests and the cancer’s spread was confirmed by the body scan. It is the opinion of the Yogyakarta medical team that the condition is advanced, has spread extensively and that no surgical intervention is now possible. On the basis of the results sent to me, I concur with that assessment, but I did encourage Professor Pitcairn to allow me to repeat the same tests to clarify things. Professor Pitcairn was resistant to this idea.

I told Professor Pitcairn these details during our consultation this morning and advised him that there did exist a treatment regime involving radio- and chemotherapy, but that this would be merely palliative. It would be administered in hospital initially, then as an outpatient and finally, if the process lasted into the medium term, it could be administered at home, with visiting nurse support. I offered an assessment that this care may prolong his life by six months, a year at most, but that the treatment’s side effects would be significant. Professor Pitcairn initially stated that he would refuse such treatment. He said he would prefer to use what time he had to complete some outstanding work and could not therefore risk suffering incapacity. I explained that his current life expectancy was in the order of weeks rather than months, an opinion that made him even more resolved not to accept any form of treatment.

In any case, my advice to Professor Pitcairn was that he should not return to his fieldwork, that he should take up the offer of residence with his daughter and that he should immediately contact the university administration to communicate his decision.

I submit this as a fair and true record.

A. Khan, Senior Consultant