He turns the boy’s hand
back and over feeling each

joint and bone. More useful than an x-ray.
Only hands can fix hands the way diamonds
can cut diamonds. He holds the thumb

affectionately, the ugly cousin, stumpy and awkward.
Yet indispensable in its opposition. But he loves all the digits
and the way that hands, like Swiss army knives, spring

tools for screwing, scratching, sensing. Tacked
on the wall there is a photograph, surrounded
by his framed degrees — a pudgy toddler’s hand

waving in the sun, scarred
but whole. Thanking, without
words, as only a hand can.

My dad in the neonatal ICU as a med student
was kind of responsible, at least for five minutes
for keeping all of those babies alive,
but he tried not to think about it.
He adjusted miniature IVs.
He recorded vital signs on charts and signed as
illegibly as possible, to seem official.
The babies didn’t know how frail they were.
They thought they were normal puppies.
They thought he was their dog mother.
But the machines were how they ate and breathed.
The machines in charge of keeping track
of heart function sounded like dripping tap water
or, at times, the silver resonance of a tuning fork.
The sounds crossed.
There was almost a steady rhythm.
There was almost a tune —
“Salt Peanuts” by Dizzy Gillespie, my dad thought
but none of the nurses had heard of it.
They heard heart monitors. They had clean sheets to fold.
So he had to wait thirty years to tell me and my brother
in the car on the way to dinner, as if he heard
our healthy hearts and lungs pumping, and thought of it
as if we were old enough now.

In the weeks before he died, Nigel Gray was honoured at the World Cancer Congress, drove his beloved Singer in a hill climb (complaining that he failed to beat his best time by one second), flew in a Tiger Moth biplane, played nine holes of golf with former British Open champion Peter Thomson, updated his jazz playlist, and wrote emails to be sent after his death to close friends and colleagues. He was a heroic figure who lived life to the full and made remarkable contributions to national and global health.

Originally a paediatrician, Nigel was Director of Cancer Council Victoria (CCV) from 1968 to 1995 and President of the Union for International Cancer Control (UICC) from 1994 to 1998, before an active post-retirement career with the European Institute of Oncology and the International Agency for Research on Cancer.

Nigel transformed CCV from a respected medical charity into one of Australia’s most prominent health organisations. He supported research and researchers such as Donald Metcalf, understood the need for cancer-relevant population data, started evidence-based public education on cancer (including the Slip! Slop! Slap! skin cancer campaign), pressed for more and better cancer services, and took the influence of cancer organisations to new levels. He was also instrumental in the development of clinical oncology and nurtured the network of specialists that became CCV’s Clinical Network.

He was best known for his achievements in tobacco control, where he was active into his last days. As early as 1969, a British American Tobacco company memorandum noted that “Dr Gray seems a formidable opponent”. In 1971, he ran Australia’s first antismoking commercials on television featuring Warren Mitchell and Miriam Karlin, overcoming attempts by television authorities to ban them. He led tobacco campaigning locally, nationally and internationally. In Victoria, he developed research and public education programs, and was the crucial figure in developing and lobbying for the 1987 legislation that banned tobacco advertising and created VicHealth, establishing a model that was replicated in other states and countries. Internationally, he led development of the first comprehensive policy approaches to tobacco control, initially for the UICC, whose tobacco program he established in 1975, and later for the World Health Organization and other health groups. He then led the first programs promoting global action on tobacco, with workshops, conferences and site visits in an extraordinary range of developed and developing countries. After hearing him speak at a cancer conference in Cairo, the Patron of the Egyptian Cancer Society, Jehan Sadat, went home and persuaded her husband, the nation’s President, to issue a decree banning cigarette advertising on television.

A confidential 1984 tobacco industry report noted: “It is the Australian, Dr Gray, who appears to have done more than any other individual to bring the anti-tobacco movement together in the international sense … his special contribution is to organise the integration of the disparate elements of the anti-tobacco movement into the most organic whole that it could be … ”

Nigel treasured this form of recognition almost as much as the more formal honours he received and the prestigious awards and fellowships named after him. He was made an Officer of the Order of Australia, received honorary doctorates from Monash University and the University of Melbourne, and was awarded a Luther L Terry Distinguished Career Award from the American Cancer Society.

Belying the appearance of a pillar of the medical establishment, Nigel was a fearless and innovative campaigner, and a generous mentor for younger colleagues whom he saw as similarly creative. A stylish figure, from television to the ski slopes, his zest for life continued to the end.

Many tributes have attested to the immense regard in which Nigel was held nationally and globally. Sir Gustav Nossal said: “Nigel Gray was the dominant cancer politician of his era. His pursuit of the tobacco industry was relentless, his use of the media superbly professional, his influence in the corridors of power enormous, belying his quiet, methodical, almost low-key approach … his courage was an object lesson, his contributions precise and positive to the end. His legacy is large and lasting.” On Nigel’s 80th birthday, the late Kjell Bjartveit observed: “Today a whole army is marching to fight tobacco and its producers. But all those involved now should never forget the pioneers who cleared the way, in spite of all resistance from indifferent authorities, professionals, politicians and media. Nigel was the front runner.”

Nigel died on 20 December 2014, aged 85, surrounded by his greatly loved family — Ann, Kirsty, Penny and Stephen. He was probably responsible for preventing more disease than any other Australian.

Nigel Gray (L) with Victorian Minister for Health David White, Parliament House, Melbourne, 1987. Reproduced with permission from Cancer Council Victoria.

Over the slosh and suck, the echo-
distorted sound as she shifts the probe,
she intones, This is your pulmonary artery,
your vena cava, your tricuspid valve,
as the noise that fills the exam room
is wrecking my sense of a river system
inside my body fanning out to water
clumps of grasses, stands of trees,
feeding silt onto fields, the seasonal pulse
of ebb and flood. But this is a factory.
This is the boiler room where the steam
rushes through the pipes so loudly you can’t
believe the ship can hold it. The technician
slides the cold metal across my ribs.
Lift your left arm, your left breast, she says.
This is amplified many times, and it’ll sound
even stranger with your heart rate so high.
I’m thinking, I just don’t want to have to
tell my mother I have heart disease at twenty-eight,
the sound waves passing through my chest,
seeking out some defect in the shape
that makes the sounds I shouldn’t hear,
hearing them doing nothing to slow them,
though really it’s almost cosy in here,
the lights dimmed, a blanket draped across
my gown, and lying back, I don’t feel
like my heart is beating at the rate
the monitor says, but there’s its sound
broadcast through the room. Whitman called
the body electric, a perfect system, a thing
to celebrate, but what was known then
of the pulses inside? How sometimes
neurons over-fire. Electric storms
run wild. I try to slow my breath to make
the thing inside me match it, think
of the steadiness of waves against a shore,
a flock of swallows contracting and wheeling,
but now on the screen, sound waves revealing
shape, my heart is forming a Rorschach,
and I don’t want to see what I’ll see.

For Coco

In the ward again, at fifteen, then sixteen

she lies frozen.

At tilt with her world

this arrival again, bleached with trauma.

She ghosts into

the opiating realms of unexplained fevers.

Notice

among the alleys of drips, hooked

to beds or wheelchairs

the complex faces of parents with their damaged children.

At the Royal Children’s Hospital Parkville,

what might divide us, distinctively

in the cumulous gift of living.

She is strange colours,

hosted by angels undoubtedly.

They patter here, yet darkly

to wrestle and reckon young mortalities.

Tested are the doctors’ reasons.

She sleeps for days, in this clock-time perversion.

My own attention, edged lucid, prayer

shaped to her breathing.

To help my mother’s eyes
small gold weights
might be placed
in her eyelids.

Naturally the eye
is always open.
It is an effort
that lets us sleep.

I imagine the pharaohs
may have had gold
in their eyelids, too —
some high sign of wealth.

The extra weight
relieving all the small muscles
of their expectations —

some new medicine
for the aches
in the dark temples
of these gods of men.

My mother and the bent-
bearded men sharing
this gold, blinking.

My mother’s eye
a blue beside
the pull of black.
Open, a queen of Egypt.

Closed, the eyes
of her failing nerves.

Crack!

So begin many Christmas parties in Australia, as guests break the ice by pulling Christmas crackers, playing with the prizes and donning the easy-to-tear paper crowns found therein. While the groan-inducing jokes about frost, penguins and snowmen may seem out of place in the heat of summer, this tradition is as popular Down Under as in its native Britain. Traditionally, the person left holding the larger portion of the cracker is declared the winner of the prizes and gets to wear the paper crown during dinner. While the prizes are rarely anything to write home about (Box 1, Box 2), guests’ competitive natures are aroused by the activity, and everyone would love to be a winner on their first try.

A natural follow-up to the pulling of crackers, particularly for parties where the guests are of a scientific bent, is to formulate theories on the best strategy to employ for a win. Such theories typically focus on technique and physical strength, but we consider here the possibility that attitude also plays a role. In contrast to the ambition typically found in those who aspire to be crowned king, in this study we investigate whether a “Bah, humbug!” passive–aggressive attitude towards Christmas may be of greater advantage. While such behaviour is typically seen as negative,1,2 it may be that the sports catchphrase “It’s not whether you win or lose, it’s how you play the game” paradoxically results in you winning far more often than losing.

Methods

Technique or attitude?

We first considered physiological features that might affect the application of stress (a commodity in ample supply at Christmas time). A cracker is made of a cardboard tube wrapped in colourful paper and resembles the shape of a giant sweet (Box 3). A standard cracker measures about 25 cm in length and has a fillable space of 10 cm3 to hold surprises: small gifts, jokes and paper crowns to make the partygoers look like Wise Men. The content can vary depending on the type of cracker. While the wrapper of smaller bonbons is twisted to keep the filling inside, there is no twisting involved to seal crackers — instead the seams are perforated at the “twist” and tied off, practically guaranteeing that the cracker will break at one of these sites.

While many anecdotes on how to win at crackers have been traded over Christmas dinners, there has been very little controlled research on the subject. Researchers have previously identified factors influencing the chances of winning the content of a cracker,3,4 including grip, angle, distance to the centre of gravity of the cracker, quality of the cracker, size of the cracker, pull and twist. Both these studies reported the importance of the angle at which the cracker is pulled down (optimally between 20° and 55°), indicating this may be an important factor.3,4 One group of researchers even devised a formula, in which the optimal angle = 11 × circumference ÷ length + 5 × quality of the cracker (1 for cheap, 2 for standard or 3 for premium).3

In this study, we focused on a single type of cracker and therefore ignored the factors relating to quality and size. We tested the following three strategies:

• The QinetiQ strategy: a firm two-handed grip, tilting the cracker between 20° and 55° downwards, and applying a steady force with no torque.4
• The passive–aggressive strategy: a firm two-handed grip at no angle, not pulling at all, and letting the other person do all the work.
• The control strategy: typical of Christmas parties around the world, where both participants pull at no particular angle but roughly parallel to the floor.

Study design

To determine whether any particular strategy had a greater than random chance of a win, we designed a binomial trial. We assumed that the probability of winning on each pull depended primarily on the strategy used, with some variability due to characteristics of the individual pullers. Five volunteers were recruited to pull crackers according to the different strategies, and for each cracker pull, the winner and details of the strategy were recorded. Volunteers were randomly paired, with one individual in the pair implementing a specific strategy and the other simply pulling with a two-handed grip in the opposite direction to the angle dictated by the first individual. Both individuals in the pair implemented the given strategy multiple times to account for individual and pair effects. All factors described above that were not varied for the strategy were held constant between the two individuals.

To estimate the probability of a win by any strategy, we considered the total number of wins divided by the number of pulls employing that strategy.

A power analysis was conducted to determine the necessary number of crackers pulled to declare a strategy as “winning”. For a success rate of 0.9, as would be expected from a “guaranteed” victory strategy,3 only five cracker pulls are required to reject the null hypothesis of a success rate of 1/2. Hence, we allotted sufficient crackers to declare whether each strategy met this criterion, and then randomly divided remaining crackers among strategies. In total, 42 crackers were used in this manner, ensuring sufficient power to test the three strategies even for success rates below 0.9.

Mean probabilities of success for each method were computed as the number of wins divided by total number of trials. Confidence intervals were computed according to the binomial distribution. All statistical analyses were conducted using R software (R Foundation for Statistical Computing, http://www.r-project.org).

The study did not require ethics approval.

Results

Angling for a win

Results from all three strategies are shown in Box 4. Multiple pullers tested the QinetiQ strategy, with no consistent wins; the probability of success was only 0.40 (95% CI, 0.15–0.65), not significantly different from that expected for random chance. The primary difference between this and the other strategies was the angling of the cracker downwards towards the puller, which we therefore cannot conclude provides an advantage.

To pull or not to pull

The remaining two strategies both involved a cracker being held parallel to the floor, but differed on whether both participants pulled or only one pulled while the other just held on. The control strategy most closely replicated typical behaviour at Christmas parties and, as expected, was the strategy producing results closest to random (probability of a win, 0.53; 95% CI, 0.28–0.79). The passive–aggressive strategy was the most successful strategy (probability of a win, 0.92; 95% CI, 0.76–1.00), where the individual who did not pull but merely held on firmly to the cracker won all but one time. This was the only strategy which could be declared “winning” in our study.

Discussion

During a Christmas-in-July party, we tested existing strategies and identified salient features of cracker pulling that may be used to be crowned king of the Christmas festivities. As the QinetiQ strategy had previously been described as “the perfect way to pull a Christmas cracker”,4 we had high expectations for its success. However, this was not supported by our investigations. In particular, in contrast to previous studies, we ruled out angle as a deciding factor in winning Christmas crackers. Further, we identified a novel passive–aggressive strategy as being the surest path to the crown.

Our study has some limitations. We attempted to account for seasonal trends by conducting our trial in winter. However, as Brisbane winters are substantially warmer than those in England (and, on occasion, English summers as well!), it is possible that our strategies would have different success rates in colder weather. We cannot claim that the passive–aggressive strategy is the only strategy that will increase the chances of winning, as we did not have sufficient power to detect smaller deviations from random chance. However, it does seem that attitude may play a greater role than technique in achieving success with Christmas crackers. It is possible that this result is specific to the brand we used and will not generalise to all types of crackers. However, there is at least anecdotal evidence that this strategy has worked previously,5 although no evidence was given to support this claim.

Finally, we did not account for unintentional biases due to differences between volunteers — for example, one volunteer had never seen a cracker before in his life. This person’s win rate was unusually high, with an average probability of winning of 0.71 (95% CI, 0.52–0.91), significantly different from random chance. No other pullers had unusual prowess or lack thereof at pulling, so we must conclude that this person was influenced by the well documented phenomenon of beginner’s luck. Interestingly, every time this individual pulled against someone employing the passive–aggressive strategy, he lost, in spite of his higher than normal success rate in general.

The traditional approach to cracker pulling sees all guests cross hands and pull crackers with their two neighbours (Box 3, D). With our final five crackers, we attempted to test whether our winning passive–aggressive strategy could be used to ensure success for all guests at once. Hence, all individuals pulled with their right hands, but not their left. Unfortunately, the strategy only achieved success for one person; two others won with both hands and the rest lost with both. While including these trials in our results did not alter the conclusions about any strategies, we omitted them due to the differences in conditions. In particular, only one hand, rather than two, was used for pulling each cracker, and as one of the individuals was left-handed, this may have influenced the success of the test.

The passive–aggressive strategy has important implications for future Christmas parties. First, we note that the strategy is useable by any demographic, as it does not require great strength to implement. Indeed, the passivity of the approach may help to avoid the types of injuries previously accorded to cracker-pulling mishaps.6 Second, the strategy is easy to employ with subtlety, unlike any strategy involving an angle, which must surely arouse suspicions in your pulling partner.

Finally, while the winning strategy does have a high success rate, this is true only if one member of the pair is aware of that fact. If both individuals employ the same strategy, the party could stretch on forever, resulting in a burnt dinner and both hosts and guests in tears. The moral of this is a caution against overindulgence in passive–aggressiveness — while judicious use may win you prizes, overdo it, and your goose will be cooked.

1 Summary of the winning content from the study, including barrettes, plastic rings, toy cars and red lips

3 Cracker construction and use

---

A cardboard wrapper with perforated seams has a noise strip glued to the interior (A), is formed into a tube (B), filled with prizes and tied off at the perforations (C). Traditional crossed-arm pulling demonstrated by two anonymous participants (D).

1.
My dead neighbour’s name typed in black.
Glossy AAA Travel insert
with two gondolas and red flowerboxes
arrives in my mailbox instead of hers.
Promises of discounts and odysseys
gleaming and alive.

2.
Jubilant to go on a movie date
when she finishes reading
Under the Tuscan sun
Shelly flutters like a songbird.
I want to return her mail
talk to her about Italy
what wine to pair with dinner.

3.
Did Death guide the mailman’s hand?
Was I buried under a featherbed
when he knocked — climbed her stoop instead?
My cloudiness frightened him
her soft soul an easy catch.

4.
She slices tree branches like butter.
Look how easy this gizmo works.
Her son’s banana curls bounce
stacking the branches.

5.
Does she glide in a gondola?
I still walk the sidewalk.
She’s in an urn with cobalt blue butterflies.

6.
Serious little girl
her daughter sits at the sill
dark eyes survey the neighbourhood now.
No replacement for mother’s love.
Just slow melting, simmering sauce
on Sundays when her aunts come by.

7.
I want to have a word with Death.
Scold him. Tell him he’s all wrong.
What about the neighbour behind her
who complains about their dead pines
every chance she gets What if they blow over?
Might kill me.

8.
Shelly lives in bold brushstrokes —
her front door, lilac; her son’s room, crimson;
the family room, magenta.
I long to sit on her celery-coloured porch
dip pitas in hummus, watch the traffic
with her laugh raising the roof.

9.
She tells me It’s okay
I see everything now.
I know your darkness
when your baby was born.
I know you tried your best
Please bring my daughter flowers for her birthday.

10.
Spring will shoulder her way in
bring buds to the dogwood
and rows of purple bulbs.
Now, her husband ploughs our sidewalk
the motion methodical, medicinal.

No small feat, fifty wing beats per
second, sixty, the tongue searching
for sweetness, seventy. Territory matters,

beauty matters. In the right light, at the right
angle, the throat shines. Recovery feels dependent
on their brilliance, bones in mid-ear vibrate to their

frequency. Learn the meaning, the magnitude
of small and nothing and easy and little.
The procedure is nothing, they said; the scars

are small, there will be little pain. Try to swallow.

A hummingbird’s heart is smaller than a pearl, larger
than a grain of rice; it’s nothing, just a little larger
than nothing. Three hundred heartbeats per minute,

check your pulse, five hundred, rub circles over scars,
nine hundred, a thousand, try rising from the bed.
Admire their acceleration, manoeuvres through acres

of cherry and locust, predator and gust. Soon every move
will cease to cause a flinch; you will adjust your vocabulary
— no big deal — will refer to the surgery and smile.

But months later, long past summer, you hear echoes of the birds
in midair and your heart beats faster

(although
like hovering
you appear
still)