Author: jamescalumcampbell

When I first heard that Dame Esther Rantzen was campaigning in favour of assisted dying, I thought, “That’s it.  Sooner or later, the bill will pass.”  The presenter of the long-running consumer affairs programme entitled – perhaps rather inappropriately in this context – “That’s Life!”, is such a powerful persuader, in modern parlance an “influencer”, always with the keenest antennae for the public mood (finger on the pulse – another inapt phrase), that it is hard to imagine that the nations of the United Kingdom will not, in due course, follow in the footsteps of such countries as the Netherlands, Switzerland, Canada, and New Zealand.  Esther Rantzen has stage 4 lung cancer.  It is impossible not to have the deepest sympathy for her situation.  She was interviewed this morning on BBC Radio 4’s Today programme.  She has collected more than 200,000 signatures to a petition triggering an MP’s debate, to be held later today, in Westminster Hall.     

The Today programme went on to interview a palliative care expert, Dr Amy Proffitt, past president of the Association for Palliative Medicine of Great Britain and Ireland, who deplored the lack of nuance in what has become a divisive binary dispute.  She thought the debate at this stage had rather be in the public domain than in the Palace of Westminster.  She compared the current level of discourse with that which surrounded Brexit eight years ago.  People did not know what they were voting for.  Interestingly, in the Today interview she did not express direct opposition to assisted dying; rather she wanted to remove the entire process, whatever it might be, from the domain of the NHS. 

I’m very struck by the tacit assumption of the supporters of assisted dying, that the participation of doctors will be integral to any end of life procedure.  There is a close parallel here with the formulation of David Steel’s 1967 Abortion Bill.  I make this point without putting forward any judgment as to the moral-ethical rights or wrongs of either termination of pregnancy, or of assisted dying.  Termination of pregnancy is actually illegal in this country, except in very specific circumstances.  The relevant act of parliament dates back to 1861, and remains on the statute book.  In order for a termination of pregnancy to be legal, two independent medical practitioners must make a judgment as to whether the person requesting the termination fits into one of several strict criteria.  In most cases, the termination goes ahead because two doctors consider that a continuation of the pregnancy would harm the physical or mental health of the pregnant patient.  Now it is true that, de facto, patients may undergo termination of early pregnancy, on request, because doctors who may not wish to sanction the process, on grounds of conscience, are nonetheless obliged not to frustrate the will of the patient, but rather to point her in the direction of clinicians who are prepared to carry out her wishes.  But it would be wrong to assert that termination is a patient’s right.  The decision to terminate resides solely with doctors, empowered by an Act of Parliament.  It could all turn on a dime.  Think of Roe v. Wade.

Now we find that assisted dying, should it become legal, will also depend upon the judgment of two doctors.  When I was a medical student I remember asking a consultant obstetrician how he (of course he was male) went about making a judgment as to whether or not to proceed with termination.  He told me quite frankly that he provided terminations solely and simply on request.  Who am I, he said, to make judgments as to the level of my patient’s anguish?  By the same token, I can well imagine something similar happening with assisted dying.  When termination was debated in parliament in 1967, proponents of the bill reassured those who were dubious, particularly in the House of Lords, that termination would only occur in exceptional circumstances.  Then look what happened.  I could well imagine that, 60 years from now, assisted dying will be available on demand.

This notion is often referred to as “the slippery slope” argument.  Mission creep.  Not so, say the advocates of the bill.  Safeguards, measures of protection, will be robust.  Well, one way to ensure that the mission will creep is to hand the administration of it over to doctors.  You see, we doctors understand that everybody is terminally ill, and that everybody is not quite of sound mind.  And everybody, one way or another, is being coerced.  And we are notoriously bad at prognosis.  (When Mr al-Megrahi, allegedly responsible for Lockerbie, the worst act of terrorism on British soil, was released from prison, terminally ill, on August 20^th, 2009, and returned to Libya, on compassionate grounds, he lived far longer than was anticipated.  He died on May 20^th, 2012.)

Sixty years hence, a sixteen year old girl will present herself to one of my colleagues and say, “Doctor, I’ve had enough.  I’m suffering intolerably. I want you to end it for me.”  And my colleague, reaching for the relevant forms, will say to himself, who am I to make a judgment about the extent of my patient’s suffering?                                                   

On Saturday evening in the Glasgow Royal Concert Hall, the Royal Scottish National Orchestra performed a concert of music which the programme described as “all British”.  Actually it was all English – The Forgotten Rite by John Ireland, Elgar’s Sea Pictures with soloist Alice Coote, and Holst’s suite The Planets.  I don’t know why the English are so reticent about the extraordinary flowering of English music that occurred during the late nineteenth and twentieth century.  Talking of planets, the conductor was the most musical man on this planet – John Wilson.  I noticed that the pre-concert talk was an interview between John Wilson, and the RSNO’s principal flute Katherine Bryan.  I don’t normally attend pre-concert talks, but I thought that was pretty special, and went along.  I’m a great fan of both.  I’ve heard it said that Katherine Bryan is one of the six greatest flautists who has ever lived.  How you could reach such a conclusion I’m not quite sure, but I could certainly believe it.  John Wilson made his name by conducting various manifestations of the Great American Songbook at the London Proms.  But his range knows no limits.  And great musicians love to play for him, perhaps attracted by his meticulous attention to detail, the composer’s detail within the score, and his complete absence of pomposity.                   

I was amused by an exchange of anecdotes concerning Holst’s final planet, Neptune.  It concludes with a wordless, offstage, female chorus, in a fade-out.  Fade-outs in pop music are commonplace, or at least used to be.  In the recording studio they were easily managed.  The singer, or the group, would reiterate the final jingle, while the recording engineer simply turned the volume down.  I always thought well of the Beatles, in that they rarely employed the fade-out technique.  Their extraordinarily terse utterances had a beginning, a middle, and an end.  Anyway Holst wanted a fade-put for Neptune, and that is not so easily managed in the concert hall.  There are loads of tales of Neptune fade-outs going wrong.  Ms Bryan and Mr Wilson recounted a few, for example, a back stage choir vanishing into the distance along a corridor, only to find that an intervening door had been locked.  I myself can remember a previous performance of The Planets in Glasgow, when the gradual fade out of the choir was abruptly terminated by the sound of a door slamming.  And by an odd coincidence, in an ancient tape recording of the piece I once made from a live radio performance, the tape ran out seconds from the end of Neptune, so that the choir was stopped by a sudden unscheduled descent of pitch, followed by an abrupt click.  What a strange thing is the musical memory.  On every subsequent occasion that I have heard this piece, I have anticipated the loss of pitch, and the click.

Mind you, prior to this weekend, the last time I attended a performance of The Planets was at a London Prom.  The Prom opened with a magnificent performance of Vaughan Williams’ Sinfonia Antarctica, followed by an execrable performance of Xenakis’ Pleiades.  And I say “execrable” not necessarily because the percussive music was awful, but simply because it was, painfully, pathologically, too loud.  So I never heard the second half of that concert – The Planets.  Instead I repaired to the bar, and then, in a mood, left.  It was only subsequently that I learned that the day of that concert had been the day on which the conductor Vernon Handley had died.  When I heard that, I regretted that I had not been able to calm my disturbed emotions, and stay on.  I was a great fan of Vernon Handley, principally because he championed the music of a great hero of mine, Arnold Bax.  I cherish his recordings of the seven Bax symphonies, as well as his enlightening conversation in the same box set with Radio 3’s Andrew McGregor. 

I bring all this up, because this weekend formed a strange parallel with that London concert.  I learned on Sunday that the distinguished conductor Sir Andrew Davis has died.  A frequent visitor to Scotland, Sir Andrew also frequently conducted the Last Night of the Proms.  I hope nobody takes umbrage, and to be honest I’m rather glad, that Sir Andrew conducted the Last Night in my novel of the same name.  I particularly remember the fiftieth anniversary concert, in the Royal Albert Hall in 2008, of the death of Ralph Vaughan Williams.  Sir Andrew conducted the BBC Symphony Orchestra in an all-RVW programme – the Tallis Fantasia, Serenade to Music, Job: a Masque for Dancing, and the Ninth Symphony.  It was quite magnificent.  Stephen Bryant, the leader of the BBC, had a huge part to play, and I remember Sir Andrew making eye contact with him at the end, as if to say, I told you you’d be wonderful!   

Over the weekend I read Salman Rushdie’s memoir Knife, Meditations After an Attempted Murder (Jonathan Cape, 2024).  On August 12^th 2022, Salman Rushdie was attacked by a man with a knife while he was giving a lecture in upstate New York, on the importance of security and protection for writers.  He nearly died.  He lost the sight of one eye.  The memoir deals with the incident in the context of Rushdie’s personal life at the time, the immediate aftermath, and then a long process of recovery.  I expected the account to be harrowing, and indeed it was, but I was surprised by the book’s message of gratitude, optimism, and hope.  It is not a book of hatred.  On the contrary, it is a book of love.  Rushdie takes a profoundly negative experience, and turns it into something else.  I was reminded of George Orwell, who received an injury not unlike at least one of Rushdie’s, when he was shot in the neck during the Spanish Civil War.  Orwell, too, wrote about his experience, with a similar analytical dispassion.

In Knife, the first responders at Chautauqua NY, and subsequently all the doctors, nurses, and health care professionals come out of the tale very well.  No wonder Rushdie dedicated the book to them all.             

The “button” question has come up again.  The nuclear button.  Actually, I’m given to understand, the button is not a button at all, but more resembles a starting pistol.  Would Sir Keir Starmer, widely expected to be the UK’s next Prime Minister, be prepared to fire it?  Yes, unequivocally, said Sir Keir.  The deterrent “only works if there is a preparedness to use it.” 

That’s a very strange utterance.  How can you use a deterrent?  If you deploy a hydrogen bomb in anger, it will be either as a pre-emptive strike, or as a retaliation.  In the first instance, you will not have been deterred by the nuclear capability of the opposition; in the second instance, you will have been subject to a nuclear attack.  This would show that the deterrent did not work, and had never worked. 

Prime Ministers, and prospective Prime Ministers, are routinely asked the “button” question.  I remember Mrs May answered in the affirmative, looked very uncomfortable, and was not inclined to expand upon a monosyllabic reply.  I had the sense she was saying something along the lines of, “The nuclear deterrent functions as a deterrent every day.  For its deterrent value to have credence, my answer has to be ‘yes’.”  I suppose she could have been bluffing.  But then, had she responded with a monosyllabic “no”, that, too, could have been a bluff.  Who knows what she wrote in her letters of last resort, residing in the four safes of the continuous at sea deterrent (CASD). 

Jeremy Corbyn when he was campaigning for the premiership said “no”.  I had the distinct sense that was not a bluff.  Some people say that reply, among other things, made him unelectable. 

Nicola Sturgeon said “no”, but then that was rather academic, defence being a reserved and not a devolved issue.  I recall that during PMQs in Westminster Michael Gove asked the PM – I forget which one, there have been so many recently –  the question, clearly a plant, whether he agreed that the SNP’s quibbling about the prospective cost of the Trident upgrade was akin to a eunuch moaning about the cost of Viagra.

(Other erectile dysfunction treatments are available.)

The PM’s reply was once more monosyllabic.  Yes.

I thought of the Viagra allusion when I heard about the recent test-firing of a Trident missile off the coast of Florida earlier this year.  Defence Secretary Grant Shapps was in attendance.  The missile was intended to fly several thousand miles, but in fact only managed a few hundred yards before falling into the sea.  Apparently an “anomaly” had occurred.  I was reminded of Elon Musk’s description of a failed launch of one of his space rockets: “rapid unscheduled disassembly”.  Grant Shapps stated the test had “reaffirmed the effectiveness” of the deterrent.  Thus do our political masters inhabit a universe parallel to our real one.       

The redoubtable Brian Quail, famous in the greater Glasgow area (the prime target in the UK) for his implacable opposition to nuclear arms, has written a characteristically subtle letter to today’s National, praising Sir Keir for his candour.  His point is that “yes” means “yes”.  That truth lies at the kernel of the doctrine of nuclear deterrence.  Deterrence is guaranteed – supposed to be guaranteed – by the fact that the systems are “locked and loaded”.  A nuclear attack will be so swift that there is no time during the event to make executive decisions.  They have to be prearranged.  We are effectively saying to our enemy, “If you attack us, we will immediately attack you.”  In the event, there’s nothing to be done about it.  We have effectively concluded with our putative adversaries a suicide pact.  The world is awash with nuclear weapons – about 12,000 of them.  It’s an “accident” waiting to happen.

I have a modest proposal.  Why doesn’t my Alma Mater, the University of Glasgow, since it is directly in the firing line, create a Faculty of Peace, and offer a Master’s degree inviting our best young minds, not to get swallowed up in the financial sector, but to consider the question, how can we best get along with one another, without destroying ourselves, and the planet?    

A young lady acquaintance of mine sent me a text the other day, outlining one of life’s difficulties she had encountered, perhaps seeking the sage advice of an elder statesman – though why anybody should consider that somebody who has led a life as chaotic and ramshackle as mine should be a fount – or should that be font? – of all human wisdom, I simply can’t imagine.  Anyway I did my best.  First I commiserated: “Dearie me!”  Then I didn’t presume to give advice, although I think I may have said what I would have done under similar circumstances – which of course is not the same thing.  Anyway I pitched my spiel and, just prior to pressing “send”, went back to the top to check the text.

“Desire me!”

You see – predictive text could have landed me in all sorts of bother.  Fortunately I spotted the error and corrected it.  I wonder what would have happened if I had received such a message rather than (nearly) sent it.  I could have been the victim of a so-called “honey-trap”.  Honey-traps have been in the news last week because an MP fell into one.  A honey-trap works by seducing the victim, who then compromises himself, and renders himself vulnerable to blackmail.  Honey-traps are intimately associated with social media, because so many people seems to conduct their affairs (as it were) using a myriad of platforms seemingly designed for the task.

But honey-traps of one kind or another existed long before the advent of the silicon chip.  They predate Samson and Delilah.  The femme fatale with the hidden agenda.  Hollywood noir is full of them.  In Double Indemnity, Barbara Stanwyck sees the hapless insurance agent Fred MacMurray coming, and seduces him into murdering her husband, he for love, she for money.  It all ends very badly.  In From Russia with Love, the chess grandmaster Kronsteen, working for the KGB, concocts an exquisite honey-trap designed to enmesh James Bond, the lure being one Tatiana Romanova.  Actually James is not really seduced by Tatiana.  Rather M is seduced by the prospect of getting his hands on a Spektor decryption machine. 

But the sad fact of modern life is that every time you answer the phone, or open an email, or even a letter delivered by the Royal Mail, the first question you need to ask is, “Is this real?”  Scams of one kind or another are becoming increasingly sophisticated, and our institutions in turn try to keep up by introducing increasingly refined security measures.  The result is cyber warfare and a cyber arms race, as each side tries to outdo the other.  Whenever a representative of a bank tells me their digital vaults are impregnable, I cock an eyebrow.

Being the victim of a burglary (house-breaking north of the border) is a painful experience, not merely because of the loss of property, but because of the intrusion into your private life.  Your filing cabinets have been rummaged and rifled by alien hands.  Similarly, being the victim of a scam is painful not merely because of the loss of money, but because you have been tricked.  It is a form of character assassination.  You are a patsy; a fall guy.  How could you possibly be so naïve?  What an idiot.  It is an injury to self-esteem.

We shouldn’t be too hard on ourselves.  After all, our sole misdemeanour was that we were trusting of our fellow human beings.  You might resolve never to be taken advantage of again, and regard every subsequent human interaction with profound suspicion.  But by now you have retreated into your security bunker, surrounded by high walls, barbed wire, goon boxes, and security cameras.  All human transaction becomes remote.  Before you can begin to communicate, you must enter a PIN, then a password, another PIN, another password, then a six digit number sent to your mobile.  This is the way we live now.

There is a theory given wide credence, that there is nothing intrinsically good or bad about any given digital platform; what matters is how you use it.  I am beginning to doubt this familiar trope.  We have gone down the wrong track.  The dystopia we have recreated cannot be beneficent.  We are not designed to sit huddled over a computer screen.  We are meant to be out and about.  In my latest novel, The Last Night of the Proms, I took the liberty of quoting Thomas Hardy’s The Return of the Native:

The time seems near, if it has not actually arrived, when the chastened sublimity of a moor, a sea, or a mountain will be all of nature that is absolutely in keeping with the moods of the more thinking among mankind.

Log off. 

On March 28^th I wrote to the Herald, as follows:

Dear Sir,

Reading the text of the Assisted Dying for Terminally Ill Adults (Scotland) Bill, published today (March 28), I am struck by 3 things.

First is the fact that the delivery of this proposed service is utterly dependent upon the participation of medical practitioners.  If my ex-colleagues decline to take part, the bill will collapse.

Secondly, there is no provision for an unsuccessful attempt.  Remember, there is not a medication in the world, or poison for that matter, that does not have a failure rate.  Under these circumstances it would be rational for the attending healthcare practitioner to administer a coup de grâce, in some form, but that would be illegal.  With this new set of circumstances, the initial directive of the patient (or rather, client), would be null and void, and the healthcare practitioner would be obliged to provide the client, perhaps in a coma, with palliative care. 

Lastly, Paragraph 17, Death certification, states “The terminal illness involved is to be recorded as the disease or condition directly leading to their death (rather than the approved substance provided to them).” 

In other words, the medical practitioner is being instructed to tell a lie.

Food for thought. 

Yours sincerely…

I was published the following day, more or less verbatim.  Well, not quite.  The first sentence was removed and replaced by a banner headline:

There are three major flaws in the provisions of the Assisted Dying Bill.

One thing any seasoned writer to the newspapers knows is that he has no control over the headline covering his piece.  I would not have composed that headline, because it implies that if the three major flaws could be ironed out, the bill would be flawless.  But I have an idea that it would not matter how carefully you crafted this bill, how lengthy it might be in an attempt to anticipate every contingency that might arise in every situation, there would always be a gap, through which somebody might fall.  M’lud might baulk at this, but I think this particular interpretation and elucidation of ethics and morality is beyond the compass of the Law.

I’ve said it before: when you write to the papers, the day following publication you must look out for rejoinders and ripostes, be they bouquets or brickbats.  There was certainly a sizeable correspondence about the issue, but I was neither endorsed, nor instructed to wake up and smell the coffee.  Perhaps the points I was making were considered slightly obscure.

But the focus of my letter was not really an expression in principle of opposition to, or, for that matter, support of Liberal Democrat SMP Liam McArthur’s bill.  Rather it was an expression of irritation at the implication that the cooperation of the medical profession could be taken for granted.  I’m not sure how much consultation has taken place.  I do know that some of the august medical colleges, and associated bodies, have moved from a position of opposition, to one of neutrality.  I remember having a discussion with a very senior representative of the Royal College of General Practitioners about the efficacy, or otherwise, of online consulting.  He thought that post-pandemic, the ratio of virtual to face-to-face consulting might settle down at about fifty-fifty, half and half.  And he raised a finger and said, “Finger in the air.”  I presume he was alluding to the way the wind was blowing.  In other words, whatever the prevailing trend, the RCGP would fit in. 

We see something similar now, with the shift from opposition to “neutrality” with respect to assisted dying.  Polls suggest members of the public are, in the majority, in favour of assisted dying, with safeguards.  Finger in the air.  So whatever our political masters decide, we will play along.

But surely the medical profession should debate this issue and come up with a point of view, and a policy, albeit one that medical practitioners may as individuals wish to eschew on grounds of conscience.  The idea of abstaining, standing on the side-lines awaiting the political vote, and then accepting the result with a shrug, is abhorrent.

I still can’t get over Paragraph 17.  I think I scoffed out loud when I read it.  Here it is in full:

17 Death certification

• This section applies where a terminally ill adult has been lawfully provided with assistance to end their own life and has died as a result.
• For the purposes of section 24 (certificate of cause of death) of the Registration of Births, Deaths and Marriages (Scotland) Act 1965, the terminal illness involved is to be recorded as the disease or condition directly leading to their death (rather than the approved substance provided to them by virtue of section 15).    

Muddled thinking is often characterised by woolly modes of expression.  Sometimes in common parlance we use “their” to mean “his or her”.  In a legal document it sounds almost inarticulate.  Perhaps the law-makers are concerned that people who profess to be non-binary may slip through the loop.  But in any case, how can the politicians take it upon themselves to make, from afar, a pathophysiological diagnosis?  How dare they?                    

Prof Dame Clare Gerada, one time chair of the Royal College of General Practitioners, now co-chair of the NHS Assembly, has been touring the BBC radio studios, trying to introduce some nuance into the debate about the huge rise in work absenteeism due to mental health conditions.  Mel Stride, Work and Pensions Secretary, has made the point that many such conditions are being overdiagnosed, and that the normal vicissitudes, the ups-and-downs of daily life, are being mistaken for pathology.  One can see how a discussion like this tends quickly to become polarised.  On the one hand, we have the stiff upper lip party.  Don’t be a snowflake.  Pull yourself together, pull your socks up, and just get on with it.  On the other hand, we have the “It’s okay not to be okay” party.  If you are struggling, seek help.  There is no stigma.  It’s good to talk.

Clare Gerada had some sympathy with Mel Stride’s point of view.  She felt that overdiagnosis was to some extent an import from the USA.  She quoted “conditions” like loneliness, homesickness, and shyness.  But in any case, whether you are just lonely, or whether you are clinically depressed, in most cases you are much better going to work.  The worst thing you can possibly do for a twenty-year old with a mental health problem, is to sign him, or her, off long term.  In other words, at least from the point of view of the capacity to work, the diagnostic issue is merely a question of semantics.

Yes, said Jeremy Vine (BBC Radio 2), but was the massive increase in numbers of people affected, particularly among the young, actually real? After all, he said, the suicide rate overall is if anything slightly lower than it was 20 years ago.  “Burnout” is on the rise.  But Clare Gerada pointed out that burnout has been around for over 100 years, first appearing in the medical literature about 1910.     Yet in some cases, an epidemic of mental illness appears to be real.  Brian Dow, chair of the charity Mental Health UK, pointed to the extraordinary rise in eating disorders amongst young women.  That is real. 

So the debate has developed this narrative.  Why are so many people off work?  Are they really sick, or are they “throwing a sickie”? 

But there’s another way of looking at this, which doesn’t generally seem to have been picked up on.  Maybe the problem isn’t with the workforce at all; maybe the problem is with the work.  Maybe people are exhibiting “work refusal” because the work place has become such a toxic environment.  The deterioration in the workplace certainly drove me, at long last, to refuse to go to work.  Not that I got a sick note, or a “fit note”; I just retired.  But then I was lucky to have that option.  Roughly from the start of the new millennium, I could see the way that the purveyors of, and traffickers in, information technology, had infiltrated my profession and taken over its governance.  Within a remarkably short timeframe, all business taking place within the general practice consulting room was conducted through the prism of the computer screen.  We became paper-light, then paperless.  The patient record, the laboratory investigations, appointments, and GP-consultant correspondence, all became virtual.  This took place during the noughties around the time of the new GP contract.  This defined a Quality and Outcomes Framework (QOF) that dictated the hurdles a GP needed to leap, or the hoops she needed to pass through, in order to satisfy the criteria for remuneration.  A series of pop-up menus dominated the computer screen, reminding GPs of the tasks required to be undertaken.  They might include documentation of smoking status, fulfilment of targets, say, with respect to cholesterol or BP control, and frequency of medication review.  Initially, the targets were pretty easy to attain and optimal remuneration pretty easy to achieve.  Then things got more complex.  Gradually, the third person in the consultation room, the computer, took over the consultation, which became dominated, not by the patient’s agenda, not even by the GP’s agenda, but by the computer’s agenda.  Who devised this agenda?  Down at the coal-face, we never really knew. But if the overseers were medical, they had bought into the IT model of patient care. 

Next up, “Whole Systems Working”, a series of table-top exercises generally concealing a hidden agenda, such as the perceived need to cut down GP-hospital referral rates. 

Within a decade, the entire modus operandi within general practice had shifted from the traditional model of the medical consultation – history, examination, targeted investigation, diagnosis, formulation, and management, to the imposition of a series of algorithms which rarely bore any resemblance to any real clinical presenting complaint, and the way it might be approached in a caring and compassionate way.  I hated it.  I fashioned a sign and stuck it up on my office wall: The QOF must be destroyed.  Then I got out.

I’m a little out of touch now, but from talking to ex-colleagues I don’t think the situation, either in general practice or in hospital is any better.  The “junior doctors” in England are perpetually on strike, or about to strike, and apparently the dispute is all about money.  But I suspect the discontent goes much deeper than that.  It is a humane and natural response to the dystopian work environment we have created in the twinkling of an eye. 

I don’t know, but I suspect something similar is happening in many other walks of life where IT has established itself, like a cancer, deep within our systems and has dehumanised the workers by making them stare at a computer screen all day, not allowing them to interact with fellow human beings in a normal and compassionate way. 

At work, I was never so happy as when the computers crashed.  For a brief interlude, we were allowed to establish eye contact with our patient, and get on with our job.  You need very little technology to conduct an effective medical consultation. Okay, the MRI scanner needs a computer, but keep it in the back shop.  Out front, all you need is a quiet room, a handful of simple devices such as a stethoscope, BP cuff, tendon hammer, and ophthalmoscope; some knowledge, skill, and wisdom, and an abundance of tender loving care.            

One of my Mitschüler (fellow students) in my German class remarked the other day that I’m always banging on about music.  I think he was more amused than offended by my preoccupation, and indeed I make no apologies for it.  If you talk in German (or any other language) about that which interests you, the attendant vocabulary will stick.  Still I accept it’s an obsession.  Last week I blogged about a Royal Scottish National Orchestra concert, and I wouldn’t normally revisit this theme so soon.  But circumstances prevail. 

A dear pal of mine sent me a text on Saturday to arrange a catch-up, and during our exchange she happened to mention, almost as an afterthought, that she was going to the Glasgow Royal Concert Hall that evening because her daughter, an actor, was to be narrator in Mendelssohn’s Midsummer Night’s Dream.

Whoa!

I also had a ticket for this concert, but I had not known that Christine Steel was the actor in question.  Last week, conductor Thomas Søndergȧrd had talked up the concert and merely said, “We will have an actor to narrate…” or words to that effect.  I remember saying to somebody, “I wonder who they’ll book?  Some thespian luvvie.  It’ll be portentous, vapid, and hammy.”  Talk about rank prejudice! 

But now the concert had assumed a new dimension of fascination. 

We began with Fanny Hensel’s Overture in C Major.  Beautiful, and, I thought, rather Mendelssohnian, which may be hardly surprising as she was Felix Mendelssohn’s older sister, and they were very close.  I guess Felix learned a lot from her.

Then the RSNO Youth Chorus performed James Burton’s The Lost Words.  Acorn-Newt-Lark-Conker-Bluebell-Willow-Wren… All vanished from the childhood vocabulary, presumably because children favour their tablets, and virtual reality, to the great outdoors.  A sobering thought.  Yet the RSNO Youth Chorus’ evocation of that which we have apparently lost was so vivid that I felt there might still be hope that we have not entirely removed ourselves from the natural world.  The music was immediately appealing.  I’d love to hear it again.

Interval.

Then, an hour of pure delight.  If I had any butterflies on behalf of my friends during the break, they were completely dispelled when Ms Steel entered, took her bow, and took her seat beside the conductor’s rostrum.  Carine Tinney, Soprano, and Rosamond Thomas, Mezzo, occupied positions behind the orchestra.  Ms Steel has remarkable stage presence; neither overblown, nor portentous; merely quietly confident. 

There followed fourteen passages of glorious incidental music, mostly orchestral but with some solo voice and Youth Chorus involvement, all joined together by Shakespeare’s glorious verse.  Ms Steel was the star of the show, as she needed to be.  She spoke in an unaffected Scottish accent and her diction was superbly clear.  She spoke the words trippingly.  There was no thespian aura, no overlay.  The language spoke for itself.  It was an extraordinarily musical performance.  The rhythm was always in keeping with the tempo of the music.  It was note perfect.   

I see in this morning’s paper that Herald critic Keith Bruce agrees with me.  Puckish fun makes Mendelssohn’s Shakespeare-inspired tale a dream.  “Alongside the composer’s magnificent melodies and orchestration, shimmering and opulent, the other key element is the text extracted from Shakespeare, which was superbly delivered in this performance by Christine Steel, her verse-speaking an example of clarity and expression with just enough Puckish fun.”

Exactly.

The RSNO had also taken this programme to Dundee’s Caird Hall on Thursday, and Edinburgh’s Usher Hall on Friday.  Christine Steel’s performance will have been noticed.  We are going to hear a lot more of her.  So I will be banging on about music again on Thursday, at our last German conversation class before Easter.  We are all repairing to a local restaurant after the class where I have the honour of proposing a vote of thanks to our teacher.  I’ve always felt slightly uncomfortable speaking in public places like restaurants, where my fellow diners may not wish to overhear what I’m saying.  And in German.  I’m getting sweaty palms thinking about it.  I wish I had Ms Steel’s sanguine performing temperament.  But I will attempt to emulate her Puckishness, and immaculate sense of timing.

Else the puck a liar call.

So, good night unto you all.

En route to the Royal Scottish National Orchestra’s Glasgow concert on Saturday evening, I ran once more the gauntlet of the M80 converging on the M8.  Speed limit?  What speed limit?  But there is a new development.  They are installing average speed cameras.  I’m not sure if they have gone live yet, but their presence certainly makes a difference.  Everybody had slowed down.  Actually there’s not much point in speeding here, because you are only running into a bottleneck.  The M8, for years, has been “up”, and going west it has been reduced down to two lanes.  I think the M8 is posing a fundamental, existential problem for the engineers.  Many people think that, fundamentally, the M8 was a mistake, going back to the 1960s, when it first cut a swathe through Charing Cross and fatally injured the heart of Glasgow.  The RSNO felt its effects even then.  Glasgow’s beautiful St Andrew’s Hall had been destroyed by fire, and the orchestra was relegated to a cinema, the Gaiety Theatre on Argyll Street.  I would take an electric train to Charing Cross and walk through a mud bath to an oasis of culture surrounded by the diggers and pile drivers.  I remember an afternoon concert being abandoned because the orchestra could not compete with the din outside. 

There’s still a bleakness about entering Glasgow to attend a concert.  Doubtless the desertion of the High Street by people who choose to lead their lives online has not helped.  The environ of Sauchiehall Street is a ghost town.  You can almost see the tumbleweed floating east from Charing Cross to the concert hall at the top of Buchanan Street.  Everything shuts early.  There is a seven storey carpark in Buchanan Galleries, just next door to the concert hall, which closes at 9 pm.  What earthly use is that on a Saturday night?  And the Concert Square car park across the road and next door to the bus station is not salubrious.  It has a sullen, ammoniac aroma. 

Despite all that, the RSNO continues to be completely wonderful, even when events conspire to thwart its best endeavours.  At the start of the concert in the Glasgow Royal Concert Hall on Saturday evening, Chris Hart, the orchestra’s principal trumpet, came to the front of the stage to announce that the concert programme had had to be radically altered at the last minute.  I can see why the orchestra’s management would have asked Mr Hart to undertake this unenviable task.  He has a relaxed, laconic style. 

We were anticipating an evening of French music with a watery theme: Trois Femmes de légende by Mel Bonis (1858 – 1937), a Scottish Premiere, les trois femmes in question being Ophélie, Salomé, and Cléopâtre; Ernest Chausson’s Opus 19 Poème de l’amour et de la mer, sung by Scottish Mezzo-soprano Catriona Morison, double winner of the BBC Cardiff Singer of the World competition in 2017; Ravel’s Une barque sur l’ocean, and Debussy’s La mer.  Alas, Ms Morison had taken unwell.  Conductor Thomas Sondergard later remarked that she had only managed to get through the performance in Edinburgh the previous evening.  Orchestras are often very adept at finding replacement soloists at the last minute, but I imagine finding a Mezzo familiar with this repertoire would be extremely challenging.  Accordingly, the orchestra’s renowned principal flute Katherine Bryan had volunteered to fill in with Francoise Borne’s arrangement of melodies from Bizet’s Carmen.  Then, alas, during rehearsals on Saturday afternoon, Ms Bryan took ill.  Not only was Carmen out, but the orchestra was short of a flute in a French programme typically full of the sound of the flute.  Adam Richardson, a graduate of the Royal Conservatoire of Scotland, got the phone call at 7.00 pm, and was on stage half an hour later.  He played second flute, and second flautist Jenny Farley was bumped up to the principal position.  So we now had a truncated programme with a revision of the order: Ravel, Bonis, interval, Debussy.  Despite all of that, it was a marvellous concert.  The audience was extremely supportive, and the flute section took a special bow.  Well sight-read!        

Talking of music, The Last Night of the Proms, Part 3 in the life of the troubled doc, is out, not only online, but in print, between covers.  Troubador Publishing Ltd, copyright 2024 James Calum Campbell, ISBN 978 1 80514 311 6.  This is a shameless plug.  Order it at a bookstore near you!

In her biography of the future Prime Minister, Winston Churchill as I Knew Him (Eyre & Spottiswoode and Collins, 1965), H. H. Asquith’s daughter Lady Violet Bonham Carter described her first meeting with the great man, at a dinner party, in 1906, when she was 19 years old.  Churchill asked her if she thought that words had a magic and a music quite independent of their meaning.  She certainly thought so, and quoted Keats as an example:

Charm’d magic casements, opening on the foam

Of perilous seas, in faery lands forlorn…

Churchill had never heard The Ode to a Nightingale, but he was entranced, and went on to learn all Keats’ Odes by heart, and then of course, characteristically, to recite them back, mercilessly, verbatim.    

I’ve never been convinced by this notion that the power of language can be divorced from its meaning.  On the contrary, Charm’d magic casements are so powerful precisely because so evocative, the conjured imagery so intense.  The idea of relishing language independent of its meaning I find rather dangerous.  I think we should resist the temptation to value something that sounds mellifluous, even although it is gobbledegook.  You can make any piece of nonsense sound sensible, if your accent is posh enough.  This week I’ve greatly enjoyed reading Miriam Margolyes’ autobiography This Much is true (John Murray, 2021) and its follow-up Oh Miriam! (John Murray 2023).  The actor, perhaps most renowned for her potty mouth and outrageous anecdotes, was educated at Oxford High School and then Newnham College Cambridge, and she understands very well that one reason that she has gone so far in life is that she has “perfect vowels”.  Sometimes if I hear somebody with a cut-glass accent espouse a questionable piece of dogma, I subject the utterance to what I call “the stairheid patois test”, repeat it in broad Glaswegian, and hear the rickety edifice of verbiage crumble and collapse.  Language devoid of meaning is worthless.  So unlike Lady Violet, I would have denied Churchill’s assertion.  But I would have conceded that oratory can exert such magical, even diabolical influence.  Some people can hypnotise an audience by cadence and charisma, even supposing they were reciting the telephone directory.

Churchill of course went on to become an orator, after a fashion.  It didn’t come naturally to him; he had to work at it.  He had a speech impediment and lisped his sibilants.  He turned this to his advantage by cultivating a measured, drawling delivery.  He wasn’t quick on his feet, nor adept at repartee.  Rather he mobilised heavy artillery.  He once experienced a mental block in the House of Commons and dried up altogether, and had to sit down.  He feared he was going to be overcome by the same pathology – at the time termed “general paralysis of the insane” – that had prematurely struck down his father Randolph.  Ever after, Winston wrote his speeches down word for word in verse form, and memorised them.

We shall fight on the beaches

We shall fight on the landing grounds

We shall fight in the fields

And in the streets.

We shall fight in the hills…

That is perhaps his most famous peroration.  It is in fact so famous, that it has become sentimentalised and widely misunderstood.  It is thought of as an inspirational rallying cry to resistance, which it certainly is.  But it is not devoid of exactitude of meaning.  It is a prediction of an overwhelming invasion, literally a blow-by-blow account of an ordered retreat (note how the fighting theatres move steadily inland until the towns are occupied and the resistance is house-by-house), then a resurgence, taking to the hills and adopting the tactics of guerrilla warfare.  Churchill is telling the nation, without softening the blow, how it’s going to be.  The most remarkable thing about Churchill, his greatest achievement, was that he managed to persuade everybody to go along with him, when anybody in his right mind would have sided with Lord Halifax and sued for peace. 

Two questions we must ask of our orators.  Is what they are saying true?  And are they sincere?  If what they are saying is untrue, then it’s a lie; and if what they are saying is insincere, then it is humbug.  But in any case, are there any orators left?  Rishi Sunak?  Sir Keir Starmer?  I was a bit underwhelmed by Mr Sunak’s sudden appearance at the No. 10 podium on Friday evening, after George Galloway won the Rochdale by-election.  Usually when the Downing Street podium comes out, a world-shattering announcement follows, such as a Prime Ministerial resignation, or a declaration of war.  Mr Sunak regretted the election to Parliament of “Galloway” – he was not granted the courtesy of “Mr”.  Normally when somebody is elected to Parliament, he or she is congratulated, even by their most vociferous opponent.  Mr Sunak also regretted some, but not all ongoing street demonstrations, perhaps as exemplified by the heckler just outside the big gates, in Whitehall.  Apparently we are all tearing ourselves apart, but I didn’t get the sense that the Prime Minister’s speech was going to draw us together.  Meanwhile Sir Keir for the most part avoids oratory.  One has the impression he just wants to get to the general election without making a Big Gaffe.  Apparently the election is his to win (just like Neil Kinnock back in 1992).  It’ll be a shoo-in.  I’m not convinced.  I wouldn’t be surprised if the shenanigans last week in the House of Commons involving the Gaza ceasefire debate delivered him a delayed-action, but nonetheless fatal blow.  Sir Keir’s demeanour reminds me of that of Hilary Clinton at the run-up to the 2016 US Presidential election.  Desperation is not a vote-winner.  A couplet from Siegfried Sassoon comes to mind:

Somehow I always thought you’d get done in,

Because you were so desperate keen to live.

Now Mr Galloway is an orator.  He is currently the most powerful speaker in British politics.  Irrespective of whether you agree with his views, he is utterly formidable. The remarkable debate between him and the late Christopher Hitchens, concerning the Iraq War, which took place at Baruch University, New York, in September 2005, has with some justification been called the debate of the century.  And on the same side of the Pond, another remarkable orator, again irrespective of his views, is Donald Trump.  He can mesmerise a crowd.  That is why it is so important to listen carefully to what people are saying, and to analyse it in the cold light of day.  Give it the stairheid patois test. 

But close textual analysis is not currently flavour of the month.  Rather you can download instant opinions from Social Media, and get some piece of AI software to package it for you.  Nowadays you could probably complete a liberal arts degree without one single, original idea ever crossing your mind.  Dr Leavis (Ms Margolyes is a fan) must be spinning in his grave.  

“I was delighted,” said my boss back in 1982, “to have dinner yesterday evening with Mr. Speaker.”  I wasn’t surprised.  He was very high, an Edinburgh consultant general physician, a breed now all but extinct.  The unit had four consultants, the other three being respectively a neurologist, a cardiologist, and a liver specialist, all of some renown.  I was a Senior House Officer (now known as Foundation Year 2), attached to the unit for six months, and I remember early on my boss asking me where I was from, and what my father did.  I told him I was from Glasgow, and my father a retired policeman.

“Oh.”

I thought he was just making small talk.  I had no idea he was trying to place me, socially.  I have an idea that my bosses at the various Edinburgh hospital units in which I worked thought I came from a higher social caste than I actually did.  I peppered my conversation quite unconsciously with Scots words like “scunnered” or “wabbit” or “glaikit”, and they thought I was being ironic and highly amusing, whereas I was just, like, talking normal.  I must say they all treated me with great kindness, much as I would guess Robert Burns was received by the Edinburgh literati, 200 years before I paced the wards in Edinburgh Royal Infirmary.  I expect the manners of the New Town have barely changed in the interim.  “You must come and meet Rabbie!  He has a beguiling turn of phrase!  A little uncouth, of course…”   

One morning I arrived on the ward to hear from the Ward Clerk that the consultant neurologist, a heavy smoker, had dropped dead, as smokers do.  I had the unenviable task of breaking the news to my boss.  I knew they were very close.  I remember his immediate reaction was to take out a tiny diary, study it closely, and muse, “That’s going to complicate the on-call roster.”  Then I informed the consultant cardiologist, who turned as white as a sheet and said, “S*** a brick.” 

But I digress.  I really wanted to talk about Mr Speaker, various Messrs Speaker, and a Madame Speaker.  Speakers are elected by consensus, and there’s a bit of ritualistic dumb-crambo when the elected figure is hauled with faux-reluctance by a cross party posse out of the back benches and manhandled into the Speaker’s chair. The Speaker takes up residence in a rather opulent grace-and-favour apartment within the Palace of Westminster, Speaker’s House, and until recently was expected to wear anachronistic apparel with wigs, breeches and the like.  My consultant’s Mr Speaker was George Thomas (1976 – 83), subsequently Lord Tonypandy, who had succeeded Selwyn Lloyd, and was in turn succeeded by Bernard Weatherill (1983 – 92), and then Betty Boothroyd (1992 – 2000).  If I remember little about them it was because I was completely swallowed up in the world of Medicine, and in any case I spent most of the last fifteen years of the twentieth century abroad.  But in addition, these Speakers, while being colourful characters, avoided publicity and made themselves invisible, essentially by chairing a prolonged committee meeting for the most part with dispassion and even-handedness. 

But as we moved into the twenty-first century the Speakers began to encounter difficulties.  Michael Martin (2000 – 2009) became associated with the MPs expenses scandal.  Essentially he was a scapegoat, as he had presided over MPs’ outlandish claims for the upkeep of moats, duck ponds and the like, and eventually he had to resign.  He was referred to disparagingly as “Gorbals Mick”, a misnomer as his constituency was actually north of the Clyde, in Springburn.  But in any case “Mick” is a highly offensive term for a Roman Catholic.  MPs can be remarkably tin-eared. 

John Bercow (2009 – 19) eventually succumbed to accusations of bullying.  His last days resembled the fall of the Roman Empire.  Brexit was the issue of the day, and for about two years the BBC news was interrupted by the chants of hecklers on College Green.  Interactions across the House became increasingly fractious.  “This Parliament,” bellowed the Attorney-General, “is a dead Parliament!”  It was like the Monty Python dead parrot sketch. 

The appointment of Sir Lindsay Hoyle as Speaker was an attempt to give the role back to a safe pair of hands.   But there were remarkable scenes in the House of Commons last week.  There is something deeply ironic in the idea that a debate supposedly seeking, temporarily or otherwise, a sensation of hostilities in the Middle-East, should have descended into chaos in an atmosphere of bitter acrimony.  Blessed are the peacemakers.  Ha!  Over the years we have watched, with smug disdain, schadenfreude, and even hilarity, footage of Parliaments in various corners of the world descending into anarchy.  The representatives have a fist fight.  Or the military Junta of a Latin-American country suddenly bursts in on the scene firing pistols into the air and, as the parliamentarians take cover under the desks, declares martial law.  The military are dressed garishly in outlandish uniforms, often with ridiculous headwear.  We say they belong to a “banana republic”, an expression which I forecast will shortly become taboo.  It is, after all, an affront to bananas.  George Orwell parodied the stereotypical English notion of Johnnie Foreigner, across the water, “jabbering and gesticulating”, while within these islands our leaders calmly and serenely epitomised the great triad of Britishness: parliamentary democracy, fair play, and the rule of law.

No longer.  Our parliamentarians have become the jabberers and gesticulators.  It’s a grave matter when we can no longer take our representatives seriously.  Parliament needs to be placed in Special Measures.