Author: jamescalumcampbell

The other day I came across a ridiculous German word.

Der Eierschalensollbruchverursacher.

It’s an item of cutlery, somewhat like an elongated spoon you might utilise if you chose to sup with the devil.  In fact it’s a device for removing the top, or bottom, depending upon whether you are a “little endian” or a “big endian”, of a boiled egg.  I came across it while watching a video posted on U-tube by one Liam Carpenter.  Mr Carpenter is an Englishman who went to Germany to play professional basketball.  I’m not sure that his career on the basketball court really took off, but he has made a name for himself by making short, humorous videos, mostly making fun of the cultural differences between the Germans and the English.  For example his English persona clearly finds the existence of an Eierschalensollbruchverursacher to be inherently absurd.  It says something about the German stereotype of the national devotion to efficiency.  Vorsprung durch Technik.  Equally absurd as the entity is its name, apparently cobbled together, literally something like “eggshell designed to break causative agent.”  Of course, long words in English can also be cobbled together.  They usually have a Latinate provenance, and often they are tongue in cheek.  Floccinaucinihilipilification bears a double irony, because its meaning – a belittling – is in inverse proportion to the word’s length.  But the seemingly limitless German penchant for concocting long words is entirely devoid of irony, and this is what the English find so amusing.  Well done, Mr Carpenter.  Humor hilft immer.  Or, as the Reader’s Digest used to say, laughter is the best medicine.

Perhaps by way of contrast, Taylor Swift is coming to play Edinburgh, as part of her “eras” tour.  Apparently the world tour has already grossed over a billion dollars in ticket sales.  Ms Swift appears on the cover of Time magazine.  I don’t get it.  I went to the Glasgow Royal Concert Hall on Saturday night to hear the greatest music in the world played by the greatest musicians in the world to a hall half full, or half empty, depending on your temperament.  It occurred to me that, although I would have recognised Ms Swift by appearance, with her trademark signature red lipstick, I had no idea what her voice sounded like.  So I went out and bought her latest CD, The Tortured Poets Department.  I wondered if that title owed anything to one of my favourite films, Dead Poets Society.  Perhaps membership of the department allows, and predates, admission to the society.  Anyway I quite like the CD, and now I would recognise Ms Swift’s voice.  It’s a nice voice.  (Good heavens.  Am I becoming a Swiftie?)  The musical language is diatonic, and very simple.  The lyrics are clever.  But I don’t really get it.  I don’t get the hype.  It’s not the Beatles.  The Beatles, at least the early Beatles, had joy, even when heartbroken.  But the world of the tortured poets is indeed tortured.  Frankly, it’s miserable, and maybe that’s why Ms Swift has struck a chord.  Teenage angst has reached a new and even lower depth of despair.  It also seems to be temporally perpetuating itself; Ms Swift is, after all, 34 years old, but she’s still singing “F*** it if I can’t have him.  Down bad.  Down bad.” 

I could perfectly believe that youth is more miserable than ever.  Look at the world we have bequeathed them.  It’s not just the global warming, the pollution of habitats, the mass extinction of species, and the destruction of the natural world.  All these are bad enough.  Infinitely worse is the implication that it doesn’t matter, because we can all live virtually.  All of our problems can be sorted by access to a tablet.  Presumably that is why everybody is wandering the streets in a trance, staring at a mobile.  I heard an artificial intelligence guru on the radio say that pretty soon all our “menial” jobs would be undertaken by robots, ergo it would be better to make all the “menial” employees redundant, and give them a basic wage.  The head of “smart places at FarrPoint”, one Steve Smith, wrote an agenda article to the Herald earlier this month, entitled “Could AI help find answer to social care problems?”  He wants to install a device into the kettle of an elderly person, to alert family if the loved one is no longer making a cup of tea.  “Smart technology” writes Mr Smith, “assisted by artificial intelligence, has the potential to revolutionise social care by improving quality and efficiency, while also empowering people to live independently for longer.”

That sentence could have been generated by a piece of AI software. It’s a portent of a dystopia; a vision of Hell.                       

I didn’t manage to catch the aurora that has graced our skies over the last two or three nights, thanks to all the unusual solar activity.  I did take a stroll around my village on Saturday evening at about 10.30.  The skies were clear following a very beautiful day when the temperatures had reached 25 degrees Celsius.  But it was still too light, and I decided not to set the alarm for 2 am.  Actually, on occasions such as these, I am reminded of John Wyndham’s The Day of the Triffids, in which, if memory serves me right, virtually the entire population of the world goes blind having been exposed to a spectacular cosmic light show.  I know it’s absurd, but Wyndham’s brand of Sci-Fi made such an impression on me when I was a child, that I’ve tended to avoid gazing at auroras.  Following Triffids (1951), John Wyndham Parkes Lucas Beynon Harris (1903- 1969) went on to write such memorable tomes as The Kraken Wakes, The Chrysalids, The Midwich Cuckoos, Trouble with Lichen, and The Seeds of Time.  They seem to capture the spirit of an age, with an atmosphere not dissimilar to that encountered in the novels of Wyndham’s contemporary Nevil Shute (1899 – 1960).  Shute, an aeronautical engineer, was also interested in science.  The English scientific world in the 1950s has a peculiar atmosphere, captured by C. P. Snow – whatever F. R. Leavis might have to say – and also by Nigel Kneale of Quatermass and the Pit fame.  I call it “The Jodrell Bank effect”.  A sense of oppression, threat, and paranoia, doubtless attributable to the Cold War, and the ever-present, never-absent Bomb, hanging over us like the manifestation of “Hob”, the devil, overhanging an apocalyptic vision of a London on fire, whose population goes on the rampage in “the hunt”, the search for “the other”; a depiction of what the Germans call „Völker-Mord“, or ethnic cleansing.  Like Wyndham, Kneale was not so much interested in science fiction, or even fiction, as in ethical codes. 

Quatermass is a bit like Macbeth, an exploration of the way in which humanity can be overtaken by a malevolent external force.  Last week the BBC unearthed a radio play version of Macbeth from the 70s, which was thought to have been lost.  Ever since I saw the horrific Roman Polanski film, I have shied away from the Scottish Play.  But I did manage to listen to a few passages, with their exalted verse.  Actually Macbeth works very well as a radio play.  The language is distilled; the on-stage gore is left to the imagination.  I have always admired G. Wilson Knight’s critique of Macbeth in The Wheel of Fire, Macbeth and the Metaphysic of Evil.  Prior to Knight’s essay, critics thought of Shakespearian tragedy in terms of great heroes with an hamartia or fatal flaw, in Macbeth’s case, “vaulting ambition”.  His lust for the crown led him to murder.  I was taught this at school, just as I was taught about “the causes of the First World War” in terms of “the cockpit of Europe”, the balance of power, and failed diplomacy.  Even at the time it crossed my mind that all of that did little to explain the collective insanity that led to the trenches and the horrors of the Western Front.  A medieval outlook, the notion that we had become possessed by evil spirits, seemed more accurate, and that still pertains today.  Ukraine.  Gaza.

What can you do?  Well, as St Paul said, “Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, think on these things.”  So yesterday afternoon I played in the Dunblane Chamber Orchestra’s spring concert.  Mozart’s Symphonia Concertante for oboe, clarinet, horn, and bassoon; Faure’s Pavane, and Mozart again, the fortieth symphony.  Just before the concert started, an orchestra committee member, and fellow viola player, asked me, “What do we do in the event that somebody in the audience collapses?” 

I suggested, “Make an announcement.  Is there a doctor in the house?  But do you realise, you’ve just put the hex on the concert.  Now, something will happen.”

Sure enough, half-way through the third movement of Mozart 40, there was an almighty crash from the rear of the hall.  Well, I’m retired.  Things move on in medicine very quickly.  I’d only be a liability.  So I kept playing Mozart.  At the close of the movement, the conductor, all credit to him, turned to the audience and asked if everything was all right.  Apparently it was.  So we went on to the last movement, and finished the concert.         

Then everybody left by the south door, because the north door was inaccessible, part of the ceiling having collapsed.  As a friend subsequently remarked to me, as we dined in the Lion & Unicorn, “You brought the house down.”  At least nobody was hurt.

Mozart 40 is extraordinary.  Very syncopated; very chromatic.  The second half of the finale commences with a reiteration of the main theme that is so distorted that the audience in 1791 must have been completely nonplussed.  In fact it’s a tone row, incorporating every note in the twelve note chromatic scale, except that of the home key of G.  Mozart anticipated Schoenberg by well over a century.  It really is enough to make an edifice collapse.            

Standing in a queue in the local shop the other day, the man ahead of me turned round and said, “Hello, doctor, how are you?”

“Doing away,” I replied.  “And yourself?”

“Very well.”  And when he had left the shop, I said to the shopkeeper, “Who’s he?”  The shopkeeper was very amused.  He was able to identify the man for me.  But then, my shopkeeper knows everybody.  It’s a great talent, and one I don’t have.

The following day I was in a Starbucks coffee house and another man ahead of me said, “Hello, doctor, how are you?” 

“Doing away,” I replied.  “And yourself?”

“Very well.”  But then, “Do you remember me?”

I always think it’s best to be completely up front, otherwise you will land yourself in all sorts of difficulty.  “I’m afraid not.”

He introduced himself, and even gave his address.  “Remember now?”

I said, “Forgive me.  Since I retired, everything is a blur.”  I’ve often found this to be a reassurance to people.  Whatever confidential information I was once privy to, has been deleted from the memory banks.  But I had the odd notion that the man in Starbucks was slightly miffed.  Probably my imagination. 

The following day I complimented my German teacher on her remarkable ability to remember the name of everybody in the class.  I told her about these recurring episodes when I am accosted in the supermarket by somebody who says, “Hi, doc”, then points to a particular part of the anatomy, or holds up a limb.  “It’s much better now!”  Actually I’m on safer ground here.  I explained to my teacher that I can’t remember names, but I can remember diagnoses.  She found this very amusing.  

We doctors call this difficulty with names, rather pompously, “nominal aphasia”.  Actually it’s a misnomer.  I believe nominal aphasia is actually a real clinical entity, perhaps a complication of a stroke, in which the unfortunate patient really can’t remember names, even of loved ones.  It’s the sort of thing the neurologist Oliver Sacks would have written about in books like The Man Who Mistook his Wife for a Hat. But I doubt if my difficulty with names is truly pathological, more likely a character failing on my part; a reprehensible, remote detachment.  After all, the technique of remembering names can be learned.  When I was working in Broadford Hospital, Isle of Skye, at the beginning of this century, there was a general election, and the late, much missed Charles Kennedy dropped by, by helicopter, as you do.  I was introduced to him.  “This is James Calum Campbell.”  (Or words to that effect.)  He shook my hand, looked at my face as if taking a photograph, and said, “Hello, James Calum Campbell.”  So, he had a technique. 

Group introductions I find particularly difficult.  You know the sort of thing.  I find I have to introduce six people to six other people.  I’d much rather go round the table and ask everybody to introduce themselves, as you might do at a committee meeting.  But if it’s not a committee meeting, but rather a dinner party, that’s really not on.  I am inclined to panic.  All I can do is try to anticipate the event, and rehearse. 

Then there is the socially awkward phenomenon of being on familiar terms with somebody you have been acquainted with for quite some time, but whose name escapes you.  You really ought to have owned up months ago, but you let the opportunity pass you by, and now it’s too late.  You suspect you might know their name, but you’re not sure.  To give it a stab and get it wrong would be quite the faux pas.  The only possible solution is to find some mutual acquaintance and extract the necessary information from them. 

Then there are the people who you know just have the wrong name.  I know a Liz who really ought to be Jill. I once called her Jill and she looked puzzled.  Some names get mixed up.  I confuse Deborah and Rebecca, even in their shortened forms, Debs and Becks.   

Why are people affronted when their name is not remembered?  What’s in a name?  Romeo’s Juliet evidently thought, not much.

That which we call a rose

By any other word wold smell as sweet…

…Romeo, doff thy name,

And for thy name – which is no part of thee –

Take all myself. 

For myself, I don’t mind not being recognised as I move about the world.  I concealed my name when I published my first book.  At least, I lost it in translation.  I did it, ostensibly, because I was still in practice at the time, my book contained a lot of medicine, and I did not wish my patients to suspect they were appearing in my book.  Now I have published four books, and I have retained the habit of concealment, ostensibly, for continuity’s sake.  Yet I suspect the real reason lies deeper.  I crave neither fame nor notoriety.  I highly prize the gift of being able to walk down the street unmolested. 

Of course I would prefer that the books that have been printed be sold rather than pulped.  I have no desire to be remaindered.  But success and fame are not the same.  I should like to observe any such success from a position of anonymity.  I wish James Calum Campbell all the luck in the world.     

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.