Author: jamescalumcampbell

Ken Bruce signed off from Radio 2 on Friday.  I was – am – a fan, so I listened to his last show right through.  I performed dismally as usual on Pop Master, but fortunately the last ever contestant scored a creditable 27 out of 39, and then solved “3 in 10” in approximately 1.5 seconds!  Ken told him he knew his stuff.  Always cheerful, witty, unfailingly courteous.  He has an encyclopaedic knowledge of popular music, and I noticed that he always identified the name of the songs he played, and the artists who performed them.  Well, maybe just once he didn’t, but that was for his last song on Friday.  He chose the last three tracks of Abbey Road which the Beatles perform without a break – Golden Slumbers, Carry that Weight, and – suitably enough – The End.  Maybe you don’t need to identify the Beatles.  I love Golden Slumbers, full of yearning for the past.  McCartney at the height of his powers.  

The show reminded me of other Radio 2 swansongs.  In 1984 Terry Wogan bowed out, albeit temporarily, to concentrate on TV.  He had, as usual, a bit of banter with Jimmy Young whose show followed Wogan’s.  I seem to recall Wogan saying, “If you spill coffee over the controls you’ll never hear the end of it.”  Jimmy Young said, “I won’t wish you luck because you won’t need it.”  Wogan said, “Who doesn’t need luck?”

Then it was Jimmy Young’s turn to go.  He wasn’t happy about it; definitely was pushed, rather than fell.  He kept saying during his last outing, “This isn’t my idea, you know!”  He might have listened to Wogan who once said that one of three things can happen to you as a DJ.  Either the management will get fed up with you, or the audience will get fed up with you, or you will get fed up with yourself.  Wogan once said that he liked going to parties, but never stayed till the bitter end.  Similarly, he said that he would pack his tent and go in his own time. Which he did. 

But after TV he had a reincarnation on Radio 2 and then it was Wogan – Bruce banter that we got at 0930.  Wogan could be hysterically funny, but there was another side to him, opinionated, acerbic, that perhaps only came through in his writings, particularly for the Telegraph. 

On Friday Ken received a lot of accolades, which he mostly deflected with admirable modesty and tact.  Recently a Pop Master contestant said to him, “Such an honour to speak to Radio 2 Royalty” to which Ken replied, “You must mean Richie” (the travel man).  Ken said people from Scotland, particularly Glasgow, didn’t like to receive praise.

Glasgow!  I seem to have spent a lot of time there this week.  After a gap of nearly half a century I have re-joined a private swimming club near the city centre.  It was originally a Victorian spa for the Glasgow gentry.  Moustachioed gentlemen could be seen in waspish swimwear swooping across the pool on rings and trapeze.  Pictures of them might have been used as an advertisement for Bovril or Woodbine.  There were Turkish baths, a gym, a reading room, and snooker tables.  What’s not to like?  I was lured by a notion at least a century old of “going up to town and relaxing in my club”.  But not without some trepidation.  Returning to the past is always a bit of a gamble.  I remember getting a panic attack when I went back into my medical school’s anatomy lecture theatre after a gap of forty years.  And I never even made it across the entrance to my old school. 

But in fact my first visit to the baths was reassuring.  I felt (in a good way) as if I’d never been away.

On Thursday at the Goethe Institut we did a segment on Austrian German, so in preparation I asked an Austrian friend of mine for some typically Austrian idioms I could use. 

He said, “Hast du ein Vogel?”  Actually he said something more like, “Host du un Vogel?”  I said, “You mean, Hast du einen Vogel?  Have you a bird?”

“Nein.  Host du un Vogel?  Are you mad?  Or, Spinnst du?  Similarly, are you mad?”  (Literally, I suppose, are you spinning a yarn?)  And then something about an imaginary border that separates Austria and Bavaria from the “Hochdeutsch” north – “Die Weißwurst Grenze” – the white sausage border.  So I went to my class, suitably briefed.  But of course, as so often happens in a conversation class, none of it came up.  We ended up talking about the current trend of editing out politically incorrect material from classic novels.  First Dahl, then Blyton, and now Fleming.  I said, “Ja!  Doppel null sieben!”

And again on Sunday, another visit to the big G, for lunch, a walk, and a private piano recital.  It was a lovely spring day and it was a joy to see the crocuses, some daffodils, and some early spring blossom on the trees.  I believe it is my favourite time of year.  The gradual fading of winter (not done yet), the lengthening days, and the growth, are tonic to the soul. 

Then, on the drive home, a darkening of the sky, the sun low on the horizon, some rain, and then the appearance of the most remarkable rainbow I have ever seen in my life.  I first noticed a segment of it somewhere abeam Kirkintilloch, and it occurred to me that I had never seen a rainbow so broad.  By the time I reached Cumbernauld, there was a huge multi-coloured semicircle encompassing the sky, horizon to horizon, and outside it, its inverse reciprocal, hardly less intense, complete in itself.  I have never seen that, in such entirety, before.  The colours of the second rainbow are in reverse order: Vain In Battle Gave York Of Richard. 

There is a rainbow mythology, that its appearance is a reassurance that the Almighty will never again inflict the flood upon us.  I hope it’s true, but I don’t think we should risk complacency.  If the sea levels rise much more – and I believe the computer modelling is not reassuring – then the number of people across the world seeking higher ground is certain to increase, exponentially.  The Prime Minister may wish to deport illegal immigrants immediately from these shores, but if these shores start to vanish, then maybe we too will find ourselves washed up on some distant land, craving asylum.                                              

Hot on the heels of the Roald Dahl débâcle, I see from the front page of the Sunday Telegraph that the James Bond books have been edited to remove racist references.  All fourteen spy thrillers are being reissued in April to coincide with the seventieth anniversary of the publication of the first, Casino Royale.  Apparently the alterations followed a review by “sensitivity readers”.  I suppose this must refer to a group of people who have gone through the texts with a fine-tooth comb looking for offensive words, phrases, or extracts that need to be expunged.  I seem to recall that Syme, a character in Orwell’s 1984, was similarly entasked.  He too, like the text he worked on, was disappeared. 

Apparently not all disparaging racist remarks have gone.  Bond has remained critical of Oddjob, Goldfinger’s Korean man servant.  Was he North Korean or South Korean?  Perhaps some ethnic groups are still fair game.  And sexist and homophobic remarks have been allowed to remain.  So the main focus of attention is on Afro-Caribbean peoples.   When I read that an entire chunk of dialogue, a conversation in Harlem between a black man and his girl faithfully and phonetically reproduced, had been expunged from Live and Let Die, I got out my second impression (1954), and refreshed my memory.  Bond and his friend Felix Leiter sit in a booth in a diner in Harlem and eavesdrop, rather after the fashion of Professor Higgins studying the speech patterns of cockney flower girls in London’s east end.  It struck me that both Fleming and Bond are rather complimentary to the couple in the next booth.  Just for the record, I don’t think Bond was a racist.  He got along just fine with his friend Quarrel, a Cayman islander, in Dr No, and with Fidele Barbey, from the Seychelles, in The Hildebrand Rarity.  Despite the fact that, like his creator, he was an Old Etonian, he wasn’t even a snob.     

I can well imagine there will be a backlash.  Actually two backlashes.  Some people will say, “Enough of this woke nonsense!”  Others will say, “If black people are not to be disparaged, then what about women?  Why has the tang of rape been allowed to remain sweet?  And what about the LGBTQI community?  You haven’t gone nearly far enough!”  Then Ian Fleming Publications will be in a real pickle.

The Enid Blyton canon is undergoing a similar revision.

Is censorship of Ian Fleming’s canon “political correctness gone mad”?  I myself avoid this expression, along with “woke nonsense”.  In my experience they are usually employed by people who occupy positions of power.  In order to figure out whether a remark is hurtful, vicious, and damaging, you need to try to put yourself into the shoes of the person at the receiving end, the butt of the joke, the victim of the barb. 

In 2004, When Boris Johnson was editor of the Spectator, he published a poem by James Michie entitled Friendly Fire, calling for the extermination of Scottish people, who were “polluting our stock”.  The poem is said to be satirical.  It presents a caricature of the Scottish nation as wee, chippy, provocatively foreign, and a drain on the economy.  The poem advocates the refortification of Hadrian’s Wall, and the formation of a ghetto on its northern side.  But James Michie would go further:

The nation

Deserves not merely isolation

But comprehensive extermination.

We must not flinch from a solution.

(I await legal prosecution.)    

Maureen Fraser, then director of the Commission for Racial Equality in Scotland, condemned the poem as very offensive, and deeply inflammatory.  She found some of the language to be completely and utterly unacceptable.  The SNP MP Ian Blackford raised the issue in the House of Commons.  Some people thought his outrage was of the “faux” variety.  Humbug.  He was advised to lighten up.  It’s only a bit of banter.  And it is self-evidently a terrible poem, written in the style of William Topaz McGonagall.  The clue is in the title.  The “fire” is “friendly”. 

Of course, a friend’s ammunition is just as lethal as an enemy’s.  And more dangerous.  As was discovered in the Vietnam War, not all incidents of friendly fire are purely accidental.  You don’t expect to be shot in the back.      

“Just a bit of banter” is, like “woke nonsense”, another expression to be avoided.  All these references to sandy hair, knobbly knees, kilt, skean-dhu, sporran, and the Free Kirk (of which Kate Forbes is a member) – they are all clearly light-hearted and jocular.  And the last line with its acknowledgement that the poet is sailing close to the wind is evidently a disclaimer, a literary volte-face or palinode, a get-out-of-jail-free card.  The Jocks will take it all in good part.  

On the other hand, there is clearly a conscious and deliberate deployment of language that has a long and dark history – verminous race, polluting our stock, offensively foreign, ghetto, extermination, solution.      

The final solution.  You see what is being evoked.  I wonder if the editor of the Spectator had any idea that the Gaelic nation that was being lampooned had indeed, in the proscription of the tartan, the Gaelic language, and in the Highland Clearances, been subjected to a final solution.

Following the furore, the Spectator removed Friendly Fire from its website. 

I wish they hadn’t.  I would prefer the purveyors of friendly fire to remain in full view, out in the open, shooting themselves in the foot.  I wonder whether the Spectator removed Friendly Fire because they were persuaded it was in bad taste, or because they felt it was causing the organ reputational damage.  They might have said, “We fouled up.  This is not who we are.”  Removing a scurrilous article is a bit like the establishment stripping a disgraced individual of his knighthood, not because the individual is a cad and a bounder, but because the perpetuation of his gong tarnishes the establishment’s sheen.  That person is not a knight.  He was never a knight.  Like Dreyfus, his epaulettes are ceremonially ripped from his shoulders. 

No.  Let history remain to be seen, unmodified, as it happened.  Don’t obliterate it with a blue pencil.  Just write “stet”.  And don’t offer up an apologia.  You know the sort of thing: This language which seems entirely unacceptable to us, was commonplace in its day and reflected societal views widely held at the time.  Duh.  Freedom to critique is the reciprocal of freedom of expression and should not be micromanaged by any self-appointed arbiters of taste.  One of the most basic freedoms to be cherished, perhaps the most basic, is the right we each have as individuals to make up our own minds. 

Thursday, February 16.

Up up and away at crack of dawn to Glasgow, and my weekly tussle with the German language for the better part of three hours in Glasgow’s Goethe Institut.  I parked for free on Cleveden Drive.  It’s still about two miles from my destination, but I’m too mean to pay the exorbitant parking fees on Park Circus, and I enjoy the walk through Glasgow’s West End, via the Botanic Gardens.  I paused as usual for a flat white at The Paper Cup on Great Western Road.  I was able to read Nicola Sturgeon’s resignation speech, in full, in The National.

It’s a very good speech, frank, honest, and deeply personal.  I don’t know why some of the First Minister’s critics were so mean-spirited about it.  Even Donald Trump managed to be more gracious to Hilary Clinton when he won the Presidency in 2016.  He’d said her crimes were “egregious”, and had his mass gatherings chanting “Lock her up!”  Then when he defeated her, he thanked her for her years of public service.  “And I mean that most sincerely.”

I left The Paper Cup, walked past Hillhead School and cut through the cloisters of Glasgow University and then up through Kelvingrove Park in the direction of the statue of Lord Roberts of Kandahar, on horseback, looking back towards the University Tower.  Somebody has defaced the statue with the word “Murderer”. 

German was great fun, but terribly difficult (for me, anyway).  Viel Spaß, aber furchtbar schwierig. 

Afterwards, to unwind, I headed down as usual to the Kelvingrove Art Gallery in time for the daily 1.00 pm organ recital.  You are more likely to hear a medley from The Sound of Music than J. S. Bach’s St Anne’s Prelude and Fugue.  Don’t knock it; Climb Every Mountain is rather impressive on the organ.

Then I retraced my steps to the car, parked about 100 metres from my birthplace, Redlands Hospital, no longer there (the hospital, not the car).  Having some time on my hands, I took a further walk down Amnesia Lane, passing the various houses where I stayed as a child.  We continually flitted between grand mansions, because my mother and her three sisters ran care homes for the elderly in Glasgow’s West End.  My earliest recollections are full of the decrepit, the incontinent, and the confused.   My mum’s oldest sibling, Auntie Susie, had an extraordinary ability to acquire grand houses.  I don’t know how she did it.  She said she never had to take out a mortgage.  She was a Gael and I think she cultivated Highland connections.  She had started life downstairs “in service”, and she ended up looking after the aristocrat for whom she had worked.  50 Cleveden Drive had a rather grand bathroom on the first floor which had been installed to accommodate a visiting Prime Minister – I think it might have been Andrew Bonar Law.    

One of my school chums lived virtually next door in another grand house at the corner of Cleveden Road and Cleveden Drive.  This was a “home for unmarried mothers.”  I would pass them on my way to school, smoking cigarettes at the corner, heavy with child, looking as if they were about to be run over by a truck.

I crossed Great Western Road and walked past Gartnavel General Hospital to Hyndland Station, over the footbridge and into Broomhill.  For some reason the street names are all redolent of English history – Marlborough, Randolph, Churchill, Naseby, Edgehill…  I used to get up at 0630 to deliver papers on Naseby and Beechwood Drive, and because I rarely went to bed before midnight I spent half my school career in a state of terminal exhaustion.  I just remember the letter boxes were as tiny as the Sunday papers were bulky, and there were an inordinate number of homeowners in Beechwood named Colquhoun.   

51 Rowallan Gardens.  Our longest stay.  I have fond memories of it, but you forget the bad times.  We had a protracted war with our neighbours who couldn’t stand the sound of the piano or the viola, and would turn their radio up full blast.  I remember my father later voicing a regret.  We should have moved. 

Hyndland School.  The alma mater.  A penitentiary in red sandstone.  Spero meliora, said the school motto.  Were meliora achieved?  Goodness only knows.  I popped into Hyndland Bookshop, a wonderful independent bookshop full of enticing titles.  I bought Stephen Hough’s Enough, Scenes from Childhood (Faber, 2023).  I had already read the concert pianist’s Rough Ideas (Rough, Enough, rhymes with Hough).  I suppose this was Hough’s own version of a walk through the environs of his childhood, in his case the Wirral.  He doesn’t have a good word for Chethams, the music school, at least as it was in the 1970s.  It sounds bleak, tatty, and even sordid.  I was reminded of George Orwell’s memoir of a miserable childhood, Such, Such Were the Joys. 

17 Dowanside Road.  I remember a “speaking tube” between the ground floor and the basement, presumably whereby you could in a former age demand of the help a cup of afternoon tea.  At the top of Dowanside Road and just round the corner, 4 Crown Road North.  Auntie Susie also acquired No 6 and knocked a hole in the wall between them, while her sister Effie had the tall and stately number 15.  I stayed in 15 when I started school aged 5.  It was a walk of about half a mile.  I remember on day 2 I decided that school wasn’t for me, and walked home about mid-morning.  I was promptly turned around and sent back. 

1 Queens Gardens, opposite Notre Dame School.  Auntie Mhairi’s business, after 30 Marlborough Avenue.    

And finally, 2 Lorraine Road, the first of the nursing homes, acquired I think just before, or perhaps during the war.  My mum being a midwife delivered all my cousins there.  I took it all for granted.  Four highland women running a network of care homes across Glasgow’s West End – well, it was just de rigueur.  Quite extraordinary.                                  

Boris Johnson has told us that Richard Sharp knows nothing of his personal finances.  He can tell us that hundred per cent for ding-dang sure.  It’s another example of the BBC disappearing up its own fundament.  Mr Johnson’s slang is as anachronistic as Billy Bunter.

Fundament?

Chambers fundament the lower part or seat of the body

And then, perhaps more pertinently, the next entry in Chambers –

Fundamentum relationis the ground of relation, principle of, or the nature of, the connection.

What is the fundamentum relationis twixt Mr Sharp pointing Mr Johnson in the direction of £800,000, and Mr Johnson pointing Mr Sharp in the direction of the chairmanship of the BBC?  The Parliamentary Digital, Culture, Media, and Sport Select Committee explored this issue with Mr Sharp.  They tried to get to the bottom of it.  Well, good luck with that.  Following an audit trail in London is like trying to find you way home through a dense fog.  A real pea-souper.  A committee member, the SNP MP John Nicolson, described Mr Sharp as “haughty”.   

Well, I suppose Mr Sharp has much to be haughty about, if he so chooses.  He graduated in 1978 (PPE, Christ Church, Oxford) and worked as a banker for J P Morgan for 8 years, and then Goldman Sachs for 23 years, where he was Rishi Sunak’s boss.  He was an adviser to Mr Johnson when the latter was London Mayor, and to Mr Sunak as Chancellor of the Exchequer.  He has donated £400,000 to the Conservative Party.  So, irrespective of the nature of the fundamentum relationis, Mr Sharp’s appointment to the BBC chairmanship was not exactly by “blind audition”. 

I can’t say I have the foggiest notion as to what a financial institution like Goldman Sachs actually does, but I imagine being a member of that particular club would open doors for you just as attendance at an English public school, then Oxbridge, would do the same.  The whole purpose of attending Eton, or Harrow, or Winchester, and then Oxford, is to establish what Jane Austen calls “useful acquaintance”.  The freemasonry of the haughty.  It’s a meal ticket for life.  The aim is to become recognised as “one of us”.  You become a member of an ancient, druidical witanagemot whose manners and customs are instantly recognisable within the fold, but not beyond.  The deployment of smoke and mirrors is so sophisticated as to create an illusion of transparency.  “Levelling up” is sleight of hand, a conjurer’s trick.  The rich get richer, and the poor ye will always have.  Yet the privileged have no real idea just how privileged they are, because they have no idea what lack of privilege must feel like.  They sit above the glass ceiling, look down upon those beneath who are unable to break through the ceiling, and they are contemptuous because the ceiling, being made of glass, is invisible, so they forget that it is there.                                      

It’s a very expressive word, haughty.  It comes from old French halt, haut, and Latin altus, high.  So it aptly describes the attitude and demeanour of the ruling class.  It’s highly perfumed, is haughtiness.  Hauteur.  Burns captures its quality perfectly in his radical poem A Man’s a Man for A’ That.  He has intense contempt for it.

Ye see yon birkie ca’d “a lord,”

Wha struts, an stares, an a’ that?    

Yes, hauteur certainly “struts and stares”.  It is a remarkable thing that when the Scottish Parliament was reconvened after a gap of nearly 300 years, Burns’ poem was sung in the presence of the monarch.  For some, Scottish Nationalism is primarily an attempt to escape from disdain.  The “establishment” becomes an object of mockery.

The man o independent mind,

He looks and laughs at a’ that.

There is something inherently ridiculous about the high and mighty. 

Meanwhile, an extraordinary (sic) cross-party summit has been held at Ditchley Park in conditions of the utmost secrecy to discuss the catastrophic economic fall-out of Brexit.  It’s like something out of a John Buchan “shilling shocker”, with mysterious men in Ulsters alighting from shooting brakes to gather at a country seat in order to manipulate the levers that control the world.  But why should such a meeting be held in camera?  Fog, everywhere.  It is the default mode to obfuscate.  The trick is not to be open, but to seem to be open.  That’s for ding-dang sure.  Hundred per cent.    

It occurred to me the other day, in a slow-witted way, that one’s mood is rather like the weather.  Some days are dreich, some cloudless, but mostly round these parts, it’s showers and sunny periods.  There’s not much point in complaining about it; just wrap up and get on with whatever you are supposed to be about.  You could imagine the late Duke of Edinburgh saying as much.  I don’t suppose he would have had much time for his grandson’s book, whose German translation is entitled „Reserve“.  But nowadays the quality of reticence, of being reserved, the stiff upper lip if you will, has rather fallen out of fashion.  It’s okay not to be okay.  So we say, let’s talk about the weather.

I haven’t read Prince Harry’s book.  I said in my German class last week that I was waiting for it to be remaindered.  Then I would pop into Waterstones and say, “Have you got a spare spare spare?”  It was a cheap gag.  I’m not proud of it.

When I was a medical student the psychiatrists were keen on making a distinction between “reactive” or “exogenous” depression on the one hand, and “endogenous” depression on the other.  You might be low, on the one hand, because outrageous fortune had just hurled too many slings and arrows at you, or, on the other because of some chemical imbalance in the brain which depressed your “affect” no matter what your external circumstances were.  The distinction was not clear-cut; there could be a progression from reactive to endogenous depression because sooner or later life’s endless vicissitudes would alter the brain’s hard wiring.  You might say, “Life eventually got to me.”  In this sense, endogenous depression was seen as a more serious illness than reactive depression, more likely to culminate in an altered mental state, a psychosis.  The voices might tell you to kill yourself.  This was the end of the spectrum psychiatrists were interested in.  Talking therapies were not so much in vogue.    

I remember the lecture when these theories were being propounded.  My neighbour leant over, shook his head, and whispered to me, “It’s all reactive.”  I don’t know why he thought that.  Maybe he looked at the patients, and at how miserable their lives were, and concluded than in their shoes he would be just as wretched.  But if he was right, then you might argue that depression was hardly a medical condition at all, rather a social one, and that its treatment would involve an attempt to improve a patient’s living conditions.  Yet at the time, major depression was seen as an organic disease, to be treated by interfering with neurotransmission, using potent drugs such as the tricyclic antidepressants.  The trouble with the tricyclics was that they were very dangerous in overdose, and after all, depressed patients were liable to overdose.  The selective serotonin reuptake inhibitors, SSRIs, were yet to come on the market.

Electroconvulsive therapy, ECT, was still in vogue.  Here, the idea was that if depression really was a disease of neurotransmission, then somehow you could “wipe the slate clean” by passing an electric current across the brain.  I suppose it was analogous to treating ventricular fibrillation by passing a current across the heart, thereby “defibrillating” the rogue arrhythmia and bringing the heart muscle to a standstill in the hope that it would recommence in normal sinus rhythm.  ECT’s immediate effect was to cause an epileptiform convulsion.  Thereafter, it was hoped, the brain in quietude would revert to something more like its normal self.  The first locum I ever undertook as a medical student was in a psychiatric hospital and I assisted at a weekly ECT session.  The therapy was performed, mercifully, under general anaesthetic.  The anaesthetist was a cheerful young woman with a very sunny personality and the clinic was always a happy one.  I often wondered whether it was actually the weekly contact with her that improved the patient’s mood.  Or could it have been the general anaesthetic itself, rather than the ECT? 

ECT still fulfils a role, albeit more limited, but this sense of “wiping the slate clean” still persists in state-of-the-art therapies, for example, involving the use of hallucinogenic drugs to reset the brain’s myriad connections.  Professor David Nutt, head of Imperial College London’s Centre for Psychedelic Research researches this field, using Psilocybin, a component of magic mushrooms, under strict monitoring conditions.  (Don’t try this at home.)  You may imagine the use of such drugs to be controversial, and indeed Prof Nutt is no stranger to controversy.  He used to be chairman of the Advisory Council on the Misuse of Drugs (ACMD).  He told the government that horse-riding was more dangerous than ecstasy, so they sacked him.   

Nowadays, the distinction between reactive and endogenous depression has rather fallen out of favour, and psychiatrists are more inclined simply to note the severity of the condition in terms of its impact on the patient’s life.  (To return to the weather analogy, is this a short-lived squall, or is it what the inhabitants of Auckland have just experienced, the worst weather event in 200 years?  I look at the pictures of the Auckland streets, so familiar to me, turned into rivers.  Fortunately, New Zealanders are extremely resilient.)

The mood-weather analogy is not purely theoretical.  Seasonal Affective Disorder is a real entity. The climate continues to change, there is war in Europe, earthquakes abroad, rampant inflation at home, strikes and rumours of strikes, bile on social media, violence in the classroom…                                                       

Yet whose mood is not now beginning to lift, despite this winter of discontent, at the sight of banks of snowdrops, and the prospect of longer days?  I await, with buoyancy and hope, the crocuses. And then the daffodils.    

Back in the nineties in New Zealand they aired a US TV show about a guy whose weekly purgatorial task was to possess a given individual’s psyche and hence sort out somebody else’s existential crisis, whilst that individual was despatched temporarily to “the waiting room”.  I suppose it was a variation of The Fugitive, in which Dr Richard Kimble, played by David Janssen (and Harrison Ford in the movie) is a man wrongly accused, and convicted, of murder, who escapes and week by week enters other people’s lives incognito, solves a problem, and then must get on the run again.  He is always hopeful that at some stage he will be afforded the opportunity to solve his own existential crisis.  Similarly the serial possessor of psyches is a reluctant benefactor who is always hopeful that he will find a way out of his own labyrinthine dilemma.  I don’t know if this programme got to the UK, but perhaps you recognise it.

The protagonist had a companion or side-kick, part minder, part amanuensis, who would orientate him each time he glanced in the mirror at his new persona, and wondered what ghastly tangled web he had to unweave.  One week he’d be a concert pianist, the next he would find himself in the electric chair.  The minder would consult a device I did not recognise at the time, which belonged firmly to the realm of science fiction.  In fact it was a cross between a smart phone and a tablet.  It would spew out data about the particular life that needed to be sorted out that week.  The side-kick would consult the screen of his tablet regularly.  He was never off it.

I thought the whole thing was based on an absurd premise, and I had no inkling that it was all going to come true.  Nowadays, everybody navigates their way through life’s catacombs by consulting their mobile, to find out who they are, and what they should be doing.  What a catastrophe. 

Not that these devices don’t have their uses.  I imagine you could download an App, say, to help you navigate your way out of the Hampton Court Maze.  The route from a given location (identified by built-in Satnav) could be coded as a single number, given in binary.  0 is left, 1 is right.  Say the number is 011010010110.  You just navigate each junction sequentially, and escape. 

The trouble is, we have modelled all human dilemmas as an attempt to get out of a maze.  If this, do that.  Medicine is full of algorithms, constructed as a series of binary choices, and hence a series of branching lines.  Does the patient have chest pain?  Yes.  Is it severe?  Yes.  Has antacid medication provided relief?  No.  Is the pain of duration longer than an hour?  Yes.  Does the patient have pallor, sweating, or shortness of breath?  Yes.  Eventually you reach the bottom line.  Phone for a blue light ambulance.   

But of course experienced physicians don’t consult algorithms.  And they don’t think algorithmically.  They understand the severe limitations of this kind of pedestrian trudge, which is more than likely to lead you off into a remote branch line ending in a deserted cul-de-sac from which there is no way back.  We see the unintended and disastrous consequences of algorithms in many walks of life.  Look what happened to the sub-post masters when a computer system identified them all as criminals.  Look what happened to the A-level students from disadvantaged backgrounds whose exam grades were brutally downsized by an algorithm, during the pandemic. 

But in every walk of life, the high priests of information technology reign supreme.  During the first decade of this millennium they sold eye-wateringly expensive computer systems to public services such as the NHS, state education, and the police.  In primary care, the delivery of medical practice began to be dictated by pop-up menus on computer screens, targets enshrined in the Quality and Outcomes Framework, often reproduced as an aide-memoir on mouse pads, computerised systems of test result management such as Docman, and extremely time-consuming team-building exercises such as “Whole Systems Working”.  “Whole Systems Working” had better had been called “Entire Systems Collapsing” because that is the “Quality Outcome” the systems presaged.  Now, you can’t get through to the practice, you can’t see the GP, you can’t even get a timeous response to a 999 call, you can’t get an ambulance, you can’t get into hospital, but if you do, you can’t get out again. 

All the health care workers are either on strike or they are threatening to go on strike.  Mostly, governments, management, and workers talk about, or refuse to talk about, pay.  But in truth, no amount of pay could compensate for the intolerable misery of working in the toxic, dystopian environment we have created.

It goes without saying that there is too much bureaucracy, but I wonder if the problem isn’t much deeper than that.  The binary, algorithmic, digital way of looking at the world is profoundly inhuman.  I don’t believe that our brains are constructed to wander down a series of branches constructed as twenty questions in a Yes-No interlude.  At a deep level, “yes or no” don’t really work.  It may be fanciful, but perhaps the human apprehension of a dilemma is more akin to a series of so-called “double slit” experiments in which a single electron appears to pass through two disparate gateways simultaneously, but only if you are not looking.  (See Richard Feynman’s Lectures on Physics, volume 3, chapter 1, 1-4).

Now I read in the Sunday Telegraph of the “Hospitals at home” plan to save the NHS.  “Elderly and frail patients who fall will be treated by video link.”  Whatever happened to compassion, the human touch, and tender loving care?      

Those whom the Gods wish to destroy, they first make mad.                                            

Jacinda Ardern, New Zealand Prime Minister, has announced her resignation.  It came as a surprise.  Of course she has her critics, rather more at home than abroad, but there were no murmurs of discontent within the Labour Party, no intrigues, no back stairs jobbery.  She was expected to lead her party into the general election in October.  But she herself has decided that she is not now the person to lead the country.  In her own words, she has nothing left in the tank.  

It has been said that all prime ministerial careers end in failure.  Here, you lose the confidence of the electorate, or the confidence of your own cabinet, and you are hauled out of No. 10, kicking and screaming.  It’s the exact opposite to the way in which the House elects Mr Speaker.  The appointee is dragged apparently reluctantly from the backbenches, by a cross-party posse, to the chair.  There is good humour across the floor of the house.  It’s a piece of pantomime.  But there is nothing light-hearted about an eviction from No. 10.  It is salutary to consider the mode of demise of the post-war British prime ministers. 

Mr Attlee lost the election in October 1951.  Churchill came back and clung on, despite failing health, until 1955, while his heir apparent waited in the wings, increasingly impatient and frustrated.  Yet Anthony Eden himself went in 1957, destroyed by a botched cholecystectomy, and Suez.

Macmillan was in turn destroyed by the Profumo scandal, and That Was The Week That Was.  Accusations of sleaze made the government an object of mockery.  You can’t govern if nobody takes you seriously.  Alec Douglas Home took over, but he lost the general election in 1964.  Still, he was such a patrician figure that he rather bucks the trend, and stepped down with equanimity.  Perhaps the job was always beneath him.      

Harold Wilson is another exception.  Yes, he lost to Ted Heath in 1970.  He didn’t see that coming, and neither did the polls.  Mr Wilson looked very rueful.  But he made a come-back, and defeated Mr Heath in 1974.  Margaret Thatcher took over the Tory leadership, and Mr Heath reputedly went into the longest sulk in parliamentary history.  Nowadays, prime ministers can’t continue to lead their party if they lose an election.  They are like football managers, with coats on shoogly pegs.  Yet Harold Wilson found himself PM once more in 1974.  But then, somewhat like Ms Ardern, he surprised everybody by stepping down in 1976.  Rumour attributes causation to an early visitation from Herr Alzheimer. 

Callaghan was undone by a winter of discontent.  Crisis?  What crisis? He lost the 1979 general election to Mrs Thatcher, who was able to cross Downing Street and address the press with a quotation from St Francis of Assisi which now carries an ironic ring.  “Where there is discord, may we bring harmony…”  Her tenure in office was doubtless boosted by the Falklands war.  But in the end she was destroyed by her own party.  One remembers the devastating demolition job in the house by the mild-mannered Geoffrey Howe. 

John Major took over, a surprise choice, even to himself, having had a whistle-stop tour of the high offices of state at breakneck speed.  Then he surprised Neil Kinnock, who snatched defeat from the jaws of victory.  But the close of his tenure was very painful.  Remember “Put up or shut up”.  And “The bastards!”

Then Mr Blair arrived.  Things could only get better.  This is the dawn of a new age, is it not?  It is said that he made a deal with Mr Brown to step aside in good time and give Big Broon a fair crack of the whip.  But Mr Blair was a very successful politician and he won three general elections, so why quit when you are ahead? 

Mr Brown was known as a big political beast with a huge intellect and an enormous capacity for hard work.  But he never looked as if he was enjoying himself, and he didn’t have the knack of making his own luck.  He had the financial crash to deal with.  He lost in 2010.  He tried to cling on and form a government, but the numbers didn’t stack up.

Enter Mr Cameron, on the basis of a slick performance, versus Mr Davis’s lacklustre effort, at the conservative party conference.  The referendum on proportional representation went his way, as did the referendum on Scottish Independence.  But, like a gambler’s lucky streak, it all vanished with the Brexit Referendum, and he had to go.

Mrs May, a Remainer supervising the Brexit negotiations, was handed a poisoned chalice.  She called a snap general election, promising – remember? – “strong and stable government”, and it all went disastrously wrong.  She became reliant on the support of the DUP.  The attorney general bellowed from the despatch box, “This is a dead parliament!”  It was like a Monty Python sketch. 

Hence Boris, who would rather have been dead in a ditch than not “get Brexit done”.  But then the pandemic came along.  As Mr Macmillan said, “Events, dear boy…”  Covid nearly did for Boris, and certainly his disregard for Covid rules did for him politically.  He went with extreme reluctance, hinting at a Cincinnatus-like comeback. 

Ms Truss lasted six weeks.

Against this backdrop, the refreshing thing about Jacinda Ardern is, quite simply, that she is normal.  And she inhabits a country, not without its problems, but open, transparent, and at ease with itself.  Back here in Blighty, on Mr Sunak’s watch, there are two murky stories unfolding, one concerning a government minister’s tax affairs, the other an allegation of cronyism twixt the government and the chairman of the BBC.  Dickens’ depiction of Victorian London still holds good.

Fog, everywhere.                 

My doorbell rang early yesterday morning – Friday 13^th, take note.  It was my neighbour.  He said, “Do you want the good news or the bad news?”

“I’ll take the good news.”

“I have an air compressor.”

“What’s the bad news?”

“You have a puncture.”

I wasn’t entirely surprised.  I said, “Front, passenger’s side?”  I’d actually checked the pressures the day before, and found the latter to be a little soft.  What was it Matt Damon said to the magnificent Franka Potente in one of the Bourne films?  “I thought your tyres were a little squelchy.”

“No.  Back, driver’s side.”  

True enough, flat as a pancake.  Anyway my neighbour kindly pumped it up.  Not only that, he then followed me in his car, with compressor, ten miles into Stirling and made sure I got there.  Such kindness. 

At the tyre shop, they told me both front tyres needed replacing.  I wasn’t surprised by that either.  I have a talent for ignoring impending problems until they turn into a crisis.  I said, “Whatever it takes.  All-weather tyres, if you have them.”  They cracked on.  While I was waiting I ran into a friend from a German class I used to attend in Stirling, and we had a blether.  Einen Schwatz.  The puncture was repaired and the tyres replaced in double-quick time, and I headed into town for breakfast of coffee and a croissant.  Back at the car, rear driver’s side was flat again.  I hobbled back round to the tyre shop.  They took the tyre off and invited me to join the examination and subsequent morbidity and mortality meeting, glooming me up for the bad news that, basically, the tyre was, to use the technical term, f*****.  I acquired a third all-weather tyre.  Should I bite the bullet and replace the lot?  No, the fourth tyre still had some mileage.  It’s a good place, that tyre shop.  They are straight.  They don’t rip you off.  

Well, if that’s the worst thing to happen to me on Friday 13^th, I won’t complain.  I couldn’t help but contrast my experience with the appalling reports we hear of people whose problem is not a leaky tyre but, let’s say, a leaky aorta.  I suppose an equivalent experience in the motoring world might, in the absence of a kind neighbour, look something like this:

I call a breakdown service to find they are on strike, for all but the direst emergency.  A flat tyre is no such thing.  Call again the day after tomorrow.  I do so.  I’m still a low-echelon caller.  Expect a delay of two weeks.  Three weeks later the breakdown vehicle picks me up and drives to the tyre place but can’t get near it because of the tailback of waiting, ailing cars.  My car is incapacitated so the breakdown vehicle has to stay in line with me, inching agonisingly forward. 

Eventually I reach my destination but I can’t get any further than the reception because the bays are all occupied.  The throughput is agonisingly slow because, as it turns out, the mechanics are on strike and are only attending to the worst cases.  And so on.

You will jalouse, gentle reader, I am making reference to the NHS.  But you know, such an analogy, the leaky tyre leaky aorta analogy, is of little use.  Human beings with hearts are not remotely like cars with internal combustion engines.  Car mechanics might talk about “running diagnostics”, but pathophysiological diagnosis is something quite different.  I remember Joe Epstein, one of the great founding fathers of emergency medicine in Australia, used to say, “People do not come into emergency departments with diagnostic labels attached to their foreheads.  Some people think they do, but I can assure you, they do not.” 

Of course much of the current crisis (sic) in the NHS is due to chronic understaffing and underfunding, but I believe another problem exists at a deeper societal level.  I call it the erosion of the medical consultation.  The sanctity of the medical consultation has been under attack throughout the twenty-first century.  Lay people, and, I have to say, some health care professionals, don’t really understand what a medical consultation is.  The medical profession cannot be exempt from blame in allowing the structures of health care systems to be designed by politicians, management, and the IT industry.  There is no more instructive example of what I mean than Matt Hancock’s dictum (a few Health Secretaries ago) that GPs conduct the main part of their business online, and not return to their “bad old ways”.  You can certainly run a health service on line if all the patients have a diagnostic label attached to their foreheads.  Heart attacks and strokes down this corridor, cancers here in this fast track, hip and knee replacements here, mental health in an entirely different wing, worried well go private, malingerers get short shrift, etc. 

What medicine fundamentally needs, is an ambience in which a patient can meet a doctor in a quiet, safe, confidential environment, and an atmosphere of calm.  The doctor greets the patient, bids him sit down, and says, “What’s up?”  Then the doctor goes into a trance and listens.  For a moment, he steps into the patient’s shoes.  He becomes the patient.  And he doesn’t interrupt.  Only later will he ask a few pointed questions, for sake of clarification.

Next comes the physical examination.  If you don’t look, you don’t see.  After that, nine times out of ten, the doctor will have not only a diagnosis, but a notion of how the diagnosis affects this particular patient, in a unique way.  Further tests may be needed, but they must be used sparingly. 

If ever you want an example of a bad consultation, listen to the response to the first question on Friday/Saturday’s Any Questions (BBC Radio 4) from Newport.  An A-level student asked the panel whether they would advise her to pursue a career in medicine.  The members of the panel translated this question into politik-speak and started haranguing one another along traditional party lines over the management, or mismanagement of the NHS as it currently is.  They didn’t listen to the question.  They didn’t listen.  As usual, the chairperson became a fifth voice in an increasingly incoherent ramble.  Nobody answered the question.  And critically, the chair did not return to the student questioner to ask her opinion of what she had heard.  It was beyond pitiful.

And on Tim Harford’s statistics show More or Less, a study suggesting there are excess deaths in England and Wales due to “A & E” (sic) “waits” (sic) was discussed by an economist and an actuary.  Statisticians I know and love always tell me that when they enter somebody else’s world, it is not enough merely to crunch the numbers; in order to understand the numbers, you need to have some understanding of the field into which you have been invited.  From the discourse and the language, I don’t think the economist or the actuary knew much about emergency medicine. 

Then Sir Keir Starmer wrote in The Sunday Telegraph.  I think he’s glooming up the left for the need for a radical reform of the NHS.  There are no sacred cows.  But he was pretty thin on detail.  And why would he not be?  He’s not a doctor, he’s a lawyer. 

However things turn out to be organised, we need to protect the medical consultation.  Doctors must not allow bureaucrats to tell them how to do their job.  And diagnosing a subarachnoid haemorrhage, or a ruptured spleen, or an aortic aneurysm, is not like diagnosing a flat tyre.  Some people think it is, but I can assure you, it is not.                                                                                     

On Sunday in Dunblane Cathedral the minister told a story about a boy at school in America, tasked to write an essay on his hopes and dreams for the future.  He had always wanted to create a stud farm, and rear the finest race horses in America.  He drew up an elaborate plan, and submitted his essay.  It received a poor mark.  He approached his teacher and asked what was wrong with his work.  “Well,” said the teacher, “it’s just not very realistic.  Rewrite it, make it more down to earth, and I’ll see if I can award you a better mark.”

The boy went away and thought about this for a while, and then returned to the teacher with the same essay.  He said, “You can keep your mark, and I will keep my dream.”  In due course he went on to found the most successful stud farm in America.  

It’s a nice story.  Who among us has not had a piece of work in which we took pride cast back at us?  And what a great line – “You can keep your mark, I will keep my dream.”  Mind, I wouldn’t have dared say it at school.  That would have been living too dangerously. 

Is it crucial to the story that the boy eventually fulfilled his dream?         

Nowadays, by and large, pupils are encouraged to dream.  Still, there might be a downside to telling people of aspiration that all they need is perseverance, and their dreams will come true.  In the film Dead Poets Society, Mr Keating encouraged and inspired his English scholars to “carpe diem” and discover their potential.  His colleague, the Scottish classics teacher Mr McAllister, warned Keating that his pupils would come to hate him when they realised they were neither Mozart nor Michelangelo.  Perhaps Mr McAllister was the same teacher who told the pupil to rewrite his essay about the stud farm.

During the festive season I played my viola in a ceremony of lessons and carols which happened to take place in a high school for girls in Glasgow, and during a break in rehearsal I took a meander down a school corridor, glancing at the notice boards as I went.  They were full of “rah-rah” calls for increased endeavour.  Realise your potential.  Be all you can be, and more.  Make the difference, be the difference!  I paused to admire the names, embossed in gold on a bronze background, of excelling alumni, “duces” of the past.  And I felt a sense of envy for the pupils who would walk down this corridor, conscious of the propaganda all around them, and entirely impervious to it.  Blessed are the unambitious.  They know, and have always known, at some deep level in their being, that the people who peddle this stuff – well, their heads are full of s***. 

The glossy brochures for the independent schools are full of rah-rah calls, directed in this case at the parents who wish to maximise their children’s potential and, crucially, help them make useful acquaintance.  The freemasonry of the connected.  Sport, especially team sport, is integral.  It encourages esprit de corps.  And IT.  It must be state of the art.  Connectivity is everything.      

Philip Larkin wrote a poem, Born Yesterday, for Sally Amis.  He said to new-born Sally, without any sense of irony, far less misanthropy, or misogyny, May you be dull.  I think Larkin must have walked down the same school corridor as me, and realised that those who are capable of happiness, who have conjured the trick of life because they take life easy, they just don’t need any of that stuff.  They don’t need a dream, because they already know how to live in the present.  Oh yes, they are quite happy to be at school.  They will take from school that which they need.  Learn to read, learn to write, to count, acquire the basic skills that will allow you to navigate the world.  You might find you are interested in something, and good at something, and if these things happen to be one and the same, well, as Larkin would say, you’re a lucky girl. 

Yet all the while, they are living life, these people who have solved the trick of life, quite naturally, and easily, on a different plane.  They have friends.  They are sociable.  They probably like going to gigs.  They have a capacity for fun.  They understand, without even thinking about it, the fundamental importance of having fun.   

I was never like that.  I was always living in the future.  As the school motto had it, Spero meliora.  I hope for better things.  I still make New Year resolutions.  Next year, Jerusalem!  I continue to make black marks on paper and submit my plans for the stud farm to newspapers and publishers.  Perhaps I am like one of these guys on a television singing talent show, convinced of the righteousness of his destiny, whose sense of pitch is excruciating, but who can never be discouraged.  Simon Cowell shakes his head and says, “No. No. No.”  I don’t pay the slightest attention.  But perhaps I should have listened to that girl down by the salley gardens, who bid me take life easy.  

So I envy these people who don’t dream, and who live in and for the here and now.  They have achieved what Larkin called

…a skilled,

Vigilant, flexible,

Unemphasised, enthralled

Catching of happiness.       

It’s Groundhog Day on the apparently dismal “A & E Waiting Times”.  The Herald reported them on Friday, along with the opposition politicians’ calls that the Health Secretary be sacked.  I wrote a letter to The Herald, comme toujours, and was delighted to be published on Hogmanay under the banner headline Time to get clinicians, not politicians, to sort out the NHS.  Here it is:

“We were expecting this week’s A & E figures to be bad, but these are awful” (Analysis, The Herald, December 29^th).  Here we go again.

In the 1990s when I was clinical head of the emergency department (ED) of Middlemore Hospital in Auckland, New Zealand, the then health minister, Bill English, shortly to become Prime Minister, dropped by, not to tell me how to run the department, but to ask me, “What do you need?”  I told him we needed to double the staff, a remark which at the time I didn’t think went down particularly well, yet, in the event, it happened.

Our politicians, throughout these islands, would do well to follow Mr English’s example.  I think the standard of political debate concerning the NHS is, frankly, pitiful.  You have been publishing the same story intermittently for years now, in language you might have used in 1948, concerning “A & E”, or “Casualty”, or “Cas” not “seeing casualties” within four hours.  For the record, this means that emergency departments are not discharging patients within four hours.  This seems to be a surrogate marker for catastrophe.  Opposition parties call for the health secretary to be sacked.  

Political point-scoring is useless in this context.  It would be better if a cross-party committee asked clinicians the Bill English question, “What do you need?”

Better funding and better staffing are obvious requirements.  Yet there are profound systemic problems within the NHS and it must be the clinicians who take a lead in outlining what they are, and how they should be tackled.  One example: few members of the public, least of all politicians, are aware of the turf war that exists between acute medicine and emergency medicine, and that has resulted in an apartheid system of patient care at hospital front doors.  Medical assessment units don’t implement a four hour rule. 

The medical assessment unit and the emergency department must amalgamate to form a true specialty of emergency medicine.  The entire delivery of hospital acute care would take place around the central hub of the ED, which would no longer function as a first aid outpost, like a dressing station inundated during the Battle of the Somme, but as an integral part of the hospital.  Emergency Department “waiting times” would cease to have any meaning.  

Sincerely…

It’s not the first time I’ve written this letter, or something like it, but I suspect it might be the last.  I’m not in practice any more, and you lose currency in medicine very quickly.  It is said that there is nothing so “ex” as an ex-politician, and the same might be said of a doctor.  It hardly matters what I think.  It is the opinions of the health care workers in harness that matter.  The trouble is, they are so busy that they have no time to think. 

The last time I time I suggested in The Herald that the acute physicians and the emergency physicians merge, somebody wrote in with a gag, that the new college could be called something like the Scottish College Royal for Emergency and Acute Medicine, or SCREAM.  Well, I had to laugh.  Nevertheless, intentional or not, this was a put-down.  And I have no doubt that if, while I was clinical head at Middlemore, I had made this proposal to the elder statesmen of the Royal College of Physicians, it would have gone down like a lead balloon.   

Where did the specialty of Acute Medicine come from?  There used to be a species of consultant encountered in hospital known as the “general physician”.  In fact, most physicianly elder statesmen were general physicians “with a special interest”.  I think for example of a renowned chest physician at Edinburgh Royal Infirmary.  “Never let a patient die of an undiagnosed chest condition, without a trial of antitubercular therapy.”  He was famous the world over, yet he was still on call for his ward’s receiving night, and in the subsequent morning ward round would have to make clinical decisions about patients with all sorts of conditions not relating to the chest. 

But as medicine became more super-specialised, the general physician became an endangered species. In addition, the model of care whereby the acute management of ill patients rested solely with junior, sometimes very junior, doctors, could not be sustained.  So general medicine morphed into acute medicine.  Acute medicine has its own college, its annual conference, its research publications, its own department, the acute assessment unit (AAU), and its own textbook, the Oxford Handbook of Acute Medicine.  I’m holding it in my hand now, along with a companion volume, The Oxford Handbook of Emergency Medicine.  Of course the remit of the emergency physician is far wider than that of the acute physician, yet the acute handbook (third edition) runs to 869 pages, as compared to the emergency handbook’s (fourth edition) 749 pages.  The main topics of the acute handbook all appear in the emergency handbook, though not vice-versa.  If the acute and emergency physicians were to amalgamate, then it might be argued that while the acute physicians would need to increase the breadth of their knowledge, then the emergency physicians would need to increase their depth.  So, a challenge for all. 

It doesn’t make any sense to have two work forces operating in more or less independent silos seeing the same, or at least an overlapping, patient population.  Why not merge?  What is the impediment?  Traditions run deep.  Both disciplines would need to surrender a degree of sovereignty.  No doubt the emergency physicians would be frightened of becoming swallowed up by one of the ancient royal colleges, while the acute physicians would be frightened of opening their portals to a tsunami of undifferentiated humanity.     

There’s more bleak news in The Herald today.  “Patients turn to ‘DIY medicine’” and “Health chief warns 500 could be dying each week due to delays in emergency health care”.  One thing’s sure: the status quo is not an option.