Author: jamescalumcampbell

A weekend in Glasgow is always a walk down Memory Lane.  The Scottish Chamber Orchestra played The City Halls, Candleriggs, on Friday night – a hallowed venue, beside the fruit market in the Merchant City.  Chopin played here.  And Dickens gave one of his famous public recitations.  After the disaster of the fire that destroyed the St Andrews Hall, and after the purgatory of an orphaned Scottish National Orchestra playing the mud-bespattered Gaiety Theatre in Argyll Street, in competition with the pile drivers forging the M8, the SNO under Sir Alexander Gibson found a home in Candleriggs, and this is the era I remember each time I come here.

The SCO opened with Ginastera’s Variaciones Concertantes, a showpiece for every instrument in the orchestra, opening with a mesmerising duet for cello and harp, with subsequent solo contributions from viola, violin, and bass.  Everybody in the SCO is a virtuoso.  Then Bertrand Chamayou played the Ravel Piano Concerto in G.   Another virtuoso display, with, between the jazzy outer movements, such sadness and poignancy in the sustained Adagio assai, reiterated by the cor anglais.  Then Beethoven 4.  The orchestra seized us by the throat.  Debussy said that Beethoven was a wonderful composer whose music was spoiled by aggression.

The RSNO is currently touring the United States, but fortunately the National Youth Orchestra of Scotland played the Glasgow Royal Concert Hall on Saturday.  That is apt, considering the new partnership the NYOS and the RSNO have forged, and it was also fitting that the NYOS should have been conducted by the RSNO’s Principal Guest Conductor Elim Chan.  Steven Osborne played Rachmaninov’s Third Piano Concerto.  I’m sure it was an experience the members of the NYOS will never forget.  In this most technically demanding of all concerti, Osborne gave it everything.  That he should have been able to return to the platform and play the D major Prelude Opus 23 No. 4, with infinite delicacy and tenderness, was astonishing.

After the interval, the NYOS played Andrea Tarrodi’s Liguria, and then the Ravel orchestration of Mussorgsky’s Pictures at an Exhibition.  Composed in 1874, what a modernistic and demonic piece it is.  There was great sonority from the brass ensemble, and some wonderfully intricate wind playing.  I was particularly struck by the saxophonist in Il vecchio castello.  What a talent.

Meanwhile, the RSNO were playing the Mondavi Center for the Performing Arts near Sacramento.  Sibelius, Rachmaninov, and Prokofiev, in a programme I heard in Glasgow a few weeks ago.  A treat for the good folks of Sacramento.  With the RSNO away, I suppose in the Royal Concert Hall on Saturday night we had a foretaste of how the RSNO might be in twenty years’ time.  When I heard the NYOS last year they played Copland 3 and I was struck then by the extraordinary strength, depth, and sonority of the strings.  On Saturday the string sections were notably smaller, and it crossed my mind that maybe the depth of available talent had similarly grown smaller.  Nicola Benedetti, who is patron of the NYOS junior orchestra, is a tireless champion for free music tuition in schools.  Is it fanciful to imagine that the erosion of such free tuition has so quickly produced an adverse effect?  Thanks to such free tuition, I was playing Mussorksy’s Pictures in a Glasgow youth orchestra around the time the pile drivers were knocking hell out of the Gaiety.  I think it was far easier at that time, compared with now, for somebody from a modest background to find a path into music.  But the gap between rich and poor has never been so stark in my lifetime.  You only need to take a short walk from Waterstones Sauchiehall Street to the concert hall at the top of Buchanan Street to see, in every doorway, people clinging to the margins of existence.

It seems to me that if we pass by the derelict on our way towards the ivory tower of classical music, the refined pursuit of the alumni of private schools, if music becomes divorced from real life, then music will die.  Every time (nearly every time) I hear a piece of contemporary music, I wonder if it isn’t dead already.

But I mustn’t be pessimistic.  To hear the NYOS, and to hear the whoops of appreciation from their young friends in the audience, gives me hope.  So long as they remember to switch off their devices.

Achtung!  Intensivtraining!

German studies continue.  My reverse Brexit – but that’s another story.  The study of another language makes one consider anew one’s own native tongue.  I wonder what it is like to learn English as a second language.  English isn’t terribly inflected – no accusative and dative endings to worry about.  Gender is purely biological, men being masculine, women feminine, and things neuter.  (Okay ships are female – there’s always an exception.)  Plurals are remarkably regular – just add s: thing/things; or es for sake of euphony: box/boxes.  Child/children is an exception but I struggle to think of another unless it’s a Latin loan word: medium/media or stigma/stigmata.  No, the real difficulty with English lies in mastery of idiom.  You see the problem if you examine just one facet of English grammar, say, tense.

Tenses are a bit complicated.  German has one present tense, English at least three.  Ich komme:  I come, I do come, I am coming.  You might add a fourth: I am used to coming; or even a fifth: I be coming.  But most native English speakers hearing the latter would conjure the image of a pirate with a wooden leg and a parrot on his shoulder.  He might be hunting for pieces of eight (eight?  Eight what?) – using a map bearing the legend, “Here be dragons.”

An English learner might imagine that the simplest form of the present tense (“I come” in the above example) would be the commonest in use, but actually to describe that which we are doing in the present, we hardly ever use it.  If I say, “I play the viola”, you would not imagine the instrument to be under my chin right now.  I might more accurately say, “I am in the habit of playing the viola from time to time.”  A German speaker might ask me, “Play you the viola?”  Or a French speaker, “Is it that you play the viola?” or more likely, “You play the viola?”  But an English speaker would say, “Do you play the viola?”  I might reply, “Yes I do play the viola”, but such a reply would resonate with a certain emphasis, so to say: “Yes I do play the viola.  How did you know?”  It’s a minefield.

The odd thing about the simple present tense is that when it is used sequentially, it is understood to be a form of dramatized past tense.  The drama thus recounted may be either fictional or non-fictional.  “He stands up.  He yawns, he stretches, he takes a few paces towards the dresser.  He opens the top drawer.  He takes out a squat, snub-nosed, heavy metallic object.  It is a Walther PPK…”  To write a novel in the present tense much more than a century ago would have been incomprehensible.  It was the rise of cinema, and subsequently television, that made such a mode of expression intelligible.  We tend to watch a movie in the present tense.  That is its impact; it is happening in the here and now.  Then historians borrowed the technique.  You might hear a historian pontificating on Lord Bragg’s In Our Time: “Churchill is in a bind.  He must show loyalty to his chief, but he knows that Halifax, a peer, is in an impossible position, and that therefore it is Churchill for whom the king, albeit reluctantly, must send.”   Personally, I don’t care for either novels or histories to be recounted in the present tense.  But I’m prepared to put up with it, if the material is of interest.  I seem to recall that Robert Harris’ novel about the Dreyfus affair is in the present tense.  I thought it was awfully good, and I admit I stopped noticing after a while.  But still, there is something portentous about the past masquerading as the present.

Is there any such thing as a novel written entirely in the future tense?  A poem, maybe?  Yeats’ Lake isle of Innisfree?      

The various past tenses in English can be as confusing as those in the present.  I have gone, I went, I used to go, I was going.  We don’t say “I have went”, though I don’t suppose there is any reason why we shouldn’t, went being the past tense of the verb to wend.  That reminds me of the wee Glasgow boy whose mother asked him how he had enjoyed his first day at school.

“Och, ah wish ah hadnae go’ed.”

Naturally his mother corrected him.  “You mean, you wish tae goad you hadnae went.”

Then there’s the pluperfect – the remote past seen from the perspective of the past:  I thought… I had thought…  I don’t suppose there is any reason why this recherche into temps perdu shouldn’t carry on ad infinitum; the hall of mirrors of reminiscence – I had thought, I had had thought, I had had had thought…

But the real can of worms, in English, is the subjunctive.  The English learner might wish to think twice before going there.  It’s an optional extra.  Many native speakers, perhaps the majority, never use it.  The subjunctive is rather hifalutin, almost a class thing.  Perhaps for the foreigner that is its lure.  Master it, and you receive the keys to High Society.  You move effortlessly amid the Establishment, One of Us.  Avoid it, and you remain an artisan, calling a spade a spade.  But of course the real trick with the subjunctive is to master it, and then never use it.  It’s like a nuclear deterrent, invisibly making its presence felt.  Kipling’s If might have been written entirely in the subjunctive, but it sits under the surface.  Its blatant use is an affectation.  If you adopt the subjunctive, you become a theoretician moving in a rarefied atmosphere; a dandy, a fop.

A distinction is made between the present subjunctive (“If I were a rich man…”) and the historic subjunctive (“Then I thought, would that I had been born rich…”) but the whole essence of the subjunctive is that it lies outside the realm of quotidian experience.  It is not a tense; it is a mood.  In considering what might have been, you step through a sliding door into a realm beyond time.  “Would that I had known then what I were later to discover.  Had it been so, I had done better.  Had I taken more cognisance of that which, heretofore, I had had removed from my consciousness, I had had wiser counsel.  I had better had done nothing.”

A German learning English might say to himself, “I had better avoid that.”  Yes, you had better had had.

All Herr Müller wanted to do was order an espresso in Prȇt.

April 1^st.  What a relief yesterday to move the clocks forward an hour.  No kidding.  Did I hear a rumour that Brussels has issued a directive – no, an advisory – that EU states settle on a time and stop monkeying around with their clocks?  I imagine Westminster will pay scant regard to that, even supposing the UK ends up contesting the EU elections on May 23^rd.  So come October 27^th, we will be back on GMT, or, as the RAF chaps put it, Zulu.  Or, as the aviation world puts it generally, UTC.  UTC stands for Universal Co-ordinated Time.  Why not, then, UCT?  The received wisdom is that the acronym UTC is a sop to the French, who have a penchant for placing the adjective after the noun.  But then, why not TUC?  Did the Trades Union Congress get in first?  How about TCU?  Temps coordonné universel.  Whatever.  The aviation world is full of three letter acronyms.  The atmospheric pressure at sea level in millibars (or hectopascals in the System Internationale) is the QNH, while the atmospheric pressure at airport surface level is the QFE.  But QNH and QFE stand for nothing at all.  They’re just gobbledegook, designed to confuse the enemy.

But to return to Zulu, or Zulu + 1, I’ve adjusted all the clocks in my house.  I note the computer on which I scribble away has done it automatically, as has my mobile phone.  The clock in the car is on permanent summer time.  I like to think that is because I too choose always to remain on summer time, but actually it’s because I can’t figure out how to adjust the clock.  I ought to get the manual out of the glove box and look it up but I can’t be bothered.  Similarly, I should find out how to jam the car radio’s annoying habit of constantly interrupting Radio 3 with a travel report.  The surprise lurking in the slow movement of Haydn 94 is obliterated by an update on the snow blocking the road twixt Cockbridge and Tomintoul.  The Cockbridge-Tomintoul road has been blocked for as long as I can remember.  When Freddie Grisewood chaired Any Questions, and the newscaster told us what the Queen was wearing, the Cockbridge-Tomintoul road was blocked.

There is I believe universal relief (or relief universal) when the clocks spring forward, just as there is consternation when they fall back.  The end of October signals the onset of Seasonal Affective Disorder.  The nights are fair drawing in.  Each year there is a debate as to whether we stay on GMT, or on British Summer Time, or we keep swapping, or indeed revive British Double Summer Time.  There may be a town/country split on this; there is a farmers’ lobby, and a lobby vociferous on behalf of children creeping reluctantly to school.  The kids themselves couldn’t care less.  In their feral world, they have far better things with which to concern themselves.  But I have a modest proposal to put forward.  Rather than change the clocks, we should change our habits.  If it’s too dark in the morning to send the kids to school, wait until it gets light.  In other words, shorten the working day during winter.  The children will be delighted.  So will the adults, who should all go into the office an hour later and come back an hour earlier.  Hunker down and mend the fishing nets.  The only reason for going out in the dark is to undertake “works of necessity and mercy.”  If I were a sitting MP I would put it forward as a Private Members Bill.  But Mr Speaker, that man in the green chair so cavernous that it makes the incumbent look like Richard Matheson’s Incredible Shrinking Man, would never allow it.  Lead balloon territory.  We cannot allow ourselves to fall behind these incredibly driven and industrious Chinese.

But is this not a most beautiful time of year?  I wandered lonely as a cloud, floating, in this instance up and down the vales and hills of the Switchback Road heading north out of Glasgow, and the banks of daffodils were truly stunning.  I’m sure Mr Wordsworth really was stunned too.  I’m less convinced about his emotional state while walking over Westminster Bridge on September 3^rd, 1802.  Granted the Palace of Westminster is a very beautiful building, but then again it wasn’t there in 1802.  Call me dull of soul, but surely the sun can more beautifully steep something other than ships, towers, domes, theatres and temples, eh?  I mean, what is so “Dear God” about sleeping houses?

Westminster has put me in a mood.

In these troubled times, when wise and benign world leadership is in short supply, who would not be impressed by the New Zealand Prime Minister Jacinda Ardern?  Following the Christchurch atrocity, she has been able to articulate the desire of New Zealanders to live in peace and not at war, to love and not to hate.  She has been able to reach out to people of every age and from every social and ethnic background, and to articulate grief, resolve, and hope.  Politically, she was able, within 72 hours, to win the broadest support for a reform of New Zealand gun laws, and within a single week she has essentially banned military-style semi-automatic guns and assault rifles.  That is utterly extraordinary.

I can’t help but compare the New Zealand “can-do” attitude, her self-reliance, and her resilience, with the Brexit impasse here in the UK.  This holds true irrespective of one’s desire either to leave or to remain within the European Union.  Here in the UK we have grappled with a problem for nearly three years and achieved, precisely, nothing.  Remember, “Nothing is decided until everything is decided.”  Well, nothing is decided.  I believe this tells us something about leadership.

In a Liberal Democracy (as opposed to a Dictatorship), faced with a crisis, what does a Leader need to be, and to do, in order to step up to the plate?

1. She needs to feel that she has certain skills, attributes, insights, and inner convictions that make her suitable for the job.
2. She needs to feel that the challenge before her is worth taking on. Personal ambition may be a help or a hindrance, but is neither necessary nor sufficient to ensure she is equal to the task.  She might even take up her post with extreme reluctance, driven by a sense of duty or even of Destiny.  What matters in a crisis is that she comes with a coherent strategy.
3. She must on no account have a hidden agenda. She must be open and straightforward.  She mustn’t use the real crisis facing the people as a surrogate for a perceived crisis affecting a particular constituency.
4. She must be collegiate. She should consult widely.  She should listen in particular to opponents, and carefully weigh opinions that she may not necessarily wish to hear.  She should remember the words of Oliver Cromwell, “I beseech you, in the bowels of Christ, think it possible you may be mistaken.”
5. She should strive for simplicity. That is not the same as being simplistic.  The art of achieving simplicity, simultaneous with being right, is very complex.  She must study a mass of detail, and make sense of it.  She looks at all the trees and tries to see the wood.  She must search for an underlying solution to the problem, the way a physicist looks for a unifying equation that is both simple, and beautiful.
6. Once armed with a solution, she must convince, and gain the support of not only a cabinet, a constituency, or a party, but the whole body politic.
7. She must stick to her guns, and deal with set-backs and unforeseen impediments. She might echo the words of Winston to the boys at Harrow, “Never give in.”  But she should also remember that even somebody of such sublime inner resolve as Winston added a rider: “Never give in, except to convictions of honour and good sense.”

On Sunday we saw on our television screens images reminiscent of a John Buchan “shilling shocker”, of men in Ulsters emerging from shooting brakes before a Buckinghamshire country mansion.  The atmosphere of the Buchan world, of grey eminences wielding the sinews of power to influence world events, is a world away from the open society of Aotearoa.  We are befogged.  Our leaders have proved unable to make sense of the predicament they face.  They have not found a simple solution.  And the opposite of simplicity is not complexity; it is obfuscation.

Another “critical week” has started.  It would be a brave man, or woman, who is ready to predict what is going to happen.  Frankly, I would be amazed if Westminster pulled a white rabbit out of a hat.  If they can’t find a way through to a solution, events will develop a momentum of their own.  Brexit is turning out to be an “all or nothing” phenomenon.  Either we abandon the whole project, and stay in the EU, or we walk away.  Abort, or crash out.

Ki mai koe ki ahau

He aha te mea nui o te ao?

Maki e ki atu

He tangata, he tangata, he tangata.

 

I am told there are people who do not care for maps,

And find it hard to believe.  (Up here,

The wind is persistent, the houses still as the grave.

The sheepdogs lie on the grass

And glance philosophically about them.)

This is smoke-down time, this is your rag-butt end

Of a decaying semester, where people,

Moved by some ribald hocus-pocus of the soul

To some obscure…

And God knows what…

 

They say Captain Cook had sight of

Te Waha-o-Rerekohu, which in turn

Had welcomed the Arawa canoe of the Great Fleet,

This giant Pohutukawa on the long pathway at Te Araroa,

With her canopy spread of forty metres

The oldest Pohutukawa in the world.

These gnarled and tortured branches also stretch above

The cataract falls of Karekare, or stand alone, aflame

At water’s edge, eschewing society of trees

– Ngaio, lacebark, golden kowhai, white manuka

The rata, the kahikatea, the dead silence of the kauri forest –

The blood-red blossom bursting forth

As crimson as the redcoats lying on the beach

(Te Paranga Pa they never took by force).

Thus Pohutukawa groves make tapu

An ancient site of battle,

Metrosideros excelsa.

Nectar to the tui.

 

As kuaka godwits muster, screaming

Over Cape Maria van Diemen

Te Maori mourn another passing spirit.

Their murmuration never ceasing, Maori know

(Without recourse to social media sites)

There has been great and doleful massacre.

Where the stream Kapo-Wairua runs

Into Tom Bowling Bay, demons try

To snatch the souls, hurrying

To Muriwhenua at Land’s End,

Lacerated with obsidian flakes,

Crowns of thorns

Knotted into death’s chaplets.

Here, before the oceans’ confluence, Tatu-o-te-Po

The last Pohutukawa

Leans down to the surf.

The disembodied spirits of the dead

Follow the Ara Whanui a Tane:

Ki ro kauwhau o te riri

Ka rere koe

I te Hiki o te Ika e-e!   

What sign for those who come after?

 

Hi iwi Kotahi tatau

Perusing the book shelves in a branch of W H Smith, I picked up a couple of books more or less at random.  They both looked interesting and readable, and indeed both turned out to be so.  I read them quite quickly.  When you read books in parallel like this, they seem to augment one another in unforeseen ways, even when you wouldn’t suppose they had anything remotely in common.

The first book was War Doctor, Surgery on the Front line, by David Nott (Picador 2019). (Let me say immediately, lest I forget, that this book should be compulsory reading for any future Prime Minister minded to enlist our armed forces in some so-called “Discretionary War”.  Here is a vivid depiction of what it means to drop bombs on people.)  The second book was Feel the Fear and Do it Anyway by Susan Jeffers (Century 1987, revised and updated edition Vermilion 2012).  I knew that David Nott was a trauma surgeon with a vast experience of working in war zones, and as an emergency physician I was fascinated to read about his work.  By contrast I had no particular interest in Susan Jeffers’ work and if I’m being honest I have heretofore entertained a scepticism towards inspirational self-help books.  My preconception was that self-help was for neurotic Californians for whom having a therapist would be de rigueur.  But Feel the Fear and Do it Anyway is a famous title, familiar even to me, so I thought I would give it a go.

Self-help books were tremendously in vogue in the 1930s, and James Thurber lampooned them mercilessly in Let Your mind Alone (Hamish Hamilton, 1937).  He mined a rich seam of humour in contrasting the smug inner certainty of these Desiderata with the angst-ridden lives of nonplussed, middle-aged American men.  I wonder what Thurber would have made of Dr Jeffers encouraging us to place inspirational “affirmations” on post-its, scattered round the house?  I suspect he would have made quite a lot.  I confess that Let Your Mind Alone has prejudiced me against self-help books.  Did Thurber really despise them?  It hardly matters, as Thurber is a persona, a character in his own bizarre and unpredictable world.  It’s not that he’s in denial of the fact that he’s neurotic, merely that he can’t take seriously the off-the-peg solutions of the psychotherapists.  Maybe if they went off to Aleppo and worked as an orderly in an underground hospital in what David Nott calls an “austere environment”, they would find they didn’t have time for introspection.  Incidentally, David Nott runs a course called “Surgical Training for Austere Environments (STAE)”, which strikes me as quite a euphemism.  It might aptly be renamed, “Surgical Training for Hell.”

So I really did think that there would be no connection between these two books, and that attending a seminar on how to make your life more fulfilling would have nothing to do with how to patch up a mangled body while somebody is about to drop a bomb on you.  I mean, get real!  Susan Jeffers describes the trance-like episode which turned her life around almost in terms of a miracle.  Spontaneously, and without any forethought, she entered an academic institution unknown to her and told a stranger (who turned out to be the head of the department) that she was there to teach a course on Fear.  The rest is history.  Aye, right.  I read all this with a degree of resistance.  It’s all very well to say that all is for the best in the best of all possible worlds, but just look at Aleppo!

But then Dr Jeffers played the Viktor Frankl card.  Frankl’s Man’s Search for Meaning (Ein Psycholog erlebt das Konzentrationslager, 1946) is a book which periodically falls out of the sky upon me.  I even found a dog-eared paperback copy in a hut in the Highlands of Papua New Guinea.  Viktor E.  Frankl was a psychiatrist, a survivor of Auschwitz who averred that life was meaningful even in the direst of circumstances.  He went on to develop a system of psychological treatment known as Logotherapy which seems to me to share a lot of ideas with Susan Jeffers.  I began to read Jeffers with a new respect.  I like the message that is encapsulated in the title of her book.  She permits us to be fearful.  Angst is part of the human condition; it is not of itself abnormal.  I wonder if, amid the current epidemic of antidepressant prescribing, we have lost sight of that fact.  Dr Jeffers borrows from Viktor Frankl a technique called “Paradoxical Intention” in which a patient does not try to combat, dodge, or obliterate his fear, but, paradoxically, to reproduce it.  Somebody with a phobia of public-speaking, for example, might be encouraged to get up in a public place, make a speech, and deliberately fall apart.  The paradox is that the subject finds himself able to make the speech, but unable to fall apart.

It occurred to me that “Feel the fear and do it anyway” – recurrently – is what David Nott has done.  Sarajevo, Kabul, Freetown, Monrovia, Darfur, Rwanda, Yemen, Libya, Haiti, the Central African Republic, Gaza, and of course, Aleppo.  It clearly is a very special person who volunteers repeatedly to subject himself to this level of risk, and to operate in an environment of utter degradation, for no material reward.  What drives him?  David Nott tries to address this question in his book.  From a professional point of view, he clearly relishes the challenge of practising in the austere environment, where you have little if any recourse to laboratory and radiological back-up, and you are forced to rely diagnostically solely on your own clinical acumen.  To make the right decision, and to achieve the right outcome, is very gratifying.  This is closely aligned with the humanitarian aspect of the work he does.  You sense his sense of pride in saving the life of a terribly traumatised child.  With respect to personal risk, he admits to being something of an adrenaline junkie.  He describes watching the news in London, hearing about the destruction being wrought in the world’s latest war-zone, and having an irresistible desire to go there.

I was very interested to read about David Nott’s other professional life.  He is a pilot, both fixed wing and rotary, and he has practised that art at a high level.  I wouldn’t claim for a moment to have advanced half so far as Mr Nott in either aviation or medicine, but as an emergency physician and a private pilot I do claim a special interest here.  You might imagine going fishing (a fishing rod was his chosen luxury on Desert island Discs) would be a more therapeutic off-duty pursuit for a stressed surgeon, than flying a Lear Jet from Luton to Heathrow in the world’s busiest airspace.  But it was during the 1990s in Auckland that I began to appreciate that aviation was therapy for the emergency physician.  I would leave the madhouse of Middlemore Emergency Department in South Auckland and drive south out of Auckland through Alfriston to Ardmore Aerodrome.  I would take Whisky Alpha Echo, a Slingsby Firefly, aloft and do loops and barrel rolls and stall turns and spins.  The act of putting yourself into a situation of extreme personal vulnerability, in which you are totally reliant on your own skill to retrieve the situation, somehow invests you with the power to help somebody else in extremis.  After the sortie I’d have a pint in the club bar and then drive home to Bucklands Beach (legal there and then – couldn’t do it now).  I’d always have to stop, at the same lay-by in Alfriston, and get out and look at the view, overcome by a very strange mix of serenity and euphoria.

I would hazard a guess that something like that feeling is what drives David Nott.

But it comes at a price.  Things can go wrong.  David Nott is candid – remarkably candid for a doctor I’d say – about cock-ups, in both medicine and aviation.  That trip by Lear Jet from Luton to Heathrow did not go well.  Aviators will recognise the symptoms: if you’re not flying all the time, you lose currency.  There’s a hierarchy of multi-tasks a pilot must carry out, and if he can’t do some of them unconsciously, he gets overloaded; pilots call this being “maxed out”.  Then there was that close shave in the helicopter.

He doesn’t gloss over the medical mishaps either.  The burr hole on the wrong side of the skull, the massive transfusion reaction from incompatible blood – it’s all there. There are many extraordinary and highly dramatic scenes depicted in War Doctor – the many passionate and acrimonious disputes between colleagues in the operating theatre; the occasion of being abandoned in the pitch dark in theatre during a bombing raid; the decision to continue operating under threat of immediate obliteration; but the episode which stood out for me occurred in Aleppo when Daesh broke into the operating theatre.  David Nott’s assistant whispered to him, “Don’t say a word.”  David Nott prayed to God that his hands would stop shaking.  They did.  He was able to complete the operation.

I have the sense of a man who has taken his craft to the absolute limits and who finds himself in a zone in which he no longer has any reason to put up any sort of front.  You can sense it, if you track down his appearance on Desert Island Discs on the BBC Sounds App, and listen.  I liked his musical choices.  His soundscape had serenity.  And when he recounted his experiences, he relived them.  You are never more in touch with humanity than when on the verge of tears.  I recognise this zone myself, again, from clinical practice.  It’s a kind of catharsis.  Catharsis, the purgation of pity and terror, was for Aristotle the defining characteristic of tragedy.  I never really had an inkling of what this might mean until I saw Roman Polanski’s film of Macbeth.  The terrible world Shakespeare conjured – and Polanski recreated – might not be unlike the world to which David Nott is recurrently compelled to return.  It is a frightful place, but towards the end of the Polanski film there is an inexplicable lightening of the atmosphere which is truly cathartic.  I remember I used to experience something similar at the end of a particularly hellish and protracted shift in the emergency department.  I felt I could do anything.  I was as light as air.  Yes I will stitch up that gash on the beautiful face of the daughter of the Professor of Plastic Surgery.  No problem.  Next morning, I’d be back to my old neurotic self, braced for another day.  Feel the fear and do it anyway.

 

I pushed the twenty-three gauge hypodermic needle decisively through the skin and then infiltrated local anaesthetic as gently as I could – it is liable to sting.  I said, “All right?”

“Yes,” said Françoise.  The voice was cautious, exploratory.  She lay prone with her head lying sideways on her forearms.  I raised a bleb of white skin in a margin round the pigmented neavus.  I said, “It looks perfectly benign.  I don’t know why we’re doing this.”

“Humph.”

Actually I did know.  She was a Canadian radiology registrar, very Québécois.   I kind of knew her because we both played in the orchestra – St Matthew’s in the City.   She’d come into the department at the end of her shift and said, “Will you lop a mole off my back?”  Sometimes you do a thing simply because you are importuned.

I took a size 11 scalpel blade, on a No. 3 handle, and incised round the mole, with a slim margin of normal skin.  “Okay?”

She said dreamily, “Can’t feel a thing.  Except the touch of your fingers.  Rather soothing.  You should be a masseur.”

Concentrate on the surgery.  Don’t blur the boundaries.  I held the naevus in forceps, on its pedicle of subcutaneous tissue, and gently dissected it away.

“There!”  I dropped it into formalin, ready to send to Pathology.  I opened a packet of 4/0 monofilament nylon, and grasped the atraumatic needle with the needle-holder.

“Closing now.”  Then the lights went out.

I said, “Now there’s a thing!”  There was a screen over the theatre door and it was absolutely pitch dark.  Françoise remarked, rather redundantly, “Must be a power cut.”

“Just as well I can suture with my eyes closed.”

“Don’t you dare!”

“Only kidding.  D’you suppose the nurses will remember we’re in here and come and rescue us?  I could try the buzzer on the wall but I don’t want to lose sterility.”

“No.  It’s never a good idea to lose sterility.”

It wasn’t unpleasant to sit in the darkness.  I could feel the gentle rise and fall of her rib cage under the green drapes.  She said, “Do you know why Jimmy Galway left the Berlin Philharmonic?”

“Did he fall out with Karajan?”

“They were playing Beethoven Five in the Musickwerein in Vienna one night, Karajan conducting.  Suddenly all the lights went out.  Nobody could see a thing.  They couldn’t read the music and they couldn’t see Karajan waving his arms.  But the music never faltered.  They went on to the end, note perfect.”

“So why did he leave?”

“I guess he felt you shouldn’t live life on automatic.”  Françoise was whispering, as if the darkness were sacred.  Then, from directly above us, a shrill and persistent bell started to ring.  Françoise giggled.  “Is that a fire alarm?”  Then the theatre door opened and Karen Jones said, “What are you two up to?”

“What’s happening, Karen?”

“Power cut.  The whole of Otahuhu and Mangere are out, apparently.”

“What about the hospital generator?”

“Hang on.”  She went to the wall and threw a few switches.  An X-ray screen sprang to life.  “How’s that?”

Ghostly fluorescence.  I said, “It’ll have to do.  What about the alarm?  Are we supposed to evacuate?”

Françoise said, “I’m not going out on to the street with a hole in my back!”  We were all raising our voices because of the stridency of the bell.  Karen said, “I’ll check it out,” and disappeared.  Then, beyond the door, I heard the ambulance r/t blasting away. What now?

Three sutures were enough.  I lay some tulle over the wound, and a dressing.  Françoise said, “Stitches out in a week?”

“Longer in the back.  Maybe twelve days or so.”  Then Karen opened the door again.  “You aren’t going to believe this.  There’s a bomb scare.”

“Is that what the alarm’s for?”

“No.  There’s a fire, too.  The bomb’s at the airport.”

The Maori have a saying, that all bad luck comes in threes.  “Are we on standby?”

“It’s a full alert.  They want you.”

“Oh good.  If the hospital’s on fire, I want to go to the airport.”  Françoise had turned on her side and was leaning negligently on an elbow.  I said, “Fancy a trip to the airport?”

“Sure.”  Her voice was full of interest.

“Let’s go.”

The department was buzzing.  All the available X-ray screens had been turned on and there was that same pale phosphorescent eerie half-light drenched over everything, that we had had in theatre.  At the nurses station somebody was lighting candles.  I’m constitutionally addicted to power cuts.  I love the underground, Blitzy atmosphere.  Administrators don’t give you crap during a power cut.

I picked up the ambulance r/t report.  “Where’s the fire?”

“By the lifts.  Cigarette in a trash can.”  The ambulance report read, “AIA full alert.  United Airways 747 Auckland – Honolulu, outgoing.  Bomb scare.  Landing 2310.”  We had twenty five minutes.  At the r/t station I picked up this spiffing new device – a cell phone the size of a car battery.

“We’re off!”

It was very dark outside.  As we stepped out into the ambulance bay a fire truck pulled up and six men, heavily clad in bright yellow overalls started off-loading.  Then more fire engines pulled up at the taxi rank by the hospital front door.  I was parked 100 metres away.  There was no street lighting but the eerie glow from the hospital was enough for us to pick our way.  I started up without preamble and we went like hell down Hospital Approach Road.

There was a policeman at the intersection at the top of the bridge.  I pulled the green light from under the dash with its extensible cord attached to the cigarette lighter, passed it through my window and slapped it on like a limpet to the car roof.

“Kojak!” said Françoise.  She was enjoying herself.  The policeman on points duty waved us left.  We accelerated out along Massey Road.  I said, “I can’t tell you how wonderful it is to get out of there!”

“Does this sort of thing happen often?”

“Surprisingly often.  We have a ‘special relationship’ with the airport.  There are three echelons of callout.  Most of the calls are first echelon – ‘Stand By’.  Maybe a 747 with one engine shut down.  That happens quite a lot.  The next echelon is this – ‘Full Alert.’  Full emergency service response.  We expect a problem.  If it’s a false alarm, we’ll be stood down.”

“And the third echelon?”

“Crash.”

I had caught up with an LSU, a Life Support Unit.  I snuck into her slipstream.  I was thinking about the one ‘Crash’ call-out I’d had, and the miserable freezing night out on the threshold of Runway 05, waiting for the divers to fish the two pilots of a freight aircraft out of the Manukau Harbour.  I had the melancholy privilege of declaring one of them lifeless.

There was a points man at every intersection, and in ten minutes we had turned left down George Bolt Memorial.  The whole of Mangere was blacked out.  We turned left, then right and, down at the airport perimeter, drew up at our assembly point, a sign that said starkly, “DON’T PARK HERE EVER.”  The LSU pulled up and I drew into the kerbside beside him.  Outside, here on the airport flatlands, there was a chill in the air.  I fetched two sheepskin-lined parkas from the boot, and a couple of fluorescent bibs bearing the legend, ‘Doctor’.  “Here, put this on.  It’s going to get cold.  And this.  There.  Now you can go anywhere, do anything.”  I switched off my green light.  In contrast to the darkness of Mangere, now we found ourselves in a great, phantasmagorical, psychedelic array of multi-coloured rotating lights coming off two dozen emergency vehicles.  From the air it would be dazzling.  I said, “I hope the pilot doesn’t think we’re the runaway.”

My friend Terry Dunstaple was at the wheel of the LSU.  I effected the introductions.  He looked at his watch.  “Landing in five minutes.”  He shivered.  “Let’s hope it’s another hoax.”

“Let’s hope so.”

“Incredible when you think about it.  An aircraft with 350 people on board 100 miles out over the Pacific turns back.  They’ve just dumped 130 tons of fuel.  130 tons!  All because some joker thinks it’s a helluva dag to phone up and say there’s a bomb on board.”

I scanned the horizon.  Where was the wind coming from?  It was a south-westerly, 25, gusting to 35 knots.  They would use Runway 23 and the aircraft would come in over the Whitford Beacon and Manukau Heights, tracking more or less directly down Puhinui Road and screaming over Pukaki Creek at two hundred feet with full flap and undercart down ready to touch with the grace, lightness, and splendour of a pelican.

There she was, bang on schedule, tracking straight down the runway’s extended centre line.  I could see the wink of the wing tip lights and the flick of the undercart strobe, low over Totara heights on final approach.  Françoise gripped my arm.

The 747 flared out over Pukaki, held off, nose up, and, as the engine note died, there was a wisp of tyre smoke off the asphalt.  Down!  The nose wheel sank gently on to the runway.  From nearby came a faint cheer and a smattering of applause.  Terry said, “They’re going to taxi to the apron just off 05 threshold and disembark there.”  I knew the form.  They would get passengers and crew off double quick, secure the area, and the bomb disposal people would move in.  The airport would stay open.  I said to Françoise, “Let’s go and get some coffee.”  Domestic or International?  I chose International.  “Terry – I’ve got the hand-held.”

He nodded and said cheerfully, “You’d hear the explosion anyway.”

 

At swimming practice (Hamilton Crescent School, relocated to Balshagray at the bottom of Broomhill Drive, Wednesday afternoons), I floundered up and down the pool and Mr Mennie barked, “Campbell, when are you are going to learn to swim?”  It was one of these occasions when the appropriate repartee only occurred to me later: “When are you going to teach me, sir?”  But then again, it was always dangerous to be precocious at school; you might get a clip round the ear.

Much later, at medical school in Edinburgh, I was studying along with some of my colleagues in the Royal Medical Society in its rooms across the quad from McEwan Hall, and above the Potterrow Bar.  A young consultant who was making a name for himself in the literary world called by to cut a swathe through our allegedly dull and studious lives.  I think he thought he was Somerset Maugham or Mikhail Bulgakov, but he was more like that grotesque James Thurber character in his laugh-out-loud piece Something to Say.  He said to me, “What are you going to be when you grow up, Campbell?”  On this occasion the apt riposte arrived on time: “A doctor.  What about you?”  He snorted and said to the company in general, “Here’s a man who knows exactly where he’s going, and nothing’s going to stop him!”  Actually he couldn’t have been more wrong.  I had no idea where I was going and, to paraphrase the late great George Harrison, if you have no idea where you are going, any road will take you there.

How do we choose our path in life?  As a kid, I think I would have been rather good at the pole vault.  I was a monkey on the rings and trapezes of Arlington Baths, swooping around over the pool to my heart’s content.  I have this fantasy of approaching Mr MacKay the PE teacher and saying, “I would like to learn to pole vault.”

“Pole vault.  Pole vault!  I’ll pole vault ye!”

(Pole faulting did not feature in the curriculum.)  But perhaps I am doing Mr MacKay an injustice, after the fashion of the driver who gets a flat tyre late one rainy night out in the boondocks.  He sees the light from a cottage in the distance, and plods his weary way in that direction, in the hope of borrowing a jack.  En route, soaked to the skin, he convinces himself he is going to suffer a frosty reception, and works himself into such a lather that when he knocks and the door is opened, he yells, “You can keep your f****** jack!”  For all I know, down at the playing fields in Scotstoun during “Games”, Mr Mackay might have produced the fibre glass pole.

But I don’t really regret not having tried the pole vault.  It strikes me that regret is a particularly redundant emotion, useless because it is incoherent.  If you no longer have the desire, what is the point in nursing the ambition?  And if you do have the desire, then, dammit, go for it.  Remember Tennyson’s Ulysses.

Tho’ much is taken, much abides; and tho’

We are not now that strength which in old days

Moved earth and heaven; that which we are, we are;

One equal temper of heroic hearts,

Made weak by time and fate, but strong in will

To strive, to seek, to find, and not to yield. 

With this in mind, at the beginning to 2019 I started a beginner’s evening class in German.  It’s something I’ve been meaning to do for a long time.  I always had the notion, listening to Mrs Merkel on the telly, that I nearly understood what she was saying.  German has a staccato quality quite unlike the syllable timed lenition and enjambment of French, and each subordinate clause is clearly punctuated both in speech and in print.  So I think it has an accessibility to the native English speaker.  I put it to an Austrian friend of mine that English was really a dialect of German but he reckoned that was going a bit far.

Anyway the German class is great fun.  It is so recreational to take up something entirely new.  Early days of course, but I do have a sense of the accessibility of the language.  One of the reasons I wanted to try was that I listen to a lot of German music, including lieder.  Listening to a Schubert song cycle and not knowing what is being said is like playing the viola at the back of the orchestra pit; you only get a partial, and distorted notion of what’s going on.  With this in mind, I listened to a performance of Mahler’s Das Lied von der Erde on Radio 3 on Friday night, and I followed the German text.  It was a Pentecostal moment.  What a revelation!  It was almost like the restoration of a missing faculty, like sight or hearing.  I thought, what on earth have I been doing for all these years, wandering around in a twilit world following the collapse of the tower of Babel?  Why didn’t I do this before?

I didn’t study German in school.  I did French and Latin, and, in my 6^th year, Spanish.  But I was never a linguist.  Indeed, looking back, I’m not sure we were ever educated to be linguists, merely to master some grammar and pass the exam.  When I started to learn French as a twelve year old I don’t think there was a single person in the class who had ever been abroad.  And there were precious few in the entire school who had come from Elsewhere, even from anywhere outside Glasgow, and even, come to think of it, from beyond the immediate precinct and catchment area of the school.  Of course it is more difficult for inhabitants of an island to master a foreign tongue, because of the lack of opportunity to speak the language in the real world.  I noticed when I lived in the antipodes that this was also true of New Zealanders, being so far removed from everywhere else.  New Zealanders are broadly as poor linguists as Brits, with some notable exceptions, usually people who have mastered Japanese or Mandarin.  The Dutch, by contrast, are fantastic linguists.  They need to be, in a country barely the size of Yorkshire, surrounded by the great European powers.  I remember a Dutch girl in New Zealand, Kate, who said, “I think I’ll learn Maori; it looks pretty easy.”  You see, there’s the difference.

There we were, in High School French class, struggling with the subjunctive.  “Il aurait fallu que nous assassinassions le Cardinal Richelieu.”  Or something.  But who cares?  Nobody talks like that.  Nobody uses the Past Historic, apart from General de Gaulle.  Learning a language is not an academic pursuit at all.  I was made sharply aware of this when as a doctor I had as a patient a teenage girl from Costa Rica, holidaying in Scotland.  My ‘O’-level Spanish was hardly up to it, so the patient’s friend, a local teenage girl, came in with her and acted as interpreter.  She had holidayed in Costa Rica and picked Spanish up.  She had sat at the feet of the patient’s grandmother, thumbing through a dictionary, saying, how do you say this; how do you say that?  She turned out to be a fantastic interpreter, and mind, the conversation, turning on symptomatology, became quite technical.  I told her afterwards that she had a great talent, and asked, might she be interested in pursuing a career using her Spanish?  Yes, she would like to, but she couldn’t see a way to do it because she had absolutely no school qualifications at all.

Well, what does passing an exam tell you about somebody?  It tells you they are good at passing exams.  And the trick of passing exams is knowing how to avoid making mistakes.  But the essence of learning a language is to make thousands of mistakes.  The essence of learning a language is not to be careful, but to be bold.  Just go out there and blurt.  Nobody gives a damn.  Put yourself in the shoes of the person listening to your efforts.  You know what it is like when a foreign visitor asks you for directions in the street.  “Can you say please me where is castle?”  You don’t discourage, do you? You certainly wouldn’t mock.  You are glad to be of help.  You use your arms, and clear, simple language.  He says, “Mine English bad,” and you reply, “Better than my Latvian.”

I suppose the study of German might be for me a route into Wagner.  But here I confess, I don’t really “get” opera.  I remember one night Paul Merton saying of opera on Have I got News for You, “It never really caught on, did it?”  In Pretty Woman, Edward Lewis takes his Vivian by private jet up from LA to San Francisco to see the opera.  He tells her that if you aren’t truly an opera lover, you might learn to appreciate the art form, but it would never enter your soul.  I guess that’s me.  I’m okay with opera if I close my eyes and just listen to an aria.  But I can’t get past the idea that there is something preposterous about the whole package.  I just can’t suspend my disbelief, voluntarily or otherwise.  In the 1987 film of The Untouchables (which incidentally has a distinguished musical score), Al Capone occupies a box at the Opera and listens to some lachrymose Verdi lament – I seem to recall it was from Pagliacci, in which a clown is heartbroken to discover that his lover has been unfaithful, yet he still must put on the greasepaint and go out on stage and be funny.  It is the most pathetic thing.  Capone sits there, weeping.  Then one of his lackeys comes in to whisper in his ear that one of the Untouchables, an Irish cop played by Sean Connery, has been bumped off.  You see Capone’s tears turn to laughter.  His tears all along had been crocodilian.

But all operatic tears are crocodile tears.  I watched a programme on BBC 4 on Sunday night when Antonio Pappano talked about the Aria throughout the history of opera, discussing arias with some of the great opera singers of our day, and rehearsing with them.  The music was wonderful, as were the singers.  But I can’t take the libretti seriously.  And the acting is so hammy.  A few weeks ago I had reason in these annals to extol Michael Caine’s memoir Blowing the Bloody Doors Off.  It’s a book that some opera singers might do well to read.  In Rep, Sir Michael was rehearsing the part of a drunk man, and the director said to him, “Michael, what are you doing?”  “I’m acting a drunk.”  “But that’s my point.  I don’t want you to act a drunk.  I want you to be a drunk.  You are trying to act drunk, but what a drunk does is try to act sober.”

So who knows, maybe opera would work if the players remembered that “less is more”.  Hamlet tells the visiting troupe at Elsinore to “speak the speech trippingly”.  I have an idea Mozart also favoured a lightness of touch.  In Così Fan Tutte the men farewell the ladies and go off to the wars in music that would break your heart.  But of course it’s all tosh.  They are not going to war at all.  They are going to play an elaborate sex trick on their lovers.  I can’t think Mozart looked to Lorenzo da Ponte, his librettist, for psychological depth.  He probably read the stuff, burst out laughing, and said, “That’ll do.”

But who knows, once I’ve got a little more German under my belt, maybe I’ll become a regular attendee at Bayreuth, solemnly responding to the summons of the Wagner tubas.

Hier wird der Vorhang aufgezogen.

Volles Wogen der Wassertiefe.

 

 

 

 

This was the prequel to Misadventure.

I still get the flashbacks, the PTSD.  I haven’t worked in the department for over twenty years, though periodically I visit, twice in the last year, like a felon drawn back to the scene of the crime.  Sometimes I dream about the place; I grapple all night, amid a zone of chaos, with an intractable problem.  I remember hundreds of these nights.  We used to think that there must be a better way of doing this.  We joined forces with our colleagues across the Tasman, in the college in Melbourne, and organised.  We had a plan, and a vision, and I think that is why there was a period in the 90s when despite the pandemonium I used to wake with buoyancy and hope.

Shortly after midnight on Sunday, December 21^st., 1991, an invisible swirl of wind darted between the Manukau Heads, flashed across the Manukau Harbour, thundered briefly through South Auckland and vanished out into the Hauraki Gulf.  In its brief and violent passage across the built-up area east of the airport, tongues of the wind flicked down avenues with the venturi effect of tremendous acceleration between tall buildings, resulting in short-lived and chaotic street-tornadoes that cut a swathe of devastation almost before people had realised that the wind had picked up.  I worked on in the bowels of the emergency department, completely oblivious to this little local natural disturbance.

It was only a forearm flesh wound requiring a few sutures, but the patient had been kind enough to inform me that he was HIV positive, and I had taken him, not into one of the main theatres, but into Room 9, a small treatment room towards the back of the department, where I had set up a suture tray, then carefully gowned, and masked, and put on the heavy Perspex visor, then the sterile gloves.  A staff nurse looked in.  No, I didn’t need any help, but could she put screens over the door, and, no interruptions please.  I sat down and, carefully and methodically, cleaned and closed the wound, then applied tulle, an outer dressing and, finally, a sling.  I had closed out all the extraneous noises coming from the rest of the department, but I had heard the snarl of the ambulance siren, and was aware that something was taking place in Resus.  I carefully disposed of all sharps, then delivered the used suture tray and all the protective clothing into a large marked laundry bag which I closed up and deposited in its place at the back of the sluice.  I competed the paper-work, handed a copy to the patient, and bade him good evening.  I walked into Resus.

“Clear!”  Yolande applied the defibrillator paddles.  The patient gave an indifferent shrug, a 360 Joule shrug.

“Back in sinus!  Have we got an output?  Yes!”

I said accusingly, “You have resuscitated Mr Proudfoot.”

Mary Heenan said, “You haven’t resuscitated Mr Proudfoot?”

Mr Proudfoot, who was in the end stages of a severe cardiorespiratory illness, had requested that the next time he was admitted in cardiac arrest, he should be left in peace.  His cardiac consultant Dr Finlayson had even taken the trouble to come down to ED.  “The next time Mr Proudfoot dies,” he had said, “(and I choose my words carefully) – the next time Mr Proudfoot dies, he should not be resurrected.”

What had we done?  He had set his lands in order, made his will, paid all his bills, said goodbye to all his friends, kissed his family and told them he loved them, and made peace with his maker.  There was nothing to fear.  This was merely part of the progression of things – birth, childhood, education, career, marriage, children, domesticity, patriarchy, the twilight years and now, another physiological entity in its due place, demise.  Yet indeed there was something to fear.  The Health Service.

The Resus door opened and a trolley was pushed in.  An agitated, fit-looking young man.  “We need to double up,” said the staff nurse.  “Push Mr Proudfoot over there.”  The doors closed then immediately opened again.  Another trolley, bearing a screaming toddler, accompanied by two desperate parents.  “Near drowning.”  We were getting crowded.  I was looking at the agitated man.  He was dressed in Lycra, with the knee-length shorts of the cyclist, and a colourful top.  He stared wide-eyed at the ceiling.  Bizarrely, he was still cycling, still on his bike, peddling furiously.  I turned to the child.  Pink, well-perfused, alert, screaming robustly.  I asked the distraught parents what had happened, and at the same time I could hear the nurses trying to deal with Mr Proudfoot.  “There’s no room for him in resus.  We can’t monitor him in the corridor.”

I said, “Take him off the monitor.  No more shocks.”

“Right.”

The near-drowning child was in good condition.  It was a classic story.  They had moved house that evening.  The parents paused for a rest during the unpacking, and noticed the child was missing.  They found him, face down in the pool.  They must have found him immediately after he’d fallen in.  No hypoxia, no aspiration, no neurological damage.  Another minute and the story would have been very different.  The mother cried tears of vexation, anger, guilt, and overwhelming relief.  I knew they would never forget this night.  Twenty five years from now, at his son’s wedding, the father would make a light-hearted and witty speech about his son, embarrassing him with a few anecdotes of childhood.  He would touch with wistful levity on this fateful night.  There would be laughter from the wedding guests, and his bride would smile fondly over the notion that she had nearly been widowed a quarter century ago.  The best man would make a lewd and raucous speech.  Dave taking a header into the family pool when he was two.  What a joke.

But amid the laughter, the mother and father of the groom would cast a glance at one another, and hold one another’s gaze fractionally, and utter a silent prayer of gratitude that fate had looked down upon them, albeit indifferently, yet chosen to let the coin fall one way.

The cyclist was still peddling.  I laid a hand on his shoulder.  “Come on mate.  Off your bike.  Was there a triathlon today?”

Karen Jones nodded.  “Pukekohe.  2.4 km swim.  180 km bike ride.  And a marathon.”

“But it’s past midnight!”

“Yes.  There are still a few runners out.”

“What’s his temperature?”

“38.”

“Good enough.  Give him some intravenous fluids and see how he goes.  Come on, pal.  Climb down.  You’re in hospital.”

He grinned.  “Hospital.”  But he kept peddling.

The ambulance R/T squawked away.  A fight, in a hotel.  Gang-related.  There were knives, and somebody had a firearm.  The Armed Offenders Squad were in attendance.

Yolande tapped me on the shoulder.  “How do you reduce a dislocated jaw?”

“Glove up, put your thumbs on the lower molars, and your fingers behind the angles of the mandible.  Pull down, then rotate the jaw forward, then push it back.”

She rehearsed it in mid-air.  “Down, forwards, back.  Okay!  Got it!”  It is sometimes said that there is no such thing as a Teaching Hospital.  There are only Learning Hospitals.  We had accrued knowledge and experience by peddling and trafficking in information by word of mouth, the oral tradition.  Thus, the nightmarish, medieval, corrupt, exploitative, sleepless training: “See one, do one, teach one.”

Mary Heenan grabbed my elbow.  “Resus.  It’s a hanging matter.”

He was middle-aged, overweight, double-chinned, balding, and moustachioed.  He wore nothing but an expensive-looking silk dressing gown, and a silk cravat in the same pattern, claret-red with Chinese lettering in green.  The cravat had become a noose which the paramedics had loosened.  I   could see the constrictive erythematous abrasion all around the neck.  The patient’s nipples were skewered by hatpins.

“What on earth…”

“Watching blue movies.”

“The things we do.”

And unlike the near-drowned child, this man was very unwell.  Airway… breathing… circulation…  Eyes open to pain, localising pain, incomprehensible grunting.  He needed a rapid sequence induction.  Could he have a spinal injury?  Better assume so, protect the neck, and paralyse and intubate in the neutral anatomical position.

Yolande came back.  “No good.  I can’t get my thumbs into his mouth.  Would sedation help?”

“What?”

“The dislocated jaw.”

“Oh that.  Unusual if he doesn’t have an open mouth.  Are you sure of the diagnosis?”

It was my mistake.  I should have gone to see the patient at this point.  Yolande shrugged. “What else could it be?”

“I’ve seen a drug dystonic reaction mimicking a dislocated jaw.  Is he on something?  Did somebody slip him something in the pub?”

“I’m not sure.  I’ll check.”

Mary Heenan said, “I’ve got as cast iron a stomach as anybody.  I don’t mind blood, I don’t mind pus, or vomit, or even sputum, and I’ll take any amount of crap, but this is too much.”

“What is it, Mary?”

A sallow, unkempt man lay in Room 10.  There was a piece of tulle over a substantial lesion on the outer aspect of the left upper arm, held in a stout Gamgee.  Mary slipped on a pair of gloves.  “Ready?”  She took the dressing down.  The patient’s wound was seething.  Maggots.  Mary said, “I’m sorry, I can’t deal with this.”

“It’s okay.  Get somebody to put hydrogen peroxide on the wound and leave it for half an hour.  Then he can take a shower.”

Yolande was back.  “I don’t think it’s a dystonic reaction.  I still think it’s a dislocation.”

“Are you still dealing with that jaw?  Come on Yolande, we need you.  Send him to X-ray for tempero-mandibular joint views, open and closed.”

It was my mistake again.  I should have recognised a request for help, and gone to take a look.  Instead, I looked into Theatre 1.  Lawrence was suturing to music.  Mozart.  I thought, great!  I’m running round like a headless chook, Yolande’s fixated on a jaw, and Lawrence is listening to Mozart.  Meanwhile outside in the ambulance bay in a gale force wind the ambulances were disgorging.  I spent an hour darting between the broken wrists and ankles, the dislocated shoulders, falls, assaults, crashes, collapses, and the stigmata of hitherto undescribed states.  Suddenly the department was full of big heavy tattooed men in black leather jackets.

“Mary, I don’t want to alarm you, but I’ve just seen an emblem belonging to the Power, and a tatt belonging to the Mob, and when they run into one another, there’ll be hell to pay.  Get the police.”

“They’re on their way.”

The first of the stabbings from the hotel fracas arrived.  “Tension pneumothorax.  Drain, please.  No – skip the X-ray.  Where are Lawrence and Yolande?  Get them in here.  Next!”

“Doctor to Resus 3!”  A girl of 16, unconscious, unresponsive.  The attending staff nurse held up the empty pill bottle.  “Barbiturates.”

“Really?  How old-fashioned.  How long ago?”

“Twelve hours estimated.”  That was really bad news.  Another crash induction.  Yolande came in.  “What’s that?”

“Barbiturates.”  I turned down the right lower eye lid.  “See that?  See the conjunctival oedema.  That’s ‘the tear that never falls’.”

Karen Jones and Mary Heenan came in together.  “That was ambulance control.  Big crash at Ramarama.  Car versus car versus truck.  Six patients, status 3.

Well, just keep working away.  It could be worse.  It could be an earthquake, or a volcanic eruption, or a nuclear holocaust.  I said, “I think it’s time to declare a state of ‘Acopia’.  We’ve run out of hands.  Send for reinforcements.  Are the orthopods scrubbed?”  And Yolande was still messing around with a jaw.

“I got the TMJ views.  Pity I can’t interpret them.”  I took the films and held them up to the light.

“Normal.  See, this is open, this is closed.  See the condyle of the mandible riding forward on the temporal bone.  It’s within normal limits.”

“Well if it’s not dislocated, I don’t know what we’ve got.”

I did what I should have done two hours before.  “Take me to him.  Let’s carry out a quick Grand Round, before the next wave arrives.”

They all lay around, like the wounded on a battlefield, drunks, stabbing victims, overdoses, asthmatics, dislocations and fractures, and the man with the maggots.  I counted six policemen.  The leather jackets had receded into the background.  I looked into Theatre 1.  It was empty.  Completely empty.  The portable CD player and speakers had vanished.

Yolande found her patient.  She swept the curtain of the cubicle aside.  “Here.”

I felt myself blanch.  “He’s got tetanus.”

 

 

 

 

 

 

 

 

“How did you know it was tetanus?”

At 4.30 am I was tempted to drink a cup of tea with Mary Heenan before turning in.  I shrugged, recalling the peculiar quality of the trismus, the rictus, the risus sardonicus.  “I’m lucky.  I’ve seen two cases of full-blown tetanus before, in Papua New Guinea.  They both looked just like that guy.”  I could still remember the nervousness of the wait on the postage-stamp air strip perched on a mountain top at Maramuni; the cackle of the wind through the Pandanus trees, the monotonous buzzing of the flies in the afternoon sun, and the hot stench of the red-brown New Guinean earth.   

“Well,” said Mary, “I’m impressed.”  I swaggered off to bed.  Pride cometh before a fall.

I climbed into the sleeping bag on the floor of my office.  Light filtered through the chinks in the curtains.  I shivered and felt vaguely sick.  It was horrible, going to bed at dawn.  We had a debate one night in the Edinburgh Royal Hospital for Sick Children – “Sick Chicks” – about whether it was better to go to bed for one hour, or stay up all night.  The definitive answer was supplied by a Shetland girl who spoke with a beautiful, sing-song, almost Nordic accent.  “Go to bed and get rid of the ankle oedema.”  And what was that desperately poignant thing a prisoner in Auschwitz had said?  “How do I get rid of my oedema?  I weep it away.”

I slept.

In the exhausted, hospital semi-sleep snatched after the false dawn, one dreamed vividly.  These dreams were intense and could be remarkably coherent.  They were a combination of the rational and the surreal.  They could be monodelusional.  Somewhere, lurking within the confines of the dream, would be a stark anomaly.  This morning, my dream was all of a piece.  I entered in on it fully furnished with the prior information to make sense of it.  Dr Da Silva was a research haematologist, middle-aged, of mysterious mulatto-creole origin.  He was carrying out research under the auspices of, and with the aid of a substantial grant from a wealthy Japanese pharmaceutical company.  He was researching the oxygen-carrying capacity of various synthetic molecules.  In particular he was looking for a molecule which, while it mimicked the oxygen dissociation curve of adult human haemoglobin, was neither carcinogenic, nor allergenic, nor teratogenic; in addition, it had to be stable in plasma, and had to have certain properties of pliability, fragility, and viscosity.  In short, Dr Da Silva was trying to make artificial blood.  We were interested in Dr Da Silva’s project because we were always running short of blood.  Our patients were always running short of blood.

Dr Da Silva’s research was far advanced.  Results from experiments with an animal model were proving extremely promising.  But he had run into problems with the Medical Ethics Committee.  Meanwhile the Japanese stock market was unusually edgy, and Da Silva’s sponsors, though polite as always, were fidgeting.  They needed a break-through.  Desperate times demand desperate measures.

That was my dream’s back-story.  Where did it come from?  I have no idea.

I was standing in Resus tinkering with a Hamilton blood-warmer when Dr Da Silva floated silently in.  I looked up, and gasped.

“Dr Da Silva!  What has happened to you?”

Dr Da Silva gave me a ghostly grin, raised a white hand in a salute as from a great distance, and floated on.  I followed him through the department.

“Dr Da Silva!  Wait!”

As he passed down the corridor, two nurses standing together in earnest conversation looked up, gasped, and I saw one of them put a hand up to her mouth.  They separated to let him pass.

“Doctor!  You are so pale!”

He was, in fact, deathly white.  Yet still ostensibly Caribbean.  He looked like something out of Voodoo.  A zombie.

I followed him down the medical corridor, a few steps behind, and to his right.  I noticed he placed his steps with exaggerated care, careful not to bump into anything.  I imagine even minor trauma might have been a concern.  He could not be sure how his molecule would affect the clotting factors, the cascade mechanism.  Outside Physiotherapy, the Professor of Medicine was talking to his secretary, a well-dressed middle-aged lady, holding a pair of ornate horn-rimmed spectacles several inches in front of her eyes, squinting at a file.  As Da Silva passed, she looked up, uttered a soft, strangled scream, and dropped the file.

Dr Da Silva reached the end of the medical corridor.  I had the impression that, all the way along, his feet had not actually made contact with the floor.  He put a hand gingerly on the door handle at the end of the corridor and turned to stare at me with his sickening, bloodless smile.  “Do you think I should risk going outside?”

I thought, why not?  After all, being dead already, a zombie cannot be killed.  I said, “Dr Da Silva, are you all right?”

“Perfectly.”

But I had the notion that when Dr Da Silva had performed the exchange transfusion on himself, he had lost his soul.  Perhaps there were functions that the red calls performed, vital neuropsychiatric functions, about which our physiologists knew nothing.

Dr Da Silva passed through the door and floated across the car park.  A 1962 Hillman Minx, making its way from Occupational Health to the main hospital thoroughfare, seemed to become momentarily confused, meandered over the kerb, and slumped gently against an empty dustbin.  My eyes flickered at this minor diversion.  When I next looked, Dr Da Silva had vanished.

My locator sounded.  “Beep… beep… beep…”  I switched it off and turned to walk back down the medical corridor.

“Beep… beep… beep…”

I opened my eyes.  The room was full of pale grey light.  I reached for the phone, dropped it, retrieved it, and spoke into the ear-piece, inverted the phone, and spoke again.

“Whassis?”

“Are you awake?”

“Was mah?”

“We need you to do an arm block.”

“Fetch Dr Da Silva.”

“You there?”

“Car hit a dustbin…”

“Doctor!  Get up!  Both feet on the ground!”  Was not this how they came for you, in the middle of the night, to disappear you into the Gulag?

I pulled myself up.  “What is it?”

“Can you put in an arm block for a broken wrist?”

“Get Lawrence or Yolande to do it.”

“They’re not credentialed.”

“Get them to do an ischaemic block, a Biers’ block.”

“Come on doctor.  You know we’ve banned them in the department.”

“Oh Hell.”  I got up and staggered across to the nurses’ station in the acute assessment area, in rumpled theatre blues.   I couldn’t get Da Silva out of my head.  He’d seemed so real.  I could not begin to fathom how I’d dreamed him up.  Did he exist?  If so, who was he?  Had I invented him?  If so, who was I?

“Where’s the wrist?”

“In there.”  The staff nurse pointed.  “Here’s the x-ray.”

I gave it a cursory glance.  “It’s broke, that’s for sure.”  I checked the label.  The X-ray belonged to a certain Mr Wilson.  Resus room 3.  A placid, bald-headed gentleman sat by his bedside.

“Morning sir.”

“Good morning doctor.”  He was disgustingly cheerful.

“Which is the sore wrist?”

He may have paused uncertainly for an instant before answering, but then he lifted his right arm.

“I’ve been asked to pop the arm off to sleep.  Then I believe the orthopaedic surgeons will be looking after you.”

“You’re the boss.”

I even got him to sign the consent form.

I put the X-ray of the fractured wrist up on the viewing box, drew 40 mls of 1% prilocaine with adrenaline into a 50 ml syringe, and attached it to a 45 degree bevelled needle via an anaesthetic extension set.  I invited the patient to lie supine on a trolley, and he complied.  I brought his right arm into abduction and full external rotation at the shoulder such that the hand and wrist were lying behind his head.  I found the axillary pulse in the right axilla, and injected into the surrounding sheath of the neurovascular bundle.

“Feel a tingling?”

“Slight, in the fingers…”

“Hand’s going numb…”

“Good.”  I injected the entire content of the syringe.

“Okay?”

“Good as gold.”

I glanced again at the X-ray.  It was a Colles’ fracture, quite severely displaced, comminuted, and foreshortened.  Funny how the wrist clinically hadn’t looked so bad!  I peered at the X-ray.  I felt an insidious gnawing emptiness create itself in the pit of my stomach.  There was a large letter “L” superimposed in the top left corner of the X-ray plate.  It was an X-ray of a left wrist.  If I felt angry at Mr Wilson, it was only because I felt twice as angry with myself.   But how could he lie there and let me anaesthetise the wrong limb?  Did he think we were performing some esoteric therapeutic manoeuvre at a remote site?  What did he think I was?  An iridologist?  Only one thing for it.  It’s always the same in medicine.  If you make a mistake, own up.

“I’m terribly sorry.  I’ve numbed the wrong arm, Mr Wilson.”

I bit my lip.  He nodded comfortingly at me, and said, without rancour, “I’m not Mr Wilson.”

“Beep… beep… beep…”

This time I woke up in a cold sweat.