Author: jamescalumcampbell

In what my dear Northland friend reliably informs me is the trendiest Kiwi youth-speak, what’s the haps?

My latest hap is that, in an effort to escape the winter and the cracked fragment of shellac that is Brexit, with its 78-rpm needle stuck fast, I have “popped down” to New Zealand, courtesy of Singapore Airlines.  I was going to record what a marvellous thing the internet is, to allow me to arrange an itinerary, at short notice and on a whim, and to make it all come to pass at a click of a mouse.  But that was before I started grappling to post this blog from my upside-down position.  The gremlins have caught up with me.  I need a helpful youth to ask me what’s the haps and sort out my cyber woes.

But mustn’t grumble.  Glasgow – Heathrow – Singapore – Auckland went on schedule and without a glitch.  There was a flurry of snow on the edge of Glasgow but I never seriously thought we would be grounded.  I certainly didn’t have the difficulties encountered by Hercule Poirot in the in-flight movie, “Murder on the Orient Express”, where not only was somebody done in, but the train was derailed by an avalanche.  I don’t suppose I would have gone to the cinema to see an Agatha Christie melodrama, but I rather enjoyed it.  Stellar cast, beautifully shot.  There is a very powerful conversation between Kenneth Branagh and Johnny Depp.  Then I read Yanis Varoufakis’ “Talking to My Daughter About the Economy”, the only time I’ve ever managed to finish a “dismal science” text, and before I knew it I stepped through Customs where an officer obligingly cleaned my muddy running shoes, and out into the blazing sunshine.  The huge New Zealand flag above Ihumatao obligingly came out of freeze frame and flapped in the breeze.  And I am back in this extraordinary land.  Girls in downtown Auckland were offering free hugs, girls in Devonport free apples, and the taxi driver gave me a tip.

I slipped into the Kiwi idiom.  The girl on Coast Radio said, “We’re so Friday – loose as a goose.”  I bought The Daily Hap, aka the New Zealand Herald.  I was amused, perhaps bemused, that there was absolutely no British news at all.  I really have escaped Brexit.  All politics is local.  There was a lot about Cyclone Gita which has devastated Samoa and Tonga and is on its way here, but we never heard about that in the UK.

The drive from the airport to Auckland’s North Shore is not as slow as it used to be, now that a new highway by Mount Roskill takes you to a new tunnel and on to Highway 1 and the North West Motorway.  Next up, get over the jet lag.  The best thing is to plunge into a punishing social schedule.  I walked the six volcanoes of the North Shore – “the local group” – Onepoto, Styak’s Swamp, Lake Pupuke and – “the local subgroup” – Mount Victoria, Mount Cambria, and North Head.  I saw “Romeo & Juliet” in the open air at the Pump House by Lake Pupuke on Friday.  Romeo even came and sat and conversed with me while trying to avoid his carousing mates roistering abroad in the streets of Verona.  On Saturday I heard the magnificent New Zealand Symphony Orchestra in Auckland’s beautiful Town Hall.  On Sunday I renewed my acquaintance with the good people of St Luke’s Remuera, and then I drove up to Whangarei.  Ah – to walk the Hatea Loop round the Whangarei River in high summer.  This is really the gateway to the far north.  Tomorrow I’m off to Waitangi, to renew auld acquaintance.

But the news follows you, much as plastic waste migrates to the shores of Antarctica.  The Herald is full of the latest US High School Massacre.  Another tragedy.  I don’t think the US Congress will ever solve this problem.  If there is an answer, it will come from the grass roots, from the common man, and woman, who will take to the streets, as they did in the Civil Rights movement of the sixties.  Surely the people will say, “Enough already.”

A family member had reason to visit his local GP surgery one day last week, and on approaching the reception desk he was faced with the following notice:

We run ten minute appointments.  Please present a single problem.  If you have more than one problem, you need to make a further appointment.

Nothing could be more emblematic, than that pitiful notice, of the crisis in which General Practice currently finds itself in this country.  That sign needs to be removed immediately.  It’s an appalling sign.  Life just isn’t like that.  The human predicament cannot be reduced to a grocery list.  By and large, people don’t go to the doctor with one problem; they go with a syndrome.  A syndrome is a concourse, concurrence, or combination of symptoms.  Reiter’s Syndrome, for example, comprises nonspecific urethritis, arthritis, conjunctivitis and uveitis.  Does the GP really need four consultations before he twigs, in a slow-witted way, that his patient’s complaints might all be joined up?  But of course that is precisely what happens when you practise medicine like a shopkeeper fetching nostrums piecemeal from the shelves.  The really worrying thing about that reception desk notice is its signal that the doctors who put it up don’t know anything about pathophysiology, don’t know that most syndromes don’t have a name because every patient’s constellation of symptoms is unique.  If you must put up a sign, let it read:

There is plenty of time.  Make sure you say everything you need to say. 

Now that’s all very well (you might say in defence of the GPs), and in an ideal world the latter notice might hold good.  But the fact is we are in crisis and there’s no sense in denying it and certainly no sense in concealing the truth from the patients.  How can a GP give his patients all the time in the world if he needs to see 40 of them in a day?  And that’s not counting the home visits.  That’s before the GP attends to the mail, looks at the results, orders more tests, makes more referrals, negotiates more absurd bureaucratic hurdles, undertakes further medical education, and ticks 1001 more boxes.  The GP is constrained, and therefore the patient must be constrained also.

40 patients a day?  Goodness, even with 10 minute appointments, that’s two three and a half hour surgeries allowing for a ten minute coffee break, say, 9.00 am to 12.30 pm, lunch, then 1.30 pm to 5 pm.  That fills a 9 – 5 day but then there are all the other commitments just mentioned, which could even keep the conscientious doctor at work till past midnight.  Maybe the doctor will be on call overnight and have a disturbed night, then start the whole thing again at 9 am the next day.  It’s not sustainable.

Could we offload some of the consultations on to other health professionals, such as nurse practitioners and pharmacists?  That’s being piloted at the moment, but a lot of GPs are sceptical; some even think the other professionals end up creating more work for them.  What about telephone consultations, advice hot lines, email, and social media?  More pilots – and certainly such platforms are widely used, and heavily subscribed, but there is evidence again that they don’t put a dent in the GP work load, but rather increase it.  It’s as if the public has an insatiable desire for multifarious forms of the health care product.

Let’s take a step back, stop looking for a moment for a quick fix, and consider what the best model for primary health care delivery might be.

I assert that the gold standard not just for General Practice but for Medical Practice across the board, is the medical consultation.  The patient consults a professional who has been specifically trained to practise the art and science of medicine – a doctor.  It is certainly true that if there is no doctor available in an emergency, the intervention of another health care professional might be invaluable and even life-saving.  When Louisa Musgrove suffers a head injury jumping off the Cobb at Lyme in Jane Austen’s Persuasion, she is attended by the apothecary.  Currently the medical profession’s ruling bodies, and the Government, are quite keen on reviving this arrangement.  Still it seems self-evident that the person best suited to consult at such a time is a person who has been specifically trained to the task.

If the patient-doctor interaction is the gold standard, then, it is also best that it be face-to-face.  A telephone, or Skype, might be useful in the Australian outback when the doctor is 1,000 miles away, but the advantages of the consultation being real rather than virtual, not least because a physical examination can take place, are self-evident.

The medical consultation is a holy and sacred thing.  It takes place in a setting of absolute trust, behind closed doors where confidentiality is assured.  The vulnerable patient must feel he is in a place of absolute safety.  Nothing must be allowed to intrude, no third party, no politician or manager, no obtrusive IT system with its own alternative agenda.

The power of the medical consultation is not widely understood.  The public is not generally aware of the four-pillar structure of the consultation in its widest sense – History, Examination, Investigation, and Diagnosis.  To these I would a fifth and a sixth – Formulation, and Management.  The public is not aware, for example, that far and away the most powerful diagnostic predictor in the consultation is the History.  Patients habitually phone their practice to ask the receptionist if their results are “normal”.  But the question has no meaning, because the results cannot be interpreted outside the context of the History.  Nine times out of ten, perhaps even more frequently, an experienced GP will have a good idea of “what’s going on” with a patient, on the basis of History alone.  This is why nothing must be allowed to interfere with the telling of the History, and why it is such a travesty that a practice should attempt to put a cap on what a patient wishes to say.

The medical consultation is sacrosanct, but I believe it is under threat, both from within and outwith the profession.  All of the pilots, remote consultations or consultations by allied professionals, are suboptimal.  We should not allow the medical consultation to become diluted.  The consultation is an “all-or-nothing” phenomenon.  Patients: never seek half a consultation.  Doctors: never offer half a consultation.  Rather than advising patients to opt for second best, we must strive to have patients understand that the consultation requires complete commitment from them as much as from doctors.  When doctors and patients meet in the consulting room they are, effectively, entering a contract.  I call it the Consultation Contract.  By adhering to it, doctors and patients ensure they get the most out of the consultation.  The contract’s twelve points follow.  Notice these directives apply as much to the doctor as to the patient.  This truly is a contract.

The Consultation Contract

1. Remember: the medical consultation is “all or nothing”.
2. Dress for the occasion.
3. Turn up on time.
4. Shake hands.
5. State your business in simple terms.
6. If you have a hidden agenda, reveal it.
7. Tell the truth, the whole truth, and nothing but the truth.
8. Listen.
9. Articulate your fears.
10. If you have a question, ask it.
11. If you don’t understand something, say so.
12. Table any other competent business.

You can’t do all that in ten minutes.  But GPs who schedule 15 minute appointments and conduct high quality consultations will, by and large, run to time.  Still it’s not easy.  The power of concentration the doctor requires is such that for a short while, every consultation, the doctor steps into the patient’s shoes.  The doctor becomes the patient.  This is really why doctors cannot sustain seeing 40 patient daily long term.  100 patients a week for a full time GP is quite sufficient.  GPs who manage modest list sizes, say a flock of 1,000 souls, will not earn megabucks but they just might have a chance at happiness.

President Trump used the words “America” or “American” 79 times, and the words “United States” five times, during his first State of the Union address on January 30^th.  I sat down to watch it, but there was a lot of hanging around, periodically interrupted by the announcement of the arrival of various VIPs such as the Diplomatic Corps and the Supreme Court.  Then the gentleman from Nebraska, and the gentlewoman from Illinois, et al, went off to provide a Presidential escort while Congress continued to glad-hand and network, and the Speaker of the House and the Vice-President chatted as they stood by their chairs.  It was all designed to create an air of excitement and expectancy for an annual event of national importance.  It was the New World equivalent of Black Rod summoning the Commons to the Lords for the Queen’s Speech.  At length came the grand announcement.

“The President of the United States!”

To sustained applause, President Trump with entourage slowly progressed down the grand hall shaking hands, clapping backs, and pointing laconically at those supporters out of his reach, before reaching his position at the podium immediately below Mr Pence and Mr Ryan.  More hand-shakes.  Finally it was Mr Ryan’s high and signal honour to introduce the President, and the speech got under way.

I only gave it ten minutes.  Not that the President gave anything less than a sterling – perhaps I should say a silver dollar – performance.  It was the audience choreography that got on my nerves.  Literally after every sentence, the Republicans rose to their feet and gave the President a standing ovation, while the Democrats sat on their hands, dour, stone-faced, and immobile.  In the West we used to smile condescendingly at footage of the Soviet Union Politburo endlessly applauding their chairman, and we still scoff at the North Korean generals similarly adulating Mr Kim.  But is this much different?  Well, different in one respect.  At least Congress had a binary choice.  But even some Democrats occasionally felt compelled to join in.  It must be hard to cavil at “God bless America.”

I switched off, but I didn’t give up.  I printed the speech out and read it, just as I’d previously done with Mr Trump’s acceptance of the Republican nomination, and his inauguration speech.  That’s how I know he said “America(n)” 79 times; I counted.  To the extent that this was an intensely patriotic speech, it could hardly be said to be controversial, and in matters of policy, in that it reflected much of what was said at the Inaugural, it was predictable.  Much of the speech was given over to acknowledging the work of unsung American heroes invited to be present for the occasion.  This was intended to offer bipartisan appeal and therefore to contribute to the idea of the House and the Senate putting aside differences and working for the common (American) good.  As well, as much of the speech was retrospective as it was prospective.  The President trumpeted (sic) the achievements, mostly economic, of 2017.  Apparently America is booming.  Real or fake news?  There’s a lovely quote in Michael Wolff’s Fire and Fury in which the President says “My exaggerations are exaggerated.”

So, when you get down to the nitty-gritty, that is, policies for the year ahead, you could summarise them on the back of a postcard:

Give Cabinet Secretaries power to remove under-performing Federal employees.

Reduce pharmaceutical prices and allow terminally ill patients to undergo experimental treatments.

Fix trade deals and enforce trade rules.

Generate $1.5 trillion to invest in infrastructure.

Introduce a “four pillar” immigration plan.

Intensify the war on drugs.

Modernise and rebuild the nuclear arsenal.

Extinguish ISIS and keep Guantánamo open.

Give foreign assistance only to America’s friends.

Restore “clarity” about adversaries – Iran, North Korea etc.

 

So, no surprises there.  But why be so interested, from this side of the Pond, in the State of the Union?  It is because, remember, we have a “Special Relationship”. We are “shoulder to shoulder”, “joined at the hip”.  You could hardly be more Siamese than that.  Whither thou goest, I will go…

It occurs to me that Mr Trump has developed a presidential expression, one intended to convey iron will and determination, characterised by clenched teeth and a pugnacious jowl.  I venture to say he has modelled this look on Winston Churchill, whose bust has returned to the oval office.  Churchill himself enjoyed the honour of addressing a combined sitting of Congress, at this same venue, during the war.  He made a quip that had always struck me as being rather heavy-handed; I couldn’t understand why Congress found it so amusing.  He pointed out that, had his father been American and his mother British, rather than the other way around, “I might have got here on my own.”  It was only 76 years later, while listening to Trump, that I finally got this joke.  I’d just assumed Churchill imagined he would have entered US politics and come to Capitol Hill.  But he was implying much more; he was suggesting that he would have been the President.

Had the technology been available, I doubt if Churchill would have tweeted.  His speeches were drafted and redrafted through blood, toil, tears, and sweat.  President Trump gives the impression of being a President-on-the-hoof, making it up as he goes along.  No doubt what he says is sincere when he says it.  “We’re going to have a great relationship, great relationship, we’ll make billions, believe me.”  But it’s a mistake to underestimate him.  In his unique way, he is Presidential.

Yet it seems to me that, on the world’s stage, he has not been tested.  What his Presidency stands for is yet to be characterised.  We may be apprehensive about his plans to step up military actions (“Our warriors in Afghanistan also have new rules of engagement”), apprehensive about his adversarial attitudes and, and most of all about the nuclear arsenal.  But what will define the Trump Presidency remains unknown.  All we can say with certainty is that something will happen.

Somebody once asked Harold Macmillan what defined a premiership, and his reply – perhaps apocryphal, perhaps fake news – was said to be, “Events, dear boy, events.”

I don’t so much inhabit a house, as a book repository.  My visitor cast a glance around the place, and said, “Gosh, have you read them all?”

“Every word.”  She laughed.

From time to time, things get out of hand and there are books strewn across every surface.  Then I have to buy another bookcase.  It happened last week.  I got a modest four-tier flat-pack from B & Q.  I used to struggle to put these things up, get into a lather, lose my temper, and inflict damage on the structure.  I despised these parsimonious instruction leaflets comprising a series of diagrams devoid of explanatory text.  You would have thought a bookcase, of all things, would have predicated a literary explanation of its own construction.  The thing is, these components, these slabs of wood manufactured by robots with precisely located indentations for the screws provided, have “chirality”, or handedness.  They need to be orientated correctly, otherwise you end up with a bookcase half of which is upside down and the other half back to front.  If you are flat-pack naïve, you can sense the instructions sneering at your gauche trials and errors.   You are not collegiate; you need to bloody yourself before being admitted to fellowship of the flat-pack “mistery”.  But I’m definitely getting better and indeed this time I constructed the edifice expeditiously and without hassle.  Then I chose a nook within my bijou cottage – there wasn’t much choice – stacked the shelves with all the orphan books, turned the whole thing through ninety degrees so that the titles might beguile my visitor, marvelled at the relative tidiness of the place, gave myself a pat on the back, and phoned a relative.

“The books are stacked.”  It might have been a cryptic message from the BBC to Pierre in Cherbourg in early June 1944.  “Les livres sont empilés.”

“Aye.  For now.”

And there’s the rub.  I am a bibliophile.  I cannot walk past a bookshop, just as some people can’t resist a tobacconist’s, or a pub.  I like to think my addiction is less self-destructive but that may be a delusion.  There’s no reason to suppose the latest flat-pack will curb my acquisitive tendencies.  Why not get a Kindle, I hear you ask, and buy on-line?  Well, I have a Kindle.  I bought it so that I could have the experience of downloading the electronic edition of my own first published book, Click, Double-Click.  I did so, recognised my own composition on the tablet, switched it off, and never switched it on again.  I relished more the experience of taking my own book, in its material form, from the shelf at Waterstone’s, and buying it.  The book sellers often engage me in conversation about my choices, and as a I approached the desk I didn’t know if I was going to remain incognito or own up to the authorship.  But on this occasion we concluded the transaction sans parley.  To me, printed paper is infinitely preferable to the electronic screen because reading is a tactile experience, and a book should be a thing of beauty, to be caressed.  Was not the lure that brought us as children into the world of books their physical attraction?  When I see old copies of children’s adventure books in second-hand bookshops, with their colourful dust jackets, I can still conjure that sense of wonder at the possibilities of exploring new worlds, through books.  I hold such a book in my hands now, Tom’s Midnight Garden by Philippa Pearce, OUP 1958, well preserved with an immaculate dust jacket in dark greens showing Tom in pyjamas and Hattie in pinafore under a Victorian pile in the midnight garden.

Books have an aroma.  I can remember as a child on wet summer’s days rummaging in the cupboard under the stairs of boarding houses, amongst the chess and draughts sets, the Scrabble and Monopoly, to discover well-thumbed books about Biggles and Jennings and the Famous Five, and Nevil Shute books describing a world that has ceased to exist, all having that musty-musky, deeply comforting papery scent.  At the other end of the spectrum is the heady fragrance of glossy, sheeny magazine paper.  When I open a brand new magazine the first thing I do is smell it.  It’s unseemly, really.  My addiction is not merely cerebral, but visual, tactile, and olfactory.

Apart from bookcases, I have another strategy for attempting to keep my book habit under control, and that is to move books on.  Last week I offloaded a pile of paperbacks in a local charity shop.  Mostly they were “intelligent thrillers” by Robert Harris.  Fatherland, Enigma, Archangel, The Ghost, The Fear Index, An Officer and a Spy, Conclave and Munich.  All went.  I kept Imperium because I haven’t finished it yet.  Not that I have anything against Robert Harris.  Quite the contrary; his books are page-turners and he is a master of pace.  The plots are very clever, the twist on the last page can be – at least to me – completely unexpected, and the research and level of historical accuracy afford the books an authenticity.  An Officer and a Spy, which concerns nineteenth century France and the notorious Dreyfus case, is perhaps his most substantial work.  It won Harris the Walter Scott prize for historical fiction.  The Ghost is a professional ghost-writer who writes the autobiography of an ex-British Prime Minister who sounds awfully like Tony Blair.  It is full of subtlety, not least the realisation on the last page – if it isn’t too much of a spoiler – that you have been reading a communiqué from a ghost.  And The Fear Index is a truly nightmarish vision of what might happen if IT systems are allowed to take over.

Yet I gave them away because I knew I would never read them again.  I’ve done the same with the books of Ian McEwan, another writer I greatly admire.  I’ve kept Nutshell, a hardback first edition signed by the author, so that McEwan is represented on my shelves.  I dare say the fault is mine and I read these books too quickly.  I look forward to the next publications from both Harris and McEwan.

Yet, when I cast an eye around my shelves, I realise there are books here that I will keep for ever.  What is it about these books?  They must have a quality that makes me want to revisit them, over and over.  Reference books, of course.  Dictionaries in English, Latin, French, German, and Gaelic – Chambers (20^th and 21^st century editions), Bloomsbury, Shorter Oxford, Churchill’s Medical Dictionary and, definitively – bit of an oddity – the complete Oxford English Dictionary in a single volume with accompanying magnifying glass.  I’ve also got a complete Encyclopaedia Britannica which is now about 25 years old.  I suppose it would be more sensible to download Encyc Brit and the OED or access them in the cloud or whatever, but I like to turn the pages, and I frequently do.

Then there are volumes of a certain sentimental value – gifts and heirlooms, school prizes and so on.  Roget’s Thesaurus, Aldous Huxley novels published by Chatto & Windus in their beautiful russet covers, Joyce’s Ulysses, Dostoevsky’s The Possessed in the Constance Garnett translation, Bulgakov’s The Master and Margarita and Patrick White’s Voss.  Richard Feynman’s Lectures on Physics in the elegant three volume commemorative issue.  Classics like Shakespeare and Dickens and Jane Austen.  RLS complete.  Buchan on Scott and Scott on Napoleon.  The Richard Hannay yarns.  Special interests: first editions of Ian Fleming and Graeme Greene.  Bernard Levin’s Enthusiasms, and The Pendulum Years.  Churchilliana.  C. P. Snow’s The Two Cultures which I mischievously shelve contiguous with F. R. Leavis’ Two Cultures? The Significance of C. P. Snow.  Music – Arnold Bax’s Farewell, My Youth, and Lewis Foreman’s biography and study of Bax.  Rachel Carson’s Silent Spring.  Sir James Frazer’s The Golden Bough.  Scarne on Cards.  G. Wilson Knight The Wheel of Fire.  Vansittart in Office by Ian Colvin.  South Col, signed by the author, Wilfred Noyes.  Lorimer’s New Testament in Scots.  Wilfred Owen’s Letters.  The Stories of Katherine Mansfield, Definitive Edition.  James McNeish – The Man from Nowhere, and Lovelock.     Medical texts: Gray’s Anatomy, 40^th edition; Mattox, Feliciano and Moore – Trauma; the New Zealand First Aid Manual which I had the honour to edit.  I reread Ganong’s Medical Physiology the way people used to paint the Forth Rail Bridge; the tenth edition of Brain’s Diseases of the Nervous System which the pharmaceutical company Boehringer-Ingelheim gave me when I provided some case studies for a meeting they sponsored.  Books that have altered my world view, like Kafka’s The Trial.  Books that have fallen out of the sky like Victor Frankl’s Man’s Search for Meaning. This is just a snapshot.  More music and musicians, shed-loads of sheet music for piano and viola.  Poetry, history, biography…

You see my problem.

Here in Blighty, the English Channel seems currently to be providing a backdrop to our contemplations of the past and musings about the future.  Monsieur Macron popped across to have a pub lunch with Mrs May in her Maidenhead constituency and to inspect the Coldstream Guards at Sandhurst.  He certainly looked very presidential.  But then, he has a huge mandate.  He also sounds very presidential, judging from the interview he gave on the Andrew Marr show.  He is young, cool, and eloquent.  His English is very good.  Of course, we who inhabit these islands are, as a general rule, indifferent linguists.  Perhaps it has something to do with our detached status as islanders.  New Zealanders, and the Japanese, are almost as bad as we are.

Monsieur Macron announced that he was lending the UK the Bayeux Tapestry.  The Bayeux Tapestry is nearly a thousand years old and depicts the last time these islands were successfully invaded, by William of Normandy who won the Battle of Hastings in 1066.  Churchill, as you would expect, put it more eloquently; he talked of the last time the enemy’s camp fires were seen on these shores.

Churchill has featured in three recent blockbuster movies which have also focused on the English Channel – Churchill, Dunkirk, and Darkest Hour.  In Churchill, the great man was played by Brian Cox.  The film focused on Operation Overlord and the run-up to D-Day in 1944.  Churchill was depicted as a man haunted by his memories of the First War and in particular the carnage of Gallipoli.  He was only too well aware of the perils involved in moving a large invading force safely across the channel.

In Dunkirk, we are back in May-June 1940 and the film depicts the evacuation of the British Expeditionary Force.  Churchill does not appear in the film, but a repatriated soldier on a train up from the coast reads for our benefit a substantial extract from Churchill’s speech to parliament –   “War is not won by evacuations….”

And in Darkest Hour, Gary Oldman plays a Churchill asked by a reluctant King George VI to form a government on May 10^th 1940, mistrusted by the Conservatives and under immense pressure to sue for peace and seek terms with Herr Hitler.  He conceives the crazy plan of evacuating the BEF from Dunkirk using a fleet of pleasure boats.

Both the films in which Churchill the man features are to an extent revisionist in nature.  You might even say they both take diabolical liberties.  In each case, a revisionist stance becomes the motive force of the film.  In Churchill, the PM is portrayed as a man who, four years after his finest hour, has lost the plot and has become to his generals a thorn in the flesh and an interfering nuisance.  Of course there is a grain of truth in that.  Read the diaries of the CIGS – Lord Alanbrooke, Chief of the Imperial General Staff, and the wonderful, if ethically questionable memoir of Lord Moran, Churchill’s personal physician, Churchill, The Struggle for Survival 1940/65.    Lord Moran describes Alanbrooke as wringing his hands and crying, “That man!  That man… Yet, where would we be without him?”  Churchill who was indeed apprehensive about opening a second front (he’d been holding out against Stalin’s plea for years) asked Alanbrooke to undertake a feasibility study of invading occupied Europe via the Pyrenees.  Alanbrooke told him immediately it was a non-starter, but Churchill insisted on a researched report, which Alanbrooke duly organised and presented.  The Pyrenees plan was not feasible.  Churchill accepted that.  Alanbrooke went on to say, “Now I’m going to tell you, Prime Minister, what I think of you wasting my time and that of my staff…”  And he went on to tear a strip off his political master.  Churchill always listened to his generals and took their advice in the end.

That much is so, but it can hardly be justified to present Churchill in 1944 as a disempowered, half-gaga version of King Lear.  One scene is more than reminiscent of Lear’s great crazed invocation to the elements –

Blow winds, and crack your cheeks!  Rage, blow,

You cataracts and hurricanoes, spout…

Churchill has the PM getting down on his knees to ask the Almighty for bad weather over the channel in order to scupper Overlord.  Unlikely.  And you only have to read the Memoirs of Field Marshal Montgomery to see that the portrayal of Monty as contemptuous of Churchill is quite inadmissible.

In Darkest Hour, the motive force is the sense of a Churchill swithering, almost minded to accept Lord Halifax’s advice and sue for peace, yet stiffened in his resolve by sounding out the British people on whether they were minded to fight on.  Again, a grain of truth.  After Coventry was “coventrated”, he took a trip up north because he’d heard people were growing “fretful” and he wanted to see for himself.  When the people responded to his own evident sense of compassion, he recorded, “I was completely undermined, and wept.”  So yes he sounded out the mood of the people.  But that he should undertake to do this by going for a ride in the London underground strains credibility.  Attlee yes.  He used to take the tube to work when he was PM.  But not Churchill.  Churchill was an aristocrat.  He even says himself in the film that he’d never been on a bus.  After it was all over, Churchill said with uncharacteristic modesty that it was indeed the British people who had the heart of a lion and that he was merely called upon to give the roar.  Yet Lord Moran once told Churchill he lacked antennae.  He was a transmitter rather than a receiver.  The sublimity of his vision was innate.

Yet, both films contained a scene that moved, perhaps because they each carried a sense of authenticity, and both involved the king.  In Churchill, the king told him, gently, that he should not allow himself to go to France with the invading army.  Churchill had been intent on going but he relented.  Only the king could have made that happen.  In Darkest Hour, when Churchill finds himself devoid of support and utterly alone, the king supports him.

Over fifty years after his death, Churchill continues to fascinate.  In his own sad period of decline at the end of his life, he himself came to dwell on the events of 1940 and to see 1940 as the great culmination of his life.  Yet there is a danger for us, in this peri-Brexit UK, of harking back nostalgically to a Blighty that no longer exists, if it ever did, and harping on about its finest hour.  It happened.  Get over it.  What next?  Churchill got interested in striving for a lasting peace, and he talked quite openly of a “United States of Europe” although, granted, his vision of Britain’s place in Europe was probably always to be semi-detached.

Fast forward seven or eight decades, to Sandhurst, and l’entente cordiale.  M. Macron wants to weave “a new tapestry”.  Despite the fact that the Brexiteers are accused of pulling up the drawbridge, Boris wants to build a bridge over La Manche.  I gather most of his colleagues think the idea is ridiculous.  I think Winston might have liked the idea.  When France was about to fall in 1940 and he was desperately trying to keep them in the struggle he even proposed the British and French share mutual dual citizenship.

Still, if we are not going to have a bridge to Normandy, I propose one from the Mull of Kintyre to Antrim.  It’s only 11 miles.  Currently my favourite region of Scotland, beguiling Argyll, is like Brigadoon, in a state of deep hibernation.  Let’s open up the Celtic World.

I tell you what – in Westminster, that would go down like a lead balloon.

The season is back into full swing for disgruntled curmudgeons noising off in the newspaper letters column.  2018 is barely two weeks old and already I’ve appeared three times.  I might even be The Herald’s prolific correspondent of the year to date.  I’m not sure that’s a good thing.  Do I want to join an elite group?  There he goes again, banging on… Usually I write about medicine.  Heaven knows there’s plenty to talk about just now.  I read something that causes me to splutter into my cornflakes and call for pen and ink.  By “pen and ink” I’m being figurative.  Actually I go on-line and fire off an email and there’s the rub.  It’s very easy to say something intemperate in the heat of the moment.  It’s happening all the time on social media. Everything from mild bad manners to vicious bile.  So I’ve made a resolution never to fire off a letter unless I think I have something constructive to say.  It’s no good saying somebody’s latest idea is a bad idea, unless you can come up with a better one.

I check the paper the day after publication in search of rejoinders.  There may be nothing, or there may be a letter of support.  I keep thinking somebody will write something along the lines of, “Dr Campbell really needs to wake up and smell the coffee.  Does he live in cloud-cuckoo land or what?”  Hasn’t happened yet.  Sometimes I think I write deliberately to provoke such a response – but surely not; I’m as thin-skinned as the next man.  I happened to look at The Herald on-line after my second letter of the year – the only time I’ve ever looked – and somebody did remark that Dr Campbell was talking a load of old cobblers.  I can hardly say it was an offensive remark but it did highlight for me an important difference between remarks in print, and remarks on twitter and the like.  Printed remarks are liable to contain an assertion backed up by some semblance of argument, otherwise they are unlikely to be published.  Remarks on social media are unedited and are likely to be short assertions with no back-up.  Accordingly I have made up my mind never to look at such sites.  I would say to anybody who is being upset by personal remarks on any site: shut the site down and never, ever revisit it.

So I carry on banging on.  I make no apology for repeating myself.  Newspapers have a short half-life.  I think it was Bernard Levin who said that his carefully crafted columns were wrapping up the fish and chips by dusk.  If you want to make an impression, you really do need to stick with it for the long haul.  If you think your words of wisdom are going to change the world overnight you are likely to be sorely disappointed.  I’ve been trying to influence the debate about emergency medicine for years but as far as I can see I am making little headway.

I find the level of public debate about emergency medicine to be extremely cringe-worthy.  The BBC keep using archaic expressions like “Casualty”, “Accident”, and “A & E” that the rest of the English-speaking world stopped using a generation ago.  In the mid-80s the newly formed Australasian College for Emergency Medicine decided to dump all these terms because they were associated with the baggage of slummy, underfunded, under-resourced, underperforming hospital departments.  At that time, “Casualty” was the name of the BBC’s flagship medical soap, and it still is.  But look up the word “casual” in Chambers.

Casual kaz(h)’u-al, adj accidental: unforeseen: occasional: off-hand: negligent: unceremonious… casualty department, ward a hospital department, ward, in which accidents are treated; casual ward formerly, a workhouse department for labourers, paupers, etc.

You can see why people think of having to spend time in such an environment as even more of a calamity than the pathophysiological insult that has put them there in the first place.  What a disaster to become a “casualty”!  No wonder everybody wants to get the “casualties” out of this s***hole (to use a word much in vogue, allegedly) as fast as possible.  95% within four hours, or God help them.

The Australians and the New Zealanders realised the nomenclature had to change.  You will never hear an Australasian, or an American emergency physician refer to a patient as a “casualty”.  It is the most dehumanising word in the emergency medicine lexicon.

“Accident” had to go too.  There is no such thing as an accident.  A road crash is like a heart attack or a stroke in that it has an aetiology, pathogenesis, morphology, and clinical outcome.  It is only when you believe that, and stop thinking that things just happen out of the blue, that you can make a difference.

I well remember the day in Auckland we took the “A & E” sign down and replaced it with “Emergency Department”.  All of us who worked in the department would answer the phone not with “A & E” but with “ED”.  The other hospital departments were initially rather scornful and dismissive, but we persisted and actually it only took a week until everybody knew we were the “ED”.  Similarly we stopped saying “RTA” (Road Traffic Accident”) and started saying “RTC” (Road Traffic Crash”) and I remember the satisfaction when I first heard a paramedic handing a patient over to us from an “RTC”.

Here meanwhile, the newspapers are still droning on about “casualties” in “A & E” waiting more than four hours to be “seen”.  It’s like a report from a dressing station at Passchendaele.

Of course it is untrue that patients in the emergency department wait four hours to be seen.  They are all seen immediately, by a triage nurse, who prioritises each patient’s level of acuity according to a triage scale which, depending on the institution, will be something like

Triage category 1: to be seen by a doctor immediately

Triage category 2: to be seen by a doctor within 10 minutes

Triage category 3: to be seen by a doctor within 30 minutes

Triage category 4: to be seen by a doctor within 60 minutes

Triage category 5: to be seen by a doctor within 2 hours.

I am not the only correspondent to have written in to point out that the media’s use of the word “seen” is misleading and, frankly, sloppy.  Doesn’t make a whit of difference.  Yet I don’t intend to give up.  Why else would I write this blog?  May I invite you to banish the terms “accident”, “accident and emergency”, “A & E”, “casualty”, and, worst of all, “cas”, from your vocabulary?  If you hear other people using these terms, please politely correct them.  Patients are seen promptly, and cared for, in the Department of Emergency Medicine.  Will you join me in this?

As Winston said, “Never give in.  Never never never never never…”  I will keep scribbling.

And another thing…

Serendipitously, the year has started well for procrastinators.  It was surely reasonable to continue the festive revelries throughout the twelve days of Christmas.  That would take us to Twelfth Night on Friday.  Time to take the Xmas cards down.  Bit of a relief really.  As we say in these parts, back to auld claes an’ purritch.  Yet the weekend followed so really the New Year only starts proper, with the resolutions kicking in, on Monday January 8^th.

Talking of Twelfth Night, I saw a production of the Shakespeare play last time I was in Auckland.  Orsino, Duke of Illyria, says

If music be the food of love, play on,

Give me excess of it that, surfeiting,

The appetite may sicken and so die.

That strain again, it had a dying fall.

O, it came o’er my ear like the sweet sound

That breathes upon a bank of violets,

Stealing and giving odour.  Enough, no more,

‘Tis not so sweet now as it was before.    

Shakespeare probably wrote Twelfth Night in 1601. That bank of violets is reminiscent of a play he wrote in 1596 or 1597, The Merchant of Venice.  I think music must have spoken to Shakespeare.  Lorenzo says to Jessica

How sweet the moonlight sleeps upon this bank!

Here will we sit, and let the sounds of music

Creep in our ears.  Soft stillness and the night

Become the touches of sweet harmony. 

Ralph Vaughan Williams famously set these words in his Serenade to Music for 16 solo voices and orchestra.  I heard it at a London Prom which I made a point of going to in 2008.  It was the 50^th anniversary of the death of RVW.  The BBC Symphony Orchestra was conducted by Sir Andrew Davis.  It was a very remarkable concert.  In addition to the Serenade, they played the Tallis Fantasia, Job – a Masque for Dancing, and the 9^th Symphony, a remarkable feat for the performers, not least the orchestra’s leader Stephen Bryant who had significant solo passages to play throughout the evening.  RVW’s music has a remarkable, unique, spiritual quality which, live in concert, exerts an extraordinary effect upon the audience.  The Serenade to Music’s premiere was also given in the Royal Albert Hall, on 5^th October 1938, at a gala concert to celebrate Sir Henry Wood’s Golden Jubilee.  Rachmaninoff played his 2nd piano concerto in the first half of that concert, and remained to hear the Serenade.  He sent a note round to RVW saying how much he had enjoyed his music.

But to return to Twelfth Night, a precis of the plot would I think be reminiscent of the brief digest you get from the Radio 3 announcer anchoring an opera beamed in from the New York Met:

A shipwrecked girl (Viola), disguised as a boy (Cesario), serves a young Duke (Orsino) and undertakes to act as go-between, representing him as suitor to a noble lady (Olivia) who proceeds to fall in love with her but mistakenly marries her twin brother (Sebastian).

A short multi-choice examination will follow.

In the Auckland performance, it was all the more confusing, and indeed disconcerting, because the play, as it would have been in Shakespeare’s Globe, was performed by an all-male cast.  I was especially struck by the roistering Sir Toby Belch’s rebuke of Olivia’s stuck-up and prissy steward Malvolio:

Art any more than a steward?  Dost thou think because thou art virtuous there shall be no more cakes and ale?

There is a wonderful ambiguity about these lines.  Sir Toby is berating Malvolio and saying, “Don’t imagine we are going to change our behaviour just because you are here.”  But he’s also making the wider point.  Revelry and virtue are not incompatible bed fellows.

It is sometimes said that there is no textual reason why this play should be called “Twelfth Night”.  Indeed, its subtitle, Or What You Will suggests as much.  If he’d been writing today, Shakespeare might have called it “Whatever”.  But maybe the cakes and ale line (Somerset Maugham borrowed it as a title) gives a certain relevance to January 5^th.  I’m having a Malvolio January.  No ale.  I did the same last January so I can’t say I’m wary of the unknown.  It’s a mind game really.  On this occasion I’m concurrently reading The 28 Day Alcohol-Free Challenge by Andy Ramage and Ruari Fairbairns (Bluebird, 2017).  Ramage and Fairbairns warn of the danger of caving in at the first big social occasion.  I see from my diary that on January 12^th I’m going to an ex-work “Do” which starts in a rather posh whisky-gin outlet in Perthshire, with a gin tasting session.  There’s an analogy nagging at the back of my mind: dragging along my Malvolio persona – it’s a bit like taking a peashooter to a gunfight at the OK Corral.  Gin has rather taken off in Scotland.  All the distilleries have become interested in the juniper berry.  I’ve been rehearsing my tactics for the gin night.  “Could I just have the Fever Tree tonic please?  I’m on the 28 Day Alcohol-Free Challenge.”  To which Sir Toby Belch might reasonably reply, “Well what the hell are you doing here?”  Or, in other words, “Dost thou think because thou art virtuous…”  Maybe I’ll just take the car.  Or I can buy my way out of trouble by purchasing a bottle of very expensive Scottish gin for February.  Whatever.

Scotland’s central belt got a huge dump of snow on Thursday night and Friday morning.  We woke to a world that was very beautiful, muffled, silent, hunkered down.  I put on my boots and walked down to Flanders Mass on the Carse of Stirling.  I only saw one car, and the driver kindly pulled up to offer me a lift, but I said I was out for the walk.  We agreed the winter wonderland was entrancing.  After that, I and the horses and alpaca had the world to ourselves.  A track leaves the road and heads west towards the Moss for about a kilometre.  There were six inches of snow, utterly pristine.  At that time there weren’t even any tracks in the snow from wildlife.  As the rather dreich carol puts it (five verses – best keep the tempo up) “Snow had fallen, snow on snow.”  I think of it as a concrete, or perhaps more accurately a crystalline, poem:

Snow

Snow         snow

Snow

Snow…

Two squadrons of wild geese flew in low and in tight formation, fussing and caterwauling.  They performed a ceremonial fly-past and then landed with precision and consummate airmanship.

Winter’s not gone yet, if the wild-geese fly that way.

So the world holds her breath.  Because, I suppose as a matter of chance, the earth has a declination of 23.45 degrees, we have seasons.  Recently the northern hemisphere has been tilted away from the sun, hence on Dec 21 we had our shortest day.  As the earth’s orbit continues inexorably, the days begin to lengthen, though in somewhat asymmetric fashion.  While daylight expands, dawn remains gloomy.  Still, already we have a sense that we have tilted.  We have crossed un point d’appui.  Perhaps that is why this is the season for reviewing the past, and anticipating the future.  Resolutions?

It’s built into the human condition to strive for improvement.  Next year will be better. Next year I will be better.  Superficially, it may just be a reaction to the excesses of the Christmas season, sloth and gluttony.  So, from the post-prandial perspective of Christmas and New Year, we resolve to have an abstemious January, join a gym, work on the abs and glutes, abjure tobacco, eat 5-a-day (or is it 10?) – you can see how the list gets longer and longer.

Yet, I fancy for most people, resolve goes deeper than this.  In my work, how often did I hear people say, “If I had to do it all over again, I would do it quite differently.”  They are not talking about some minor adjustment, fine-tuning, a little tweak here and there; they are talking about some change so fundamental that the resultant life they would have led would have been unrecognisable.  This idea of fundamental change runs very deep in our culture.  Nicodemus visited our Lord by night and asked what he needed to do.  It turned out that he had to be “born again”.  Imagine that.  Not merely a complete rebranding.  No, more than that, for this has not merely to do with style, but absolutely with substance.

When I was young, I was desperate to metamorphose. It was my ambition to go to bed one night a grub, a caterpillar, and wake up a butterfly.  I would slough off the noxious slimy straitjacketed integument of my life and change, utterly.

But how?

How?

Like Pierre Bezukhov in War and Peace I would explore walks of life in search of answers.  I dallianced with freemasonries.  I would learn to fly.  Literally.  I had a fantasy picture of myself as a kid in jeans and T-shirt sitting on the wing of a Spitfire being interviewed by the BBC.  I was telling the outside broadcaster from Tonight about the occasion that changed my life.  “It was such a small thing,” I said.  “I’m not even sure that I recognised its significance at the time.  And yet it changed my life for ever.  And I never looked back.”

Back to Cliff Michelmore in the studio.  And that’s Tonight for tonight.  The next Tonight will be tomorrow night.  Good night.

I still await my Damascene experience.  Yet oddly enough, by some strange act of grace. I’ve recently been freed from this notion that I am condemned to fall short, that I am always, like Richard Carstone in Bleak House, about “to begin the world”.  I owe a debt of gratitude to Medicine, and its daily practice.  If I had to do it all again – would I do it differently?  Flawed as I was, I did it differently the first time.  And now?

Next year, Jerusalem.

Somebody asked me the other day for an example of an oxymoron, and I suggested, “Safe sex.”

Oxymoron oks-imo’ron, n. a figure of speech by means of which contradictory terms are combined…

Safe sex is, in my opinion, the oxymoron of our time.  I was sharply reminded of this fact on Friday when I saw a letter in The Herald headlined “The decision to allow abortion pill at home must be stoutly defended”.  The letter had 17 signatories, each one acting in a stated official capacity (giving the letter an air of authority), and the signatories’ address was given as Marie Stopes UK, c/o 18 Ashwin Street, London.  The letter was a response to news that the Society for the Protection of the Unborn Child (SPUC) intends to mount a legal challenge to the decision of Scotland’s Chief Medical Officer, Dr Catherine Calderwood, to enable women, for whom it is clinically appropriate, to take Misoprostol – the pill that completes an abortion – at home.  Dr Calderwood’s decision has been supported by Lord Steel who of course was instrumental in introducing the Abortion Bill in 1967.

Misoprostol is taken twice.  At the moment, patients receiving the treatment have to attend hospital twice.  The result of this arrangement is that women may well start to abort while travelling on the bus.  It is legal for women to take misoprostol at home but only if they have suffered a spontaneous miscarriage.  However this does suggest that home administration is medically safe.

I can’t think that SPUC has a case here.  The thing is, once society has concluded that termination of pregnancy is, under certain circumstances, a legitimate medical procedure, surely the issue as to where the procedure is carried out diminishes in importance.  I can only imagine that SPUC take issue with the notion of home administration because it may appear to afford the procedure of termination of pregnancy a certain casualness.  One takes misoprostol as one might take emergency contraception (the morning-after pill) – now available without prescription – and one takes the morning-after pill as one might take the pill.   No doubt SPUC will be aghast at this sentence in the Herald letter: “Abortion is vital, routine healthcare that around one in three women will experience in their lifetime.”

I was very surprised at that statistic.  Given the weight of 17 signatories, I imagine it must have an evidence base.  It does rather suggest that contraception, as a public health initiative, isn’t very successful.

I suppose it is a little perverse of me to be discussing abortifacients on the day of a Nativity.  This is the time of year when the aggressive secularists can be particularly strident – angels, wise men, virgin births – I ask you!  I hadn’t thought to blow the dust off my viola and play at the annual ceremony of lessons and carols, but J is very persuasive and I was there.  What can the idea of a virgin birth mean?  I refer you to Hugh MacDiarmid’s enigmatic poem O Wha’s the Bride?

Wha didna need her maidenheid

Has wrocht his purpose fell.

Every birth is a virgin birth.  Birth, and continuity, in the face of the second law of thermodynamics, is the most extraordinary miracle in all creation.

I think the greatest change in social mores I have seen in my lifetime has been in the attitude towards sex.  Contraception became available in 1960 and termination of pregnancy in 1967.  Of course the 60s is thought of as a time of great sexual liberation. The 60s spawned “the permissive society”.  It was perceived as a time of great freedom because the pill annulled – for those who partook – the possibility of pregnancy, and antibiotics provided a sure-fire treatment for sexually transmitted diseases such as gonorrhoea, syphilis, and chlamydia.  Herpes was not yet recognised to be the nuisance it was, nor human papilloma virus, and HIV was yet to be invented.

I imagine it must be difficult for young people now to imagine life as it was for us in the 60s.  To fall pregnant out of wedlock at that time was a great disgrace.  The options available to people in that situation were limited.  Termination of pregnancy was illegal and, unless one had money and connections and were able to travel abroad, extremely hazardous.  I recall in Glasgow in the mid-60s there was a home for unmarried mothers on the corner of Clevedon Road and Clevedon Drive in the west end of Glasgow.  I know this from two sources, first because for a time my family lived 200 metres from the home, and second because my school pal Billy was the son of the people who ran the place.  I just remember seeing on my daily walk to school heavily pregnant young women standing at the street corner smoking a cigarette, looking as if a truck were about to run them over.

Much of this backdrop came to my mind this week when I met up with a dear friend of mine who has two daughters currently making their way in the south of England.  One of them recently had a date with a young man who, following the assignation, was disposed to ask, by text, for feedback.

Feedback?

Feedback?

Do you suppose the feedback was to be in free text or were a series of highly particular points pursued?

1. Initial greeting.  Was the gentleman warm and welcoming or was he cold and evasive?  Answer 1- 10 – 1: very cold, 10: very warm.
2. Preliminary chat. Did he deftly deal with any unforeseen social awkwardness and did he make you feel at ease as the evening commenced?  Answer 1- 10 – 1: very awkward, 10: at ease.
3. Did he give you free rein to peruse the menu or did he, in the style of a foodie Fascist, tell you what to eat? (Answer 1 – 10 – 1: Fascist, 10: liberal.)
4. Was he polite towards the “wait person” or did he treat them with complete disdain? (1 – 10 – make it up.)
5. During the meal, was he completely absorbed with his own preoccupations or did he show genuine interest in your own passions?
6. If something untoward happened in the vicinity, say somebody at the next table with Tourette’s kept shouting ****! – was he discombobulated?
7. You had an entirely unpredictable reaction to the fish entrée requiring the emergency attendance of paramedics and the administration of epinephrine and steroids. Was he supportive?
8. Did he betray a sense of revulsion when you threw up?
9. Did he try to kiss you?
10. Did he pay?

On the subject of osculation I have some observations.  There can be no doubt that the whole dating scenario has become extremely hazardous for the young man.  Given that a member of parliament might be faced with the accusation, “He put his hand on my knee 25 years ago”, how is a young man to proceed?  I am only reiterating something a very charming young lady in a bikini said to me the other day in the sauna in my local gym.  She was supine on the sauna’s upper tier when I entered, but she quickly sat up.  I said, “Do not derange yourself on my account,” but she insisted, and we went on to have an interesting conversation.  She said, “I’m not sure what the health benefits of sauna might be”, and I, “I’m not sure there is evidence of any, but so long as you don’t stay in too long, it’s very pleasurable.”

“Of course, if we were in France or Germany, we would both be naked.”

Aye aye.

But on the subject of kissing, I seem to recall Jeremy Vine did a piece on his show in which he posed the question of whether it would be appropriate for a chap to ask permission of his date to kiss her.  There seemed to be general agreement that such a strategy would be liable to kill spontaneity stone dead.  This all reminded me of the Merchant Ivory film of E M Forster’s A Room with a View.  Lucy Honeychurch, an upper-middle class English girl played by Helena Bonham Carter, is on holiday in Italy, where she encounters, in the same pension, one George Emerson, played by Julian Sands, whose passion for her she initially abjures.  Lucia is a pianist of some ability and when a parson, played by Simon Callow, hears her play Beethoven’s Appassionata Sonata (or as it the Waldstein?), he says (I paraphrase), “If Lucy lives as she plays, then we may expect fireworks.”  We have the sense that Lucy is repressed by convention.  She has a suitor, Cecil, played by Daniel Day-Lewis, who becomes her fiancé, and who, enraptured by her performance of Schubert, attempts to kiss her and only succeeds in dislodging his glasses.  Contrast this with George who, seeing Lucy on a flower-strewn Italian hillside, is moved to embrace her and unsolicitedly kiss her with great passion.  That this scene should be accompanied by Puccini’s Chi il Bel Sogno di Doretta gave it an emotional power I am incapable of expressing.

Was he right to risk it?  The fact of the matter is this: if it’s welcome, it’s right; if it’s not welcome, it’s awful; and that is the essential dilemma a young man faces, and why the entire enterprise is so filled with dread.  Young men understand instinctively that there is no such thing as safe sex.  People who try to peddle it are just bizarre scout commanders and matrons of an adolescent boot camp introduction to “sex”.

E M Forster wrote a brief epilogue to A Room with a View in which he tried to envisage how the characters would be some years down the track. I think Lucy’s husband George went on to have an affair, but then there was a war on. Beethoven being German got a poor press.  I recall Peter Cook and Dudley Moore doing a sketch about Beethoven.  Dudley Moore was a young pianist playing the Moonlight Sonata.

“That music you are playing, Jeremy, is by Beethoven…

“Beethoven was German…

“That’s something you are going to have to work out…

“Later on.”

Jeremy needn’t have worried.  Lucy’s failed suitor Cecil assures us; Beethoven was Belgian.

 

 

 

 

Got a phone call from my West Highland agent.  “James!  I’ve got a treatment for your next book.”

“Make your pitch.”

“Landfill.”

“Is it a sequel to Skyfall?”

The movie trailer voice-over was rendered in an impossibly deep, gravelly, mid-Western tone.

The ocean depths spawned the kraken;

Transylvania sent us the undead;

Martians visited us from the red planet;

And from beyond our galaxy, our worst nightmare…

But now looms a new threat

Stirs a creature of our own making

Yet, beyond our imagination,

Here with us, now

Beneath our feet…

Landfill.

He dropped the accent.  “What d’you think?”

“It’s a million dollars.  Run with it.  Kerching kerching.  But listen.  It’s your Landfill, not mine.”

“There’s something down there, I know it.”

“Of course there is.”

“Miramax will snap up the film rights.  It’ll be huge.”

“Ace in the hole.  Cash in on it.  You don’t need me.”

“I need you, James.  You can do this.”

“Yes I could do it, but it would become a spoof.  And let’s face it, it’s no laughing matter.”

I’m rather concerned about landfill.  I’m trying to take my recycling more seriously.  We have five rubbish bins – green: paper and cardboard; blue: plastics, cans, and cartons; brown: garden waste and foodstuffs; blue box: glassware; and grey: non-recyclable items, that is, landfill.  Four of the receptacles are each in their own way rather picky and fastidious.  Green: no plastic bags or bubble wrap, polystyrene, wrapping paper, or disposable cups; blue: no hard plastics, batteries, or electrical items; brown: no non-organic material; blue box: no broken glass.  But grey bin: the grey bin has a capacious maw and will seemingly take anything.  Now I don’t think that’s right.  In an ideal world we wouldn’t need a grey bin at all.

I’m actually short of a brown bin at the moment.  Last April it vanished.  I suspected, uncharitably, that somebody in the street had nicked it, but I guess it could just as easily have been swallowed up by the refuse disposal van.  Anyway I phoned the council at the time.  “Rest assured, Dr Campbell.  We will put a new brown bin by your door.”  It hasn’t appeared.  I phone them periodically. “Oh yes we have logged your calls.  This is quite unacceptable.  I’ll get this sorted for you.”  This saga has been running for eight months.  I even offered to drive in and pick a brown bin up but that is, apparently, out of the question.  My trouble is I’m too polite and self-effacing.  “Sorry to bother you.  I’ve been on the phone a couple of times.  Would it be possible to chase up…”  I need to take some lessons from movers and shakers who know how to put a rocket under somebody.  “Aye yes Dr Campbell here.  No no no – you see, you don’t understand – this has gone way beyond a joke.  Your name?  How do you spell that?  Who’s your line manager?”

But I’m not really irate, more fascinated in a sickly way.  I’d quite like to get to the bottom of the process that is currently going on, or not going on, to understand the cause-effect relationships.  I suspect there is a management protocol at work.  It will be in the form of a digital algorithm, with multiple potential steps to be taken.  Perhaps I’m half way down a cascade shaped like a Christmas tree.

So what have I been doing in the interim?  I’m afraid some of my organic detritus has gone into landfill.  I may well be the route-cause of the next great apocalyptic cataclysm to threaten mankind.  I’ve also manifested cuckoo-like behaviour and furtively added my detritus to the neighbours’ brown bins.  I don’t like to do this because I myself get irritated when people top up my grey landfill bin.  Last week I got home and opened the bin at the kerb to see if it had been emptied, only to find somebody had stuffed in a child’s pram.

My other option is to drive seven miles to my nearest local tip.  That’s fine – visiting the tip does have a recreational side.  I’ve heard it said – doubtless this is fake news – that some east-end Glasgow families regard a visit to the tip as a great day out.  My particular tip is run by a wonderfully helpful if somewhat taciturn wee man.  He is a Dickensian character.  He has an office that he has personalised and turned into a snuggery by decorating it entirely with stuff that was intended for landfill.  Several times he has stopped me on my way to the last skip on the lot and said, “That’s a lovely piece!  Can I have that?”  He is like that character in Our Mutual Friend who is responsible for an enormous mountain of dust.  Our Mutual Friend must be the definitive study of the relationship between money and rubbish.

Of course the other option I have as yet not succumbed to is fly-tipping.  I stop short of that.  I don’t approve of litter.  Yet I come from a city that has a litter culture.  I was standing at a traffic light in Glasgow not so long ago beside a guy who was eating kebabs out of a polystyrene container of the sort that I can’t put into my green or blue bin.  (I could empty the contents into the brown bin, if I had one.)  When the wee green man came on he dropped his entire half-finished dinner on the road and crossed.  I know he was completely oblivious to the idea that this might be a failure of civic responsibility.  If I had taken issue with him he would have been completely gobsmacked.   Oddly enough, I have the notion that if I’d berated him as rudely as possible, he would not particularly have minded.  I might have said, for example, “Oh for ****’s sake Jimmy what the **** d’you think you’re playing at?” and he would probably have taken it as banter, shrugged, and walked on.  On the other hand, if I had taken him to task in an elaborately polite way – “Excuse me sir, I hope you don’t mind my interrupting you, but I think you’ve dropped something.  Would you mind picking it up and depositing it in that receptacle, handily sited for the purpose?” – then I would be in deep trouble and there would be a raucous and potentially violent stand-off in the middle of the road, to the blaring horns of the traffic trying to get by.  Incidentally, I have heard the actor Nigel Havers is on a mission to get people to cut their car engines while sitting in traffic.  Discharging CO2 emissions and diesel particulates is after all another form of littering.  Apparently Mr Havers taps gently on the driver’s door and says, “I’m terribly sorry, but would you mind…”  I would strongly advise Mr Havers not to bring his mission – at least in that form – to Glasgow.  Saying that, if anybody could get away with it, Mr Havers could.  I could even imagine kebab-man looking bewilderedly at him and then stooping to pick the remnants of his dinner.

Litter culture is an index of a lack of self-respect.  And a littered city is like a man who is down on his luck, a professional man who begins to descend the social scale and who loses interest in his personal hygiene, dress, and appearance.  But I daren’t be pompous and sanctimonious about this.  The fact is that homo sapiens is by nature a litter-lout.  Kebab-man merely does in an overt and honest fashion what we all connive to do in secret.  I can’t think that we really take our waste disposal seriously.  We just spill waste into the air or chuck it into the sea or stuff it under the earth and try to forget about it.  I particularly worry about my blue bin – plastics.  Remember The Graduate and the conversations between Benjamin and his parents’ grotesque friends.

“Ben!”

“Mr Maguire.”

“Ben.”

“Mr Maguire.”

… “I’ve got one word to say to you, Ben.”

“Yes sir.”

“Are you listening Ben?”

“Yes I am sir.”

“Plastics.”

A lot of plastics are very non-biodegradable.  They hang around for aeons.  They go everywhere.  You can recover them in the gut of fish.  These small deposits are called nurdles.  Have you ever made yourself a cup of coffee, and a sliver of plastic from the milk carton-top drops into your Americano?  That is a nurdle.

I propose that we take this waste disposal business much more seriously.  We could make it our aim to reduce all waste products to their constituent elemental parts.  That would be a high-tech operation.  It would involve the best brains in physics and chemistry turning their minds to how to detoxify the world.  People who collect and manage waste should be regarded with a degree of deference and respect.

But I’m conscious that there is an element of absurdity attached to the bourgeois habit of hand-wringing at the parlous state of the world.  Last week I chanced to come across Conversations with Menuhin (William Heinemann Ltd 1991).  This is a celebration of the great violinist’s 75^th birthday, and is a protracted conversation between Menuhin and David Dubal, a pianist on the Juilliard School faculty in New York.  It is in two parts: Part 1 on music and musicians (intensely interesting) and Part 2 on music and life (intensely amusing and not in a good way).  Menuhin and Dubal seem in broad agreement that, even in 1991, the world is going to Hell in a hand cart and there is precious little we can do to stop it, that everything is being driven by the carnal instincts of the mob whose insatiable desire for gratification is turning the world into a gigantic rubbish tip.  Popular culture is ghastly.  Interestingly, Donald Trump gets a mention.

Nigel Kennedy does a wonderful impersonation of Menuhin, capturing his horror at Kennedy’s attempt to introduce him to the delights of Heavy Metal.  “Oh Nigel…”

I read Conversations with Menuhin with an inappropriate sense of mirth.  I was reminded of a character in Woody Allan’s film Hannah and her Sisters, Frederick, played by Max von Sydow.  Frederick is an artistic European intellectual living in New York.  He has a Svengali relationship with Lee, a beautiful and much younger woman played by the wonderful Barbara Hershey.  Ms Hershey’s character has benefited much, culturally, from the relationship, but you can tell it is coming towards its end when von Sydow launches into a great diatribe about the state of the plebeian world, and Ms Hershey says, “Lighten up Frederick.”  Frederick gets terribly upset when he realises he is about to lose her, and who could blame him?

It’s a thankless task, being a profit of doom.  It’s almost built into the role, the expectation that nobody will listen to you.  The classical world understood this.  Cassandra was cursed never to be heeded.  People who are pessimistic about the future are dubbed “Jeremiah”.  It doesn’t really matter if you are right; you will always be thought of as an odd ball precisely because you put yourself apart from the relentless onrush of the Gadarene swine.