Author: jamescalumcampbell

Brian Quail is back in jail.  The redoubtable 79 year old CND pensionista and former Glasgow Schools Latin teacher was arrested for his part in a peaceful demonstration outside the nuclear arsenal at Coulport.  I’m not sure what the charge was.  The last time he was in court it was on a charge, ironically enough, of breach of the peace.  He halted the progress of a nuclear convoy by lying down on the road in front of it.

This time his trial is set for August 3^rd.  He was offered bail, on condition that he agreed not to go within 100 yards of Faslane or Coulport.  He said he was unable to give this guarantee; consequently he is currently languishing in HM Prison Low Moss, from which he sent The Herald a letter, which appeared in the Letters Column on Thursday.  It is, as ever, beautifully written.  Mr Quail belongs to a movement, Trident Ploughshares, which condemns Trident as being manifestly illegal and morally reprehensible.

On July 7^th the United Nations agreed a draft treaty banning nuclear weapons.  122 states signed up to it, but this did not include any of the nine recognised nuclear powers.  Despite the fact that Winston Churchill advised us that to jaw-jaw is better than to war-war, the UK did not even turn up for the UN treaty negotiations which ran between 27^th  to 31^st  March, and from 15^th June to 7^th July.  (This goes a long way towards explaining why Mr Quail is a supporter of Scottish Independence.  The SNP would remove Trident from Scottish waters and Mr Quail believes there is no viable harbour for it anywhere else in the UK.)  So far as I could see, UK mass media gave the UN negotiations scant coverage.  I didn’t see anything about it on the BBC.  I am fortunate to be kept informed by my sources in CND and, indeed, Low Moss.

Mr Quail is widely respected.  He said himself that the police who arrested him treated him with the utmost courtesy, and I imagine that the judge who sent him down did so with the greatest reluctance.  Yet, with respect to hawks and doves, the hawks are winning the debate.  People who go on CND marches are a bunch of bearded vegans in sandals, admirably idealistic but hopelessly naïve.  Sir Michael Fallon’s arguments carry the day: we effectively use Trident round the clock because every day it functions as a nuclear deterrent.  This is why it is being upgraded, in order to provide us with defence for the next half century.

Well, there has been an impasse between the hawks and the doves for the past 72 years, and I guess this blog isn’t going to make a whit of difference.  Yet can I move the debate forward one Angstrom?  It seems to me there are two preconceptions about the pro-Trident camp that are widely accepted as being true but which are, under scrutiny, fallacious.  The first is that those who are pro-Trident are supporters of multilateral nuclear disarmament.  That this cannot be true is demonstrated by the fact that the UK government did not send representation to the UN conference.  I have the General Assembly’s ten page document in front of me now.  “United Nations conference to negotiate a legally binding instrument to prohibit nuclear weapons, leading towards their total elimination.”  Anybody truly seeking a nuclear-free world would have gone to that, if only to highlight difficulties in the path ahead.  But the current British government has no intention of relinquishing the Bomb.

The second misconception is that in some sense the hawks are really doves; they are only bluffing.  The interviewer says to the Defence Secretary, “Sir Michael, why are you spending vast sums of money on a weapon you can never use?”  And Sir Michael, who is a very plausible man, replies, “On the contrary, we use our deterrent every day.  Every day our submariners are on patrol, our shores are protected.”  Hence the Bomb’s use is not in its deployment, but rather in its state of readiness.  So when Mrs May was asked in the House if she would be prepared to deploy the weapon, she immediately and unequivocally replied, “Yes.”  This was widely understood not necessarily to be a statement of fact, but rather a necessary utterance without which the entire Trident project must collapse.  In order for the deterrent to work, a potential enemy must believe that you are prepared to deploy the weapon.  So it helps to project a swashbuckling persona with more than a hint of instability and unpredictability.  The nuclear power which from our viewpoint carries off such a coup-de-theatre most effectively must be North Korea.  Whether their possession of a long range ballistic missile and their imminent perfection of a deliverable nuclear warhead makes their country safer (as apparently Trident makes us safer) is another matter.

We don’t know whether or not the PM is bluffing because we are not privy to the contents of her directives to the Trident submariners, the “letters of last resort”.  Is it not outrageous that in a parliamentary democracy the future – or otherwise – of the entire planet should be at the whim of a single individual who need not communicate let alone debate her decision with anybody else?

Yet I have a sense that it matters not one whit whether or not the PM is bluffing.  Events develop a momentum of their own.  If the payload, and the means of delivery, are held in readiness, then the deployment becomes merely a matter of time, either by accident or design.  We witnessed the same thing in 1914.  A planned mobilisation was simply put into effect.  The inevitability of war was merely subject to the vagaries of railway timetables.  In our present case, all you need is a rapid deterioration in international relations, and the sense that a nation state is facing a supreme crisis.

But we already knew that the Bomb is not a bluff.  Just ask the hibakusha.

The London Proms have returned.  Over the course of the weekend, the Berlin Staatskapelle played Elgar’s First and Second Symphonies under the baton of Daniel Barenboim.  It is always a pleasure to hear a great non-British orchestra under a great non-British conductor play Elgar.  Somehow all the barnacles of tradition and convention are stripped away and you hear the music first-hand, afresh.

When I was a schoolboy the Scottish National Orchestra under Alexander Gibson undertook an Elgar season.  What a revelation it was.  Yehudi Menuhin, who famously recorded the violin concerto in 1932 with the composer conducting, performed to a packed house.  I was standing at the back.  Nowadays, the only violinist who fills the hall in Glasgow like this is Nicola Benedetti. (She’s playing Shostakovich in the London Prom on Tuesday).  Menuhin, ever a generous man, was actually playing in a slum.  In 1962 somebody threw away a cigarette following a boxing match in St Andrews Hall and the magnificent edifice, all but the façade, went up in a puff of smoke.  That it took the City Chambers twenty eight years to replace the hall is a dark stain on the record of the city fathers who for decades told the populace what was good for them and in the latter half of the twentieth century created an asphalt jungle of concrete flyovers and underpasses heading nowhere.  The trams and trolley buses had already vanished.  Sauchiehall Street conveyed nothing but tumbleweed.  Of a Saturday evening I would take the electric train from the west end along a deserted Clydeside dominated by a huge empty and derelict granary.  At Charing Cross I would alight and head for the river across a mud bath where the pile drivers were gouging out the future M8.  Stranded in this blighted landscape stood the Gaiety Cinema where the SNO had become refugees.  I imagine Menuhin must have been reminded of Paris in 1944 when he returned to the newly liberated city to resurrect culture.

In that same season, Jacqueline du Pre was to play the Elgar Cello Concerto but she was indisposed.  (Might this have been the start of her tragic and debilitating illness?)  Andre Navarra stood in at short notice.  I remember the spike of his cello kept slipping!

The First Symphony made a huge impression on me with its opening A Flat theme, nobilmente.  I was sitting next to a pal of mine who ostentatiously opened his copy of The Daily Record I think in some vague protest against the British Empire but even he let the paper slip to the floor.  What else did the SNO play?  I remember the Introduction and Allegro for Strings, Falstaff, and the Variations on an Original Theme, Enigma, the enigma being that Elgar never told us what the original theme was.  It’s like Fermat’s last theorem, a tease.  Elgar liked such mysteries.  He inscribed the score of the violin concerto “Aqui esta encarrada el alma de…” (Here is enshrined the soul of…)  Of who?  I remember Sir Michael Tippett conducted Enigma.  I was sitting in the front row, barely six feet from him.  He was very moved.  He actually sang all the variations as he conducted, from Nimrod to the end.

Daniel Barenboim came on the Andrew Marr Show on Sunday morning principally to talk about an up-coming concert in aid of research into Multiple Sclerosis, the condition that thirty years ago took away his wife Jacqueline du Pre so cruelly.  He spoke very warmly of the Proms, of its attentive audience and particularly of its adventurous programming.  This certainly struck a chord with me.  In an age when “bums on seats” are so important, and when many orchestras’ subscription series can be very conservative, and repetitive, the Proms seem to be able to fill the vast capacity of the Royal Albert Hall every night with music that can be extremely audacious.    On Sunday night, for example, Elgar 2 was paired with the UK premiere of Sir Harrison Birtwistle’s Deep Time.

The mood of Elgar 2 is quite unlike any other piece I can think of.  In many ways it harks back to Beethoven’s Eroica Symphony.  Both are on a vast canvas; both in E flat; both have a funeral march in the second movement.  Both have some connection with disillusionment.  Beethoven was disillusioned with Napoleon declaring himself Emperor.  In the Elgar the sense is more abstract.  There is a wistfulness, a profound nostalgia for something that is being lost.  Elgar lingers for a while, in a coda perhaps reminiscent of the close of Brahms 3.  The rendition on Sunday night was beautiful.

Then something extraordinary happened.  The Staatskapelle played Pomp & Circumstance March No 1 as an encore.  It was extraordinary because they had already done the same on Saturday night.  It was as if they were hijacking the bill of fare of the Last Night, and divesting it of its jingoism.  As if to underline a point, Maestro Barenboim made a speech – another Last Night tradition.  To be honest, it’s a bit of a cliché, to say that in a fractured world music has the healing power to bring people together.  But is it true?  Didn’t the Nazis purloin the music of Richard Wagner for their own nefarious purposes?

It would be no exaggeration to say that Daniel Barenboim is the preeminent musician in the world today.  I think of him as having assumed the mantle following the untimely death of Lord Menuhin in 1999.  His work with the West East Divan Orchestra has put him in a position, like it or not, of moral leadership.  He has taken the orchestra to Israel, and to Palestine.  He wants to take them to Tehran.  Now, it seemed to me, he was wading into the Brexit debate.  He is worried about the parlous state of the world, about religious fanaticism, and, in a European context, about isolationism.

But what exactly was he saying?  He said he wasn’t being political, a remark that elicited some ironic laughter.  His solution to the problems of the world?  Education.  (Tony Blair would have said education education education.)  He might have said coffee bars in book shops.  His remarks ended up as runic and enigmatic as any quotation Elgar might have inscribed above his score.  I think I prefer the Shelley quote Elgar put at the head of his Second Symphony.

Rarely, rarely comest thou, spirit of delight.     

Saturday.

To digress immediately, have you read Saturday, by Ian McEwan?  Of which more anon.

Day 7, post aura, and I awake migraine-free.

It started last Sunday morning while taking a shower, a rather abrupt onset of frontal headache, shortly followed by a disturbance in the left visual field.  That is unusual for me; usually the visual disturbance precedes the headache.  Then I developed a left upper quadrantic hemianopia – I lost a quarter of my visual field altogether.  I noticed it while watching the Andrew Marr Show.  If I focused on Mr Marr I lost the paper reviewers completely.  I didn’t panic.  I just self-diagnosed migraine and swallowed two paracetamol.

Generally I find the visual disturbance lasts about twenty minutes and then reverts quite suddenly to normal.  In Click, Double-Click, Dr Alastair Cameron-Strange suffered a classical episode.  On Sunday my hemianopia was slow to resolve and then was superseded by two further discrete episodes of aura, shimmering wavy lines and “fortification spectra”.  The headache persisted.  I still entertained the notion of sitting at the back of Dunblane Cathedral but by 10 am I had abandoned this ambition and, by 11.30, with the onset of nausea, I had made a phone call to cancel lunch in Glasgow.  I then spent a miserable day lying on a couch with a bucket parked beside me.

My migraine attacks are infrequent and usually mild.  Sometimes they consist of little more than 20 minutes’ aura then the dullest of headaches.  If I’d been born a woman, I would not have been able to take the combined oral contraceptive pill; it would have been “contraindicated”, not because of the migraine, but because of the aura.  By the way, the charismatic Professor of Family Planning at UCL, John Guillebaud, describes a clever method of deciding whether or not sufferers of migraine should take the pill.  You sit directly opposite the patient and ask her about her vision.  If she lifts up one hand and flutters her fingers, don’t prescribe the pill.

The last time I had anything as severe as this was in 1984.  I was a GP registrar in Edinburgh.  It came on after morning surgery.  My boss sent me home at lunchtime, and with great kindness actually carried out a home visit on me that evening.  Earlier that year when I was a paediatric senior house officer I was similarly sent home at lunchtime with, I’m ashamed to say, a hangover.  These were the only two occasions when that happened, and indeed I have been incredibly fortunate in that throughout my entire medical career, knock on wood, I never took a day off owing to sickness.  I had a week’s compassionate leave in 2005, and again in 2008, with the passing of my parents.  There is something of a tradition in medicine of dragging yourself into work because if you don’t, you know your hard-pressed colleagues are going to have to absorb even more pressure.  This probably isn’t very wise.  Maybe a doctor with an upper respiratory tract infection dispenses more harm than good.  I used to get episodes of acute low back pain and would take about an hour to get up in the morning.  I would conduct morning surgery looking like a half-clasped knife.  I wonder if I didn’t gain some perverse satisfaction in observing that I looked much worse than some of my patients.  Interestingly, now that I no longer practise, I don’t get any back pain at all.  Maybe it was all psychosomatic.

Monday was almost as miserable as Sunday.  But I never seriously entertained the notion that migraine might be a misdiagnosis, that this might be something more sinister.  Like most doctors I am in a state of denial; illness is something that happens to other people.  There is a famous image of a world-famous cardiologist who was found dead in his hotel bedroom at a medical conference, with a bottle of antacid sitting on the locker.  Of course he had had a myocardial infarction.

Some doctors don’t like headache.  It presents a diagnostic dilemma.  Which headaches are benign and which sinister?  We call the majority of benign headaches “tension headaches” which I suppose implies they are caused by – well – tension, maybe tension in the musculature of the head and neck, or psychological stress.  It may or may not be so.  Medicine is full of instances of attributing low-echelon symptomatology to guesswork without much of an evidence base.  Irritable bowel, lumbago, chronic fatigue…  Maybe it would be more honest if we were to put our hand up and say, “I don’t know what’s causing this, but I can tell you what it’s not.”  So I was pretty sure my prolonged headache was not due to meningitis, subarachnoid haemorrhage, or a brain tumour.

Or at least I was pretty sure, until this week I read Admissions, A life in Brain Surgery, by Henry Marsh (Weidenfeld & Nicolson, 2017).  I’d already read and greatly enjoyed Mr Marsh’s Do No Harm, so when I stumbled on Admissions in Waterstones Dunfermline, I snapped it up.  I notice that Mr Marsh acknowledges his wife Kate for coming up with the title.  I like its ambiguity, referring as it does not only to hospital admissions but to admissions, nay confessions, of remorse, regret, and guilt.  Believe me this is very unusual in a doctor.  I have heard senior consultants at Morbidity & Mortality meetings pay lip-service to the need for honesty, humility, and candour in owning up to professional error, and then proceed to lead by example in presenting the biggest load of sanitised, cosmetic eyewash you could imagine.  It’s rather like the old job interview chestnut, “What is your main strength, and your main weakness?”  Those who are groomed for high office know to present a main strength, followed by another main strength, disguised as a weakness.  “I’m very impatient.  I need to learn to listen to others, to try to understand where they are coming from.”  Yadda yadda yadda.  Candour is professional suicide.  “I’ve got a tremor.  I find alcohol helps.”  I don’t think so.

Mr Marsh is extraordinarily candid. Admissions is a series of reflections on a lifetime of neurosurgery by a surgeon on the cusp of retirement.  And what a roller-coaster ride it is.  Triumph and tragedy, at home and abroad.  He writes with great vividness.  I’m not surprised there is an endorsement on the sleeve from Ian McEwan – “a great achievement”.  Ian McEwan’s novel Saturday describes a fictionalised day in the life of a neurosurgeon.  Mr McEwan has always been interested in professions, and the wider lives that professionals lead.  I imagine Admissions must have seemed a rich seam to him.  Descriptions of Kathmandu, Ukraine, and a decrepit lock-keeper’s cottage in Oxfordshire are as vivid as those of awake craniotomy, the medicolegal world, and the domination of the NHS by absurd managerial pseudoscience.

For me, the narration of events in theatre, ICU, and on ward rounds are the most vivid.  Mr Marsh is not always kind to himself.  He describes an episode of visiting a patient post-operatively in ICU to find that somebody had inflicted him with a nasogastric tube.  He asked the nurse to remove the tube but the nurse refused because it contravened some written protocol.  Mr Marsh lost his temper and assaulted the nurse.  He does not come out of this episode well, and he knows it.  (I couldn’t help wondering, why didn’t he just remove the tube himself?)  I’m not sure that I would have enjoyed working for him.

Yet his humanity shines through.  It takes an extraordinary personality to be a neurosurgeon and to inhabit this dark world in which so much can go wrong and so many outcomes are bleak.  Of all the specialties, there is surely none so bizarre as neurosurgery and there can be no activity as extraordinary as that of literally entering somebody else’s head.  In undertaking awake craniotomy, that is, carrying out brain surgery on a patient who is not anaesthetised, Mr Marsh asked his patient if he would like to see his own visual cortex on the television screen.  (My dentist even looked dubious when I asked to see the wisdom tooth she had just extracted.)  To look at your own visual cortex is to look at yourself looking at yourself, a metaphysical experience, I imagine, akin to inhabiting a hall of mirrors where your own image recedes endlessly to infinity.  The patient looked and said, “Crazy!”

Much of Mr Marsh’s memoir is an intimation of his own mortality and a contemplation of the inevitability of failing faculties and a running out of time.  So.  All week I was weak as a kitten, waking each morning to a dull nagging headache, and moving in the obtunded twilit world of the migraineur.  Did I have the dismal terminal diagnosis of one of Mr Marsh’s patients?  I gave myself the piece of advice I have given patients thousands of times: “I think we should hold our nerve, and keep a watching brief.” And here we are, Saturday, and I am well.  But it did cross my mind – one of these days, I will suffer an illness from which there will be no recovery.  I’m not dwelling on it.  Mr Marsh professes to be terrified of dementia, partly because his father developed it.  I’ve never seen much point in trying to predict the future, other than in a ribald way.  I think of myself in the care home, disinhibited, making inappropriate advances to the nursing staff.  “That’s enough of that, Jimmy.  Just keep your hands to yourself, you old lech!”  My experience of looking after “the worried well”, ever vigilant for the approach of the grim reaper and trying to cut him off at the pass, is that they seldom see the direction from which he comes.  Best just to take each day at a time, and live it with faith, hope, and love.

Yet I did find myself wondering, if I were to receive a sudden call, should I have any abiding regret?  Would it be regret of a sin of omission or of commission?  Should I try now to rectify it?

One thing.

But of this I cannot speak.  I’m not admitting anything!

 

Do you give alms to the poor?

Sometimes I do.  Not always.  If I were to distribute largesse at every opportunity travelling east on Princes Street or Sauchiehall Street, by the time I had reached, respectively, Edinburgh’s Balmoral Hotel, or the Glasgow Royal Concert Hall, I should be bankrupt.  There is an argument that, faced with a huge and intractable problem, there is no point in carrying out an individual act, because its effect on the overall problem will be indiscernible.  The counterargument is that the effect on the individual who is helped is tangible, and therefore worth doing.

Some people think the problem is factitious.  These people sitting on the pavement, perhaps shrouded in a cowl, accompanied by a snoozing dog, with an empty polystyrene cup in front of them, with a message of helpless abandonment scrawled on a piece of cardboard – well, maybe they’re skivers, working under the tutelage of an overseer organising a corporate scam, much as a bevy of prostitutes might be overseen by a pimp.

When I was a medical student in Edinburgh I was once accosted by a tramp (I have a notion that terminology might be politically incorrect but it was the patois of the time) in Nicholson Square.  Nicholson Square was a meeting place for tramps.  It was a stone’s throw from Edinburgh Royal Infirmary. I particularly remember Mr Black, alias Mr Green, a tramp who would occasionally present to the Emergency Department with an acute medical problem.  He would be admitted, sorted out, and discharged to resume his former vagrant life.

Anyway, this particular tramp said to me, as I passed, “Have you got the price of a cup of tea?”  I said to him, “Come with me and I will buy you your dinner.”  We attended a fish and chip shop and I bought him a fish supper.  He stuffed it in a pocket of his overcoat and as I bid him farewell, he said, “Have you got the price of a cup of tea?”

Around the same time I treated a waif, a street urchin, in the Infirmary’s Emergency Department.  He had no shoes.  I nicked up to the hospital residency and grabbed an old pair of slippers and proffered them to him.  He gave me a look of disgust and said, “I wouldn’t be seen dead in these.”

I was reminded of these and similar memories on July 1st when I happened to visit the newly opened Carnegie Library and Museum in Dunfermline.  It is a splendid facility in a spanking new building beside Dunfermline Abbey.  The Abbey and its ancient environs give the town a medieval feel.  The library has an old-fashioned air.  Good heavens, it’s full of books!  Mr Carnegie opened almost 1600 libraries in the US alone during his lifetime.  His generosity continues.  He gave Pittencrieff Park to Dunfermline.  It is situated directly west of the Abbey, with a deep gorge (“The Glen”) its remarkable geological feature.  Directly above it stands the remains of Malcolm Canmore’s tower.  The king sits in Dumferling toune, drinking the blude-ried wine!  The park is very well maintained.  I imagine that is due to Carnegie‘s legacy again.  In the new museum’s café I sat and read his remarkable essay The Gospel of Wealth.  Agree with it or not, it is a beautifully written piece.  It is a robust defence of Capitalism and an abrupt dismissal of Communism.  It’s basically a piece of advice directed towards rich men.  By rich men he meant people like himself, people of fabulous wealth.  He said, don’t pass your wealth on to your descendants.  That’s just vanity and it won’t do your offspring any good.  He even said don’t give your money to the poor and needy, or at least, not without provisos.  It will merely be diluted and likely as not squandered.  Rather you must do good works.  Give a helping hand not to the indolent but to those who would help themselves.   And don’t merely leave the money in your will for this purpose.  You will have no say in what becomes of it.  Rather, you must spend the bulk of your wealth on public works, while you are alive, so that you bring to the project the same talent that allowed you to accrue all that wealth.  It is disgraceful to die rich.  You can’t take it with you.

In his argument, Carnegie chided a friend of his who gave a quarter of a dollar to a beggar.  Another act of vanity.  He does not advocate “such imitation of the life of Christ as Count Tolstoi gives us.”  The Gospel of Wealth is indeed a new gospel.  I am reminded of Mrs Thatcher’s take on the Parable of the Good Samaritan.  The Good Samaritan was able to help the injured man at the roadside precisely because he was a man of wealth.  I’m always a little wary of invocations of the Parable of the Good Samaritan.  They often shed more heat than light.  On Radio 4’s The Moral Maze about a year ago the issue of how to deal with the influx of refugees crossing the Mediterranean was discussed.  Don’t patrol the waves, ran one argument; it only encourages them!  This inevitably led to an invocation of the Good Samaritan.  You can always tell when The Moral Maze is about to degenerate into a shouting match.  Did the Good Samaritan merely encourage lots of other people to make that dangerous trip from Jerusalem to Jericho?  So who are you in this story, passing by on the other side?  The priest?  The Levite?

I think I’m the man lying injured in the gutter.  I confess Andrew Carnegie paid me through Medical School, courtesy of a Carnegie Trust Grant.  It was my second degree.  I might still have been paying off the fees.  38 years later I was sitting at the back of Dunblane Cathedral and I had an odd moment of epiphany.  The Reverend Macintosh asked the question from the pulpit, “What is that one thing that you need to do, that you have been putting off?”  It was as if the entire cathedral emptied itself so that the minister and I were the sole occupants.  He addressed me across the vast space of the nave.  What is that one thing?  I realised I needed to hang up my stethoscope.  So I visited my accountant – his office happens to be in Dunfermline – and asked if I could afford to quit.  Well, I could.  I danced out of the office and popped into the modest cottage beside the Abbey that is Andrew Carnegie’s birthplace, to pay my respects.  Then I returned to my car in the carpark next to the Abbey and, in a trance, promptly reversed into the BMW parked behind me.

On June 24^th I found myself, serendipitously, on the battlefield at Bannockburn.  I’d forgotten it was the 703^rd anniversary of the battle.  I’m not inclined to celebrate battles but, finding myself in theatre, I paid my respects to King Robert mounted on his huge steed, and read the quotation on the plaque beside the high flagpole with its huge saltire, flapping in a westerly gale.

We fight not for glory, nor for wealth, nor honour but only and alone freedom which no good man surrenders but with his life.

In 1940, Winston Churchill, or George Orwell, could both have said just that, or something like it.  The previous day I had read Churchill & Orwell, The Fight for Freedom by the American Pulitzer Prize-winning author Thomas E. Ricks (Duckworth Overlook, 2017).  A thumping good read, I’d say.   It’s a clever idea – if an unlikely one – to interweave within a single volume the lives and thoughts of two men whose personalities and politics could hardly have been different.  Churchill was implacably opposed to socialism and during the 1945 general election campaign he opined that socialism could only be imposed upon British society by means of a Gestapo; Orwell wanted to create a specifically English form of socialism and to overturn the English ruling class of which Churchill was a member.  Churchill remarked that he had not become prime minister to oversee the dismantling of the British Empire; Orwell since his Burma days conceived of the Empire as a corrupt system of exploitation.   Churchill and Orwell never met, but it seems they had a respect for one another.  Churchill admired 1984; he thought it a remarkable book and read it twice.  The last article Orwell completed and published before he died was a review of Volume Two of Churchill’s Second World War memoirs, Their Finest Hour.  Orwell recognised Churchill’s qualities as a war time leader, particularly in 1940.  He also admired Churchill’s ability as a writer, and in a more general sense, his humanity.

So what common theme links these two disparate characters?  It is their defence of democracy and the liberty of the individual.  This, argues Thomas E. Ricks, is the reason why Orwell and Churchill remain so important to us today.  Democracy and liberty continue to be under attack.

It seems to me that they shared other common features.  Both were distant from their fathers.  Both were dispatched to English preparatory schools where they were miserable.  Churchill described his early educational experience in My Early Life, and Orwell in Such, Such Were the Joys.  Both went to public schools, Churchill to Harrow and Orwell to Eton (where he was briefly taught by Aldous Huxley).  Churchill was rebellious and educationally backward; Orwell was, and remained, an outsider.  Neither attended university; instead, both headed off in directions contrary to their ultimate destinations.  Churchill joined the army and Orwell the Imperial Police in Burma.  Both were men of enormous physical and moral courage.  Churchill put himself in danger so frequently that he really ought not to have survived.  Orwell fought in the Spanish Civil War and sustained a gunshot to the neck from a Fascist sniper on 20^th May 1937.  He too ought not to have survived.  Orwell’s description of this episode is as vivid as Churchill’s description of his part in the British army’s last cavalry charge, at Omdurman on September 2^nd 1898.

Both were heavy smokers.  Eventually, both became, and remained, journalists and authors.  Stylistically, their writings have much in common.  Churchill is wordier and more flamboyant; Orwell is pared down and sparer.  But they both share a dislike of abstraction and redundant phraseology.  Churchill liked “short words and vulgar fractions”.  He berated his subordinates for loquacity and asked for reports to be confined to a single side of paper.  Orwell expressed similar sentiments in his essay Politics and the English Language.  While both could relish beautiful language and vivid imagery, you could never imagine either of them choosing to attend a creative writing course on a literary retreat.  Always their language subserves another purpose.  This is because both were, at heart, politicos.  Churchill might write about painting as a pastime, and Orwell Some Thoughts on the Common Toad, but their writing was never for writing’s sake.  Churchill was never a novelist.  His one attempt, Savrola, rather embarrassed him.  And although Orwell wrote novels I don’t believe he was truly a novelist in the sense that Dickens, another writer with a political conscience, was a novelist.  I think Orwell was primarily an essayist who happened to write two longer pieces which made him world famous.  Animal Farm uses the allegory form and 1984 the novel form but it’s the political message that really matters, just as Churchill’s writings during his wilderness years of the 1930s are dominated by his warnings about the rise of Nazism.

Perhaps what binds Churchill and Orwell most closely is their shared love of England, or their individual conceptions of England.  When the Japanese attacked Pearl Harbour on December 7^th 1941, Churchill was overwhelmed with relief because he knew that the USA would enter the war and that, therefore, England would survive.  The closing paragraph of Orwell’s Homage to Catalonia is deeply nostalgic of a sleepy old England that I daresay some Englishmen would not have recognised.  In The Lion and the Unicorn Orwell admits he might be treading on toes when he conflates England with Great Britain, but he proceeds to do so.  Well, everybody has their blind spot.  On February 14^th 1947 he wrote a piece for the left wing periodical Tribune about Scottish Nationalism.  An extract from it appears in Seeing Things as They Are, Selected Journalism and Other Writings, (Harvill Secker 2014).  Orwell’s hopes for the dissolution of Empire stopped somewhere north of Carlisle.  Yet I like to think that his criticism of the proscription of the Gaelic language in Scottish schools suggests he was embarking on a journey.

Then there are the differences.  Churchill was always a lover of luxury who said his tastes were simple – nothing but the best.  Even when he was at the front during the First World War he had Clemmie send him supplies of delicatessen and enormous quantities of booze.  He was prone to bouts of melancholia – his “black dog” – but on the whole his outlook always remains optimistic; he has a conception of “broad sunlit uplands”.  Can the same be said of Orwell?  Orwell’s world is often grim.  It smells bad.  Orwell seems to have had a heightened sense of smell and his olfactory world is deeply unpleasant.  In this, he follows in a long tradition of scatological English satire going back to Jonathan Swift.  1984 is utterly dark, a dystopian nightmare without remission.  Orwell when he left the Imperial Police deliberately descended into a world of abject poverty in London and Paris, and later in the north of England.  His career choices, if such they can be called, must surely have contributed to his poor health and premature death at the age of 46.  A croft house in Jura in winter could hardly have been the ideal sanatorium for a man with advanced pulmonary tuberculosis.  He was treated in Hairmyres Hospital in Lanarkshire and subsequently in London.  It was a tragedy that he turned out to be allergic to streptomycin and that treatment had to be stopped.

But what really binds Churchill and Orwell together is their attitude to a man neither of them met, Adolf Hitler.  Churchill nearly met Hitler in a Munich hotel in 1932.  The meeting was arranged but it is said that Churchill’s criticism of Hitler’s anti-Semitic views caused Hitler to cancel the meeting.  Orwell was never likely to meet Hitler, although it was highly likely he, like Churchill, was on a list of people to be executed in the event of a successful Nazi invasion of Britain.  In his review of Mein Kampf, Orwell confessed he felt no personal animosity to Hitler, and indeed saw something attractive about him, but he added that if he had ever met him he would have tried to kill him.  Both Churchill and Orwell recognised what Chamberlain and Lord Halifax never recognised, that Hitler was not a man you could negotiate with; he had to be resisted.

The one battle I feel happy about celebrating is the Battle of Britain.  Battle of Britain day is September 15^th.  Nowadays it is rather overshadowed by the commemoration of 9/11.  15/9/40 was the day Goering sent his entire Luftwaffe across to southern England.  Churchill watched the aerial battle unfold from the HQ of No. 11 Fighter Group at Uxbridge under the command of the New Zealander Keith Park.  At one point the entire resource of Fighter Command was engaged and there were no reserves.  It was a close run thing.  This was the day Churchill borrowed Shakespeare’s notion of “the few” from Henry V’s Agincourt speech and used it in his own “Never in the field of human conflict…”  Then he took a four hour siesta.

It is sobering to consider what might have happened in 1940 if the British Government had not listened to Churchill, but rather to the substantial body of opinion from the English upper class, and had sued for peace.  Judging from the way Hitler dealt with the rest of mainland Europe, he would have installed a Vichy-style puppet government in Whitehall, taken over command of the British fleet, and hence the whole of the British Empire.  Joseph Kennedy, the US Ambassador to the Court of St James’s, would have been vindicated in reporting back to FDR that England was defeated.  Perhaps the US would have become even more isolationist.  What would the world have looked like now?

Probably something like 1984.

 

 

 

 

 

Jumped on a tram on Princes Street the other day heading west to Ingliston Park & Ride next to Edinburgh Airport where I’d left my car.  It beats sitting gridlocked in the chaotic late afternoon Edinburgh traffic.  £1.60 single, unless you go one further stop to the airport terminal in which case the fare is exorbitant.  Why are prices so hiked in airports?  One of the great mysteries of life is that everything in Duty Free is much more expensive than everything everywhere else.  Creating the tram lines turned out to be expensive as well.  Bit of a disgrace – like the cost of the construction of the Scottish Parliament.  But at least they both got built.  I confess I’m not a fan of the Parliament building.  It could easily turn into a slum.  I recall Edinburgh’s Old Royal High School, a neoclassical building next to Calton Hill that has been unoccupied for years was mooted as a site for the Scottish Parliament.  One rumour has it that the then Labour government voted against that because the building was too iconic.  Personally I would have gone for Donaldson’s School for the Deaf, a magnificent Grade A listed edifice (Playfair, 1851) in its own substantial grounds in the west end, that’s currently being turned into residential flats.  Meanwhile it has been suggested that the Royal High School now become the new site for St Mary’s Music School.  That would be good.

Anyway, back on the Princes Street tram, there was this guy in a sharp suit standing at the back of the rear carriage conducting a voluble conversation with himself.  Only a few years ago you might have concluded that he had mental health issues, but in fact he was merely taking a phone call on a hands-free system.  He was making expansive bilateral hand and arm gestures which was odd as his interlocutor could not see them, but I suppose he was just absorbed in the conversation.  He had the appearance of somebody making a public address, which, indeed was exactly what he was doing.  He might have been cabin crew on a jet issuing safety instructions.  “The emergency exits are located as shown; be aware the nearest exit might be behind you…”  He must have got on the tram at the York Place terminus or St Andrew’s Square and as we travelled through the west end it became evident this was not going to be a short conversation.  He was clearly in the corporate world.  He seemed to be a senior figure in some kind of international conglomerate.  At first I was mildly irritated that he felt the need to share his business with an entire tram-load of people.  But then I developed a sickly fascination for the whole performance, and I rather hoped that when I alighted at Ingliston – my trip would take about 35 minutes – he would still be talking.  I suppose it was rude of me to eavesdrop, but then I hardly had any choice.  And besides, it began to sound to me like a prose poem in the form of a dramatic monologue, or rather dialogue with one part inaudible.  Francis Poulenc made an opera out of such a scenario – La Voix Humaine, with libretto by Jean Cocteau – in which a woman of a certain age has a long and very painful telephone conversation with an ex-lover.  I heard Dame Felicity Lott give a wonderfully agonised performance.  The conductor was Stephan Deneve.  Maestro Deneve told a charming anecdote about a performance in an opera house.  When the conductor came up from the pit on stage to take his bow, a lady in the audience asked her friend, “Who is that?”  Her friend replied, “That must be the gentleman on the other end of the telephone line.”

Would you conduct a protracted piece of business, mezzo-forte, in a public place?  I wouldn’t.  But then I’m used to sitting in the dining room of West Highland hotels in which everybody speaks to one another in whispers.  You sometimes come across test scenarios in textbooks of medical ethics which pose a problem as follows: you are a junior hospital doctor on an Edinburgh tram on your way home from hospital after a weekend on call.  Your irate consultant phones you because the computers have crashed and he can’t access your record relating to a critically ill patient you’ve just clerked in.  Would you be so kind as to give him a quick verbal summary?  What do you do? A Hang up B Blurt C Give the facts but disguise the names D Say you’ll phone back from home E get off the tram?

The solution is to conduct the conversation using corporate managerial-speak.  Then nobody will have the slightest notion what you are talking about.  This is why I have little compunction about reproducing the monologue of the man in the sharp suit.  Despite the length of the conversation, I could not figure out what goods or service his conglomerate purveyed.  I have an idea it wasn’t something concrete like food, drink, or clothing; but rather something nebulous like – I don’t know… Futures.

…got to be in Stuttgart tomorrow morning…

Yah; yah-yah… yah

Maggie?  Well you know the trouble with Maggie

With Maggie it’s you know, load, fire, aim…

Haymarket, please have tickets and smart cards ready

The thing is the solution’s got to be bottom-up not top-down

Yah

The thing is it should never have crossed my desk in the first place

It’s the sort of thing that should have been cut off at the pass…

Yah yah but I never said that; I never said lower echelon

All I’m saying is she’s skiing off piste   

Murrayfield

So when you chair the eleven o’clock

Put it in Any Other Competent Business

So everyone’s desperate for coffee and it gets kicked

Into the long grass or at least

On to the next meeting when we can

Do a proper workshop.

Yah.  Three sixty feedback plus…

Yah yah yah   

Balgreen… Saughton… Bankhead… the man in the suit paused momentarily to glance across at the Aston Martin showroom… Edinburgh Park Station… change here for main line services… Edinburgh Park Central…  It crossed my mind to alight.  I like Edinburgh Park, a business park that never existed when I was a medical student in this city.  From the tram it looks exactly like an artist’s futuristic impression of an idyllic space with glass buildings fronted by lawns, tree-lined paths and water features, inhabited by strolling Lowry stick figures.  I thought to take a walk past the sculptures of literary luminaries, Edwin Morgan, Norman MacCaig, and my kinsman Sorley Maclean.  Kinsman!  That’s a bit of a stretcher.  My mum’s cousin is Sorley’s brother’s widow.  Sorley was very deep.  He had the persona of a magus.  He and Norman MacCaig were once attending a recitation and Sorley was asked to read one of his poems.  Sorley composed himself, looked upwards, pursed his lips, and cleared his throat in a sonorous way with a series of coughs and groans.  He lapsed into a premonitory silence.  MacCaig gave him a gentle nudge, and said, “Sorley, I think they mean for you to recite aloud.”  I will pause by Sorley’s bust and read a few lines from Creagan Beaga

…south-east of Sgurr nan Gillean

Blaven, and the stainless moon…

But no.  I’m stuck with my prose poem.

…squidgy Brexit.  Could be floppy Brexit

Could be priapic Brexit who knows

Gyle Centre please have tickets…

But we must get the mood music right

More Gordon Ramsay than Gordon Lightfoot

More Oasis than Blur yah

Edinburgh Gateway… Gogarburn

Next stop Ingliston Park & Ride thank God

Passengers not bound for Edinburgh airport must alight here…

The elegant white carriages swished to a halt and I passed out on to the platform, conscious of a vague sense of diminuendo.

But then you see that’s Maggie all over all over again.  It’s her lunar cycle don’t quote me on that…

Yuh.  Yuh…

Yuh

 

 

I’m currently writing a tract On Snobbery.  4,000 words on the slate; I think I’m about halfway.  But it keeps burgeoning; it’s such a vast topic.  Snobbery is everywhere!  I can hardly remember what set me off.  I think it might have been a consciousness of the vast difference in the experience of living in New Zealand and living in the UK.  That’s not to say snobbery doesn’t exist in New Zealand.  But the snobs are fewer in number and for that reason more easily identifiable.  They have an obsolete aura of empire and colonialism about them that make them easier to parody.  Crucially, they are really not part of the mainstream.  The really big difference between NZ and UK is that, while in NZ you can prosper as an individual, in the UK, if you want to get on, you had better be part of a group.  As an Aberdeen gastroenterologist friend of mine puts it, “We hunt in packs.”

My Snobbery tract spends much time and effort trying to identify what exactly snobbery is, so for the purpose of this commentary I will assume that you have a sense that a snob is somebody who is excessively preoccupied with notions of rank or class.  It’s like that famous sketch by the Two Ronnies and John Cleese which took advantage of Ronnie Corbett’s diminutive stature and John Cleese’s height; Ronnie Barker was in the middle.  “I look up to him because… and I look down on him because…”  And Ronnie Corbett would say, “I know my place.”  It’s a quintessentially British sketch; it would hardly make sense anywhere else.

For myself, I’m Ronnie Corbett.  I’m a peasant.  I daren’t say that with any sense of pride or I will be accused of “inverted snobbery”.  Yet I think it’s true.  I think of myself as a churl and a serf.  My grandfather was a dynamiter in Ardeer Factory, working with Irishmen whose method of assessing the concentration of nitroglycerine was to taste it.  They suffered terrible headaches.  My father’s first job, when he left school at 14, entailed going round bomb sites identifying body parts when the manufacturing process went wrong.  It’s health and safety gone mad I tell you.  In the evening he would trawl the Ayrshire beaches collecting “duff”, a mix of sand and coal dust which, with some difficulty, you could burn.  My grandfather on my mother’s side was a publican.  But he was a Gael.  In the Gaidhealtachd, everybody is an aristocrat.

My father was clever.  He was dux of his primary school.  He went on to Ardrossan Academy but he left when he was 14.  I had always understood it was because the family (he was second eldest of seven children) needed him to be a bread winner, but now I don’t believe this was so.  He wanted to leave.  He didn’t feel comfortable in the company of the sons of gentlemen.  But he always retained a great respect for higher education and it was never in doubt that I in my turn would go to university and that I would practise some sort of profession.

Yet I am my father’s son.  I didn’t have much notion of class until I became a medical student in Edinburgh and I discovered most of my classmates had attended private schools.  On the ward consultants would ask me, “What does your father do?”  I was too naïve to realise I was being interviewed for a job.  Over the years I came to realise that people of rank would generally misinterpret my station; they thought I was posher than I really was.  Whether the process of disillusionment was bitter to them I cannot say.

After spending fifteen years in the rough-and-tumble of the Antipodes I was somewhat disconcerted on my return to the UK to find that I was afforded a deference on account of my physicianly status.  People of low rank would take trouble to dress up and look their best for the benefit of the doctor.  Not so the aristocrats; they would come in from their boats and their gardens dressed in rags and covered in mud.  I suppose they thought it was “democratic”.  Actually the fact was, they just didn’t give a damn.

Mr Trump is going to withdraw the United States from the Paris Accord on climate change.  He thinks climate change is a hoax.  It might even have been cooked up by the Chinese to damage the US economy.  He wants to fire up the US coal industry again as part of a strategy to get manufacturing industry in the mid-west rust belt to recover.

There is a stark contrast between Mr Trump’s point of view and that of Al Gore, who lost the presidential election by a hanging chad to George W Bush in 2000.  Mr Gore always had an interest in environmental issues and he went on to devote himself to persuading his country and the world that global warming was real and that we needed to do something about it.  He toured the US to give a series of lectures which are captured in the film An Inconvenient Truth.  Watching Al Gore present An Inconvenient Truth and watching President Trump announce his decision re Paris from the White House Rose Garden, it is clear that both men are consummate performers, each with their own inimitable style.  Mr Gore is rather academic, able to talk to what are known in academic circles as “busy slides”, addressing the meaning of graphs and statistics.  Mr Trump is more interested in the broad sweep of things rather than the nice details; he can hold his audience by a magnetism that is not to be underestimated.

But the question must arise, who is right?  Does global warming exist, and is the activity of mankind responsible for it?  In other words, what is the truth?

To outward appearances it would certainly seem as if Mr Gore has approached these questions with more scientific detachment than Mr Trump.  He has certainly outlined to us, in some detail, the salient scientific facts as he sees them.  By contrast, so far as I’m aware, Mr Trump has asserted that global warming is a hoax, without cogent scientific argument and back-up.  It is certainly a fact that the prevailing wisdom of the scientific community supports Mr Gore’s thesis.  If Mr Trump is privy to scientific arguments counter to the prevailing wisdom, I am not aware that he has laid them out and defended them.

I can’t help wondering what the world would have looked like if Mr Gore had won the US presidential election in 2000.  Some people think he actually did win.  These hanging chads again.  But it would seem that the US electorate vote for the man they would like to share a beer with in a bar.  Mr Kerry ran against Dubya in 2004.  Mr Kerry was a little like Mr Gore in being rather academic.  Good heavens, he speaks French!  Dubya got back in.  Perhaps we witnessed a similar phenomenon with Trump and Clinton: Hilary the Washington patrician and insider, Trump the self-professed man of the people.

The biggest event to occur in the west during this period of history has been 9/11.  Dubya looked utterly perplexed but then he was handed a gift on a plate.  A highly articulate lawyer crossed the Pond and without any need for encouragement became the voice, like Cyrano de Bergerac, for a man who could hardly string two words together.  You can see clips of Dubya behind his podium looking across at Mr Blair behind his podium with a pursed-lipped expression somewhere between bewilderment and gratitude.  It’s said Mr Blair was Dubya’s poodle but if anything it was the other way around.  Blair was miles ahead of the game.  “The kaleidoscope has been shaken…”   Then in 2003 Mr Blair persuaded the British Parliament that Saddam Hussein was such an imminent threat to the UK with his weapons of mass destruction that it was necessary to invade Iraq and remove him.  He won the Parliamentary debate by 412 to 149 votes.  Very few people in positions of influence opposed him.  Charles Kennedy did.  So did Robin Cook, whose resignation speech on March 17^th 2003 was extremely eloquent.  Both men died prematurely.  I also recall Ken Clarke stating in the House, somewhat presciently, that if we embarked on the Iraq war, we would see terrorism in the streets of London.

It seems to me that three of the people I have mentioned, Mr Blair, Mr Bush, and now Mr Trump, shared a common feature.  They had a scant regard for the truth.  They were prepared to interpret the world according to their own lights and to proceed on a course of action without much attention to external reality.  Hans Blix was telling Blair and Bush that there was no evidence of the existence in Iraq of WMD.  Virtually the entire scientific community is telling President Trump that global warming is real, and is caused by us.

We live in a “post-truth” age.  If something confronts us that is not to our taste, we call it “fake news”.  Scientists are belittled.  Not so long ago Michael Gove advised us not to pay too much attention to experts.  The idea that there might be a “truth” out there that is independent of our own imagination and will is seriously doubted.  The world is largely as we choose to see it.  This is the origin of political “spin”.  You disguise the truth by applying a heavy veneer of humbug.  You are like a defence attorney presenting a case you don’t personally believe to be true.  You could as easily argue the other side’s case by, as Mr Blair would say, “deploying other arguments”.  The Princeton University philosopher Harry G. Frankfurt dissects this indifference to external truth in his two wonderful treatises On Bullshit and On Truth.  His great insight on bullshit is that the perpetrator of it doesn’t actually care whether what he is saying is true or not; and on truth, that once you cease to believe in the reality of a truth “out there”, you cease to have any clear notion of where you as an individual begin and end.  In other words, you go a bit crazy.

After the Manchester suicide bombing some people said Jeremy Corbyn had “blamed Britain” for the atrocity simply because he had asserted that the Iraq war had fuelled Islamist extremism.

Duh.

In the middle of May the NHS computer systems throughout the UK came under cyber-attack and as a result, the NHS was temporarily crippled.  I wrote a letter to The Herald, which they were kind enough to publish, suggesting that it is unwise to become too reliant on computer systems.  The computers crash and you can’t function because you haven’t been trained to think from first principles.   Now British Airways have suffered a “catastrophic” IT systems failure resulting in the cancellation of BA flights into and out of Heathrow and Gatwick.  Serendipitously, I had likened a doctor under cyber-attack to a pilot who can’t navigate using compass turns and mental dead-reckoning.  It all reminded me of a piece I wrote in 2006 for Hoolet, the Journal of The Royal College of General Practitioners, Scotland, which I dug out and reread.  It seemed relevant to me.  As I hold the copyright, I reproduce it now.  I haven’t changed a word.

ZEITGEIST

Imagine you have been commissioned to design the front cover for the next edition of Hoolet.  The theme: zeitgeist – the spirit of the age.  The editor asks for an image that will represent for the readership the atmosphere of le nouveau siècle.  What would you choose?  Perhaps, the twin towers aflame?  An iceberg calving off the Greenland coast?  A uranium enrichment plant in Iran?  George Galloway dressed up as a vampire on Big Brother?

I choose a word picture, something I happened to hear on the radio, vivid enough for me to conjure the scene with extraordinary clarity.  It was a description, one year on, by a British tourist who happened to be in a Thai electronics shop on Boxing Day 2004 when the tsunami struck.  One moment he was browsing the shelves, the next he was swimming for his life, to escape from the shop before it was completely engulfed.  There he was – and this is my image – surrounded by floating desk top computers, mobile phones, PCs, iPods, digital cameras, and play stations, thinking, “This stuff is useless rubbish.”

He escaped with nothing but his life.  He needed rest, warmth, shelter, food and drink, and human companionship.  The local people, who had next to nothing, shared with him that which they had.  I have no idea what happened to him after that.  Perhaps he returned to Britain and resumed his job as a sales rep for Hewlett Packard.  But I’d hazard a guess that the experience must have changed his world view, and his sense of the relative value of things.  I do believe his experience has changed mine.

I am not a Luddite.  I remember as a GP trainee in Edinburgh in 1984 going on a distant house call from our practice to Gogarburn.  I made the round trip and got back, only to be given another Gogarburn house call.  I said to my trainer, “Do you think the practice should get one of these portable phones?”  I’d seen one.  It looked like a large brick, the sort of thing John Wayne might have used on Juno, Gold, or Omaha.  My trainer was dubious.  They were expensive, toys for the rich and famous, and Edinburgh was full of black holes where you lost the signal.  So we put the idea on the back burner; I paused for a coffee and signed a few repeat prescriptions that had been hand-written by the reception staff.

How times have changed.  I don’t think very many people in 1984 anticipated the sheer scale of the information technology revolution, its power, and the rapidity of its onset.  And it would be crazy, it would indeed be Luddite, to wish it away.  Apart from anything else, it is just so much easier now than it was in 1984 to book a flight, to withdraw money from the bank, to get an urgent message to New Zealand.  As one of the doctors in our practice said the other day, “We’re going paper-light; there’s no point in arguing about it; it’s coming; all that matters is that we do it right.”

Splendid.  Yet I can’t say I mind when the system crashes.  I say to the receptionist, “The computer’s down.  Thank God.  We’ll do it the old-fashioned way.” And suddenly we all talk to one another a bit more.  A computer outage affords us all a glimpse of our humanity.  There is a little frisson of excitement – you feel the same thing during an electricity power cut.  I’ve always loved power cuts.  The darkness creeps in from outside and you huddle together round the tallow lamps, sharing a kind of underground, blitzy camaraderie.

“That’s all very well,” I hear you say, “but that’s just an indulgence and a conceit.  If you were a doctor in Baghdad and you only had power for two hours every 24, you would be monumentally cheesed off!” And would I also feel the same way if the computers didn’t get up and running again?  I’m not so sure.

The miraculous thing about the medical consultation is that it can be carried out under the glow of a tallow lamp.  It is a beautiful thing.  All you need are the skills – to take an accurate and detailed history, and to carry out a physical examination with little more than your hands, ears and eyes.  Then you need the wit and experience to interpret what you have found and to consider whether you should intervene, and if so, how.  You say to yourself, “What does this person who consults me seek?  What does he need?”

Nothing should be allowed to interfere with the sanctity of the medical consultation.  If the computers go down and as a consequence we find we are unable to do our business, then I think we are in trouble.  I had the misfortune to spend ten hours in Heathrow Airport last December when the departures board suddenly and peremptorily cancelled my connection to Glasgow.  There was no explanation.  I dutifully joined a lengthy queue at the BA information desk and waited my turn.  Still no announcements.  A young man just ahead of me in the line began, politely, yet insistently, to complain to the BA staff that in the age of the superabundance of information, we weren’t getting any.  When I reached the head of the queue I learned that my flight had been cancelled, not because of a mechanical problem, but because of a computer failure; and that the outage did not affect Air Traffic Control, but the ticketing system.  “But I’ve got a ticket!” I waved my boarding pass in the air.  No matter.  I had to rescue my baggage from the carousel, join another queue, and check in to a later flight.  When I got to the head of the queue, I was told I was too early to check my baggage in.

I got home after midnight, and was moved to write a “Disgruntled of Tunbridge Wells” – type letter to The Scotsman disabusing the Roman Catholic Church of its new-found belief that Limbo did not exist; after all I had spent an eternity there.  I could give its precise location: Gate Lounge 5, Terminal 1, Heathrow Airport.

Not long after this – and perhaps this is a tiny example of the way our humanity can be bolstered by an outage – a young man came to see in in the surgery.  After the consultation, he asked me if I had written a letter to The Scotsman.  His father had sent him the cutting with the covering note, “Sounds like this doctor was in the same queue as you.”  It was a Buchanesque experience; Buchan might have written, “My eyes dislimned .”  I suddenly recognised the articulate, vociferous young man who had been ahead of me in the queue.

For most of us I believe it remains the case that when the computers go down our business doesn’t grind to a halt.  Quite the contrary, we feel freed up to get on with our work.  This should at least give us pause, not to unplug the terminals, but to consider how we use the technology and whether our use of it really does improve patient care.  I can’t decide whether the people who negotiated our contract for us were childishly naïve or cynically Machiavellian in throwing a sop to a government bureaucracy obsessed with the achievement of targets through ticking boxes on a computer screen.  I think we all know that many of the measurable parameters deemed to indicate that we perform well are risible in the extreme.  Bring me the most intractable hypertensive patient in the practice and I will get his blood pressure under 135/85 – no bother at all.  He may not be able to stand up, he may be exhausted, nauseous, impotent, and depressed, but he will be normotensive.  Tick the box.  This is what happens when the IT system becomes the business.  It’s a very dangerous ménage-a-trois, a doctor, a patient, and a computer screen.  It is so easy for the doctor to misplace his loyalty within the triangle.

For myself, considering the way things have gone, I find it difficult to separate in my mind IT and childishness.  There are 700 channels on the TV and nothing to watch.  I get 700 emails a month and about 7 of them are worth reading; the rest are either spam, or “fire and forget” blanket directives sent out by the trust to a vast readership.  Travelling by public transport has become a torment not so much because of the grime, squalor, and imminent threat of physical violence, but because of the cacophony of zings and tinkles issuing from the ear-pieces of one’s fellow-travellers, and the mindboggling banality of their one-sided telephone conversations.  Mobile phones have become a sex aid for adolescents with repetitive strain injury of the thumb.  Well, good luck to them.  C U L8R!  St Paul had a word to say about IT:

When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.

Now I think of the patient before me as the man in the Phuket electronics shop, fighting for his life, not waving but drowning.  What does he need?  Certainly not all this cyber-flotsam, impeding his efforts to escape, to be free, to live.

 

 

 

Two highly contrasting visits to Perth Concert Hall last week; on Monday to hear Nicola Benedetti and Alexei Grynyuk play Brahms, and on Thursday to hear English Touring Opera present Tosca.

Not content with playing all three Brahms sonatas for violin and piano (for the first time in one concert), Ms Benedetti prefaced each sonata with extended introductions dealing with the events in Brahms’ life at the time of each composition, the works themselves, and her own response to them.  Following the music, both performers sat down on stage for a thirty minute question and answer session with a large audience whose members almost all stayed behind for the duration.  (There was an amusing interlude when Ms Benedetti told us that her mother was in the audience.  “Where are you, mum?”  Then, with laughter and mock indignation, “Has she gone? I’m offended!”)  It said a lot for a sizeable contingent of very young people, many of them aspiring violinists, that the audience remained in rapt attention throughout.

They are a very class act, Benedetti-Grynyuk.  I’ve heard them play Perth Concert Hall once before, and particularly recall a memorable Beethoven Kreutzer Sonata.  Mr Grynyuk is as wonderful a pianist as Ms Benedetti is a violinist.  Both seem able to conjure from their respective instruments sounds of extraordinary expressivity.  (Sorry!  I sound like a guest on Michael Barclay’s Private Passions.  Sublime, Michael.)

The question and answer session was interesting.  All sorts of queries, from people of all ages.  Ms Benedetti has a rare gift for communication with warmth, sincerity, and entire lack of pretence.  Mr Grynyuk was a man of fewer words but they were well chosen and he had an irrepressible dry wit.  I was particularly struck by Ms Benedetti’s response to a question from a young girl.  “What advice would you give to somebody trying to be a violinist?”

“Do you play the violin?”

“Yes.”

There followed a conversation part private part public.  I hope I get the gist of Ms Benedetti’s reply right.  You have to decide what music, and the violin, means to you.  If you decide to devote yourself to it, you have to do the work.  Listen to your teachers and to all advice, but not uncritically.  Everything you are told has to be absorbed and evaluated by your own inner core.

It crosses my mind that when Nicola Benedetti was 16 she won the BBC Young Musician of the Year, got a recording contract, and embarked on a career.  I recall a remark she once made, that she got a lot of career advice that wasn’t necessarily any good.  She could easily have become enslaved by somebody else’s idea of what she was about.  But she didn’t.  I detect in her an extraordinary inner core of belief and resolve.  I think it was this sense of Truth to Self that she was trying to convey to her young listener.

If the Benedetti-Grynyuk-Brahms combination was inspirational and life-affirming then Tosca was something quite different.  Torture; murder; execution; suicide.  Strong meat, indeed.  I did ask myself, what are you doing here?  I have a phobia of judicial execution.  Grand Opera; honestly it’s too too bloody.  Only the other day I saw Pelleas in Edinburgh (lust, jealousy, abuse, murder) and then Bluebeard’s Castle in Glasgow (poor Judith finds herself married to a serial killer).  A Diva’s lot is not a happy one.

But, let’s face it, Grand Opera for all that it is highly stylized to the point of absurdity, does seem to hold the mirror up to human nature.  Some people think our lives are like a soap opera but on the whole I tend to think of life, public life at any rate, as Grand Opera.  In Grand Opera you are privy to the unfolding of a series of tragic events the protagonists are powerless to resist.  At the end of Act 1 of Tosca, while the Te Deum is sung in the church of Sant’Andrea della Valle, Baron Scarpia, the chief of police, formulates his dreadful plan of destruction and possession.  Puccini’s music is overwhelming.  Scarpia is a complete monster.  He tortures the painter Cavaradossi, plans to execute him and have his evil way with his lover the beautiful singer Floria Tosca.  Yet when Tosca stabbed Scarpia to death on stage I actually felt rather sorry for him.  He was in the grip of some external force of evil and as much a victim as anybody else.  This is the thing about operatic characters; they are playthings of the gods.

Following the purgation of pity and terror, you leave the theatre and resume life in the real world, disconcerted to find youself observing life on “the world stage”, and what you are observing to all intents and purposes resembles Grand Opera.  There is a horrible feeling that the libretto has already been composed; the players are merely acting it out.  John Adams composed Nixon in China.  I bet you somebody writes an opera about President Trump.  I hope it’s like a piece of Gilbert & Sullivan.  Meanwhile I can’t get the close to Act 1 of Tosca out of my head.  The bells, the bells.