Author: jamescalumcampbell

When I was a kid there was a cinema in the west end of Glasgow, the Hillhead Salon, which specialized in what repertory theatres call revivals.  Psycho made a comeback.  Big Jobs said, “Fancy going?”

“It’s an X,” I said redundantly.

Big Jobs took out a pack of Peter Stuyvesant – he had expensive tastes – and expertly flicked up the cigarettes so that they formed a histogram like the pipes in an organ loft.  He deftly snatched a 32 foot diapason between his teeth.  He lit it in one smooth motion.  Ian Fleming would have said something like, “he snapped open the tiny jaws of the Ronson…”  He took in a deep lungful of smoke and exhaled it luxuriously through his mouth and nostrils.

“So?”

Ian had asked his faithful reader, William Plomer, (I was obsessed with Bond) how Vesper might have exhaled.  How d’you get the smoke out of her?

I thought, it’s all right for you, Big Jobs.  You are six feet and 180 pounds.  You’ve looked middle aged since you were about eight.  I’m twelve and I look twelve.  How am I going to get in?  But Big Jobs said it was okay.  He knew the guy at the kiosk.

In these days of glorious simplicity, the British Board of Film Censors had three categories:  U for Universal… anyone could go.  A I think for over twelve with accompanying adult, and X for…well, X.  You had to be over 16.

Why X?  Why not G for grown-ups?  X definitely had a wrong-side-of-the-tracks connotation for us.  At school when we were right we got a tick; when we were wrong, an X.  Taboo.  Verboten.  Perhaps the film distributors, mindful of the lure of the forbidden, bribed the censors to use the term X.

There were two types of X.  Either the film was scary or it was dirty.  Occasionally it was both.  Werewolves, for example, preferred beautiful semi-clad women for their prey.  Psycho started out promisingly dirty and then seemed to go off at a complete tangent and ended up scary as hell.  Young people used to sit in the back stalls for a snog up; it all seems a bit innocent now.  There were seats designed specifically for snoggers at the back of Green’s Playhouse.  They were called “fauteuils”.  You would say to the man at the box-office, “Two, please,” and he would embrace you with a halitotic grimace.

“Fauteuil?”

Pornography on the whole wasn’t on general release.  You had to be in a club for that.  Pathetic old men in raincoats joined up at some fleapit.  If we weren’t tempted to go it wasn’t because we didn’t want to see the movies.  But the idea of being seen queuing with the dirty old men was just too much to bear.

We didn’t all make it into The Salon.  My classmates Big Jobs, Brian and I went, but for some reason kiosk man took exception to Brian.  We’d already decided that we’d live with whatever outcome we got so all we could do was shrug apologetically, leave Brian at the entrance, and pass into the darkness of the theatre.  At least he’d saved himself 1s 9d.  I envied him.  I’d much rather have gone to see North by Northwest.

There are three big frights in Psycho.  The immortal shower scene of course.  Then the long silent ascent of a detective up a stairway.  Finally the encounter with the remains of Norman’s mother.  There was a lot of hype about Psycho so to an extent you knew what was coming.  What must it have been like to go to the premier and not know to brace yourself?  After Janet Leigh’s character is murdered there is a long and essentially silent scene when the camera pans across her dead visage as the blood trickles down the plug hole.  It is curiously calming.  Catharsis, the purgation of pity and terror. You can imagine the first audience in the theatre auditorium, buzzing, almost laughing hysterically, and then gradually calming down.  Whatever next?

I had known what was coming, but I wasn’t prepared for the terrible violence implicit in the Bernard Hermann score.  The shifty, unsettling theme of the opening credits and of Janet Leigh’s exhausting drive through the night rain did not prepare you for these high-pitched squawking staccato down bows and the great fortissimo hammer blows in the lower strings.   I thought to myself, what the hell are you doing here?  You know you’re of a nervous disposition!  I stole a glance at Big Jobs.  He was lighting another Stuyvesant.  He was thoroughly enjoying himself.

Quatermass and the Pit.  Ever since that poor man in East London went back into the capsule unearthed in the London underground station to collect his spanner, and his world went berserk, I’ve been a nervous viewer.  When the policeman went into the derelict building in Hobs Lane and felt some malevolent presence, I felt it too.  A for Andromeda, The Big Pull, The Scarf.  Even The World of Tim Fraser was a bit spooky.  I watched from behind the sofa.

But there was one thing I couldn’t watch, and I discovered it with Knock on Any Door, a story about a young man drifting from juvenile delinquency to serious crime and eventually, inevitably, to the Chair.  Live fast, die young, and have a good looking corpse!  Even a defense attorney as eloquent as Bogey couldn’t get him off.  “Knock on any door, and you’ll find a Nick Romano…”  So handsome Nick combs his hair for the last time, and, surrounded by his implacable gaolers, takes that last walk down the long corridor to the blinding light in the doorway at its end.  I wasn’t just scared; I was phobic.  The first sign of a noose, a gas chamber, or device attaching you to the national grid and I’m out of there!  In Glasgow there had been a man named Peter Manuel who had broken into houses and shot people in their sleep.  He had been one of the last people to be hanged at Barlinnie.  A colleague of my father’s had been present at his demise and he said it had been terrible.  But I didn’t want to know. There was no way you could dramatise judicial execution without its horror spilling over into real life.  I preferred to watch Perry Mason, because he always won his case.  The defendant was safe.  You wondered why the DA’s office bothered to give Hamilton Burger the brief, why they bothered to take a statement from Lieutenant Tragg, when they knew Mason, his secretary Della Street, and his private detective Paul Drake were on the case. The credits rolled by against the backdrop of a pile of old law books.  Lex Angelicorum.  The music was hard, noir, inviolable, the music of jurisprudence.

Pah pah paaaaaaah…. Pa PAH!  

Other noir TV sound tracks are forever etched on the memory.  The Dick Powell Show.  The music was an American version of a British Imperial March of the style of Elgar or Walton, with a spacious and eloquent maestoso melody preceded by a rhythmic, edgy, syncopated allegro.

Pa pa pah!- pa pa-ra Pa-rah!

  Pa pa pah! – pa pa-ra Pa-rah!

  PAH! PAH! Pah! Pah…

Hollywood Noir conveyed the sense that civilization in America was the thinnest veneer.  The good and the true were vastly outnumbered.  Nothing had changed from the days of the Wild West.  High Noon is the great exemplar of a notion that has been attributed to Edmund Burke, that in order for evil to prevail, all that is required is that good men do nothing.  So Garry Cooper trawls his way around town looking for deputes, and the good men do nothing.  Even Grace Kelly, for all that she looks great, isn’t much help.  By the time he has exhausted all the possibilities, Cooper is on a suicide mission.  Why didn’t he quit and get out of town?  Did he have a death wish?  Was it fortitude? Was he resolved to do the right thing come what may?  Was it, as Grace saw it, sheer bloody-mindedness?  Could he not bear the shame of acquiescence?

All of the above.  One thing’s for sure, he didn’t do it for love.  By the time he’s through, Cooper has shot up the men he hates and anybody who is still alive he despises.  They crawl out of their shuttered houses obsequiously and he turns his back on them and rides out of town.  Even his relationship with his bride is scarred – who knows – irreparably.

Extraordinary figures, these big stars of Hollywood in the golden age.  Cooper, Fonda, Wayne, Stewart, Peck.  Who compares with them now?  Cooper seemed to radiate an extraordinary moral power.  He could convince you he was a man big enough to face insurmountable odds, and win through.  It was a recurring theme in American culture, this notion of one brave individual versus the bad guys, with no help from his erstwhile tepid spew-thee-out-of-my-mouth friends.  The hero was sympathetic because he didn’t go out looking for a fight.  He didn’t seem by nature to be braver than any of the rest of us.  In fact, he was rather vulnerable.  He had sensitivity.  His enemies mistook it for weakness.  That was their mistake.  Capone v Ness.  Robert Stack played Ness on the TV.  Like Richard Greene playing Robin Hood on this side of the Pond, Stack had the demeanour of a bank manager.  The ordinary man in extraordinary circumstances.  He alone stopped Chicago from sliding into complete mayhem and anarchy.  The booze factor was almost a side issue.  It was all about power.  The saloon cars with the duckboards screeched around town and the machine guns went ratatatatatatat and the man in spats lay in a puddle of his own blood in the gutter.

Frank Nitty!  A dirty death for a dirty man!

Power, wealth, and sex – these were the ingredients of Hollywood Noir.  These were the driving forces, the things that made the American world go round.  And the women were worse than the men.  Look at Barbara Stanwyck in Double Indemnity. The ultimate femme fatale.  What chance did poor Fred McMurray have?  At least he plugs her in the end.  It’s like Macbeth.  There doesn’t seem to be any possibility of redemption for anybody.  Even Edward G Robinson, on the side of right, is a strangely amoral figure, a virtuoso of insurance law, devoted to the aesthetic of his calling for its own sake. Fred loves him, hates him, respects him, fears him.

“Straight down the line, Keys!”

It was a terrible vision.  It seemed to be at odds with one’s personal experience.  The psychopaths at school numbered less than a handful, shared more or less equally between staff and pupils.  If somebody got seriously out of line and, say, stabbed somebody in the toilets, the police would come and there would be an expulsion and the headmaster would say, “So-and-so had to go.  He was seriously interfering with the activity of the vast majority of our pupils who come to school to learn and who just want to get on with their work.”  And it seemed to be true.  Most of the time the school seemed to function, not because of any evident manifestation of tyranny, but by a mutual consent.

Yet maybe the Hollywood Noir vision was true.  Maybe it was all on a knife edge and all this civilisation of ours could collapse in a minute.  It had happened before.  Had it not happened that way in Germany between the wars?  In the land of Bach, Mozart, Beethoven, and Schubert, the gangsters had taken over.  Could it happen here?  If it were to start happening, would I recognise it? And if I did, what would I do?  Would I keep my head down and feather my nest (there’s always somebody making money out of a war), or would I, for sheer cussedness, be Garry Cooper?

I asked my father, a policeman, about villainy.  After all, confronting villainy was his calling.  Were we all wicked?

My father said, “There are two kinds of villains; there’s the needy, and there’s the greedy.”  That rings truer than ever.

 

 

 

 

 

 

Last week a friend said to me, “Have you read Robert Harris’s Conclave? I couldn’t put it down.”  It’s an irresistible recommendation.  I got a copy (Hutchinson, London, 2016) and read it.  My friend was quite right.  The book exercises a compulsive grip upon the reader.  The action takes place behind the locked doors of the Sistine Chapel over the course of 72 hours, and concerns the election of a new pope.  118 cardinals are present, and there are a series of ballots during which the field is narrowed down until a leader emerges.  “Habemus papam.”   It is not so much a whodunit as a who’s gonna do it.  I didn’t think that I could get particularly exercised about a papal election, but the various candidates, as seen through the eyes of an individual who himself turns out to be a contender, are drawn with humanity, and I found myself taking sides.  In its attention to detail, the book had clearly been meticulously researched.  Was I surprised at the outcome?  Without introducing a spoiler, I can say the denouement had a sting in the tail that I didn’t see coming.

I fell to wondering about books like Conclave that grip us.  To say of a book, “I couldn’t put it down”, suggests a compulsion to read bordering on addiction.  Now that I have completely run out of shelf space at home, I’m clearly a book addict.  A bibliomane.  Is there such a word?  My bijou cottage resembles not so much the local village library as an asylum for a sufferer of Diogenes Syndrome.  So in the management of my book repository I have introduced a rule; if I acquire a new tome, I must pass on an old one.  (Having read Conclave I did try to fob it off on somebody who, on hearing my blurb, said, “Not much sex, then?”) You think of the remark “I couldn’t put it down” as a recommendation but the strange thing is that it is precisely this sort of book which, once laid aside, you don’t pick up again.  Such books are read linearly, and once.  You wouldn’t dream of skipping to the last page because foreknowledge of the outcome would remove the motivation to read.  By contrast, the books that you keep on your shelves are the ones you want to pick up and reread over and over again.  They may not need to be read chronologically, even first time round.  There is joy to be had in picking up such books and reading a chapter at random.  The books we revisit are written in beautiful language over which we wish to linger.  In addition, their individual chapters often have a stand-alone quality; the mastery of the whole work of art resides in the fact that it is made up of a series of entities that simultaneously work autonomously and contribute to the whole.

I’m conscious of these issues as I find myself this week nearing the completion of my draft of the next troubled instalment in the life of Dr Alastair Cameron-Strange.  It has 27 chapters and is a little longer than its predecessors.  I’ve striven to give each chapter an autonomous life, to avoid writing a chapter which merely moves character A towards a destination without pausing to admire the view.  I guess I’m less beguiled by the notion of a reader compelled to rush to the end, and more intrigued by the thought of the reader content to read one chapter a night, and sleep on it.

At any rate, I’m nearly there.  Time to stop setting alight the rough drafts and creating all that black smoke.  Time to send some white smoke up the chimney.  Habemus librum. 

This happened one Christmas an age ago, in another galaxy.

I had repaired to my office with a copy of the Annual Proceedings of the Medical Protection Society – a bulky document with an appropriately black cover – to read a few salutary tales of medical mishap, misadventure, miscalculation, misbehaviour, missed diagnoses, and occasional miscarriages of justice.  A large number of the episodes described had occurred in hospital emergency departments.  We were a high risk area.  These vignettes were post-mortems, metaphorically and also sometimes literally.  They resembled the reports of a civil aviation crash inspectorate; by their detached regard for the truth, they could be brutally frank.  And ‘pilot error’, of one sort or another, was a recurring theme.  I read the reports and would feel a familiar crawling sensation in the pit of my stomach.  I would think to myself, “I’ve done that.”

One particular report I found almost unbelievable.  And yet the details had the starkness of authenticity about them.  A thirty year old man had come to a hospital emergency department complaining of chest pain.  He had been seen by a young doctor who had made a diagnosis of ‘dyspepsia’.  The patient had been given some antacid, and discharged. Shortly afterwards (the scene had been reconstructed following the hearing of evidence in a court of law) two hospital orderlies had approached the young doctor.  “Hey doc, remember that young guy with the chest pain you sent home?  Well, he’s dead.  Collapsed behind the steering wheel of his car a couple of hundred metres up the road.  But don’t worry.  We’ve turned his car around.  It looks as if he’s driving towards the hospital, not away from it.”  So the doctor had gone ahead and destroyed all evidence of the patient’s visit to the hospital – demographics, patient file, chest X-ray, ECG, lab results.  The memory banks were erased.  The patient no longer existed.  He had never existed.

I developed sweaty palms when I read that, and I thought about that wretched young doctor.  Had he conducted himself honourably he would, no doubt, have been rapped over the knuckles.  He would have been censured by the General Medical Council, perhaps severely.  He might have incurred public humiliation.  But he would have survived.  Not now.

There was a soft knock on my office door.

“Come in!”

Delegation of two.  Mike Ruddell and Sandra Cunningham, two orthopaedic house surgeons.  “Sorry to interrupt.  Could we ask your advice?”

“Take a pew.”  Was this a clinical matter?  I noticed they weren’t carrying any notes or X-rays.  I knew them vaguely as two first year doctors who worked on the same team together, and I had an idea they were an item.  They were both about twenty three.  Mike was dark and studious looking, while Sandra had shoulder length red hair, freckles and mischievous eyes.  For a moment they looked as if they sought counselling.  Perhaps they needed the morning-after pill.  I said, “What’s up?”

“We need your advice on a ‘turf’.”

My interest waned.  “Oh yes?”

“Which service in this hospital looks after cellulitis?”

“You ask difficult questions.”  I closed the MPS disaster file.  “Let’s see.  Mondays, Wednesdays, Fridays… orthopods, unless there is no evidence of bone or joint involvement, in which case it goes to the general surgeons.  Tuesdays, Thursdays, Saturdays… plastics.  Sundays alternate.  If, however, there is evidence of an underlying disease process, for example diabetes, it would go to the physicians.  Then there are special cases.  A periorbital cellulitis generally goes plastics.  But if there is ocular involvement, it would go to the ophthalmologists.  On the other hand, if there were cerebral involvement, it might go to the neurosurgeons, but some of these patients are so sick they end up with the Intensivists.  Simple.  What’s your problem, exactly?”

Mike and Sandra exchanged glances.  “Can we run the case by you?”

“Go ahead.”

Mike presented the case.  “We admitted a twenty five year old man on to the ward last Wednesday.  A Mr Cart.  Ronald Cart.”  The hint of a smile played on Mike’s lips.  “A motor mechanic.  He presented with a hot red right upper limb and a temperature of 38 degrees. Examination revealed a large cellulitic area over the flexor surface of the right arm extending from mid-forearm to ten centimetres above the elbow.  His hands were the typical hands of a mechanic, dirty, callused, with cracked fingertips in various stages of disrepair.

“We stuck him on the ward and put him on intravenous antibiotics.  The temperature came down overnight.  Ordinarily, at this stage, we would have sent him home on oral antibiotics.  But we noticed some abnormal neurology of the right arm.”

“What abnormal neurology?”

“Wasting of the intrinsic muscles of the right hand, with some motor loss, about four-fifths.  Proximal muscle bulk seemed okay – maybe a subtle power loss.”

“Perhaps related to pain?”

“Well, that’s the funny thing.  The cellulitis wasn’t painful.  Mr Cart demonstrated this by pinching the area.”

“And he didn’t feel it?”

“He felt it.  It just didn’t bother him.”

“Anything more on that?  What had Mr Cart himself noticed?”

“Actually,” said Mike, “he had a rather strange complaint.  When he went into the fridge for a cold one he had to use his left hand.  If he used his right, he couldn’t decide which beers had been chilled.”

“Interesting array of symptoms and signs!  What did you decide at the morning ward round?”

“Unfortunately,” said Sandra, chipping in for the first time, “the boss didn’t see him.  We had sent him for a repeat X-Ray of the right arm because we thought we could see a foreign body in the cubital fossa.  So Mr Cart was down at X-ray during morning rounds, and the boss missed him.  Actually the X-ray was normal – the ‘foreign body’ was just an artefact.”

“So what happened next?”

“Well, on the basis of what we told him, the boss decided to hold on to Mr Cart and investigate him.”

“Who’s the boss?”

Mike mentioned a name.

I gave a low whistle.  “The Incandescent Light!”  It was absurd to feel intimidated by the mention of a name, but I had an image of a small, compact figure swaggering down the main hospital corridor with the glaring, crazed eyes of the occupying dictator marching down a deserted Champs-Elysees.  “If you think The Incandescent Light is ferocious now,” elderly Charge Nurses used to tell me, “you should have seen him twenty years ago.  Remember the time he beat up his House Surgeon because he couldn’t remember a patient’s haemoglobin…”  Of course, I realised, The Incandescent Light would investigate Mr Cart.  He would, if necessary, bleed Mr Cart dry to get to the bottom of Mr Cart’s problem.  He would not hand Mr Cart over to another service unless it was absolutely necessary and in particular he would not ask for nor expect any input into the management of the case from the physicians, for most of whom he had scant respect.  Poor Mr Cart!  Which was the lesser of two evils, to put up with a dodgy limb or be subjected to the full brunt of The Incandescent Light’s investigative and therapeutic zeal?  I silently transmitted my thoughts to the patient.  “Mr Cart, I don’t know you, but self-discharge now, while you have a chance.  Take to the hills – with a chilly bin of cold ones.  You can still gauge the temperature with your left hand…”

I said, “So what investigations have you done?”

“Full blood count, ESR, blood cultures, urea and electrolytes, liver function tests, calcium, phosphate, alk phos, urate, albumen, Rheumatoid Factor, Antinuclear Factor, Anti-DNA antibody, urinalysis, syphilis serology, you name it.”

“Turn up anything?”

“Everything is essentially normal.”

“How about radiology?”

“Upper limb normal.  Chest X-ray normal.  Cervical spine, normal.”

“Did you get thoracic inlet views?”

“Looking for cervical ribs?  Yes, we did.  No extra ribs.”

“So what else have you done?”

“The Incandescent Light came to see him on Friday, but unfortunately he missed him because we had sent him for some electrical studies.  Myography.  He left instructions for him to have a CT – head and neck – at the beginning of the week.”

“So has he gone home for the weekend?”

“No.  Incandescence wanted him to stay on the ward, in case he was developing a cervical stenosis, and ‘went off’.”

“How has he been over the weekend?”

“Much the same.  Three to four on five global right upper limb power loss with associated muscle wasting.  Sensory changes.  Loss of reflexes.”

“Signs all unilateral?”

“Yes.”

“Any neuro signs higher up?  Bulbar palsy?  Horner’s Syndrome?  Balaclava helmet sensory loss?”

“No.  What are you thinking of”

“He’s got classical dissociative sensory loss – loss of pain and temperature sense, with preservation of light touch and, presumably, proprioception.  I don’t say it’s pathognomonic, but you have to consider syringomyelia.  What does The Incandescent Light think?”

Mike nodded.  “He thinks it’s got to be syringomyelia, too.  Just on the basis of history alone.  He still hasn’t seen the patient.  He came in to-day, but we got the chance of fitting Mr Cart in for the CT this afternoon.  Radiology offered us a slot.”

“What did the scan show?  Was it helpful?”

“Equivocal. The head scan was normal.  The radiologists thought there was cervical enlargement and maybe evidence of a syrinx, but they weren’t prepared to be categorical, and they said it could all be within normal limits.”

Sandra said, “That brings us up to the present.  He came in on Wednesday.  To-day is Sunday, and we think it’s time he was turfed from our service.”

I shrugged.  “So turf him.  Turf him to the neurosurgeons.  What he needs is an MRI scan.  You need to know whether he’s got an Arnold-Chiari malformation.  Get the scan, confirm the diagnosis, and get him across to neurosurgery.”

Mike and Sandra looked at one another.  Mike said, “Thought you might say that.  That’s what we think.  That’s what The Incandescent Light thinks.  There’s only one problem.”

“What’s that?”

“It’s Mr Cart.  He doesn’t exist.”

*

Ronald Cart was a little Yuletide diversion that had got out of hand.  His name was a bastardisation of Rene Descartes, the French Philosopher and mathematician who had attempted to establish a solid foundation for all human knowledge based on the cogito.

Cogito ergo sum.

There was collateral invested in Ronnie.  Mike had bet Sandra one bottle of fifteen year old Laphroaig single malt whisky that he could present a figment of his imagination on the ward round of Thursday, December 19^th, and keep the figment alive until Christmas morning.  It had been planned that, during the customary Christmas ward revelries, Mike would reveal to The Incandescent Light that Ronald’s empty bed had always been empty, and that Ronald had never been to X-ray, Myography, CT, or any of the other venues to which he had been hurriedly despatched whenever The Incandescent Light was sighted on the ward.  And they would laugh – this at least was the plan – at the recollection of how the morning round had repeatedly assembled with due gravity round the foot of Ron’s bed, studying the factitious temperature chart.

It was a good, imaginative scam.  It would have been easy if the boss had been a physicianly elder statesman who spent large tracts of his week out on the golf course.  The Incandescent Light could, of course, be as much of an absentee landlord as any of the other eminent wise men of the hospital, but he was not, as far as I knew, a golfer.  I knew he was a workaholic whose whole life was tied up in hospitals, theatres, wards, clinics, and medical committees.  He started early in the morning and worked late into the night.  His movements were unpredictable and he was often seen prowling the hospital corridors in the wee small hours.  He would have taken in all the information he had been given on the airy Mr Cart, he would have forgotten none of it, and, if asked at any stage, he would have been able to tell you what particular investigation was pending, and what the likely diagnostic possibilities were.  It occurred to me that specialist registrars and nurses on the ward must have been brought in on the act.  The Incandescent Light would quite likely have phoned the ward at three o’clock in the morning to ask how Mr Cart was progressing.  So how would he take it when he found out he had been duped?  I couldn’t imagine.  I had never seen The Incandescent Light smile.

I said to Mike, “I wouldn’t care to be on your ward on Christmas Day when you tell the old man, but now that he’s sanctioned an MRI scan, I should say your Laphroaig is in the bag.  Merry Christmas.”

But Mike was shaking his head.  “No, no.  You don’t understand.  I’ve already conceded the Scotch to Sandra.  We need to turf Mr Cart.  We need to get rid of him and we need to get rid of him now!”

“Why?”

By way of reply, Mike delved into his pocket and produced a wad of computer printout paper.

“What’s that?”

“It’s the monthly budget for the ward.”  He flicked through some pages.  “This is the cost of the investigation of Mr Cart thus far.  If you add up hotel services, treatment for the cellulitis, lab work, scans etc. etc., you reach this figure.”

It was a substantial five-figured number.

“If we go ahead with magnetic resonance, we arrive at this figure.”

It was a very substantial five-figured number.  For the second time during the conversation, I gave a low whistle.

“If The Incandescent Light finds out about this,” said Mike, “there will be hell to pay.”

“But surely this is just a paper exercise.”

“No!  We have spent the money.  It’s gone.”

“Well where has it gone?  Who has it?”

“I have no idea.”  Mike’s understanding of the microeconomics of the hospital was as thin as mine.  “It seems to have vanished, down a great entropic sink.  So you see, Mr Cart mustn’t have that MRI scan.  We’ve got to cut our losses and run.  We’ve got to turf him.”

What an absurd predicament.  I idly fingered the pages of the black-covered Medical Protection Society publication I had lately been reading.  It occurred to me that Mike and Sandra’s little difficulty was exactly the opposite to the nightmarish case report I’d just read, concerning the young man with chest pain whose records had been systematically annihilated without trace.  There, it had been as if a man of real flesh and blood had been swallowed up and lost in an amorphous Soviet Gulag.  He had been a real patient of whom there was no record.  On the contrary, Mike and Sandra’s creation, the figment, Cart, was an imaginary patient with an embarrassing superabundance of annotation, an exuberant profusion of recorded data that had assumed an independent life and was now reproducing itself with promiscuous abandon.  All over the hospital, and throughout the connected network of the Area Health Board, the name Cart was steadily gaining substance as the laser printers spewed forth his credentials.  Could he be stopped?

I said to Mike and Sandra, “Do you like Soviet symphonic music?  Shostakovich?  Prokofiev?”  Mike gave me an impatient shake of his head.

“Prokofiev composed a symphonic suite based on the Russian tale of Lieutenant Kije.  Do you know it?  The Russian Tsar was reading a report from an army officer which contained a sentence beginning ‘Lieutenantki je…’, which means, ‘The Lieutenants, however…’  He misread it as ‘Lieutenant Kije…’ and took it to refer to the name of an army officer, Kije.  In order not to frustrate the Imperial pleasure, the Tsar’s military commanders-in-chief had to create a Lieutenant Kije, and furnish him with a biography, much as you have done with Mr Cart.  As a matter of fact, the army ended up in just the sticky situation you are in.”

“And what was their solution?”

“They killed him off.”

Mike pursed his lips.  “What are you suggesting?  A motor vehicle accident?  A fall?  A heart attack?”

“Definitely not.  That might go as far as the coroner.  There would certainly be a post-mortem.  No.  The solution is simple.”  I took a form of self-discharge from my pocket – I have the habit of carrying one around with me.  “Get Mr Cart to sign himself out, against medical advice…”

It was as if a cloud had suddenly evaporated from above Mike’s head.  His face broke out into a serene smile.  He said, slowly and meaningfully, “That is perfect.”

And it was perfect.  It was a perfect solution because if there was anything to make an archetypal psychopathic orthopaedic surgeon lose interest in a patient, it was a form of self-discharge against medical advice.  The Incandescent Light would quietly and irrevocably take offence.  If Mr Cart was not going to be grateful for the service offered, then he could bloody well take himself out of the hospital, and take his precious self-discharge form, and stuff it up…

And the bed clothes would be changed, the name of Cart erased from the blackboard in the doctors’ office.  The electronic record would be despatched with a click of a mouse to some virtual repository on cloud nine, and any paper notes sent back down to the bowels of the hospital records department.  With any luck, no inquisitive eyebrows would be raised at the cost of keeping Mr Cart for five days prior to his departure, and the alarming cost of Mr Cart’s upkeep would be lost amid the details and complexities of a host of other expenditures.  The Incandescent Light would deliberately and unforgivingly erase from his mind all thoughts of Mr Cart and his condition and, with any luck, that would be that.

Mike looked at me squarely.  “Thanks for that.  It’s a brilliant turf.  A self-turf, back to the community.  I owe you.”

“You do.”

Thus Mike and Sandra went off with the self-discharge form to forge the signature of Mr Cart, as it would be written in a hand that felt nor hot, nor cold, nor pain, thus to placate their Tsar.  And I returned to reading more Gothic medical horror stories, absentmindedly whistling the Troika from Lieutenant Kije by Prokofiev, who died on March 5^th, 1953, the same day as Stalin.

 

 

 

On Question Time from Torquay (BBC 1, February 9^th), the panel was asked, “If one of your elderly relatives was admitted to “A & E” tonight, how confident would you be that that person would get a bed, or stay on a stretcher?”  This pointed question soon promoted a general discussion about the parlous state of the NHS.  Owen Smith put that down to underfunding; Billy Bragg identified reducing hospital bed numbers as a cost-cutting exercise; Ann Widdecombe thought increased funding was not the answer; we needed a “grown-up” debate, on how to fund Health – but she didn’t actually say how she thought Health should be funded.  Claire Perry agreed with Ann Widdecombe.  She thought the NHS shouldn’t be a “political football”; she also thought 30% of the patients attending emergency departments didn’t need to be there.  Peter Whittle thought Health and Social Care needed to be integrated, and that moneys could be redirected from the overseas aid budget in order to help with funding.  Even the chair had a view.  David Dimbleby considered the typical left-right political posturing as represented by the panel to be sterile.  The prevailing opinion from the floor was that the NHS was poorly managed by an inflated bureaucracy.

The whole debate seemed to generate more heat than light.  There was a general expression of apprehension and anxiety that one’s putative elderly relative might end up languishing for many hours on a stretcher.  But what I found remarkable about the discussion was that, while there was general consensus that the NHS is in trouble, not one single concrete initiative was proposed.  Not one.  If for example, you want to spend more money on the NHS, you might say precisely how much more you wish to spend, and what precisely you want to spend it on.  If on the other hand, you think the NHS needs reform, you might make a suggestion as to what a reformed NHS would look like.  If you think the NHS has to offer the public a different product, you might wish to describe what this new product would be.  You might even wish to scrap the NHS.  There was none of this.  In other words, it has to be said, the standard of debate was very poor.

But it’s hard to see how it could be otherwise.  You really can’t begin to organise a health service unless you know a bit of medicine.  The construction of an NHS is an act of integration.  You might ask, how do you manage a patient who presents with a headache?  You can’t begin to answer that unless you know about the epidemiology and pathophysiology of headache, what headaches are benign, what headaches are sinister, can we intervene, should we intervene, and so on.  Then you might ask, how do you manage a patient with chest pain, and again you have to go through all the different kinds of chest pain.  Then you do exactly the same for abdominal pain, back pain, nausea and vomiting, cough, shortness of breath, altered consciousness, auditory hallucinations, suicidal intent…  It’s a huge undertaking.  You can’t begin to make any sense of it unless you immerse yourself in it for a lifetime.  This is why there is some sense in the suggestion that people should indeed not make the NHS a political football.  It would surely be better if the politicians approached the doctors and nurses and said, “What do you need?”

The trouble is, they wouldn’t get a straight answer.  It has to be said, the medical profession lacks cohesion and leadership.  The specialties still operate within their own isolated silos.  Medicine is profoundly tribal.  Interestingly enough, this is most evident at the front door of the hospital.  Most members of the public are unaware of the fact that, for patients who are acutely unwell, there are two modes of admission to hospital – either via “Accident & Emergency” (“A & E”) or via the “Acute Assessment Unit” (“AAU”).  If you visit your GP with your headache and she decides you need urgent investigation, she will send you to the AAU.  If you front up to hospital directly with your headache, you will be seen in “A & E”.  Same patient, same presenting complaint, same diagnosis – different pathway.  Depending on which path you take, you will be assessed by one of two doctors with very different training backgrounds and career pathways.  If you arrive at AAU you will have with you an accompanying letter of referral from your GP.  It’s a kind of invitation or admission ticket.  If you front up to “A & E”, you are a gate-crasher and let’s face it you might be one of the 30% that Claire Perry (and indeed Westminster Health Secretary Jeremy Hunt) say shouldn’t be there.  You need to be disposed of ASAP (certainly within four hours).  AAU will happily keep you for 48 hours, if necessary.  The front door of the hospital operates a system of apartheid.  The public don’t know about this.

Why should this be so?  It’s historical.  There used to be an entity called “General Medicine” or “Internal Medicine”.  With the rise of specialties and super-specialties the general physician became a dying breed.  AAUs started springing up about 30 years ago and internal physicians morphed into “acute” physicians and a subspecialty of “Acute Medicine” was born.  So acute physicians have a college and a career pathway and an annual conference, and emergency physicians have a college and a career pathway and an annual conference, and a lot of the time they are discussing and researching and treating exactly the same conditions, in their isolated silos.  It’s completely potty.

I’ve accused the Question Time panellists of offering no solutions so the least I can do is make one concrete suggestion.  I’m not suggesting for a moment this would be any more than a start, but at least it’s a start at the front door where that elderly patient is languishing.  I think Acute Medicine and “A & E” should amalgamate to form a single specialty which runs a single department.  Call it the Department of Emergency Medicine.

I’ve had a “dry” January.  How very middle-class and sanctimonious, I hear you say.  Then on Thursday I dined with nine ex-colleagues and broke the pledge with an excellent Pinot Grigio.  (Very fresh orchard fruits with a strong lemony zing.)  Naturally during January I felt absolutely wonderful but was it a placebo effect?  People who suspect they are lactase deficient are advised to cut out lactose for a period from their diet and see how it goes.  They usually feel better as a result.  But they cannot really know if the effect is real unless they give themselves a lactose challenge.  So I gave myself the Pinot Grigio challenge on Feb 2^nd – appropriately enough, Groundhog Day.

Groundhog Day is one of these bizarre US rituals like “pardoning” a turkey before Thanksgiving, the prerogative of the POTUS (President of the United States).  Perhaps this year the POTUS will deny clemency to the turkey.  If this is unconstitutional, it might go all the way to the SCOTUS (Supreme Court of the United States).  Ructions will follow.  Potus-Scotus hocus-pocus.  I meander.

The groundhog, or woodchuck can foretell the weather.  He wakens from his hibernation on Feb 2, and comes out of his burrow.  If the sun is shining and he can see his own shadow, then winter has six weeks left to run and the groundhog goes back into his burrow and goes back to sleep.  If on the other hand there is cloud and rain and he cannot see his shadow, he concludes that spring has come early and he stays above ground.  The most famous groundhog is Punxsutawney Phil who hails from Pennsylvania.  Apparently this year Punxsutawney has six more weeks of winter to run.  Bill Murray and Andie McDowell starred in the 1993 eponymous movie, and I think it may be from the film that the expression Groundhog Day has come to mean something boring and repetitive, like a day you are condemned endlessly to rerun.

I’m wittering on about something inconsequential because frankly I’m despondent about the news.  I haven’t turned my back on it, but I’m rationing myself.  Every time I hear the expression “President Trump” I feel I’m listening in to a futuristic dystopian radio drama.  Currently the plot line involves the attempts of the judiciary to stand up to an authoritarian Commander-in-Chief who has sacked his acting Attorney General for her apparently wilful misinterpretation of the constitution, but who has been further frustrated not once, but twice, by judges.  The C-in-C called one of them this “so-called judge.”  Maybe the judiciary will start referring to him as this “so-called President”.  He doesn’t seem to have patience with people who argue with him.  Apparently he hung up on Mr Turnbull.  (I bet he didn’t hang up on Mr Putin.)

International relations have moved into a new phase of unpredictability.  The only thing that’s sure is this: we aint seen nothin’ yet.  The world is full of walls, fear, suspicion and paranoia.  This news is everyday’s news.  I can’t think the answer is to be found on twitterfeed.

But life goes on and this despondency will never do.  I went to the Sir Alexander Gibson memorial concert at the Glasgow Royal Concert Hall on Saturday.  It was almost the Katherine Bryan Show.  Katherine Bryan is the principal flautist of the RSNO and a superstar.  She played her own arrangement of Vaughan Williams’ The Lark Ascending, in a gorgeous red gown, and then Martin Suckling’s flute concerto The White Road (a world premiere) in a gorgeous silver gown.  Ms Bryan, according to the programme note, “is thrilled to wear ROX jewellery.”  As an encore, accompanied only by harp, she played Massenet’s Meditation from Thais.  She played entirely from memory.  Most orchestral players who assume the role of soloist are given the rest of the night off but come the second half, now dressed in formal black evening dress, she played principal flute in Ravel’s Daphnis and Chloe Suites 1 and 2.  The middle movement of the second suite has a beautiful extended flute solo and I can only imagine Ms Bryan so loves music and performing that she did not wish to miss playing it.

Conductor Peter Oundjian was unfortunately indisposed and the Norwegian Conductor Arild Remmereit stepped in at incredibly short notice.  It could not have been easy to learn the Suckling in a couple of days.  He conducted the Ravel from memory.  I noticed the RSNO remained seated for two of about six curtain calls to applaud him, not once, but twice.  The whole thing was a tour de force. 

I’m not sure whether it was being in the Glasgow Royal Concert Hall on Saturday, or in Dunblane Cathedral on Sunday morning, or in Garvie’s Restaurant in Milngavie with some very charming people on Sunday afternoon, but somehow all the bad news got put into perspective and now I feel ready to return to the task of completing may latest tome, part 3 in the life of the troubled doc.  It has exceeded 100,000 words and grows increasingly apocalyptic.

As for Groundhog Day, I think Phil got it right.  Winter’s not gone yet, if the wild geese fly that way.

I’m meeting my ex-colleagues again later this week.  Same hostelry.  Local for me.  Think I’ll challenge myself to another glass of Pinot.

Following the Sunday Times’ revelation that a Trident missile test had gone badly wrong last June when the missile veered off course, Defence Secretary Michael Fallon made a statement to the House on Monday.  During the debate, Michael Gove asked Mr Fallon if he agreed that “the unilateralists on the opposition benches who are complaining today are in the position of eunuchs complaining about the cost of Viagra.”

Mr Fallon agreed.

I supposed it was just a throwaway remark, a cheap gag, but I fell to thinking about it.  In a parliamentary debate, even off-hand one-liners ought to stand up to a degree of scrutiny.  Why are supporters of unilateral nuclear disarmament eunuchs?  A eunuch is a man who has been castrated, perhaps in order that he may run a harem, or retain a soprano voice past puberty.  Neither career path offers much promise to an aspiring youth in the modern world.  Alan Turing the mathematician was offered chemical castration as an alternative to imprisonment for the crime of being homosexual.  He has somewhat belatedly received a royal pardon.  So there aren’t many eunuchs around, bar Mr Corbyn and some Corbynistas, the Greens, and the entire phalanx of 54 SNP MPs occupying the opposition benches.  I suppose Mr Gove said they are eunuchs because they have been rendered impotent.  That is certainly true of the Westminster SNP.  They all vote as one, and it doesn’t make a whit of difference.

Mr Gove seems to think it inappropriate that the unilateralists should complain about the spiralling cost of the proposed Trident update.  The implication is that because they don’t support the product, they ought to be indifferent to its cost, even though they are obliged to join in to foot the bill.  This notion is of itself so manifestly absurd that it seems hardly worthwhile to pick it apart.

But most interesting of all, why should Mr Gove think of Trident as Viagra?  Viagra (I should say sildenafil – other brands are available) is a treatment for erectile dysfunction.  This implies that the United Kingdom is similarly dysfunctional, and in need of a therapy for impotence.  Trident becomes a symbol of aspiration towards priapic pride.  This makes last June’s failure to launch all the more distressing, embarrassing and humiliating.  No wonder Mrs May was coy on the Andrew Marr programme.  She subsequently admitted she had been briefed about the unsuccessful test.  One can imagine a rear-Admiral emerging from the Silent Deep to say to her, “Prime Minister, I’m terribly sorry.  This has never happened before.”  She might have consoled him.  “There there; don’t fret.”

It would all be laughable but for the seriousness of the subject.  During the same week, the redoubtable Brian Quail, 77, a retired Glasgow classics teacher who single-handedly stopped a nuclear convoy in Balloch last March by lying down on the road, went on trial in Dumbarton Sheriff Court on a charge of Breach of the Peace.  (The irony of the charge will not escape you.)  Mr Quail has said, “Trident is the worst thing in the world.  The epitome of evil.  I do infinitesimally small things against it, because that is all I can do.  But consent by silence or inactivity I cannot give.”  Mr Quail has 14 previous convictions for similar convictions and has been in prison for failing to pay fines five times.  In other words, Mr Quail does not merely talk the talk, he walks the walk.

Which impresses you more?  Mr Gove’s remark, or Mr Quail’s action?  Which is the more potent?

The trial continues.

From the television pictures, it looked as if rather more people turned out in Washington for the anti-Trump demonstration on January 21st than for the Presidential inauguration the day before.  Mr Trump’s press officer disputes that, vociferously.  On page 13 of the Sunday Times there is a picture of the Mall taken from the President’s viewpoint which would suggest he is right, so who can tell?  I listened to the President’s inauguration speech, just as I had listened to his acceptance speech for the Republican nomination back in July (was it really that long ago?) and, just as then, I got hold of a transcript of the speech and read it carefully.  I specifically wanted to see if there was anything in it that would make me take to the streets, even if I were to stop short of shoving a trash can through a shop window – which as a gesture of protest seems rather non-specific.

Here is a digest.  See what you think.

1. Thank you.
2. The national effort to rebuild the country will face challenges, but we will get the job done.
3. Expression of gratitude to the Obamas for help (“magnificent”) during the transition.
4. We are returning power to the people. This is your day.
5. Washington’s elite has flourished at the expense of the people; not any longer.
6. Americans want great schools, safe neighbourhoods, and good jobs…
7. Right now they have failed education, crime, gangs, drugs, and unrealised potential.
8. Their pain is our pain. We share one heart, one home, one glorious destiny.
9. We have spent trillions overseas while US infrastructure has decayed. Factories have closed.
10. Our middle class wealth has been redistributed across the world.
11. “From this day forward, it’s going to be only America first – America first.”
12. Protection (of borders, products, companies and jobs) will lead to prosperity and strength.
13. We will build new roads, highways, bridges, airports, tunnels and railways.
14. We will get people off welfare and back to work. Buy American and hire American.
15. We will seek friendship with other nations but not seek to impose our way of life on anyone.
16. We will reinforce and form old and new alliances.
17. We will unite the civilised world to eradicate radical Islamic terrorism.
18. “At the bedrock of our politics will be a total allegiance to the United States of America.”
19. “When you open your heart to patriotism, there is no room for prejudice.”
20. Speak openly, debate disagreements honestly, but always pursue solidarity.
21. There should be no fear. We are protected by the military, law enforcement, and God.
22. Think big; dream bigger. No more empty talk; now arrives the hour of action.
23. We will unlock the mysteries of space, eradicate disease, harness tomorrow’s technologies.
24. “Whether we are black or brown or white, we all bleed the same red blood of patriots.”
25. Our children are infused with the breath of life by the same Almighty Creator.
26. And yes, together, we will make America great again.

After the speech I think I heard President Obama say to President Trump, “Good job.”  The centre-left liberal press has been less magnanimous, saying the speech was pedestrian, lacking the oratory of Lincoln or Kennedy, failing to reach out to political opponents to bring the country together.  In failing to offer an olive branch, it is said that the President is being less than presidential, merely repackaging slogans as if he were still on the campaign trail.

I think of the speech as being like a pep-talk a CEO would make to his company.  That is hardly surprising considering President Trump’s background.  It’s a let’s-kick-ass Ra-Ra-Ra talk.  He might have given it in a football stadium with cheerleaders behind him.  He was uncompromising about the contrast between the political elite, and the poor and dispossessed of the nation, but it never got personal.  I doubt if anybody on the Hill was really offended.  The speech’s unifying theme is Patriotism.  It’s an invitation to everyone – and in this sense the speech was intended to be unifying – to join the team.  We might be snooty about the choreography on this side of the Pond, but in 2008 at the time of the financial crisis, David Cameron and George Osborne tried to invoke the same spirit, if in a more buttoned-up way.  “We are all in this together.”  If President Trump thinks of his nation as a conglomerate, “America Inc.”, this explains why he is hypersensitive to dissent.  He can’t understand why a loyal employee wouldn’t want to back the will of the Executive Board.  George W. Bush had a similar outlook with respect to the War on Terror when he said, “You are either with us, or against us.”  He couldn’t accept that somebody might be critical while still being a friend.

But looking through the annotated points of the speech above (and I don’t think I’ve missed anything substantial out) it’s hard to find anything of itself sufficiently threatening or sinister that would make me take to the streets.  It’s pretty main-stream stuff.  It’s interesting what he missed out.  Nothing about building the wall, nothing about climate change denial.  The points that made me a little queasy are: 12, maybe 14 (but then not so long ago “Buy British” was a favourite slogan here), 17 (is it to be the War on Terror all over again? President Trump has already called that “number one tricky”), and 18 (total allegiance?  I prefer E M Forster’s “Two cheers for democracy”).

On the other hand, some of the points are quite hopeful: especially 15 and 23.  And maybe the energies and industries of tomorrow won’t include coal.  As a kinsman of mine is wont to say, “We’ll just have to wait and see.”

Is President Trump an isolationist?  His remarks on Protectionism might suggest so, but those on international terrorism might immediately contradict that.  Clearly his agenda is mainly focused on domestic affairs.  He wants the US to be self-sufficient in the broadest sense.  Well, good luck with that.  And I don’t mean to be sardonic, but completely sincere in saying that.  We might learn something from that.  We might also learn to be self-reliant.  It seems to me that we on this side of the Pond have an opportunity to redefine “the special relationship”.  Of course Winston was grateful when the US entered the Second World War, but they didn’t come in out of fondness for the British.  They came in because of Pearl Harbour, and also because Hitler declared war on them.  We’ve paid off lend-lease.  We don’t owe them anything, any more than they owe us.  I think we should stop calling the US President “the leader of the free world”.  I have a sense that President Trump does not wish to be the leader of the free world.  He’s quite happy trying to cope with his own back yard.  But judging by the appalling levels of sycophancy displayed by our leaders trying to get to the front of the queue (or line, if you prefer) for a trade deal, you’d think they were getting out of the EU in order to become the 51^st state.  Then we too could all “bleed the same red blood of patriots”.

Then again, who was it said that patriotism was “the last refuge of a scoundrel”?

I’ve had a very “Herald”-orientated week.  On Tuesday, I went to the Herald-sponsored Glasgow Cruciverbalists’ Club. We meet monthly in an upstairs room in Curlers on Byres Road and solve crosswords in a studious Bletchley Park atmosphere.  It’s better fun than it sounds.  The company’s good.  Somebody asked me what compiler’s software I used and I gave a plug for ‘Sympathy’ and said I was thinking of upgrading to their latest version.  “No doubt,” came the response, “to ‘Empathy’.”  Next month I am providing the crossword to be solved.  I was asked if my puzzle was fiendish.  I borrowed an expression from the President-elect.  More like Number One Tricky.

On Wednesday morning I opened my Herald to read about the latest Queen Elizabeth University Hospital statistics purporting to be a measure of the Emergency Department (ED) “performance”.  Like every other ED in the NHS this one has a “four-hour rule”, and every month the Herald reports the extent to which the department has fallen short in its observation of the rule.  Of course they are not alone in this.  The BBC does the same.  Every time I hear the report my blood pressure goes up and I am minded to fire off a disgruntled letter to the Herald.  Sometimes they publish me; sometimes they don’t.

I should explain why I get so exercised about it.  First up, the report is always written thus: “For the week ending 15^th Inst only 87% of patients were seen in QEUH “A & E” (sic) within four hours.  The target is 95%.”

Now, that is just not true.  I would venture to say that virtually 100% of patients were seen within five minutes – that is, within five minutes of their arrival.  They would have been seen virtually immediately by a triage nurse whose job is to assign a level of urgency to the patient’s clinical presentation, which stipulates how quickly the patient should be assessed by a doctor.  Australia and New Zealand use the National Triage Scale which identifies 5 categories of acuity.  Triage category 1 – the patient must be seen immediately; 2 – within 10 minutes; 3 – within 30 minutes; 4 – within 1 hour; 5 – within 2 hours.  Most emergency departments in the English-speaking world use a system not dissimilar to this.  The degree to which a department meets these targets is certainly worthy of study.

The four-hour rule measures something quite different.  It measures the total time the patient spends in the ED between presentation and discharge.  In the language of medical audit, the “criterion” is that patients should be discharged from the ED within four hours of arrival.  The “standard” is that this should happen to 95% of patients.  I’m always a little puzzled by medical audit standards.  They seem to me to be arbitrary.  After all, if something is worth doing, why not aim to do it all the time?

Now, each time the department fails to achieve the “standard” (and that is virtually all the time), this is deemed to be an index of, perhaps even a surrogate marker for, “poor performance”.  This notion that an emergency department’s performance somehow relates to how quickly it disposes of the patient seems to me to be utterly absurd.  Imagine a music critic berating an orchestra, not for being unmusical, but for taking too long.  The Maestro at rehearsal might tear his hair out.  “Ladies and Gentlemen, we simply must get Mahler 8 under 90 minutes!”

Anyway I wrote to the Herald in this regard on Wednesday.  I didn’t think they’d publish me.  Experience has told me that the best way to get published in the Letters column is to be polite, to make a single point worth making, and make it succinctly.  My letter was more diffuse than this; it made several points.  So I didn’t think it would go in, but at least it helped me get something off my chest.

Judge my surprise on Thursday when not only was I in, I was in poll position, complete with big headline.  “Medical staff should ignore this arbitrary four-hour rule”.  I was delighted with that.  The other main point in my letter alluded to Westminster Health Secretary Jeremy Hunt suggesting that the public might have to be educated about the “appropriate” use of “A & E” (sic).  I made the simple suggestion that the term “Accident & Emergency (A & E)” be dropped.  After all, somebody who has an “accident”, say sprains an ankle, might say, shouldn’t I go to A & E?  That, after all, is what it says on the tin.  The emergency medicine community in Australia and New Zealand understood this thirty years ago, and dropped the word “accident”.  I’ve written about this often, and make no apology for bringing it up again.  We shouldn’t use archaic terminology.  Never use the most archaic and the most dehumanising word of all, “Casualty”- either to allude to a department or to the person attending it.  The department is the “emergency department” and the person is the “patient”.  If you hear somebody using the A word or the C word, politely correct them.  Will you join me in this?

On Friday I perused the Herald Letter pages again.  I think it’s important to keep vigilant for the riposte.  You know the sort of thing.  “It’s time for Dr Campbell to wake up and smell the coffee!”  There was nothing by way of adverse comment.  Quite the opposite; the Letters editor had written a piece in praise of the paper’s correspondents and I was delighted to be mentioned in dispatches.  Then on Saturday, Myops, resident cruciverbalist, used one of my clues.  A chronicle of small beer, you say.   Yet I admit I love to be in print.  I’d have quite liked to have been a hack.

 

Quite by chance, in the first week of the New Year I’ve been reading two books in parallel which deal with overlapping subjects but whose viewpoints and conclusions are diametrically opposed.  The first book is The Letters of John F. Kennedy, edited by Martin W. Sandler (Bloomsbury, 2013), and the second is Noam Chomsky’s Who Rules the World? (Hamish Hamilton, 2016).  Sandler’s tone is reverential.  JFK is presented as “one of the greatest and most charismatic presidents of all time”.  In studying American post-war foreign policy, Chomsky chooses a wider remit.  Of the United States of America, he is almost unremittingly critical.  For example, chapter 17 is entitled “The U.S. is a Leading Terrorist State”.  JFK is referenced 13 times in the index, and every single reference is negative, sometimes damningly so.  The first reference is to his implementation in 1962 of new U.S. policy in Latin America, boosting internal security by supporting criminal regimes who used, quoting Charles Maechling Jr., “the methods of Heinrich Himmler’s extermination squads”.  All of the foreign policy interventions of JFK’s 1000 days, from the Bay of Pigs, to Vietnam, the ongoing Cold War and in particular the Cuban missile crisis, are portrayed as a series of unmitigated disasters.

Chomsky’s account of the Cuban missile crisis is entitled The Week the World Stood Still.  While Sandler says of the President, “He steered the United States away from nuclear war”, Chomsky describes a series of near misses which were survived through a combination of sheer luck and the independent decision-making of front line military personnel.  That we survived is little short of a miracle.

Well, Sandler and Chomsky, they can’t both be right, can they?

The first week of this New Year added a third parallel to run alongside these books.  I was very intrigued to read in the Letters, the communications, especially the personal ones from the Black Sea coast and the Kennedy retreat at Hyannis Port, lengthy and beautifully written on both sides, between JFK and Chairman Nikita Khrushchev, the more so in light of what the CIA have been saying about the recent US presidential election and the apparent certainty that Vladimir Putin conducted cyber-attacks on the U.S. in order to influence the election’s outcome in favour of Mr Trump.  I have to say I felt some sympathy for Mr Trump when he reminded his intelligence people that they fouled up with Iraq’s weapons of mass destruction.  They didn’t appreciate that; he struck a nerve.  Of course, they were unable to say whether the putative intervention of Mr Putin had any influence on the election result.  Another aspect that was not touched on was the one of Russian motivation.  It is not at all clear why the Russians might prefer the 45^th POTUS to be Mr Trump.  I have a suspicion that over the next four, maybe eight, years, the relationship between Mr Putin and Mr Trump might turn out to be as crucial to the world as that between Mr Khrushchev and Mr Kennedy.  We might get a sense of how that relationship will start out when we hear Mr Trump’s inaugural speech on January 20^th.  With that in mind, I revisited Mr Kennedy’s inaugural speech, also on January 20^th, back in 1961.  It is a very famous piece of oratory.

“We shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty…  In the long history of the world, only a few generations have been granted the role of defending freedom in its hour of maximum danger.  I do not shrink from this responsibility…”

We have to put that into the context of an ideological struggle between the democratic world and the communist world, and also to remember that on October 30^th, 1961, the USSR tested the biggest thermonuclear device ever detonated – equivalent to 50,000,000 tons of TNT (Hiroshima’s “Little Boy” was equivalent to 15,000 tons).  This occurred at the height of the Cuban missile crisis.  The stakes were incredibly high.  Whether it was due to the wisdom of Mr Kennedy and Mr Khrushchev, or a submariner named Second Captain Vasili Arkhipov, who decided not to fire a 15 kiloton torpedo, we got through by the skin of our teeth.

Noam Chomsky thinks that in terms of human self-destruction, the clock sits somewhere between five minutes and one minute to midnight.  The two big threats are climate change, and nuclear war.  Mr Trump doesn’t believe climate change exists, and he wants to increase the US nuclear arsenal.  I like to keep an open mind, but I shall be listening very carefully to what he has to say a week on Friday.  This is the way the world ends, not with a bang, but a twitter.

Over the festive season I’ve greatly enjoyed reading The Humans, by Matt Haig (Canongate, 2013).  It’s very amusing.  It has a farcical premise.  An extra-terrestrial being from a distant civilisation visits planet earth when it becomes apparent that a Cambridge professor of mathematics has got the answer to one of the great unsolved mysteries of number theory; he has proved the Riemann Hypothesis.  Homo sapiens is deemed to be a species so unstable as to be unworthy of such knowledge, but fortunately the professor has not yet gone public.  The alien’s remit is to eliminate the professor, assume his identity, and then eliminate his immediate family and any associates who might have been told of the proof.  The trouble is, the cosmic visitor commits the cardinal error of any anthropologist beguiled by the object of his study.  He goes native.

This notion of visitation by beings from another world seems to be endlessly fascinating to us.  Famously, Orson Welles made a radio broadcast of his (near) namesake H G Wells’ War of the Worlds that was so realistic that it’s said the population of the United States thought the world had truly been invaded, and there was widespread panic.  More recently, in films like Close Encounters of the third Kind, and ET, the aliens are depicted as benign intelligences trying to mentor us and dissuade us from our violent and ultimately suicidal path.  My favourite is a cult film from 1951, The Day the Earth Stood Still, in which Michael Rennie plays an alien.  In addition to an evidently shared fascination with extra-terrestrials, Orson Welles and Michael Rennie had something else in common.  They both depicted Harry Lime on screen, Welles in Carol Reed’s film of Graeme Greene’s The Third Man, and Michael Rennie in a TV spin-off that retained little resemblance to the original, aside from the theme tune on the zither, and the brooding atmosphere of a post-war European cityscape with cobbled plazas and abandoned newsstands.  The sharp tap of hurried footsteps and a shadow on a shuttered façade, disappearing into an alley.  And the twang of the zither…

Tya tya tya tya tyaah – tya tyaaaah….

…the tempo rather quicker, edgier, than you’d remembered.  There you were, on the Prater, high above post-war Vienna, with its heavily militarised occupied zones.  Joseph Cotton and Orson Welles.  These two always seemed to be meeting like this, in film, and re-enacting the same painful masque depicting the disintegration through disillusion of a human relationship.  Welles’ character was brilliant, charming, charismatic, flawed, Cotton’s unremarkable, industrious, plodding, reliable, faithful.  He would gradually and excruciatingly come to the realisation that his friend and hero was not all he’d been cracked up to be.  It was like being privy to the death throes of a love affair.  In a way that’s what it was.  That terrible hang-dog expression of Cotton’s.

Michael Rennie played Lime as a kind of latter day Robin Hood who would never have dreamt of watering down penicillin for personal gain.  In the TV spin-off, Lime had a man, a butler after the English style named Brad who, while being intensely loyal to Mr Lime, could barely conceal his distaste each time his master went off with another woman half his age.    There was something repugnant to him about the spectacle of a very mature Michael Rennie getting off with another teenager.  It wasn’t just the age difference.  There was something alien about Michael Rennie.  These beautiful young women were allowing themselves to be embraced by the member of another genus; they were falling into the ambit of the antennae and mouthparts of a stick insect from Pluto.

Thus his casting as an alien in The Day the Earth Stood Still was inspired because he definitely had an other-worldly quality.  He assumed human form to come to earth to tell us homines sapientes that we were making a terrible mess of our obscure corner of the universe and, unless we all pulled our socks up, we were going to disappear into some cosmic incinerator and good riddance.  On this occasion Brad was played by a robot made out of an assemblage of tube balloons.  Unlike his master he had not mastered English and had to be addressed in his own tongue.

“Gort!  Klaatu barada nikto!”

Or words to that effect.  You could tell Rennie was an alien because he wore a tunic resembling the short white coat of an orthodontist.  Rennie was an interstellar dental hygienist, come to berate us for the level of our decay.

Like the Riemann Hypothesis, the question of whether intelligent life exists elsewhere in the universe is a great unanswered conundrum of our time.  In The Humans, Matt Haig’s alien is ironically a little dismissive of the notion.  At least he points to some deficiencies in the Drake equation.  In 1961 Dr Frank Drake produced a probabilistic argument to estimate the number of civilisations in the Milky Way.

N = R* x fp x ne x fl x fi x fc x L

Each variable is a fraction of the element in the equation that precedes it.  Hence, rate of formation of stars; of those stars the fraction that have planets; number of planets per star capable of supporting life; of those, the fraction that go on to develop life; of those, the fraction developing intelligent civilisation; of those, the fraction that develop communication; and of those, the window of time during which they communicate.

It crosses my mind that Frank Drake sounds awfully like Francis Drake.  Perhaps Dr Drake was preparing to repel an invading interstellar Armada.  Is the Drake equation a spoof? To be fair to Dr Drake, you can see that it is not really an argument in support of the hypothesis that intelligent life exists elsewhere in the galaxy.  Instead, that is axiomatic and taken as read.  So, assuming the conditions in which life can evolve exist elsewhere, how often will it happen?  It’s an intriguing question, but equally intriguing to me, perhaps even more so, is the hypothesis that we are alone in the galaxy, and indeed in the universe.  There is after all some reason for suspecting this might be so.  Our search for signs of intelligent life thus far has drawn a blank.  Marconi was sending radio signals across the ocean before the end of the nineteenth century.  The transmitters have been broadcasting and the antennae have been listening out for quite some time.  We are a noisy planet.  In contrast, it’s pretty quiet out there.  Still, the universe might be teeming with life but the distances are too vast to detect it.  The signals we get from the edge of the observable universe are fifteen billion years old.

But is there any point in making a contention that cannot be proved or disproved?  Bertrand Russell made this philosophical point by positing that a teapot is in orbit between Earth and Mars.  It’s just too small for our instruments to detect it.  Just because we haven’t found it doesn’t mean it isn’t there.  In fact, even if we haven’t found the teapot after aeons, we can never prove it’s not there.

What would be the implication of being all alone in the universe?  We might find ourselves back in a pre-Copernican age, back at the centre of things.  The universe looks much the same whichever direction you look.  We have as much right to be at the hub as anybody else.  Still, I suppose we’d better keep looking out.  Perhaps we’ll pick up an intelligent and meaningful signal.  What might it be?  It could be the proof that the Riemann hypothesis is sound.  That would be cool.

Maybe this year.