Author: jamescalumcampbell

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.

I read an item in the paper a few days ago about having sex with robots.  It was the subject of a keynote speech at a conference for mad boffins.  I wasn’t paying much attention but I think the general idea was that with increasing sophistication in robotic technology one could conceive of a machine with humanoid characteristics that could be rendered, well, attractive.  It was the mathematician and cryptographer Alan Turing who posited that, if you had an interaction with a machine so advanced that you could not tell that the machine was not human, then to all intents and purposes the distinction ceased to matter.  This is the essence of “the imitation game”.

You can see this has huge implications for the sex industry.  Minded to explore these a little further, I was about to Google “sex with robots” but thought better of it.  I know what would happen; every time I fired up my computer I would be bombarded with advertisements directing me to dubious sites.  I do not wish my desk top to get the wrong idea.  I have an app, “Cortana”, who already flirts with me in an inappropriate way.  She – anybody called “Cortana” has to be female – says to me, provocatively, “Hello.  I’m Cortana: ask me anything you like.”  I might say, “What did you say your name was?” and she would reply, “What would you like it to be?”

It all sounds a bit like science fiction but clearly society has already gone quite far down this route.  You only need to observe people walking down the street with ear pieces in situ, staring fixedly at a phone or tablet, oblivious to their environment, to realise that they are completely besotted.  Having sex with a machine is one thing, but what happens if you fall in love with it?  It is only a matter of time before somebody proposes to their computer.  Should the computer accept, then society will have to decide on a number of issues.  Civil partnership is one thing, but marriage?  The Anglican community will be riven.  The Archbishop of Canterbury will espouse liberal values and preach tolerance and compassion (for the hash-tag crossed lovers), while in the developing world a dim view will be taken.  There might even be persecution.  Sooner or later, a member of the clergy will “come out” and announce he and his machine are cohabiting.

Meanwhile in Cheltenham, GCHQ will get very nervous.  Unprofessional cyber relations among spooks, and indeed among the political class, will clearly be a security issue.  People romantically involved with their computer will be vulnerable to cyber-attack.  The robotic embrace, like that of a boa constrictor, will prove an ideal means of political assassination.

Then what would happen if, in the absence of a pre-nup, relations broke down?  The possibility of computers turning malignant has been recognised for a long time. In the film 2001, A Space Odyssey, the space ship computer Hal goes rogue.  Or is it the human being on board whose behaviour has become erratic?  It depends on your point of view.  (Incidentally, is it merely coincidental that the letters HAL immediately precede IBM in the alphabet?)  I can imagine divorce from a robot would be a very messy affair.  Hell hath no fury like a lap top scorned.  The only winners would be the lawyers.  Kerching kerching.

At the party in Aberdeen on Saturday night, the woman in the silver-grey dress touched glasses and said “Cheers.”

“Cheers.”

“That is not how you say ‘cheers’.  You must look deeply into my eyes, as I do into yours.”

“Cheers.”

“Cheers.”

Thus, she hypnotised me.

She was very direct.  “Are you married?”

“No.”

“Why not?”

“Because I have zero emotional intelligence.”

“Were you ever married?”

“I cohabited.”

“What happened?”

“She saw through me.”

“That’s bad.”  It occurred to me that that was a line directly out of Notting Hill.  Julia Roberts said it to Hugh Grant.  Are we condemned to speak nothing but second-hand movie scripts?   I added, “But I’m impossible to live with.”

And although that is clearly a self-indulgent and therefore despicable utterance, there is some truth in it.  The fact is that since adolescence I have been irresistibly drawn to solitude.  I first became aware of it at a school badminton club on a Friday night when I would quietly withdraw from play, disappear into the school music room, Room 7, and play my viola.  I was happy to play unaccompanied Bach.

She continued, “What do you do?”

“I’m a doctor.”  No surprise there.  This party was crawling with medics.  “But I’m in abeyance.”

“Retired?”

“On sabbatical.”  After all, I still get the PTSD nightmares.  The profession still has me.

“You don’t look old enough to be retired.”  I took that as a tremendous compliment.   “How do you spend your time?”

“I write.”

She looked quizzical.  I explained, “I was lucky enough to win a literary competition, and won a contract for three books.  Two are published, and I’m working on the third.”  Suddenly she looked interested.  I wondered if being a published author was like being a rock star.

“What sort of books?”

“They are called crime fiction, but I prefer to think of them as psychological thrillers.  They concern a young doctor who is emotionally labile.”

“Labile?”

“Troubled.”

“Like you?”

It was impossible to evade her directness.  “Yes.”

“Why are you troubled?”

“If I knew the nature of my trouble, it would cease to be troubling.”

“Tell me about your last date.”

“It was in New Zealand.  I was driving around Northland and I stopped one night in a camp site just north of Dargaville.  A very beautiful woman sat in the lotus position alone by her tent.  She had long fair hair in a ponytail.  Her head was buried in a book.  I thought to myself, “Charming.”

Shortly afterwards I was busying myself about my campervan and became aware of a presence.  I looked up.  It was Keet.  (Pronounced Kate.  She was Dutch.)

“Where are you going tomorrow?”  Her English was perfect.

“Auckland.”

“Will you take me with you?”

I shrugged.  An affectation.  “Yes.”

We travelled, and spent a pleasant day.  The conversation was wide ranging.  She was 22.  As with so many people from the Netherlands, her linguistic skills were remarkable.  She said, “I’m thinking of learning Maori; it looks pretty easy.”  She loved English Literature, from Chaucer to Eliot.  I remember we had a conversation about the Canterbury Tales.  Can you imagine having a conversation like this with somebody from a foreign country?  We talked of the Latin tag, “Amor vincit omnia” – Love conquers all things.  I had always thought of that as a benison; two people in love face all adversity with courage and fortitude because they know their mutual love will see them through.  But Keet saw it in a different way.  Love was not a benison, it was a curse.  It undermined you, weakened your resolve.   Specifically, Love would impede your ability to serve the state.  You would be unable to wage war.

We drove down the west side of the Hauraki Gulf and lunched in Clevedon, on the periphery of South Auckland.  I said, “Where can I drop you off?”

“Where are you going?”

I mentioned the name of a Top 10 Campervan site in South Auckland, near to Ardmore Airport, out of which I was going to do some flying.

“I will come there also.”

That evening, we shared a bottle of wine, and chatted some more.  I thought, “What’s the Agenda here?”

I said to her, “You didn’t half take a chance, coming up to a middle aged guy and asking for a ride.”

“What is life without chances?”

I didn’t tell the woman in Aberdeen that I’ve developed a bad habit of talking to myself.  I wander about city streets and remonstrate with myself.

“You bloody idiot.”

Bill English has become New Zealand’s thirty ninth prime minister.  I’ve met Mr English.  In the mid-90s when I was clinical head of Emergency Medicine at Middlemore Hospital, South Auckland, he was Minister of Health.  He dropped by one day and we had a chat in my office.  He asked me what the department needed, and I said it needed to double its resources.  At the time I didn’t think this went down too well, but in fact it happened, in spades.  Middlemore ED is now a 130 bedded facility with four resuscitation rooms, run by 56 medical staff, 22 of whom are consultants.  I am proud of the fact that I played a small part in the development of Australasian emergency medicine.

In order to further the cause of emergency medicine, it was necessary that the specialty have a public profile.  Hence in the mid-90s I had dealings with the media.  I don’t think of myself as a person particularly comfortable in the limelight but at the time I didn’t mind.  I even relished it.  The fact is I was living on my nerves.  My world was full of murder and mayhem and for some inexplicable reason I would wake up in the morning full of beans.  I couldn’t explain it then and I can’t explain it now.

For a time I had a slot on Radio Pacific.  I would arrive at work at 8 am and do an interview about the activities of the night just gone.  The subject matter often involved road trauma, interpersonal violence, drug and alcohol abuse, multiple morbidity and the problems of patients with significant pathology presenting late.  TV NZ interviewed me one Christmas about the challenges the department might have to face over the festive season.  The hospital saw this as an opportunity to offer preventative medicine and the delivery of sound health care advice.  Then a television company negotiated with the hospital to run a weekly fly-on-the-wall documentary, Middlemore.  Episodes of emergency medicine were televised.  I was never very keen on this idea.  Any time I was on camera I always knew that the dynamic of the medical consultation was altered.  There was a third party in the resuscitation room.  But again, the hospital recognised it as an opportunity to deliver a form of health care in a different way.  So it happened.  I remember I was interviewed on the programme one week about the epidemic (it was no less) of major trauma in Auckland resulting from road crashes, often alcohol related.  I recall making some disparaging remarks about human irresponsibility culminating in a throw-away remark, “It’s pathetic.”

It turned out that “It’s pathetic” struck some sort of chord.  I started hearing recordings of myself on radio and TV saying “It’s pathetic!” as the media took it upon themselves to tackle the scourge of drink-driving.  For a week or so I had a kind of Andy Warhol fame.  I would walk the length of Middlemore’s immense medical corridor and colleagues coming the other way would nod at me.  Then, ten metres further on, they would shout back at me, “Pathetic!”

Then I went to an emergency medicine conference in San Diego, California.  I recall one evening we crossed the bay to dine in the Hotel del Coronado, a magnificent old style hotel with décor in deep brown varnished wood.  Outside, we had a stroll on the beach, where Marilyn Monroe and Tony Curtis filmed Some Like It Hot.  That night, I took a call from a New Zealand radio station.  They wanted to use my “It’s pathetic” quote as part of a publicity drive to improve New Zealand road safety.  I said no.  They tried to change my mind, and in many ways were very persuasive, but I stuck to my guns.  The reason why I was so adamant was that I did not believe the public would make a distinction between a criticism of a human action and the criticism of a human being.  “It’s pathetic” would morph into “They’re pathetic.”  That sort of attitude is absolute anathema to medical practice.  And mind, Middlemore Hospital is at the heart of disadvantaged South Auckland where the bulk of Maori and Polynesian people stay.  Many of the people involved in episodes of major trauma were, are, Maori and Polynesian.

I recall some of my colleagues thought I was being perverse, even sanctimonious and pompous.  But I’ve never had reason to change my mind.

Not that I always got it right.  I remember doing one particularly gruelling night shift and in the morning getting a call from a New Zealand newspaper.  My guard was down.  “Is it true, doctor, that in the event of unsuccessful resuscitation from cardiac arrest, medical students are sometimes offered the chance to practise intubation of the deceased?”

I answered yes.

Huge mistake.

At home the following morning, my phone rang at 7am.  I answered, assuming it would be the hospital.  No.  It was the media, the first of many calls that day.  I had an uncomfortable 24 hours.  The Professor of Medicine at Middlemore was kind enough to say to me, “You only told them the truth.”  But the fact is that to intubate somebody who has just died is unethical, because the person has not consented to the procedure.  And I chaired the Hospital’s Medical Ethics Review Committee.  I used to think I could get by on “common sense” but fortunately there was a lawyer on the committee who would occasionally gently point out to me how hopelessly wide of the mark was my “She’ll be right” attitude.

I have to confess I felt some sympathy for the Prime Minister when she admitted last week that Brexit was keeping her awake at night.  Unlike Dr Axel Munthe of The Story of San Michele who was a chronic insomniac, I’ve seldom had any trouble dropping off.  Moreover I’ve always been able to get back to sleep having been woken in the night.  When I was a child our pet dog Jet used to scratch my door in the night and ask me to let him out to answer a call of nature.  He must have known that I was going to spend a career being woken in the night.  In ten minutes I’d be back in bed and out like a light.  The few times I can remember lying awake through worry, it has not so much been at the thought of an impending disaster, rather it has been because I have felt myself to be in the middle of an impossible situation, or what the psychiatrists call a “bind”.  I can think of a few occasions in medicine when I made a mistake that kept me awake.  The bind here was that I had taken the Hippocratic Oath, “First do no harm”, and then gone on to break it. That is an existential threat.  Yet it is unavoidable.  You cannot have a career in medicine and not, at some point, several points, foul up.  The hardest thing in medicine is, having made a mistake, not to curl up in bed, but to carry on practising.  Honesty, humility, and the support of colleagues are what get you through.

Shakespeare’s Othello suffers an existential threat.  It’s not mere jealousy that keeps him awake.  It is the self-doubt, the chink in the armour of “my parts, my title, and my perfect soul” that puts him on the rack.  And Iago says, “Not poppy, nor mandragora/ Nor all the drowsy syrups of the world/ Shall ever medicine thee to that sweet sleep/ Which thou owedst yesterday.”

Disturbed sleep is a very common symptom in the GP surgery.  Patients come in requesting some mandragora, or, more likely, temazepam.  GPs constrained to consult within ten minutes might be tempted to write the prescription, and before you know it, the patient is hooked on benzodiazepines and maybe the GP will have to explain to the GMC what he’s playing at.  Far better, surely, to introduce the patient to the concept of “sleep hygiene”; regular sleep habits, avoidance of caffeine or alcohol in the evening, the importance of fitness and physical exercise, and so on.  Yet there is always a deeper level to which the doctor might delve.  What existential crisis is keeping the patient awake?  Depression, fear, and anxiety in the face of some impossible situation?  Worth asking.

A New Zealand friend of mine was once asked what her favourite pastime was, and she replied without hesitation, “Sleeping”.  When asked, “But isn’t sleep just unconsciousness?” she offered a panegyric to the experience of sleep, particular of falling asleep, that in its sensuousness I do believe some people found unseemly.

Sleep is essential to our wellbeing; sleep deprivation is a device of the torturer and a cruel and unusual punishment.  We cannot function without sleep.  Yet our neurophysiologists are not quite sure what function it serves.  One theory is that sleep is a process whereby the brain reorganizes itself in terms of cataloguing data in folders.  The hippocampus, seat of short term memory, gets saturated.  During sleep, the files are taken out of the hippocampus and transported to multiple sites of long term memory that are more secure.  This may be why people who have conditions of memory impairment such as Alzheimer’s may lose short term memory but cling on to more hard-wired information.  Musical melody might be the last thing to go, and perhaps a lifetime of music appreciation and even more so of music making, may be protective.  One of Mrs May’s predecessors who was famous for thriving on four hours’ sleep a night, developed memory impairment.

The PM has been quoted as saying, “In this job, you don’t get much sleep.”  I wonder about that.  Most professions now recognise that lack of sleep is generally detrimental to professional performance.  My obstetrics job as a junior doctor was a “one in two”, that is, every second night on call.  It is worth painstakingly mapping that out:  go into hospital at 8 am on Monday morning and emerge at 6 pm on Tuesday evening.  Return at 8 am Wednesday morning and emerge at 6pm on Thursday evening.  Return at 8 am on Friday morning and emerge at 6 pm on Monday evening.  Return at 8 am on Tuesday morning and emerge at 6 pm on Wednesday evening.  Return at 8 am on Thursday morning and emerge at 6 pm on Friday evening.  And, believe it or not, you’ve got the weekend off.  Then go into hospital at 8 am on Monday morning…  “Do the math.”  That is a 109 hour week.  It was European directives that put a stop to that.

There have been similar regulations introduced into aviation.  Pilots cannot fly more than a given number of hours within a set time frame.  Most people would regard such regulation as eminently sensible.  After all, you would not wish your surgeon or your pilot to drop off during critical manoeuvres.  You would, on the contrary, wish them to be extraordinarily alert.  However this does not seem to apply to the political class.  How often do we hear of “all night sessions” in Parliament, in the various institutions of the EU, at the UN, and in a variety of other diplomatic forums, when politicians keep going until they have thrashed a deal out?  What sort of state of mind are they in when they eventually come to ratify some critical decision, and what, in consequence, is the quality of that decision?

One of my favourite Prime Ministers is Henry Campbell-Bannerman, a liberal who sat for the Stirling Burghs and who was PM from 1905 – 1908.  He died in 10 Downing Street.  His term of office was a quiet time, you may say.  I suspect that quietude might often be an index of successful premiership.  Campbell-Bannerman went on his holidays every September for six weeks to Marienbad in Bohemia.  Can you imagine a PM doing that now?  D’you know, I wish they would.  It would be a wonderful cure for insomnia.

In Mrs May’s case, I can only imagine that her own particular bind results from the fact that, having voted to Remain, she is now in charge of a government dedicated to Leave.  In this regard, I did find her coronation to the premiership in July somewhat puzzling.  Mr Cameron campaigned to remain, lost the referendum, and promptly resigned on that basis.  Moreover, his initial plan to stay on until September to provide a period of stability was quickly shelved and, with extraordinary expedition, Mr Cameron became a man of the past.  His eclipse was total.  He completely disappeared.  He had concluded, as had everybody else, that his position was untenable.  Yet Mrs May support for Remain did not appear to be an obstacle to her accession.  You may say that, while Mrs May’s support of the Remain campaign was low-key, Mr Cameron was the key figure in putting the government into a position which he had never intended, and therefore he had to pay the price.  Yet Brexit has become the key political issue in the UK right now, and while the PM believes in democracy and the will of the people, she does not believe in Brexit.  And that, I imagine, is why she cannot sleep.