Author: jamescalumcampbell

I have received a letter from a financial institution which contains the following mysterious sentence:

I am writing to inform you that, unfortunately, we have had to cancel your Payment Protection cover.  Within the Terms and Conditions of the policy there are certain eligibility criteria, and while these criteria were met previously, due to a recent change in circumstances, you are no longer eligible for cover. 

I can’t imagine what my change of circumstances might be.  But it would appear to be “unfortunate”.  Has a misfortune befallen me?  If so, I would rather my financial institution spelled it out.  I don’t care for “certain eligibility criteria”.  I can’t imagine what these are, but I have a notion it would be quicker, easier, and more cogent, to delineate them.

I rang them up.

“Welcome to ***.  You will now hear 4 options.  If you have lost your credit card or had it stolen… to make a payment with a debit card… to hear about your points… or for anything else…”

I pressed 4.

“You will now hear 5 options…”

I pressed 5.

Wonder of wonders!  A human voice.  I asked for an interpretation of the arcane rune I had received.  He hadn’t a clue.  I don’t hold it against him.  Darker powers are operating behind him.  The critical thing to understand about these call menus (“You now have 27 options…”) is that they are not for the benefit of the caller, but merely for the convenience of their designers who are unaware that every conundrum is unique, and cannot be understood, let alone solved, by a piece of software.

Meanwhile HMRC has been trying to contact my doppelganger.  Both he and I have been getting mail from the Inland Revenue.  It has come to their notice that I’m not who I say I am.  I’m under cover.  I have a notion they are suspicious of my Jekyll and Hyde existence.  But it’s not unusual for doctors who write to use a nom de plume.  I would not wish my patients to read me and imagine they recognise themselves.  But I’m not really trying to trick anybody.  I think it’s more subtle than that.  Writing under another name is a way of signalling that the two endeavours, medicine and writing, are entirely separate.  When I took a medical history I like to think I was entirely focused on my patient and on the task of making him whole.  The last thing I was doing was looking for copy.

Anyway I braced myself, took a deep breath, and phoned HMRC up.  Once again I negotiated the “if this, press that; if that, press this” menu but went for the wrong option.  I had to start again and go for “a change in my circumstances” – that mysterious phrase recurring like a leitmotiv or idee fixe.  What a relief finally to speak to a human being.  Not only that – and I’m not even sure if it is permissible nowadays to own up to this – I was greatly encouraged that she had a Scottish accent.  It may not be PC to admit it, but it’s just a fact; I knew communication was going to get a whole lot easier.  Why?  Because we would share a culture, an identity, and a history.  In particular, we would have a common understanding of what it is to battle against a bureaucratic machine that is operating from a remote location.  My confidence wasn’t even dented when she said at the end of the call, “Don’t worry, I’ll sort that out for you, Dr Campbell.”

I’ve just read His Bloody Project by Graeme Macrae Burnet (Contraband, an imprint of Saraband, 2015).  It has been shortlisted for the Man Booker Prize.  No wonder.  It is an utterly compelling piece of writing.  It concerns a gruesome triple murder, committed in a dismal hamlet just south of Applecross in the mid nineteenth century, by a 17 year old boy who, in modern parlance, I venture to say was “on the spectrum”.  He and his family eke out a miserable existence in a hovel, growing crops in poor soil, and paying rent to the landed gentry, under the watchful eye of the constable, and the factor.  In an atmosphere of relentless bullying and persecution, the boy’s father approaches the factor and asks that he may see the “regulations” governing his life, so that he may avoid transgression.  The impudence of the man.

It’s unremittingly bleak.  His Bloody Project reminded me a little of Sebastian Faulks’ Engleby, which concerned another murder, and another young man on the spectrum.  But mostly, in the depiction of a struggle of a helpless individual against an impersonal and inimical authority, I was reminded of Kafka.  The first time I read The Trial I thought it was the weirdest book, but increasingly it’s looking to me to be a straight and unembellished narrative of the way life is.  You only have to look at the annual ordeal of submitting a tax return.  Our tax gathering arrangements are labyrinthine.  They are incomprehensible.  When I contact HMRC to seek elucidation, I feel as if I am approaching the factor to ask for sight of the “regulations”.  It would appear that the lowlier your circumstances, the more likely you are to come a cropper.  If you happen to be a billionaire you have developed the knack of tax avoidance. If you are a huge multinational conglomerate you have the knack of keeping your corporation tax to a minimum.  It’s the little guy who makes a mistake and gets it in the neck.  I suppose it was ever thus.  Look at the tax gatherers in the New Testament.  Despicable lot.

I wonder if this sense of helplessness in the face of Power’s bureaucratic juggernaut is what is driving the wave of volatility and uncertainty currently sweeping across the western democracies.  People feel disenfranchised and helpless.  In Scotland, Westminster is remote.  In London, Brussels is remote.  In Florida, the White House is remote.  So vote for change.  Vote for Brexit, vote for Trump.  Anything’s got to be better than the status quo.  Messrs Johnson, Davis, and Fox say, “I want my country back.”  (Funnily enough, they don’t think much of Ms Sturgeon for saying the same thing.)  When the European Union begins to creak round the edges, Mr Farage looks on with undisguised schadenfreude.

And yet, it seem to me there’s another sense in which, without any protest at all, the entire population of the world is sleep-walking into a dystopia that is Kafkaesque, perhaps even Orwellian.  I’m thinking of the uncritical idolatry, particularly amongst young people, of information technology and the digital world.  Is there any sight more disheartening than that of a group of teenagers walking along the road all staring individually at their own mobile phones and tablets?  Nothing is more isolating and alienating than being connected.  I see that the BBC want us all to sign in to iPlayer, not, apparently, so they can get our post codes and check we have a licence, but so that they can enhance our consuming experience and give us a bespoke broadcast menu.

We all have to rail against this.  Don’t allow yourself to be put in a box.  Every time you fill in a form, seek out the “free text” option and say something different from what’s on the menu.  After all, we are all unique.  Was it Evelyn Waugh who pointed out that there is no such thing as the man in the street?  But that we are all immortal souls who, from time to time, need to use streets.

This is a joint letter of protest.

Truly yours,

JCC

HMCM (my cover is brulee.)

I’ve had a fabulous weekend.  It got off to a great start with the arrival of some advance copies of The Seven Trials of Cameron-Strange.  I love the cover, in lurid blue, of the Auckland cityscape from the Waitemata Harbour as it might be perceived by somebody who is stoned or psychotic.  And I’m proud of chapter one.  Can I sustain it as the book progresses?  Well, that is why we writers keep writing.

To the Glasgow Royal Concert Hall on Saturday night to meet up with a coterie of musicians and to hear the opening concert of the Royal Scottish National Orchestra’s 2016-17 season.  Nicola Benedetti played the Tchaikovsky violin concerto.  Consequently the hall was full, including the choir stalls (where I was) and with standing room only (also full) in the upper gallery.  I like sitting in the choir stalls.  You may have a restricted view, in my case, of the percussion section, and it may not be the ideal location in the hall for balance of sound.  But on the other hand you are facing a packed auditorium and there is an extraordinary sense of occasion.  It’s an ideal location for witnessing the communication between conductor and orchestra; you get something of the perspective of a performer.

Nicola Benedetti is held in great affection and esteem in Scotland.  If she performs at a Scottish venue, a full house is guaranteed.  In the course of her career she has had to put up with a certain amount of criticism by people who imagine her success is attributable to her appearance.  The virtuoso trumpeter Alison Balsom has had to endure similar criticism.  But as Ms Benedetti has rightly said, “I’m not going to apologise for the way I look.”

It’s all beside the point.  The point is that Nicola Benedetti is a phenomenal musician.  She is able to strip away all the barnacles and other Crustacea that Old Masters accrue, and get to the heart of the musical matter. There is an honesty and a directness, and an intimacy, to her playing that I am convinced is, at the profoundest level, the reason why she has established this deep bond of communication with her audience.  The audience also know that she is profoundly committed to the cause of introducing “serious” music, or “classical” music (whether any of it may be composed in the future is matter for another blog) to young people, listeners and performers alike.

The concert opened with Khachaturian’s Waltz from Masquerade, and concluded with Rachmaninov’s Second Symphony.  Following the Tchaikovsky, Ms Benedetti, rather than playing an encore, chose to say a few words and to wish the RSNO a very happy 125^th birthday.  It was clear that she has a very close tie with members of the orchestra both professionally and personally.  She said she had listened to the Rachmaninov the previous evening (in Edinburgh) and she told us that we in the audience were in for a treat.  It crossed my mind that she was aware that she herself had been the big draw for the crowd, and she was exhorting all her supporters to stay the course.  If so, it worked.  For the second half of the concert the audience remained undiminished.

And she was right.  It was a treat.  I thought it was a clever piece of programme planning.  Ms Benedetti is a draw for a younger set (“set”? – I can’t believe I just said that) and surely the deeply romantic Rachmaninov 2 is a young person’s symphony.  It was all wonderful, but I particularly remember the second subject of the 2^nd movement, a luscious theme in which the violins indulged in a sliding glissando that might have been cheesy, but wasn’t; then there was the clarinet solo in the 3^rd movement, exquisitely played by Jernej Albreht.  The perfectly paced tempo of the last movement allowed the music to speak for itself.  It brought the house down.

Sunday… To Aberdeen to lunch.  Perfect autumn weather for the drive up.  Party of six.  We ate a fabulous curry, and there was much talk and laughter.  My late mother was very fond of a quotation, that went something like:

So let us feast, and to the feast be added

Discourse, the sweeter banquet of the mind.

Who said that?

On one of the last occasions I can remember my mum being at a social gathering – she was well into her 90s, she said to me, “People – that’s what it’s all about.”

She might have said it in Gaelic, her native tongue.  Alastair Cameron-Strange said it in Maori:

He aha te mea.

Nui o te ao?

He tangata!

He tangata!

He tangata!             

Seventy years since the inauguration of the BBC Third Programme.  I’ve been tuning in all week to its metamorphosis, Radio 3.  On October 1^st they were reviewing “iconic” recordings over the decades and, from the 60s, they chose the 1963 Decca recording of Benjamin Britten’s War Requiem, with soloists Galina Vishnevskaya, Peter Pears, and Dietrich Fischer-Dieskau, the composer conducting.  I still have it on vinyl, in its slim black box with the white lettering.  Britten had composed the work to be premiered in 1962 in the newly rebuilt Coventry Cathedral which had been destroyed by the Luftwaffe during the Second World War.  The soloists represented Britain, Germany, and Russia, the principal players in the First World War.  Ms Vishnevskaya (Mrs Rostropovich – she was a pal) couldn’t obtain a visa to come to Coventry, but she managed the following year to travel and take part in the Decca recording.

Radio 3 played the closing passages of the Requiem.  I heard it – so often it is the case – on the car radio.  I was driving to a cemetery in Falkirk to lay flowers.  October 1^st is a day of remembrance for me.  It was very comforting to listen to the Britten, and Falkirk’s Garden of Remembrance is a very beautiful and peaceful place.

Radio 3 preceded the War Requiem extract with a recording of Britten in rehearsal.  Spellbinding.  The rather clipped, old-fashioned Received Pronunciation, the attention to detail, the master-musicianship… I can imagine that playing for the maestro would have been simultaneously exhilarating and intimidating.  At one point he told off the boys’ choir for inattention.  Terrifying.

I know the War Requiem quite well, partly because I studied it at school.  I wrote a dissertation on it as part of an English Literature course.  Aside from the Latin Requiem Mass, Britten sets the poetry of Wilfred Owen, hence the Eng Lit connection.  I recall that while I was a huge Owen fan, I was a bit lukewarm about the music.  As far as English music was concerned, RVW was my great hero. My adolescent self found the Britten somewhat precious.  Doubtless this view was reinforced by Dudley Moore’s spoof on Pears and Britten, Little Miss Muffet, in Beyond the Fringe, also from the early 60s.  (I’ve still got that on vinyl, too.)

I can vividly recall the first time I met Owen’s poetry.  The poem was The Dead Beat.

He dropped, – more sullenly than wearily,

Lay stupid like a cod, heavy like meat,

And none of us could kick him to his feet;

It was like nothing I’d ever read.  Poetry wasn’t supposed to be like this.  Poetry was removed from reality, spiritual, and high flown, like Keats:

Season of mists and mellow fruitfulness!

Close bosom-friend of the maturing sun;

And yet, as I subsequently discovered, Keats and Owen were inextricably bound up in one another.  Both died at 25, hand-writing uncannily the same, and, when you read early Owen, you realise he is obsessed with Keats:

I have been urged by earnest violins

And drunk their mellow sorrows to the slake…

And then something happened.  Well, the War happened.  It gave Owen both his subject matter and his tone of voice.  Owen uses the half-rhyme:

It seemed that out of battle I escaped

Down some profound dull tunnel, long since scooped…

And again:

Wearied we keep awake because the night is silent…

Low, drooping flares confuse our memory of the salient…

It gives the verse a half-lit, other-worldly mix of poignancy and despondency.  Could Owen have been a poet without the War?  Even when his subject matter is something other, it’s still the War, as in Miners:

There was a whispering in my hearth,

A sigh of the coal,

Grown wistful of a former earth

It might recall.   

And later, the abrupt change of tone:

And I saw white bones in the cinder-shard.

Bones without number; 

There’s no escape from the War.  Owen wrote a preface to a putative collection of his poems that he himself never saw:

This book is not about heroes… Nor is it about deeds, or lands, nor anything about glory, honour, might, majesty, dominion, or power, except War.

It’s easy to forget just how shocking, how uncompromisingly horrific, and how subversive is a poem like Dulce Et Decorum Est.  It’s as if Owen deliberately allows his art to be swamped and subsumed by his subject matter.  He says as much in the preface.  The Poetry is in the pity.

Listening to Britten on Saturday, it occurred to me that he too had deliberately rendered his artistry invisible in order that it serve a greater purpose.  He wanted to communicate with people.  Stravinsky was famously mocking of the War Requiem – or maybe the hype surrounding it – and told everybody to bring along their Kleenex.  It’s his “Little Miss Muffet” moment.  A cheap gag.  And how many contemporary “classical” composers now are bothered enough to communicate with people?

Aeons ago during a former life, Philip Hobsbaum my English tutor at Glasgow, who sat at the feet of F R Leavis in Cambridge, where he formed “The Group”, was kind enough to let me study whatever I liked.  He would say, “What are you going on to, Campbell?” and I would always have a reply ready.

“Wilfred Owen.”

“Excellent!  I interviewed his brother Harold for the BBC.”  So I read Harold’s book, Journey from Obscurity (1963) about his brother.  He describes an uncanny experience he had on board HMS Astraea off the coast of the Cameroons, of seeing Wilfred, sitting in a chair, shortly after he had died at the Sambre Canal a week before the Armistice.  What are we to make of such an apparent confabulation?  I imagine it to be a product of extreme mental stress and physical exhaustion.  But who can tell?

Later, while a medical undergraduate at Edinburgh, I played viola in the Bach St Matthew Passion in St Giles.  Peter Pears was the evangelist.  (I seem to recall that Kenneth Leighton played harpsichord continuo.)  I was only a few feet away from Pears and I was dumbstruck by the pure power of his voice, even in the twilight of his career, and by his complete devotion and artistry.  I remember rehearsing in the Reid School of Music and at the end of the rehearsal I chanced to walk out of the building with him.  He said, or rather sang to me, “I thought the choir sang beau-ti-fully!”  I was so overawed that all I could do was nod in agreement.

 

 

Mr Corbyn’s victory over Mr Smith in the Labour leadership on Saturday, by approximately 62% to 38% of the vote, was very remarkable. Most opposition leaders faced with a rebellion of their shadow cabinet, front bench, and 80% of the Parliamentary party, not to mention the hostility of the press and the biased reporting – by its own admission – of the BBC, would have thrown in the towel long ago. Yet Mr Corbyn seemed to be entirely unfazed by any of this, and not only has he survived, he has increased his popular vote. Surely his position is now unassailable for the rest of this Parliament.

It seems to me that Mr Corbyn shares a quality with an unlikely and disparate group of contemporary political figures that includes Donald Trump, Nigel Farage, and Boris Johnson. He is at ease with himself; he is comfortable in his own skin. He is authentic, the real deal. He does not put on an act and he has no need for spin doctors and “special advisers”. If he makes a gaffe, it hardly seems to matter. Neither of his predecessors were like that. Mr Brown only looked at ease north of the border. Mr Miliband incurred political damage simply by eating a bacon sandwich. Mr Corbyn could be photographed dribbling a chicken vindaloo down his beard and it would matter not one whit. Similarly Mr Johnson can be stuck in mid-air in the harness of a flying fox and still look happy. Mr Farage is entirely himself with a cigarette and a pint outside an English pub. Mr Trump can be as outrageous as he likes and it never seems to do him any political harm. No matter what you think of their policies, these people have an ability to connect with the electorate simply because they look as if they are having the time of their lives. Alex Salmond and Nicola Sturgeon also possess this quality; interestingly enough, so I think does Ruth Davidson. All of the recent Scottish Labour leaders on the other hand have looked as if they are fighting toothache. It’s hardly surprising. When Joanne Lamont resigned the leadership she said that Scottish Labour were merely a “branch office” of the Westminster PLP. I think that did Scottish Labour immense damage.

It’s odd to me that the PLP should consider Mr Corbyn to be a loser. He is polite and mild mannered. He would never have threatened to “smash” (sic) Mrs May back on her heels, as Mr Smith did. While Mrs May is beginning to look and sound more and more like Mrs Thatcher, I think Mr Corbyn, if you can hear him above the absurd ya-boo taunts and jeers, performs rather well at PMQs. Last week, Mrs May more or less said goodbye to him over the dispatch box. Well, she was a little premature with that.

But the oddest thing of all has been the hostility of the right wing press. If Mr Corbyn is as deluded and feckless as they make out, why do they bother to attack him? If his continued presence as leader is going to ensure a Tory government for a generation, why are they so intent on unseating him?

It’s because they are frightened. They are frightened of the unknown. Mr Blair they understood, and tolerated. But they can’t understand why somebody as alien to them as Mr Corbyn could have risen to the position of leader in the first place, and now, against all the odds, strengthened his leadership. It’s intolerable to them. Maybe Mr Corbyn will be Britain’s next Prime Minister. And he’s a socialist. Shock horror.

We’d emerged from the 11+, “the quawlie”, more or less unscathed.  Well I say that, but that wasn’t true for all of us.  Some of us were going down.  Some of us would not proceed in two months’ time east across the playground from old to new building to start all over again.  Some of us would be herded up and force-marched Partick-wards to Hamilton Crescent, “Hammie”, the junior secondary.

Mrs Miller tried to talk Hammie up.  “There’s no shame in not being academically minded.  You will have plenty of opportunities.  In fact, you will enter life faster.  Typing for the girls and woodwork for the boys.”  It sounded like hell on earth.  Hammie had a fearsome reputation.  The pupils were all criminals-in-waiting and the teachers their gaolers.  It was borstal, thinly disguised.  You’d be beaten up in the playground and belted in the classroom.  I gave up a prayer of gratitude, not of intercession.  Thank God I’m not stupid.  Heavenly father I thank thee that I am not as one of these.

Half a lifetime ago Miss Haggart had invited me for a tete-a-tete at her desk in front of the class.  She was a terrifying woman but on this occasion she was fawning over me in a way I couldn’t understand.  She was like the big bad wolf in a bad red-riding-hood disguise.  She was almost obsequious.  Apparently I was top of the class.  It was news to me.  I’d just been trying to keep my head above water, keep my incompetence to myself.  Joyce Cooper had had to teach me how to tie my shoes laces and put on my tie.  I was backward.  There must be some mistake.

But I’d got to like it there, the view from the back of the class.  Marjorie sat across the aisle from me, with her lovely long straight red hair.  Proxime accessit.  I would flash her sickly smiles of meretricious, sycophantic concupiscence.  (I really must stop saying that.) The quawlie was no threat to me.  Smug little prig.

For seven years we had started the day with The Lord’s Prayer and then moved quickly on to sums.  We were drilled mercilessly in number for an hour and a bit, until I could blessedly escape to do the milk run.  The exams for this particular “R” of the 3-R triumvirate always took the same form: fifty marks for mechanical, 40 for problems, 10 for “mental”, total: 100.  In mechanical, we added, subtracted, multiplied, divided.  We manipulated vulgar fractions, and decimals.  We did it so often that we did it, indeed, mechanically.  We applied the techniques to problems of the sort that used to intrigue the Canadian humourist Stephen Leacock.  If it takes 4 men 6 days to dig a hole, 12 feet deep, how long does it take 3 men to dig a hole, 15 feet deep?

Well!  You could write an essay!  Is this second hole to be of the same width?  Are we digging through a similar consistency of substratum?  Are the 3 men to be chosen from the original group of 4, and, if so, do we leave out the laziest, or the strongest, or the union man?  Which is absurd.  It took a certain talent for abstract thought to realize that the problem being posed was not human at all, but that we were merely being introduced to algebra by stealth.  You tended to fare rather better at school, if you were a little bit obtuse.

One day Mrs Miller marked our papers and dished them back at us.  Ann Munro went out to dispute a mark.  I was vaguely aware of raised voices.

“The answer is 1.  You have written 100.”

“No I didn’t.  I wrote 1.”

I was summoned to adjudicate.  Ann had written 100, and then rubbed out the two nothings.  But she hadn’t rubbed hard enough.  That would have been my ruling, had I not been pressurised to take sides.  I said it was 100, and sat down feeling like Pontius Pilate, vaguely conscious that an opportunity had passed me by.  I cursed Ann for not using a cleaner eraser.  I cursed Mrs Miller, for putting me in that situation.  But mostly I cursed myself.  I wish I’d said Ann had written a 1.  Ann, I’m sorry.

After break we did parsing.

Down south, Mrs May wants to return to this.  She reminds me of the last line from The Great Gatsby.

So we beat on, boats against the current, borne back ceaselessly into the past.            

Contemporary fiction-wise, I have an aversion to tales that are told in the present tense. It’s a relatively new phenomenon. Dickens didn’t start A Tale of Two Cities with “It is the best of times, it is the worst of times…” nor Charlotte Bronte, Jane Eyre, with “There is no possibility of a walk today.” I blame it on James Joyce and Charlie Chaplin, a conflation of Stream of Consciousness with the rise in the early twentieth century of Cinema. Now authors think cinematographically. The result is like a film script. “He stubs his cigarette out in the ashtray. He stares at me fixedly. (Beat.) He gets up, crosses the room, and closes the door.” Even worse is the present continuous. “I am conscious that I am staring at the curve of her lower back. I am loving the way she leans forward…” And so on. It seems to me to have an overblown quality. If it is happening in the present, it is always happening; it is happening for all time. It’s self-indulgent, inward, preoccupied, and narcissistic. In fiction, it’s almost impossible to be kind-hearted and outgoing in the present tense.

Yet, with respect to his most recent publication, Nutshell, (I keep wanting to call it Nutcase), I have to acknowledge that Ian McEwan could hardly have used any other tense than the present. His narrator is, after all, a foetus. What else can an unborn child know other than the present? Hence: “So here I am…” It’s vaguely reminiscent of Dante, the man “in the middle way”, lost in a wood.

It is – as ever with McEwan – a clever idea. But aside from the choice of tense, it presents the author with an ever present (sic) technical problem. How can the unborn child tell a tale that takes place ex utero? Answer – by a combination of imagination, and eavesdropping. That McEwan can do this, without “clunking” page after page, is technical achievement in itself.

I’m a McEwan fan. I’ve read the canon. I tend to read his books while travelling (I’m writing this in Keflavik Airport), which is perhaps a mistake; one shouldn’t speed-read literary fiction as if it were a murder-mystery (even though, in a way, that’s what Nutshell is). It’s a great gift if you have it, to be able to write a page-turner, and yet I suspect I’m not the only person who reads McEwan too quickly. It’s probably the reader’s fault that sometimes his books seem like Chinese meals; they are appetising and enjoyable yet leave one with a curious sense of non-satiety. They are certainly clever. Again like contemporary film, they often start with a “thesis” or “postulate” that is creative and imaginative. Foetus qua narrator is an example. My favourite of his books is Enduring Love, a tale of erotomania which is really an imaginative exploration and development of a medical case-history.   McEwan tells the story and then presents the medical case as an appendix, rather as Benjamin Britten’s Lachrymae presents a series of variations and ends with Dowland’s original theme. Is it a trick, a gimmick?

McEwan does play tricks on his reader, perhaps most notoriously in Atonement, where we are tricked about the authenticity of a narration, and again in Sweet Tooth, where we are tricked about the authenticity of an identity. I’m not at all sure about this. You had thought the information embedded in the text was what mattered, when all the time it was the author’s cleverness with respect to it. Too clever by half? Too self-absorbed? Moral power is to be found in a transcendence of the self.

Another charge laid against McEwan, that his characters and his world are too middle-class, seems to me less justified. You write about what you know, and what interests you. McEwan is interested in professions and their mysteries – medicine, the law, literature, science. If his characters seem to be self-centred, mirthless, and lacking in human warmth, maybe that’s because they are indeed all of these things. He can be funny, but in a dark way. You long for somebody to appear who is cheerful, and kind.

I enjoyed Nutshell but it left me feeling anxious and fretful. It’s hard enough living the present let alone reading it. But I know how to snap out of this. I will read a chapter of Jane Austen at bedtime. Then I will know that all is well with the world.

“Now listen to what I tell you,” said Mr Mackay the PE teacher. “When Mrs Biles announces the first dance, all of you, and I mean all of you, will step forward, advance, approach a young lady and ask her if she would like to dance.”  Next month we would hold our school dance in here.  But it didn’t matter how much tinsel and crepe you draped over the wall bars; you couldn’t disguise the gymnastic atmosphere of sweat and fear.  Mackay might have been a field commander issuing instructions on the eve of the Battle of the Somme. When the whistle blows, over the top.  Fix bayonets, don’t cluster, march, don’t run.  Mackay smiled a thin lipped, gloating smile.  “And if I see anybody lagging behind, believe me…” – he held up his opposed thumb and forefinger with the tips a millimetre apart – “I will make him feel this small.”  The summary court martial; the firing squad at dawn.  A brief moment’s writhing in the mud, calling for mother, and then the blessed coup de grace.  I glanced across no man’s land – the width of a badminton court – to the enemy trench.  They looked more confident than us.  They seemed to have a better handle on what was going on.  There was amusement and laughter and even a tinge of excitement.  But here and there was a silent one, cringing on the bench under the wall bars, in dread anticipation of the cold steel of that bayonet, looking down at the stain of blood on her own gym slip, wondering what it meant.

Mrs Biles rammed the stylus down on to the vinyl.  “Gentlemen, take your partners for a St Bernard’s Waltz!”  I glanced to my left.  Buckie, impossibly, had wedged himself behind the wall bars.  He was trembling.  I said, “Come on, Buckie, it’s not that bad.”

“Leave me alone!”

We left the redoubts and parapets, we crossed the salient, not to the strain of the bagpipe, but to the cosy blend of accordion, piano, and violin.  I had no agenda, no plan, save to stay upright and go through the motions and make sure Mackay didn’t make me feel this small.  I was afraid of Mackay but I didn’t respect him.  Even then I believe I knew him for what he was, a psychopath and a sadist.  I had come to this realisation a few weeks ago in the same gym when we had been practising floor exercises under his tutelage.  We lay supine staring at the ceiling.  Then we flexed our knees so our feet were flat on the floor.  Then we placed our palms flat on the floor behind our heads.  Then we lifted our hips and torsos off the floor in a high arch.  It was called “the crab”.  Buckie couldn’t do it.  Mackay was humiliating him.

“Get your fat bottom off the floor, Arbuckle.  Higher!  Higher!”

Buckie sweated and strained and by some monumental effort achieved the arc.  Mackay placed his foot on his stomach.  The superstructure collapsed.

“Arbuckle, you’re rubbish!”

I didn’t forget that.

Mackay had been something in the military, an NCO or something, I dunno.  I didn’t understand the hierarchies, had absolutely no inkling of the ingrained class structures of army life.  I just had the sense that Mackay had retained his military bearing and persona after he’d been demobbed so that he could carry on behaving badly.  He used to take us for rugby.  We were rubbish at rugby.  All these posh schools racking up scores like substantial snooker breaks against us.  It was the most dismal part of my education.  I learned how to lose.  I was very confused about rugby.  It was encouraged over football (some people even called it football) because it seemed to be an upwardly mobile activity for youngsters.  The oval ball, muscular Christianity and all that.  I wish I’d had the nerve to tell Mr Mackay where he could stuff his oval ball.

In Ipswich Crown Court on Friday, an optometrist was found guilty of the crime of manslaughter by gross negligence, and handed down a suspended two year jail sentence, as well as an order to carry out 200 hours of unpaid work.  During an eye examination, she had failed to detect a sinister clinical sign whose recognition should have prompted her to make an urgent hospital referral.

What do you understand by the term manslaughter?

Chambers:  manslaughter the slaying of a man: unlawful homicide without malice aforethought.

Bloomsbury: manslaughter the unlawful killing of one human being by another without advance planning.

Oxford: manslaughter the crime of killing a human being without malice aforethought, or in circumstances not amounting to murder.

And, since the Oxford has raised the other m word: murder the unlawful premeditated killing of one human being by another.

Interestingly, Churchill’s medical dictionary is far more detailed in its consideration of what might constitute an unlawful killing that is short of murder:

Manslaughter the unlawful killing of one human being by another in circumstances devoid of premeditation, deliberation, and express or implied malice.  Involuntary m. 1 The unintentional killing of another by an individual committing an unlawful but not felonious act or an unlawful act not usually associated with potentially lethal injury, such as striking and killing a pedestrian while operating a vehicle in excess of the speed limit.  2 The unintentional killing of another by an individual committing a lawful act in which the requisite skills or necessary precautions associated with the act have not been deployed, such as the intraoperative or postoperative death of a patient undergoing surgery performed by an intoxicated surgeon or one under the influence of drugs, if no extenuating circumstances existed…

We begin to build up a sense of what sort of act might constitute manslaughter.  Man walks into a pub, drinks eight pints of lager, then gets into his car, drives through a 30 mph built-up area at 60 mph, knocks down and kills a pedestrian.  That is manslaughter.

I must admit the Churchill dictionary entry caused me to raise an eyebrow.  Since when was striking a pedestrian while operating a vehicle in excess of the speed limit “not usually associated with potentially lethal injury”?  And I suppose it is possible to conceive of an extenuating circumstance in the case of the intoxicated surgeon whose patient dies on the table or shortly after.  But it’s a bit of a stretcher; maybe he was off duty, celebrating a birthday out in the wilderness, suddenly called upon to carry out a piece of heroic life-saving surgery because nobody else was available.  But I digress.

The point about all these definitions is that manslaughter, though falling short of murder, is a serious crime.  The judge at Ipswich Crown Court clearly thought so.  He invited the jury to consider whether they were sure that the defendant’s conduct was “something truly so exceptionally bad and in the circumstances gave rise to a serious and obvious risk of death… (and) was in your judgement enough to amount to the very serious crime of manslaughter…  It may be that you answer no to any questions – in which case you will be led to a verdict of not guilty… Mistakes, even very serious mistakes, and errors of judgment, even very serious errors of judgment, are nowhere near enough to found a charge of gross negligence manslaughter.  Even if you have found there is a breach of duty, you still have to go on to consider if it is so bad as amounts to a criminal offence.”

The jury found the defendant guilty.

I must say that I found this conclusion so odd that I took the trouble to read a full report of the trial, which I found in the periodical Optometry To-day.  I found myself in not unfamiliar territory.  You can’t have a career in emergency medicine and not find yourself summoned as a witness to various sorts of court, District Courts, Crown Courts, High Courts, and the Medical Disciplinary Committee of the General Medical Council.  Those of us who have not been in the dock (yet), know that that is at least to some extent down to luck, and maybe the grace of God.

I am not about to offer any opinion on the Ipswich case of which I have no special knowledge, other than of the information which has been reported in the public domain.  Yet any experienced medical practitioner reading a report of this kind will recognise certain recurrent themes.

The most important point of all is that a court of law is seldom a good place in which to establish what happened in an episode of medical care that has gone badly wrong.  The best environment in which to establish the truth of the matter, is within the confines of a medical Morbidity & Mortality (M & M) Meeting.  M & M Meetings in hospital, and in General Practice, are routine.  They do not merely examine medical error, adverse outcomes and fatalities; but also interesting or unusual cases, conditions that are seldom seen, and episodes from which everybody may learn something for the future.  Success stories are included – good outcomes can be educational too.  And it is always good to present a case which at first sight looks commonplace and mundane – it often turns out not to be so.

The prerequisite, the sine-qua-non, of an M & M Meeting is that it be non-judgmental.  You may say we run into a difficulty here: how can we be non-judgmental if somebody is guilty of criminal activity?  The more frequently asked question is, how can we be non-judgmental if somebody has shown themselves to be clinically incompetent?  The answer is that an M & M Meeting voluntarily suspends judgments of morals or competencies at least until an agreement has been reached about the facts of the case.  The agenda is not to finger-point, rather to dissect the anatomy of an episode of care so that future mistakes may be avoided by all.

So M & M Meetings are formal and structured.  They always follow the same format.  The case is presented – the patient demographics; the presenting complaint; the history; allied histories – past, therapeutic, familial, social.  Then the clinical examination findings.  Then the investigative diagnostic endeavour, the diagnostic formulation, and from it, the proposed treatment or management strategy.  The patient’s progress, further interventions according to response, and a description of outcome whether it be toward recovery, or further debility, and demise.  Lastly, an overall attempt at summation.  What happened and why?  What have we learned?  And, if indicated, what can we do to prevent a recurrence?

None of this happens in a Court of Law.  The whole attempt at recreating the case is replaced by a harangue between two combative opponents intent on convincing a jury of the validity of their own narrative.  The prosecution will say that the defendant is careless, slapdash, negligent and incompetent, to the extent that their behaviour is criminal; the defence will say that the errors that have occurred were systems errors, an unfortunate concatenation of small adverse events that unfortunately and uniquely resulted in this tragic accident.   Scrutiny will concentrate on a specific episode: did the defendant look at the right digital image?  Did the defendant carry out a mandatory examination?  Was it thorough enough?  All this, when the jury is not privy to the overall picture.  What was the diagnosis?  What was the pathophysiological process?  What happened to the patient between the examination and his death?  It is the cardinal mistake of the microscopist who switches immediately to a high-powered field without looking at the slide macroscopically, thus potentially missing something glaringly obvious.

M and M Meetings take place shortly after the events they choose to analyse – usually within a calendar month.  In the Ipswich case, the optometry examination under scrutiny took place on 15/2/12, and the case came to court on 5/7/16, that is, 4 years and 5 months later.  It is hardly surprising that the answer to many questions was, “I don’t remember.”

A case in an M & M Meeting might be presented and discussed in 20 minutes.  The Ipswich trial started on July 5^th and ended on July 13^th.  This is not to say that a Court of Law should not take all the time it needs, merely to point out that a trial of this nature frequently lasts one to two weeks, while the defendant whose actions are being scrutinised was constrained to conduct a consultation and perhaps make several decisions in the course of fifteen minutes.

M & M meetings are designed to get at the truth.  Criminal Trials are designed to allow two individuals to compete to impose their version of the truth upon a jury.

And the jury?  Is it really appropriate to ask a group of lay people to study pictures of papilloedema, and make value judgments about cup-disc ratios?

The avoidable death of an 8 year old child is a terrible tragedy.  Our hearts go out to the boy’s family and loved ones.  His parents expressly wished that the defendant in this case, herself a parent, be spared a custodial sentence.

But it is also a tragedy that our legal system is not very good at uncovering the truth.  M and M meetings uncover the truth, not in order to charge somebody with manslaughter, but to attempt to lessen the chances of a recurrence of the incident; yet not – as is so often heard outside court rooms – so that “it may never happen again.”  That is beyond the scope of human achievement.

The oddest aspect of all lies in the concluding remarks of the judge.  “I have therefore reached the conclusion and sentence you on the basis that there is no obvious explanation for your breach of duty.  You simply departed from your normal practice in a way that was completely untypical of you – a one off for no good reason.”

There’s an expression of complete bewilderment if ever there was one.

 

 

 

Barely two column inches caught my eye on the front page of Saturday’s Herald:

An investigation has been launched after a human foetus was discovered within a bag inside a disused hospital building.

Full story: page 3.

But the full story shed little light and left more questions unanswered.  This was a disused hospital site that has not seen maternity services for 24 years.  All we know is that some kids with nothing better to do had broken into the place and are now under arrest.  So many obvious questions arise from this report that remain unanswered.

The derelict site in question was part of the old Glasgow hospital, Stobhill.

When I read about this, I immediately thought of a poem, Stobhill, by the late great Scottish makar, Edwin Morgan (Edwin Morgan, Collected Poems, Carcanet 1990).  Stobhill is surely one of the most upsetting and disturbing poems I have ever read.  I can hardly bring myself to outline its burden, other than to say it is concerned with a (late) termination of pregnancy.  It is an account from five people: doctor, boiler man, mother, father, porter.  The reproduction of vernacular speech from each of them is faultless.  But to speak of the technicalities of composition in this context seems beside the point.

If this poem is extremely upsetting and disturbing to me, it is because as a junior doctor I had a cameo role in an event not dissimilar and indeed, in every conceivable way, worse.  I wrote it up in 1991.  It was – for obvious reasons – distorted and fictionalised; yet when I read it now, I realise that it is entirely devoid of fiction.  Periodically I think to publish it.  Sometime, maybe.

We weren’t taught ethics as a discipline when I was a medical student (or, if we were, I must have dogged off that afternoon).  The trendy conceptual framework of the day with respect to medical education was “Knowledge, Skills, and Attitudes”.  They were taught more or less in that order.  At a time before the notion of an “integrated curriculum” had caught on, medical students spent two or three years in lecture rooms, dissection rooms, laboratories and libraries, acquiring “Knowledge”.  They gave us a BSc Med Sci at that point just in case we’d had enough.  Then we were let loose on the wards to acquire “Skills” – primarily diagnostic skills, with a few technical procedures thrown in.

The “Attitudes” bit was really something of an afterthought.  You can tell it was that because of the clumsiness of the nomenclature.  How on earth do you impose an attitude on somebody?  Pragmatically, most of us thought: keep your head down, do as you are told, and above all don’t let anybody suspect you’ve got “Attitude”.  I think the general idea was that if you paced the wards night and day for another three years you would somehow imbibe and osmose the “wisdom” of the consultants and know how to make sound and humane decisions.

Nowadays, medical students are actually taught medical ethics as part of the undergraduate medical course.  Medical students – more now than ever – are like pedigree race horses.  They are trained to jump hurdles.  They are professional exam takers, bursting with Knowledge and Skills.  Ethics – another week, another module.  What’s medical ethics condensed on to one side of A4?  It is the template of Beauchamp and Childress (it’s the modern way, to be armed with a crib, going forward), that every medical decision should be informed by consideration of its import with respect to the concepts of autonomy, beneficence, non-maleficence, and justice.

Patient autonomy is a swipe against medical paternalism which is not always welcomed by the patient.  The doctor outlines the pros and cons of a proposed procedure and seeks the patient’s “informed consent” to proceed.  More often than not, the patient shrugs and says, “You’re the doctor.”

If a procedure must be beneficent it may seem redundant to add that it also be non-maleficent, yet the inclusion of both ends of the spectrum is frank admission that no therapeutic modality on earth is devoid of adverse side effects.  Not one.  Risks and benefits – you’ve got to balance them up.  Actually you’ve got to get the patient to balance them up – because of his autonomy.

“Justice” puts the patient into the context of the wider community.  It may be beneficent to Patient A to spend £1,000,000 on him, but if this is at the expense of Patients B- Z, is it “cost effective”?  This is the ethical dilemma NICE grapples with every day.

But to return to Stobhill – my own personal Stobhill.  I cannot speak of this. Let the Morgan poem stand in for me.  I do remember that, at the time it happened, the BBC were showing a series of films by the surrealist Spanish film director Luis Bunuel – films like “That Obscure Object of Desire” and “The Discrete Charm of the Bourgeoisie”, in which everything that happens seems perfectly rational and logical, except that it is all utterly mad.  I was a bit player in a Bunuel movie.  I think that if somebody at that point had introduced me to Beauchamp and Childress’ “practical framework” for medical ethical deliberation, I would have told them it was the biggest crock of cockamamie bull…

Yet what else have we got?

 

From behind the sofa, I watched the first set of the titanic Murray-del Potro showdown on Sunday night and, realising it was going to be a gruelling contest, turned the telly off and went to bed, exhausted.  It was heartening to wake up this morning to news of the golden success of “Sensational Sunday”.  But why should we care?  Haven’t the Olympics, tainted by cheats, performance-enhancing drugs, and big money, become a barely disguised scam and a bloated anachronism?

I like the Olympics.  I like the feel-good factor which can lift our spirits for the duration of the Olympiad.  Actually that’s not quite right.  An Olympiad lasts from one Games to the next – we are always in an Olympiad, but for most people, the elation and inspiration tends to dwindle after the Olympic torch has been extinguished.  It takes a special kind of dedication to get up at 4 am every day for four years and go the pool; or to get home of a November night after a hard day’s work, put on your Nikes and go out for a fartlek or twenty.  So I doff my hat to the youth of the world who take up the invite to the next time.

But here’s an interesting statistic: the athletics (and surely track and field are at the core of the Olympics) started on Friday night and the attendance, at Havelange Stadium with a capacity for 60,000 souls, was less than 1000.  Why? Here’s my theory: sport is basically an activity of the posh.

It may not be immediately obvious that there are class barriers to success in sport (or even entry into sport) if the venue is London or Paris or Sydney, but it becomes clearer if the venue is Rio and the stadium is surrounded by favelas.  As a kid, if you are struggling to survive you might kick a ball around the back streets but the last thing you would think of doing is to join a golf club or a sailing club.  Why on earth would you wield a tennis racket or a hockey stick when all the time you are exhausted and malnourished?  To be interested in sport, you need time and leisure, two commodities the poor just don’t possess.

That much is obvious in the context of a developing country.  But it’s also true here in the UK, albeit in an attenuated way.  Certain sports are just off limits to the disadvantaged.  Can you imagine somebody from Glasgow’s Calton district getting a gold medal in dressage?  It’s inconceivable.  There are really only three sports that somebody from the east end of Glasgow can aspire to – football, boxing, and snooker.

I once went to see Billy Connolly play Auckland and make 2000 people ache with laughter during a three hour soliloquy that seemed to last about 20 minutes.  (You couldn’t imagine what he was going to say next and you had the feeling he didn’t know either.)  He told one of these convoluted stories about how it would be if a member of the aristocracy signed on at the Labour Exchange.

“What’s your line of business?”

“Toboggan.”

Connolly held up a finger.  “See!  There’s the difference!”

The man behind the counter can’t find “toboggan” on his list so checks with his supervisor, who takes a series of suspicious glances at the customer.  “Write down tobacconist.”  That is a very Glasgow solution to a conundrum.

My favourite sporting hero is Jack Lovelock, the New Zealander who studied medicine at Otago and went to Exeter College Oxford on a Rhodes scholarship.  He won the 1500 metres gold medal in the 1936 Berlin Olympics in one of the strongest fields ever assembled.  Harold Abrahams commentated on that race for the BBC.  Abrahams himself won the 100 metres at the 1924 Paris Olympics.  He was played by Ben Cross in the film Chariots of Fire, which portrayed him as a prototypic modern athlete prepared to devote himself heart and soul to the task of winning.  In the film, his academic mentors at university castigate him for his attitude which is described as “plebeian” – this, mixed in with a barely disguised anti-Semitism.  Abrahams didn’t have to run against somebody who might have been his Nemesis – Eric Liddell, a deeply religious Scotsman who refused to run on Sunday and therefore could not take part in the heats of the 100 metres.  He won gold in the 400 metres.  I can draw this tale back to New Zealand by recalling an occasion when I did a locum for a NZ doctor, the GP on Great Barrier Island.  He was the son of missionaries in China and was born in a Japanese internment camp during the war.  As a toddler, he sat on Eric Liddell’s knee.

(I can’t resist telling you a bit more about that locum.  Great Barrier Island is a very extraordinary place which features in my up-and-coming tome The Seven Trials of Cameron-Strange.  I saw a guy who had sustained a very nasty injury to a finger while slaughtering a wild boar. (You could hardly blame the boar.)   He needed the skills of a plastic surgeon.  As I was finishing up the locum (I think he was my last patient) and as I had flown to GBI in a Cherokee Warrior 2, I offered to fly him over to Middlemore Hospital in South Auckland, where he needed to go.  So he turned up at Claris Airstrip with a haunch of pig by way of thanks.)

Where was I?  O yes – the enigmatic Jack Lovelock.  There is something deeply mysterious about Lovelock.  The New Zealand writer James McNeish captures it in two books – a novella, The Man from Nowhere, and the more substantial Lovelock.  Both give a sense of what 1936 Berlin must have been like. After his retirement, Lovelock went on to practise medicine (Orthopaedic Surgery) in Manhattan, and he died mysteriously by falling under a New York subway train.

Lovelock is fascinating because he’s really a bit of an outsider.  Andy Murray has that quality.  A son of Dunblane dominating in tennis (well, nearly dominating – Murray has a Nemesis too) is almost as unbelievable as a Calton champion in dressage.

But let’s keep a sense of proportion.  It’s only a game.  I recall reading a poem at school which I’ve been unable to track down, but whose opening lines were

Sport is absurd, and sad.

Grown men…

Harold Abrahams, and his coach Sam Mussabini, may have inaugurated the era of professionalism in sport, but even they had a sense of proportion.  In Chariots of Fire, after Abrahams won his race, he and Mussabini had a few drinks and then Mussabini advised Abrahams to go and get a life.