Author: jamescalumcampbell

Last week’s blog centred on Scottish Health Minister Shona Robison’s speech on day 1 (October 1^st) of the Royal College of General Practitioners’ annual conference held in Glasgow.  Fast forward to the morning of October 3^rd.  One of the presentations was given by Nick Ross, erstwhile BBC TV Crimewatch presenter talking, not surprisingly about crime.  GPs are interested in crime because crime and pathology are inextricably linked.  Mr Ross’s talk followed that of Shami Chakrabarti who was an extraordinarily charismatic and inspirational speaker whose talk “On Liberty” received a standing ovation.  The chairperson said “Follow that, Nick!”  Well, he did, with his own style and aplomb.

Mr Ross’s thesis was that crime prevention could learn a lot from preventative medicine.  He thought that crime, like disease, has a propensity to be endemic.  Society, he said, is not made up of crims and non-crims.  We are all potential criminals.  He challenged the audience. “If you have never committed a crime, raise your hand.”  I didn’t look round, but I gather there was no show of hands.  The Left, said Mr Ross, thinks that crime is caused by poverty; the Right thinks that crime is caused by individuals who choose to commit it.  Neither side is right, claims Mr Ross.  Crime is a product of temptation, and opportunity.  Remove the opportunity, and hence remove the crime.  If your car is burglar proof, it will not be stolen.  Society needs to take steps to vaccinate itself against crime, by removing temptation and opportunity.

To be honest, I found the notion rather dispiriting.  But I can see it has a certain validity.  Injury prevention has proceeded along similar lines.   I was reminded of the work of William Haddon, the father of injury prevention in the United States.  He would say, “There is no such thing as an accident”; he would fine his colleagues whenever they used the “A-word”, and thus he applied epidemiological principles to the disease of trauma. He devised a system known as “The Haddon Matrix”, which examines any traumatic incident in terms of the incident’s host, vehicle, and environment, along a time line of pre-event, event, and post-event.  So, with respect to a road crash, pre-event you get the driver to wear a seat belt, you give him a car with a good set of brakes, and you put a speed limit on the road.  During the event, the airbag deploys, the car doesn’t disintegrate, and the crash barrier withstands the impact.  Post event, the fuel tank doesn’t explode, the driver receives excellent Advanced Trauma Life Support, and the scene is investigated in order to learn lessons to improve outcomes in subsequent incidents.

Yet even Prof Haddon didn’t neglect the need “to fix the nut behind the wheel.”  He didn’t try to exonerate bad drivers.  Mr Ross seemed to imply that dishonesty, the propensity to commit crime, is inevitable.  I don’t believe this is so.  I know plenty of people who choose not to commit crime, all the way from breaking the speed limit to grand larceny, not because they are frightened of getting caught, but because they know it is wrong.  My father, who happened to have been a policeman, used to say, “There are two kinds of criminals.” (I think possibly he was referring specifically to the crime of theft.)  “There are the needy; and there are the greedy.”  It might be a stretch to say that that is the difference between blue collar crime, and white collar crime, but greed does seem more obviously to be a propensity of the wealthy.  The more you have, the more you want; the more you consider yourself “entitled to”.

Mr Ross’s pragmatic approach, to remove the moral dimension from the debate, is certainly the modern way.  If a group of senior executives are found to have rigged the bank rate, or to have diesel emission software rigged on their watch, they will put their hand up to own up, not because of a crisis of conscience, but because they have been found out.  They certainly won’t admit that they did wrong, rather they will say that they “fouled up”.  They “let people down”.  It was “an error of judgment.”  And so on.  This is of course all bullshit and I use that technical term specifically, in the sense of Harry G. Frankfurt, the Professor of Philosophy Emeritus at Princeton University, whose two tracts, On Bullshit, and On Truth, are surely the definitive treatises on present day moral philosophy.

The trouble with removing the moral dimension from crime prevention is that all you are left with, all you can do in response to criminality of any kind, is put systems in place designed to prevent a recurrence of malpractice, by manipulating the environment to make it impossible for people to transgress.  It’s the only thing you can do if you start with the presumption that “everyone’s a dodger”.  This is what happens when inquiries are conducted into institutions such as hospitals or care homes placed into “special measures” because of a scandal, usually involving cruelty, bullying, neglect, perhaps even wrongful death.  The inquiry takes a very long time and then comes out with a fantastic number of recommendations – maybe hundreds of them.  These are designed in part to placate the desire of deeply wounded relatives who understandably wish that “nothing like this must ever be allowed to happen to anyone else”.   The Mid-Staffs Inquiry into the failings at Stafford Hospital, published on 6^th February 2013, had 290 recommendations.   Individuals implicated in such inquiries may or may not be held accountable, but either way the entire institution will in effect be punished and diminished – rather than helped – because it will be made impossible for the workforce to live and work normally.  The larger the number of recommendations, the less likely it is that the persons conducting the inquiry have reached some sort of diagnosis and formulation as to what has really taken place at the institute.  If they had, they could probably have put it all into an executive summary on one side of A4.  Critical to such recommendations would be the one that is paramount:  a small group of people in charge of the institution must be honest, trustworthy, kind, and competent.  That’s all.  Rather than trying to micromanage the institution, the inquiry should make it possible to empower a trustworthy leadership, and then say, “We trust you to fix this.”  An inquiry with 290 recommendations cannot see the wood for the trees.  Such inquiries are the product of communities whose members no longer trust one another.  I return to the Duke in Shakespeare’s Measure for Measure:

There is scarce truth enough alive to make societies secure, but security enough to make fellowships accursed.

If an entire society loses belief in the trustworthiness of its members, it can only be sustained through the application of totalitarianism.  We come to inhabit a monochrome moral universe in which, as Prof Frankfurt has said, we lose even the sense of where our own individual identify stops and another’s begins.

At the annual conference of the Royal College of General Practitioners held in Glasgow (Oct 1^st to 3^rd) Shona Robison the Scottish Government Health Minister announced the demise of the “Quality Outcomes Framework” (QOF), to the applause of 2000 GPs.  The QOF was embedded in the 2004 GP contract and awarded GPs points, and income, on the basis of fulfilling certain tasks such as recording patients’ blood pressure and smoking status.  GPs, medical students and doctors generally, are very good at fulfilling set tasks and jumping hurdles; they’ve been doing it all their lives.  The 2004 QOF was easy.  Most of the GPs got near maximum points.  So the QOF evolved.  It became more complicated, more bureaucratic, and more burdensome.  I was about to say the paperwork mushroomed, but it would be more accurate to say the electronics went haywire, and before they knew it, GPs were spending twelve hour days glued to computer screens, fulfilling more and more obscure tasks.

Running parallel to the contractual obligations were the requirements of continuous professional development (CPD).  Previously, GPs were required to demonstrate maintenance of professional standards largely by demonstrating attendance at a number of medical education meetings or courses.  Just before the inauguration of the new contract, annual GP appraisal was introduced as a means of monitoring GP CPD, checking not only that GPs were putting in the CPD hours, but were also doing so in a planned way based on their own (and their appraiser’s) perception of their educational needs.  GPs were required to “reflect” on their educational experience.  Appraisal was put in place not long after the trial and conviction on 31/1/00 of Dr Harold Shipman who was found guilty of the murder of fifteen of his patients.   The Shipman Inquiry commenced on 1/9/00 and ran for about 2 years.  Dr Shipman committed suicide in prison on 13/1/04.  By an extraordinary non sequitur sections of the lay press somehow developed the notion that the purpose of GP appraisal was “to prevent another Shipman”.  Any newspaper article on the subject of GP appraisal would almost certainly mention the name Harold Shipman.  Then, as with QOF, the paperwork, or electronic-work, of appraisal also began to burgeon and grow more complex.  The medical profession began to suspect that it was being punished and made to suffer as an expiation and apology to the public, because a serial killer happened to have been a doctor.   This was felt all the more keenly as the demands of QOF and appraisal became more surreal.  It is well known that if you wish not only to punish people but also to damage them psychologically, you give them a futile task like writing out lines at school, or painting coal white in the army.

Hence GPs would be subjected to a directive like this:

Reflecting on the practice’s outpatient referral dataset and comparison with other practices, list the internal factors that contribute to any variation in the practice overall and individual GP referral patterns (eg clinical expertise; learning needs; demographic profile etc).  If your discussions around activity levels confirm your current practice; outline specific areas of your own practice internal to the practice which are aimed at supporting independent management in the community and avoiding potentially unnecessary referrals.  List a minimum of three useful elements which could be shared with other practices.        

I’m not sure, but I think it means, are you referring too many people to hospital, and can you think of a few ways of cutting it out?

When I read the above paragraph about three years ago, I wrote an incensed letter to a prestigious medical journal, which started thus:

Dear Doctor,

I would like to invite you into Fellowship of an august medical society, DAMASK.  DAMASK stands for Doctors Against Muddle and So-called Quality (with a capital K).  You will be relieved to hear there is no subscription, no journal, no conference, and no AGM.  It’s more of a kind of freemasonry than a society.  All that is required of you is that, when you are attending a medical meeting at which somebody who doesn’t know anything about medicine propounds something utterly preposterous, you stand up and make, either figuratively or literally, a bad smell.

I got an email back from the journal to say yes, we’ll print that.  We’ll just run it by the letters editor.

Then, stony silence.

I find that stony silence is the modern way.  In this day when communication was never easier, it is only the passage of time that tells you you have become a “lapsed action”.  We have email we have twitter we have facebook we have text we have SMS we have smart phones we have landlines we have The Royal Mail.  We even have, I discovered while dining with friends this weekend, “Snapchat”.  The defining characteristic of Snapchat is that the message dissolves in the ether after 10 seconds.  Maybe my prestigious journal snapchatted, “On mature consideration, we’ve decided your piece is too inflammatory.”  And I was just too slow on the uptake.  I would have accepted that.  It’s the silence I can’t abide.

(Incidentally, why snapchat?  I can only think it’s useful if you’re into sexting or internet trawling.  You know you’re going to send out something you regret, so get your expression of regret in first.)

Medicine has learned a great deal from the world of aviation in terms of managing risk through the use of checklists.  Medicine – actually any large corporate activity – should also adopt the aviation practice of “read back”.   Read back is vital on the r/t.  I recall with nostalgia the romantic poetry exchanged between the control tower and the big jets on the runway at Glasgow while I, a callow youth, was doing circuits and bumps in the Chipmunk.  “BA 53 you are clear to Heathrow via White Nine, Amber One, to cross Lanark and Talla at flight level 55 and to climb when instructed by Scottish radar to flight level 320 today.”

And it would be read back, verbatim.

“Read back correct.”

Falling foul of a lapsed action is one of the great dispiriting experiences of modern life.  When you write a letter to a bank, or a utility company, or the Inland Revenue, or a multinational conglomerate, and get no reply, you are like a pilot in a stricken aircraft sending out a Mayday call and hearing nothing in your headphones except static.

But here I must write in praise of Shona Robison, who had the courtesy to let us know she is scrapping QOF.  Of course, being a politician, she said something along the lines of, “QOF was of its time; but it has outgrown its usefulness and is no longer fit for purpose.”  It’s not true.  It was never fit for purpose.  The politicians might not know that, but the doctors always knew it.  I like to think we went along with it out of naivety rather than out of cynicism.

Cato the Elder used to end all his addresses to the Roman Senate by reminding them, no matter the topic of discourse, “Oh – and by the way, Carthage must be destroyed.”  He knew that if he said it often enough, one day it would happen.  For a period of about five years I adopted this technique and made a point of saying, at the end of any and every medical meeting I attended, “Oh – and by the way, the QOF must be destroyed.”  I made myself an utter pain in the neck.  My colleagues would say, “James, put a sock in it.”

It just shows you.  You plug away at something.  You think your effort is futile.  You think you’re trapped. But you’re not.

         

Towards the end of term, Mr McIvor our maths teacher lightened up and cut us some slack.  “Here’s a problem for the weekend – but only if you like.  It’s not particularly mathematical.  All you need is pure logic.  It’s called the twelve cannon ball problem.”

You have twelve cannon balls.  They look identical, and eleven of them are, but one has a different weight from the others; it could be heavier or it could be lighter.  You have a simple set of scales – two pans on a fulcrum.  Can you identify the unique cannon ball in three weighings, and say whether it is lighter or heavier?

I realise this blog might be aimed at a minority interest group.  If you are allergic to numbers, it may be you are more interested in the qualitative rather than the quantitative aspects of cannon balls.  Therefore I digress for a moment on your behalf.  I had always thought the expression, “It was cold enough to freeze the balls off a brass monkey” had a somewhat vulgar connotation.  Not so!  It turns out that a brass monkey was a rack for holding cannon balls, and that in very cold weather the rack contracted more than the cannon balls and extruded them.  Back to the twelve cannon ball problem – but, as Mr McIvor said, only if you like.

So, to return to the dim and distant past, I was up for it.  I took the problem home with me and wrestled with it.  It absorbed me completely.  By Friday night I had realised that to put six balls on each pan was a squandered shot because it yielded too little information.  I was pretty certain you needed to place four balls on each pan.  All throughout Saturday I experimented with four ball patterns.  Didn’t go to the swimming baths, didn’t go to badminton club.  Didn’t watch telly.  I became a recluse and an irritant to my family.  By Saturday night I had solved the special case, when your first weighing, four x four, shows equilibrium.  Therefore the rogue ball lies within the remaining four.  You leave three of the balls you have already weighed on one pan to act as a control; you know they are all normal.  You take three of the four untested balls and put them on the other pan.  Suppose there is equilibrium.  Then the remaining unweighed ball is the rogue ball.  You use your third weighing to weigh it against any control ball in order to establish whether it is lighter or heavier.

Go back to the second weighing, three x three, however, and suppose there is disequilibrium.

(Are you still with me?  Or have your eyes glazed over because you’re not that interested?  Don’t fret.)

Well, now you know the rogue ball is one of three, and you know, depending on which way the scales have gone, whether it is lighter or heavier.  So take two of the suspect three balls, clear the scales, and weigh one suspect ball against another.  If there is equilibrium, the third ball is the rogue ball, and you already know whether it is lighter or heavier.  If there is disequilibrium, you identify the rogue ball because you know whether you are looking for a lighter or heavier ball.  Take note of this last paragraph; it is a recurring theme.  If you know the rogue ball is one of a group of three, and you know the relative weight of the ball you are looking for, you have a scenario in which the ball can be identified with just one further weighing.  Let us call this scenario “The Brass Monkey Scenario”.

Fine.  Saturday midnight, and I have my special theory.  But I’m miles away from my general theory.  I still have no idea what to do if the first four v four weighing shows disequilibrium.

Sunday.  Sunday is murder.

I struggle with combinations and permutations and seem to be getting nowhere.  Moreover, I am dogged by a nagging sense of guilt that I’ve wasted a precious weekend in a futile gesture.  But I can’t stop.  It’s not fun any more, yet I can’t stop. Isn’t this what it is supposed to be like to be addicted to something?  Am I in some kind of trouble?

Give it till Sunday teatime.  I’m sure I’ve missed something.  There’s something creative I need to do.  Something I haven’t thought of.  A little piece of lateral thinking.

I skipped Sunday evening youth orchestra.

Eureka!  I worked on, with growing excitement.  Yet still with that nagging sense of guilt, that would just not go away, even when I was on the brink of success.

Late at night, when Barry Alldis was doing his Top 20 countdown on Luxembourg 208, the dark metallic strangled voice of Gene Pitney recounted the tale of the man who lost everything twenty four hours from Tulsa.  I had it.  And yet that terrible sense of squandered energy just wouldn’t leave me.  Why are you wasting your substance on this rubbish?  This is a complete waste of time.

Maybe not completely.  If this weekend has taught me anything, it has taught me that, even when a problem seems utterly insurmountable, when you have run out of rope, still with a little bit of creativity, and lateral thinking, there might just be a way out.

McIvor had me demonstrate my general theory on the blackboard before the class.  The extra pressure of performance might have snarled up my logical circuits, but I was fired up, and my exposition was sound.

Let the balls be numbered  1,2,3,4,5,6,7,8,9,10,11,12.  First weighing:  balls 1,2,3,4 v balls 5,6,7,8 gives disequilibrium.  You know the rogue ball is somewhere on the scales.

Second weighing is 1,2,3,5 v 9,10,11,4.

That’s the little creative leap, the little piece of lateral thinking.  You swap two of the balls.

Consider now what might happen.  The scales show equilibrium.  Therefore the rogue ball is in the group of three you have removed, namely balls 6,7, and 8.  You already know whether the rogue ball is lighter or heavier because of the disequilibrium of the first weighing.   This is The Brass Monkey Scenario.  All you need do now is weigh ball 6 against ball 7.

Consider now that in the second weighing a disequilibrium occurs but the scales tip over in the other direction.  Now the rogue ball has to be one of the balls you have swapped  – 4 or 5.  If 4 is on the down scale and it turns out to be the rogue ball, then it is heavier.  If 4 is on the up scale and it turns out to be the rogue ball, then it is lighter.  Same scenario for ball 5.

Third weighing: ball 4 against any control ball.  If there is equilibrium, then ball 5 is the rogue ball, and you already know whether it is lighter or heavier.  If there is disequilibrium, then ball 4 is the rogue ball and it is lighter or heavier depending on how it now tips the scales.

Consider now that in the second weighing the same disequilibrium occurs as in the first weighing.  Then the rogue ball is in the group 1, 2, 3, because balls 9, 10, 11 are control balls, and, had balls 4 or 5 been rogue, the scales would have tipped over.  We are back to The Brass Monkey Scenario.  We now know that the rogue ball (1,2, or 3) is lighter or heavier depending on how the scales tipped, and, as before, we clear the scales and weigh ball 1 against ball 2, knowing we are looking for a lighter or a heavier ball.  If the scales show equilibrium, then ball 3 is the rogue ball, and we already know whether it is lighter or heavier.

That’s it.  Every situation dealt with.

I sat down.

There was no applause from the class.  They had long since lost interest.  Mr McIvor said, “Well done!”  And indeed there was admiration.  Yet I could sense something else.  I thought I could detect a sense of guilt that he had subjected me to this conundrum in the first place, and driven me to spend so much time on it. I was completely confused.  It crossed my mind that he pitied me. He might have shaken his head and said, “You poor sad boy!”

How is the news where you are?  The news where I am isn’t very good.  In fact, it’s so bad, I’m tempted to turn the sound down when it comes on my car radio.  But that’s a bad thing.  That’s what we did in the 1930s, closing our ears to the rumblings of continental Europe.

In Shakespeare’s Measure for Measure, Vincentio, the Duke of Vienna, goes undercover, disguises himself as a Papal emissary and moves about his own Dukedom, taking the temperature.  He meets Escalus, one of his lords, who asks him, “What news abroad i’th’ world?”

“None, but that there is so great a fever on goodness that the dissolution of it must cure it.  Novelty is only in request, and it is as dangerous to be aged in any kind of course as it is virtuous to be constant in any undertaking.  There is scarce truth enough alive to make societies secure, but security enough to make fellowships accursed.  Much upon this riddle runs the wisdom of the world.  This news is old enough, yet it is every day’s news.”

I’ve been pondering this enigmatic utterance for the duration of my adult life, and making little headway with it, until this past week.  It occurred to me, the Duke’s utterance really is a summary of the news.  Three items dominated the news during the week – the refugee crisis; the election of Jeremy Corbyn to leadership of the Labour Party; and the unprecedented interview with the head of MI5 on the “Today” programme, coming out to gloom a nation armed with desktops, lap tops, tablets and smart phones, that it will need to be snooped on to an extent that would make even the Rector of Glasgow University raise his eyebrows.

The Duke makes five points, which I venture to precis as follows:

We are suffering from an institutional malaise so profound that we can only recover by making a radical change to the way in which we conduct our affairs.

There is an appetite for change, but we seem incapable of turning our ideas into reality.

You may think it praiseworthy to be resolute in a course of action; but if your policies are outdated and no longer fit for purpose, it is not.  On the contrary, it is positively dangerous.

Public life is full of humbug.

Our lives are being rendered miserable by surveillance.

Now, I could marry up the Shakespeare remarks with this week’s items of news, but that seems rather a pedestrian route to take, and I will leave it to your imagination.  Let’s just focus for a moment on the idea of change:

At Prime Minister’s Question Time last Wednesday, Mr Corbyn made a request, on our behalf, that PMQs be less “theatrical”. Well, good luck with that.  I’m intrigued by the way the British right wing press have already ganged up on Mr Corbyn to nip him in the bud, by criticising everything about him from his demeanour to his dress to his apparent espousal of dodgy ideologies to his silence during the National Anthem to his apparent reluctance to kneel before Her Majesty as a Privy Counsellor.  And I think, why are they carrying out a demolition job?  After all, if he is the loose cannon that they say he is, wouldn’t they want him to head the opposition for ever?  I wonder if it’s because they are afraid.  They are afraid of anything they do not understand, and cannot predict.  And they are afraid of that quality of Mr Corbyn’s that won him the leadership – authenticity.  He isn’t the concoction of a focus group of spin doctors; he’s the real deal.  I can’t say I’m a fan of Old Labour, but I do think the media should cut this guy some slack and see what he has to say.  History never quite repeats itself.  Mr Corbyn is not Mr Foot.  He might surprise us.

But to return to Shakespeare, I wonder if his Duke of Vienna is right, that the news is always the same, that the old news is every day’s news.  Sophie Raworth, Fiona Bruce, Mishal Husain et al might say, “Welcome to the BBC news at ten.  The headlines tonight – we are in a terrible mess; we’re trying to get out of it but we seem to be stuck; we make a virtue out of repeating our mistakes over and over again; we completely lack any moral leadership and hence we are creating a dystopia. And now, the news wherever you are…”

So I checked it out, and you may care to do the same next time you hear the news; apply the Measure for Measure test.  I watched the news late on Sunday night.  (As Lennon put it, “I heard the news to-day, oh boy…”)

Well let’s see.  There’s chaos in Croatia where migrants are struggling to get on board west-bound trains.  Jeremy Corbyn wants to renationalise the railways line by line.  Jackie Collins has passed away.  Andy Murray has got us into the final of the Davis Cup.  Gas explosion in Derby.  Pope Frances addressed an enthusiastic crowd in Revolution Square, Havana, then met with Fidel Castro.  Good news about the release of some hostages in Yemen.  The Greek General Election is veering leftward.  75^th anniversary in Westminster of the Battle of Britain.  Rugby World Cup.  Footie.  And now, the news where you are.

And then – how often does this happen? – something slips under the radar.  Something momentous passes unnoticed.  Johann Lamont, the ex-labour leader in Scotland, recognises that a lot of Labour supporters voted Yes in the Referendum just over a year ago.  Kezia Dugdale, the current incumbent, says she won’t shut down a debate on a repeat referendum.  She said Labour MPs and MSPs should be able to argue for Independence.

It was all reported quite casually.

I don’t think Westminster will be too happy about that.

Here is a beautiful notion:  a sculptor doesn’t so much create a work of art, as discover it.  Think of Michelangelo receiving a huge slab of marble into his studio.  Does he create David, or discover him?  The idea is that David, the finished work of art, already exists within the marble.  All Michelangelo needs to do is chip away all the extraneous irrelevancies until the statue of David is exposed.  That seems like a whimsical notion, yet it is, literally, true.  It is a daunting task, because if he makes a mistake, he needs to start again.

This idea, that the work of art already exists before it is created, begs a question.  Did Michelangelo know exactly what he was looking for?

And a second question.  Can this idea of discovering something that already has an existence be translated into the world of letters?

Massive caesura here.  Let us move away from the world of high art to the mundanity of… well, whatever it is I do.

In Click, Double-Click, I break off briefly to tell an outlandish story about a man who is driven insane by a bunch of musical “worms” he can’t get out of his head.  It’s an absurd tale and I didn’t think my publishers were going to let me get away with it but, bless them, they did.  Now I find that life is imitating art.  I can’t get Click, Double-Click out of my head.  It is a worm.  I would be surprised if other writers have not experienced this same dilemma of involuntary fixation.  I had edited and reedited the tome so often that I think, had all paper and electronic drafts been mysteriously erased, I would still have been able to sit down and reconstruct it, word for word, verbatim.  Fine.  But now I need to stop thinking about it.  It’s past, gone.  Let it go.  What happens next?

The good news is I know – roughly – what happens next.  I know this to be the case because I’ve got rid of my worm.  I’ve dropped the past and turned my attention to the future. The difference is that, while the past is fixed and irrevocable, the future is wide open to possibilities.

How do you construct a novel?  How do you start from a blank page and end with a finished, complex, multifaceted, and organic whole?  Perhaps, on the one hand, you should plot and plot again, endlessly building up a superstructure whose beginning, middle and end, you can clearly see even before you have put pen to paper.  Michelangelo stares at his marble menhir, goes into a trance, and waits until he perceives David within it.

Or maybe you start with an idea.  It might not be very much.  Something you could delineate in a single sentence.  Yet it is enough to get you going.  You start, without the foggiest idea where it is going to take you.  Or yet again, maybe you think you know, but you are prepared to abandon it all if the Muse beckons you in another direction.

I suppose I exist somewhere in the middle of that dichotomy.  I have an idea, and I have a rough notion of where it is going to take me.  Yet I’m prepared to be surprised.  The thing is, I can’t think of a convincing reason that would stop me from gritting my teeth and writing that first, agonising sentence.  Here I am in my studio.  I look at my unblemished marble slab.  And I pick up my hammer and chisel and, with only the vaguest notion of where it’s going to take me, position the chisel, raise the hammer, and make the first cut.

A friend of mine from Shetland was kind enough to text to say she liked Click, Double-Click, and when was Dr A C-S coming back?  I texted back, “Dunno.  He’s in NZ just now.  I’m hoping to hear from him.”

For the last couple of weeks I’ve been wandering around in a trance, making up stories in my head, as you do.  Thursday found me on the beach at Helensburgh.  I watched a Trident sub snake out of Faslane and head out into the Clyde Estuary before submerging and going who knows where.  It – I know ships are supposed to be referred to as “she”, but there is no way this vessel was in touch with its feminine side – was the most evil looking thing.  Its presence did not heighten my sense of security.  I wondered what Dr Cameron-Strange would have made of it.  I suspect in terms of disarmament he would be a unilateralist.  His elders and betters would tell him that his opinion was naïve, stupid, and dangerous.  Last year he would have left it at that, but now he is a little older and wiser. He knows that politics is the art of the possible.  He would find a way, through a little piece of creativity, and of lateral thinking, to move the debate on a wee way from its current state of impasse.  He would think of some way of making the world a marginally safer place.

Then on Friday I was driving west along the A811 and came upon a convoy, heading east, about half a mile long.  There were police motorcycle outriders, police cars and police vans, unmarked military trucks in their anonymous dark green livery and, right at the centre of the convoy, some kind of long black, shrouded container.  There was even an ambulance.  And I thought, bet the satnavs are set for Aldermaston.  And I thought of ACS again.  I can see him down at the Waitemata Harbour (where in 1985 they sank the Greenpeace flagship The Rainbow Warrior).  It’s a nuclear free zone.  I have a notion he is being headhunted for a job back in the UK.  But he’s turning it down and he’s being as rude as possible.  “Bunch of stuck-up, smug, snobby, bloated, poncy…”  Well.  Leave him to it.

Further along the A811 I came up behind another convoy, this time one of Mercedes, BMWs, and Audis all reduced to a crawl behind a farm vehicle.  A guy in an Audi – probably an Edinburgh commuter – was getting particularly hot and bothered.  I sent him a message by telepathy.  “Take it easy, mate.  Remember the guy in the tractor is putting bread on your table.”

Then on Saturday I forsook the car and went for a walk.  Just locally.  My route was a triangle, two of whose sides were pleasant country lanes.  Not much traffic, other than a cycling peloton recurrently swooping by with a cheery “Hello again!”  However the third side of the triangle was the A84.

Big mistake.  Nobody in their right mind walks along the verge of a trunk road, even for a short distance.  I could see all the motorists looking askance at me.  Clearly I was somebody with a mental health issue.  Had I broken out of an asylum?  Ah – there’s old Jimmy, doing a runner from the care home.  God bless ‘im.  I was clearly some sort of demented war veteran making my own way to the site of some long-forgotten campaign for my own private commemoration.  I’d probably get bulldozed by a passing combine harvester.  There’d be a column inch in the Stirling Observer.  “In a tragic and bizarre accident…”

If you really want to stand out like a sore thumb, go for a walk in the States.  Not only will they think you’re a loony, they’ll think you’re an international terrorist.  The last time I was over, I stayed in the Sheraton in Charlotte North Carolina.  It was impossible to go for a stroll because the hotel was surrounded by super highways and the only thing to do was to take a few turns round the car park.  Like the exercise yard in a state penitentiary.   I once stopped over in LA for 24 hours en route to New Zealand and hired a car to drive west down Sunset Boulevard towards Pacific Palisades and the ocean.  Half way down the road the oil light came on the dash.  I pulled over and opened the bonnet – sorry, the “hood” – and checked the dipstick.  No oil.  Nada.  Dry as a bone.  Well, I didn’t want the engine to seize and  I’d seen what looked like a garage a couple of miles back along the road so I parked in a side street and walked east back along Sunset Boulevard.

Nobody in their right mind walks along Sunset Boulevard.

All the mansions were heavily barricaded and the big wrought iron gates each bore the legend – “No trespassing.  Rapid armed response.”  I only passed one other pedestrian – a Hispanic lady pushing a pram.  I reached the garage and went in and explained my predicament.  The man said, “This is not a public garage.  We only service limousines.”

But to return to Charlotte, North Carolina, I hired a car with oil in it and drove downtown and went for a stroll.  I was looking for a bookshop and peering through a window into a shopping mall when a passing police officer hailed me.

“What’s up buddy?”

He could tell I was an alien.

“Just looking for a bookshop actually.”

“Yeah, there’s one in there.  Second floor.”  (He meant the first floor.)

“Thanks.”

By the time I got to the shop, they knew I was coming.  He had radioed ahead.  “There’s a really weird guy coming up the escalator.”

I bought the Schlesinger – Jackie Kennedy interviews, 1964.  Fascinating.

But to return to the A84, I got off it unscathed, and back on to a country lane, and, in beautiful sunshine, drifted back into a storytelling reverie.   A car pulled up and a charming lady offered me a lift and I knew all was well with the world after all.  I politely declined.  After all, ideas were beginning to coalesce.  I must text my Shetland friend and tell her that I think we are going to see Dr Cameron-Strange again, in one hemisphere or another.

In the film The King’s Speech, when King George VI is preparing for his coronation in Westminster Abbey, he asks the Archbishop of Canterbury to find a seat in the Royal Box for Lionel Logue, his speech therapist.  The Archbishop thinks Logue is a colonial upstart and a chancer.  He purses his lips, looks dubious, and says something to the King along the lines of, “Well of course, I’ll see what I can do, but it’s going to be very, very difficult.”

When the Falklands War broke out in 1982, 940 school children were on a cruise in the Mediterranean aboard the SS Uganda.  They were all immediately sent home.  The Uganda docked in Gibraltar for a refit.  She was turned into a military hospital ship in 3 days.

Which all goes to show, the only thing the great Ship of State needs to make something happen, is the will to make it so.

Gordon Brown announced the public inquiry into the nation’s role in the Iraq War, on 15^th June, 2009.  Thus, at time of writing, from the time of its inception, the inquiry has lasted 6 years and 72 days, with still no sign of its completion.  The Inquiry’s chairman, Sir John Chilcot, has come under criticism for the evident delay.  He issued a statement on August 26^th which is worth reading with close attention.  “My colleagues and I understand the anguish of the families of those who lost their lives in the conflict… We expect to receive the last responses to our Maxwellisation letters shortly.  That will allow us to complete our consideration of the responses, to decide what further work will be needed, and to provide the Prime Minister and thus Parliament and the public with a timetable for the publication of our work.”

It’s also worth reading Sir John’s letter to the Prime Minister on June 15^th, the PMs reply on June 17^th, and Sir John’s rejoinder by return, on the same day.  The PM expresses disappointment to the extent that he, and the British public, “are fast losing patience”.  It is clear that Sir John is being put under considerable pressure.  Yet he is not yielding to it.

In his last decisive intervention in the House of Commons, on May 8^th 1940, concerning the brief and disastrous campaign in Norway, Lloyd George urged the First Lord of the Admiralty not to allow himself to be converted into an air-raid shelter to protect the government.  Somebody might say something similar to Sir John.  He’s taking the flak.

Six years and 72 days is an awfully long time.  The entire Second World War was fought and won in less than six years.  Governments and nations can achieve extraordinary feats within a narrow time frame when they are minded to do so.  The Manhattan Project, the construction, and detonation of the A Bomb, may be said to have taken place between the time of the famous Einstein-Szilard letter to President Roosevelt on August 2^nd 1939, and the Trinity Test at Alamogordo on July 16^th, 1945 – less than 6 years again.  Putting a man on the moon took a little longer.  JFK announced that the USA was going to do this in a speech on May 25^th 1961.  That was only 20 days after Allan Shepherd had become the second man to fly into space, 23 days after Yuri Gagarin’s inaugural flight.  No doubt that rankled.  Neil Armstrong walked on the moon on 21^st July 1969.  8 years and 57 days… I wonder if the Iraq Inquiry will still be running…

The critical fact concerning the Iraq War is that the British Parliament voted in favour of it, in March 2003, by a majority of 412 to 149.  I think the general consensus now is that the Iraq War was a Bad Idea.  If the Chilcot Inquiry agrees with the general consensus, then it means that criticism will be levelled not only at a certain number of individuals, but at the whole Ship of State.  Some people might find the idea of an entire Establishment being weighed in the balance, and found wanting, intolerable.  Perhaps this is why everything appears to be grinding to a halt.   I have a sense that the British Establishment are singing a threnody that, far from being prestissimo, presto, or even allegro, isn’t andante, or even adagio.  It’s molto largo.   But, I hear you say, this has nothing to do with the British Establishment. The Chilcot Inquiry is independent.  Every Prime Minister of this century has urged its publication.  Is it possible that Sir John Chilcot has been put into what the psychiatrists call a “bind” by people who simultaneously obfuscate, kick things into the long grass, “Maxwellise”; and then, when things come to a grinding halt, shrug?  “Nothing to do with us!”

Grieving relatives have died waiting for this report.  And is there not something profoundly ironic in the fact that even a member of the Chilcot Committee has passed away during its preparation?  I refer to Sir Martin Gilbert, the distinguished historian, and biographer of Churchill.

I feel profoundly sorry for people who suffer through the Law’s delay.  Justice delayed truly is justice denied.  It is a horrible thing to be waiting for a legal decision.  You are on remand.  This is why it is best to keep away from the Law unless you have no other choice.  Otherwise you end up like Richard Carstone in Bleak House.  Jarndyce and Jarndyce killed him, even before the suit was swallowed up in costs.  “I am ready to begin the world!”  Poor devil.

The definitive statement on the Law is the penultimate chapter of Kafka’s The Trial.  In the Cathedral.  Joseph K hears from a priest the story of a man waiting on the Law.  Before the Law stands a door-keeper.  A man wishes to access the Law, but the door-keeper says, while it is possible, it is very, very difficult.  The man spends his life at the door, waiting for admittance to the Law.  Towards the end of his life, he says to the door-keeper, why is it that nobody has sought admittance through this door, but me?  The door-keeper explains: this door was only intended for you.  I am now going to shut it.

The Law is completely indifferent to its suitors.  As Kafka said, “It receives you when you come and it dismisses you when you go.”

In Walter Scott’s Rob Roy, Frank Osbaldistone makes a journey from Northumberland north-west to the Highland fault line.  In Robert Louis Stevenson’s Kidnapped, David Balfour, an east coast lowlander, is a castaway on a west coast Scottish island and subsequently takes a flight through the heather at the time of the Appin murder.  In John Buchan’s Mr Standfast, Richard Hannay makes a journey from London to the skirts of the Cuillin, in Skye.  It’s a recurring theme in Scottish literature; a lowlander makes a trip north west to the Gaidhealtachd and, on his return, he is not the same person.

There’s something deeply significant about travelling north in Scotland, particularly north-west.  And it’s not merely a literary device.  It’s not just a concocted “Celtic twilight”.  There is a West Highland effect.  You feel it in real life.

I’ve always been drawn to the edge of places, the point beyond which you cannot go.  I’m not sure why; perhaps there is a sense that if you reach a perimeter, you have encapsulated the experience of travel.  It’s not always a comfortable experience.  Land’s End I found rather blighted, and in a pub in John O’Groats an unsmiling man told me I was sitting in his seat.  Bluff at the bottom of New Zealand’s South Island is okay.  I once took a Cessna 172 across from Invercargill to Oban in Half Moon Bay, the only inhabited part of Stewart Island, and then flew down to the southern tip of the island.  It’s entirely uninhabited and only occasionally visited by the odd fisherman or trapper.  The bush engulfs the landscape which I don’t suppose has changed in 10,000 years. It’s truly a wilderness.  I remember as I circled round two granite tors, Gog and Magog, the weather closed in and I got a bit anxious as I was 100 kilometres from Invercargill and the last man in the world.

At the other end of New Zealand, at its north-west tip, lies my favourite place in the whole world, Cape Reinga.  Each time I go to New Zealand, I make a pilgrimage.  It is a deeply spiritual place.  This is the point from which the Maori spirits depart this world.

It’s worth comparing the north-west tip of New Zealand with the north-west tip of Scotland, Cape Wrath.  I’ve only been to Cape Wrath once.  It’s not an easy trip to make.  Frankly, it’s not encouraged.  This is MOD land.  The RAF use it for bombing runs and target practice.  So sometimes the northwest peninsula is just closed to visitors.  When it’s open, you take a boat just south of Durness that takes you across a choppy inlet to the edge of the peninsula from where you pick up a minibus.  It’s an 11 mile trip to the lighthouse at Cape Wrath.  It takes an hour. That tells you something about the state of the road.

When you get there, you find you are really visiting a museum.  A derelict building on a headland once belonged to Lloyd’s Bank.  They used to watch shipping rounding the north-west corner of Scotland and they would telegraph to London to say so far so good and the insurance premium on the ship would change.  It reminds you that the whole business of the British Empire was about making money. You can get a coffee and a sandwich there but I couldn’t find a loo so just used the machair.

There’s something not right about Cape Wrath.  It ought not to be like this.  It should be like Cape Reinga.  People should always be free to travel to the edge.

It has been the greatest pleasure to me to see Click, Double-Click, Impress Prize 2014 winner, between covers.  I’ve read it many times, but the experience of rereading it in its published form was different.  It might be stretching it a bit to say it was like reading somebody else’s work, but its “official” guise did seem to lend it a certain authority, for which I was, and am, grateful.

A family member read the blurb and said, “Ah!  Your protagonist travels north-west.”  He understood that the trip north-west is not to be captured on a shortbread tin.  You might sing, in a sentimental fashion, “O ye’ll tak the high road and I’ll tak the low road and I’ll be in Scotland afore ye.”   And you might never suspect the depth of tragedy concealed behind these words.

Landline-wise, I’ve had to go on permanent answer phone.  How can I sit before my keyboard, to wrestle the best of three falls with words, and suffer for my art, when the phone keeps ringing?  I pick it up, and there is a momentary silence, prior to a recorded message, or there is the background hubbub of a call centre.  At least it affords you a split second to hang up.  Then, an impossibly thick, and indeterminate foreign accent.

“Chello?  May I shpeek plizz, with Chaimes Chamble?”

Or even worse, a local accent, chirpy, garrulous, relentlessly upbeat.  “Hi there!  Is that James? How are you to-day?”  I have an overwhelming temptation to reply, “Oh not good.  I’m so glad you rang.  I think I’m reaching the end of my tether…”   A late friend of mine used to say, “So glad you called.  I want to talk to you about Jesus.”  The line was invariably disconnected.  At his pompes funebre, we exited to the tune of “There’s no business like show business”.

The only time I pick up the phone with any confidence is 7.40 pm when, by prior arrangement, I exchange phone calls with a family member.  I used to think that as the evening wore on the risk would subside, but once at about 9.30 pm I got well and truly chugged by a very charming young lady medical student from Edinburgh University, who told me what a wonderful alumnus I was and talked me out of £50 for the swelling coffers of the alma mater.  It’s not as if they’re short of a bob or two.  I get Edit, the alumnus rag.   As a Glaswegian I can’t help being a little irritated by the smug self-confidence.  Oh yes, Professor Higgs, father of the boson, Nobel laureate, Edinburgh man, don’t y’know.  I really don’t think they should be employing students as rainmakers.  Isn’t it a form of exploitation?

Now that I’m on answer phone, I can listen to some of the messages with a degree of detachment.  They tend to be truncated by my automated reply, so I hear messages like, “…entitled to a new boiler”, or “PPI; for your refund, press 5, to opt out, press 9…”  I pressed 9, but it didn’t make any difference.  So I just press delete.  In New Zealand, I put the opening to Stravinsky’s Agon on my answer phone.  My friends left messages enquiring after my mental health.

Now it’s spilled over on to the mobile.  Mine went off as I was driving home tonight, along the A811 through the Carse of Stirling, and I pulled over and answered.

“Our records indicate that you were involved in an automobile collision within the last twelve months….”

Oh really?

So I hung a right and crossed over on to a farm track and escaped into the beguiling environ of Flanders Moss.  Here, on the edge of a quag, a grimpen, and in a breathless silence only punctuated by the occasional birdsong, I can have an “Innisfree” moment.

I will arise and go now…

Last weekend I entertained an old medical school friend for our annual jaunt up a Scottish hill.  He said to me, “What’s your wireless key?”  I said I had no idea what he was talking about.  He glanced at the label on my broadband gizmo and tapped some code into his phone and said, “Now I’m getting much faster downloads.  Your broadband speed’s pretty good.”  I said, “Is this costing me any money?”

I don’t so much live in a house as in a book depository.  No kindle here.  Me and Madonna, we live in a material world.

We climbed Ben Ledi.  Not quite a Munro – but then neither is K2.   The weather was kind.  It’s a lovely walk.  You ascend from Loch Lubnaig to a bealach west of Loch Venacher, turn right, and strike up over various false summits to the true top.  The wind got up at the bealach, but mysteriously died down completely at the top so that we were able to lunch in complete comfort just off the summit, unusual on a Scottish hill.   Visibility was excellent and we had a panorama all the way from Berwick Law to Lochaber.

Climbing a hill is the absolute antithesis to surfing the net.  There’s nothing virtual about it, the experience is completely real.  You might have attended the transfiguration.  When you descend, you are not the same person who went up.

Actually we descended to a traffic jam.  A good excuse to have a cuppa tea at Loch Earn and come home via St Fillans.  Didn’t Bertrand Russell spend some time in St Fillans and feel the better for it?  I live in the most beautiful place in the world.

Enough already.  One sleep before Click, Double-Click appears.  Hope you like it.

“Ohayo!”

I risked a surprise, disarming stealth attack, and was rewarded with smiles, like two explosions of dazzling incandescence radiating across a burnished cityscape.

  “Ohayo gozaimasu!”

Mr and Mrs Ishimoto had sprung to attention and, with the exquisite manners of the Japanese, bowed to me from the waist.  We all wore name badges, even their young child Masami, I, because I was a doctor in hospital, they, because they were part of the Utsunomiya-Manukau Sister-City Friendship Delegation.  Mr Ishimoto intoned my name in a sonorous way, pronouncing it as a true spondee that somehow conjured the image of an electrified fence, and a single peal of solemnity and commemoration.  “Dr Camp Bell.”  He introduced himself and laid a hand across the front of his cotton golfing T-shirt.  “I – Australasian representative – Toyota.”  He spoke in a hoarse whisper.  These words must have been very difficult for him.  I believe he might have practised for hours before a mirror.  I was always a little wary of treating patients in the automobile industry.  They carried with them the “Homo sapiens qua internal combustion engine” metaphor.  It might be, for all I know, useful to think of malfunctioning cars in terms of their anatomy, physiology, and pathology, and one often came across troubleshooting motoring manuals based on medical diagnostic models: engine overheating; differential diagnosis – leaking radiator, broken fan belt, blown cylinder head gasket etc.  But trying to apply the metaphor the other way, to think of the dilapidated tenement of the body as a machine on the blink, was an exercise always fraught with frustration and disappointment.  Very few medical problems, almost none, could be solved by the opening of the bonnet and the turning of a screw.  Most lay people, and indeed quite a few doctors, failed to grasp this mysterious paradox of pathology, that the insult and the body’s response to it were inseparable; that, if you will, the disease and the cure were one and the same.

Mr Ishimoto gestured to the woman and child who stood deferentially a little behind him.  We had filled up the triage cubicle.  “My wife, Akeko.  My daughter, Masami.”  Mrs Ishimoto, carrying a child of about two years, bowed once more, and Masami, straddling her mother’s hip, turned and squinted incuriously at me.  I noticed the right arm hung uselessly.  She was a beautiful child, dark-haired, with perfect white skin, intelligent eyes with the shallow orbits and epicanthic folds of the orient, and a small, rosy mouth.  Mr Ishimoto was, I guessed, about forty, and his wife, as beautiful as the child, was much younger, barely older, it seemed to me, than her daughter.

“Masami she fall,” explained Mr Ishimoto.  “We go now to Hawaii, eh…”  He searched for words.  “Holiday.”  (It sounded exactly like “horrid day”.)  “If arm broken, we go back to Narita.”  He said it with simple stoicism.  They were devoted to the child.  I don’t think I’ve ever seen such delirious, almost hysterical love and devotion lavished on children as I have sometimes seen within East Asian families, the Japanese, the Chinese, Vietnamese, and Cambodian.  I palpated Masami’s right arm all the way down from the shoulder girdle, the clavicle, the acromio-clavicular joint, the gleno-humeral joint, the humerus, the elbow, wrist and hand. She did not hinder me in my examination.  The arm hung, passive.  There was no point-tenderness.  I said, “You know what?  I don’t think you need to cancel your trip.  I believe she has a ‘pulled elbow’”.

“Pulled elbow?” said Mr Ishimoto.

“Did somebody give her arm a pull?”  I demonstrated the action in mid-air.  Mr Ishimoto conversed with his wife in rapid Japanese.

“Is possible, yes.”

I wondered if I could explain in simple English the idea of the radial head coming free of the anular ligament as a result of a traction injury.

“Dislocated?” said Mr Ishimoto.  He was the sort of man who could surprise you with an unusual word.  He had taken his language studies seriously.

I said, “In a way.  I believe I can fix it very easily, by turning Masami’s arm over.  She will cry a little, but then she will be fine.”

Mr Ishimoto nodded.  I gently turned Masami’s forearm into full supination, extended the elbow and exerted a little pressure over the radial head. There was a barely palpable click.

“All done!”

Masami fixed me with an accusatory look, and silently cried huge tears.  I recognised the look, as much surprised as pained, of a child who had never before received a hurt from another human hand.  And her mother wept too.  But five minutes later the arm moved freely and normally, and Masami was once more a happy child.

“She needs plaster, bandage?” enquired Mr Ishimoto.

“No – nothing.  She won’t have any more trouble, as long as you are careful not to pull her by the arms.  I should catch your flight to Waikiki if I were you.”  It had been, after all, an “open the bonnet and turn a screw” job, one of the few occasions when a doctor can look as if he has performed a miracle.  Suddenly the Ishimotos had burst out again into broad smiles and I felt as if I were being showered with the perfumed blossoms of a Honshu spring.  I was deluged with small and gorgeously wrapped presents, produced as if from nowhere, a key-ring in the form of a tiny running shoe, a dangerous looking bamboo implement with a hook designed, I was told, to remove wax from ears, cookies, Japanese style, and a silk scarf, Mr Ishimoto said, “For your wife.”   I was embarrassed by a welter of gifts.  He looked again, with curiosity, at my name badge.

“You not Kiwi.”

“I’m from Scotland.”

“Shotland.  Ah!  Shotland!  Whisky!”  He made the name of my country sound like a celebration of its most famous export.

“Exactly.”

He peered at my name. “James.”  (He said “Jameshu.”)  “This, very difficult, for Japanese.”  He took out a small pocket diary, with a pencil, and rapidly wrote three ideograms in Kanji on the back page.  Masami, now quite relaxed, tried to grasp the pencil.  Mr Ishimoto showed the lettering to his wife, who now laughed uninhibitedly.  He turned back to me, and pointed to the three symbols.

“Your name, in ancient Chinese script.”  He pointed to each symbol in turn.

“Leaf… Seed… Sake.”

“Leaf-Seed. Yes I like that.  It has a strong, Nordic ring to it.”  Mr Ishimoto looked uncomprehending at me and smiled politely.  He produced his card.  It was entirely in vertical Japanese script.  He carefully added his telephone number, and handed it to me.

“I will have a fine view of you, in my mind. Hell! Yes!”  (Had he been attending American conversation classes?)  “When you visit Japan” – he said, “Japang” – “you stay with me, my apartment, in Tokyo.  You be my home-stay guest, yes?”

I said carefully, “That is very kind of you.  If I come to your country, I will certainly remember your invitation.”

“Why you come to New Zealand?”  I recognised the direct invitation to friendship of the Japanese, and the insatiable curiosity, that is the antithesis of inscrutability.

I shrugged.  “I enjoy overseas travel.”  It was I who was proving inscrutable.

“You will return home?”

“Maybe.  Not yet, a while.”  I looked at my watch.  “You’d better get going.  You’ll miss your flight.”

  “Ah so desu ka!”  The Ishimotos rose.  He reiterated.  “You come Japang.  Stay with me.  Thank you very much!”  He extended his hand. “Merry Christmas, Dr Jameshu!”  And, with that, the Ishimotos left for the airport.

It had perhaps been a little early in the month for a Yuletide greeting, and indeed, Mr Ishimoto might well have had another, altogether less happy anniversary in mind that day.  He had put me in mind of a film of a book, starring a very famous British rock singer, and based on a work of Laurens van der Post who had, of course, been a prisoner-of-war under the Japanese.  Some of the film had actually been shot within the quiet cloisters of one of New Zealand’s most prestigious schools, separated from our hospital by a single fairway of the city’s most exclusive golf course.  I never saw the film, but I had read the book.  Its inner core had concerned a man who had sought peace, and redemption, after committing an act of betrayal of a loved one.  He had averted tragedy by confronting people who were in the thrall of something alien, gripped by a force outside of themselves, a power of evil.  He had confronted these people; he had forced upon them an image of their own humanity.  He had succeeded in this trial, but at a terrible price.

“Come on, Leaf-Seed,” said Faith, who happened to be Charge-Nurse that day.  She must have heard the tail end of the consultation.  “They got the Sake bit right anyway.”

I mused, “What an extraordinary day for a Japanese to visit Hawaii.”

“What?”

I attempted a rich, expansive, Franklin D. Roosevelt accent.  “On this day, a day that will live in infamy…”  But Faith only looked at me enquiringly.  And, since Mr Ishimoto had put it into my head, I began to think about the impending Yule. The Ishimotos had brought the Christmas spirit to me early.  Of course it is easy now to say this with hindsight, but I feel sure that I had, from that time, a premonition that this would not be, for me, a normal Christmas.  I had the angst mixed with excitement that might be experienced by a pilot, who leaves his carrier by night, and searches the horizon at dawn, anxiously trying to pick out a scattering of islands.  I waited, with apprehension, for Yule.  It was to be my seventh under an antipodean sun.  But, as ever, when I thought of Christmas, I thought of home.