Author: jamescalumcampbell

The Chancellor of the Exchequer has been doing the rounds of the television studios, trumpeting the mantra, “Growth growth growth”, after the fashion of Tony Blair who used to say “education education education”.  Sir Tony immortalised several other soundbites; “Tough on crime, tough on the causes of crime”; and, “Twenty four hours to save the NHS!”  If such glib utterances tell us anything at all, perhaps it is that, of all people, politicians are least best placed to effect real change, “change” being another favoured buzz word of the current administration.

I don’t really get “growth”.  Occasionally I make reference to a textbook of economics in an attempt to familiarise myself with the dismal science.  Economic growth, I read, is the change in potential output of the economy shown by a shift to the right of the production possibility frontier.  What does it mean when we say we need to “grow” the economy?  I suppose it refers to an increase in some index of productivity, such as Gross Domestic Product.  If you increase GDP, then you can increase national income.  We need either to produce more goods or supply more services, or both.  It is said that if we do not do this, if we do not “create wealth”, then we cannot afford to invest in public services, such as schools, hospitals, policing, public libraries, and so on.  The business community often reminds us of this, rather sharply, by way of a reprimand. 

But can wealth really be “created”?  Is it not rather discovered, as a source available in nature, and then utilised?  Coal, for example, made these islands very wealthy throughout the last 300 years.  But coal, or any other fossil fuel, was not created; it was discovered, deep underground.  It was, and for some remains, a source of energy.  It can be neither created nor destroyed.  It can be metamorphosed.  For example, it can be turned into carbon dioxide which hangs around, and gradually increases the temperature of the planet’s atmosphere.  You might argue that the concept of wealth creation is in defiance of the First Law of Thermodynamics. 

People who are seriously interested in wealth want to maximise income and minimise expenditure.  So they try to create a system that generates wealth whilst running on a shoestring.  It is much better for example, to run a service with robots rather than human beings, because robots do not need to be paid.  Therefore it would be much better if a public service were entirely automated.  This is what lies behind these dismal experiences we have all had, of attempting to contact a company, being bombarded with endless menus requiring us repeatedly to press digits on our cell phone key pad, and then being interviewed by a robot who cannot understand our regional accent.  The great entrepreneurial movers and shakers are trying to create a perpetual motion machine, likely unaware that they are in defiance of the Second Law of Thermodynamics, therefore doomed to failure.       

Yet still, in search of growth, government ministers traipse across the globe looking to make trade deals.  The Chancellor visited China shortly after taking office, and made a deal worth a few modest millions.  It was an awkward time for her to depart from the UK because the markets were very jumpy about something or other.  She was criticised for abandoning her post during a crisis, but she defended herself by re-emphasising the need for growth.  For a time, her coat seemed to be on a shoogly peg.  But the PM affirmed his full confidence in his Chancellor.  I’m not sure that helped.  Sometimes people who have the full confidence of the PM are gone by lunchtime.  Some people refer to the first ever female Chancellor of the Exchequer in British history as “Rachel from Accounts”.  It is a classic put-down, misogyny disguised as “banter”. 

Today, unusually, the PM is attending a meeting of the European Council, looking for closer ties, short of membership, with the EU.  Meanwhile Mr Trump has imposed tariffs of 25% on his nearest neighbours, Mexico and Canada, and 10% on China.  He is looking to do the same with the EU, and he hasn’t quite made his mind up about the UK.  Apparently Sir Keir was “very nice” on the telephone.  But I have a notion that if there is going to be a trade war, the UK will have to decide whether to be close to Europe, or close to the US.  It will have to be one or the other.  Meanwhile Mr Trump has his eye on Canada as the 51^st US state.  Next stop, Greenland.  He is certainly intent on growing the US economy.    

But surely growth, thermodynamically, and biologically, is unsustainable.  We are like bacteria on a plate of agar of finite dimensions.  We feed on the agar, multiply exponentially, and produce a toxic waste product, for example, alcohol.  If we continue to consume and to multiply, we will perish in a toxic environment that can no longer support life.  The government should be focusing its attention on nurturing a stable and sustainable environment.  But no.  The government wants to build a third runway at Heathrow.  The UK will be a hub.  It “doubles down” on its devotion to growth, while always on the lookout for some Deus ex Machina that will somehow defy the second law of thermodynamics, and annul the ever increasing entropy of the universe.  The latest magic bullet is Artificial Intelligence.  AI is the Next Big Thing.  If we don’t invest heavily in AI, if we don’t become “world leaders”, then we will sink without trace. 

I will arise and go now, and go to Innisfree…                              

Storm Éowyn swept through the village on Friday.  It had been a quiet night, but the wind picked up at dawn, and when I emerged to make the short walk to the village store, my “Berlin (Est. 1237) Down Town” cap flew off my head and disappeared 50 metres down the Loan.  Fortunately I retrieved it, and struggled against the gale in the direction of the shop, to fetch the morning papers, keeping a sharp eye open for flying debris.  But the delivery van had been held up by a fallen tree.  I made another abortive attempt an hour later.  There weren’t going to be any papers that day.  I went home and switched on my digital radio, but, I suppose due to the atmospheric disturbance, there was a continuous background burpling din, and the announcer sounded like a Dalek. 

Then a strange hooting noise wafted through the house.  At first I thought it was the warning klaxon of a van reversing down the Loan, but it turned out to be emanating from my mobile, followed by an announcement about the red weather warning, and the imperative to stay indoors.  I did as I was told.

So, in the absence of newspapers, I took the opportunity to reread Prof. Harry G. Frankfurt’s amazing tract On Bullshit (Princeton University Press, 2005), and its equally amazing sequel On Truth (Pimlico, 2007).  As the Duke said to Escalus in Shakespeare’s Measure for Measure, “This news is old enough, yet it is every day’s news.”

There seems to be a kind of post-modernist notion abroad i’ the world, that there is really no such thing as objective truth.  Common sense would tell us that sustaining such a belief is inherently absurd.  I might have made the assertion on Friday, “It’s stormy today.”  Could anybody reply with a straight face, “Nonsense; there’s not a breath of wind”?  It seems to me that holding the view that there is no such thing as “external” truth, is rather akin to holding the view (another post-modernistic view widely held) that there is no such thing as free will.  Stephen Hawking said (at least he is purported to have said), “I have noticed even people who claim everything is predestined, and that we can do nothing to change it, look before they cross the road.”  Similarly, even people dubious about the concept of truth, would rather that their surgeon, their airline pilot, the teachers of their children, had accumulated a reliable body of knowledge. 

Yet the habit of doubt is deeply embedded in western civilisation and culture.  As Anthony Quayle’s character Jack Loder says in his blunt Yorkshire accent in the 1974 film The Tamarind Seed, “In my line of business I’ve learned three things: no-one’s to be trusted, nothing’s to be believed, and anybody is capable of doing anything.”  Bertrand Russell invested a lot of time in examining the validity of statements.  He took a piece of paper and wrote down the sentence, “The statement on the other side of this sheet of paper is true.”  Then he turned the paper over and wrote, “The statement on the other side of this sheet of paper is false.” Then he sat and stared in silence at the sheet of paper for 18 months.  He came to the conclusion that the whole of epistemology is founded upon quicksand. 

So you might argue that people who are cavalier, “economical” with the truth, are merely following a proud and noble intellectual tradition.  You may say, since we cannot access the truth, all we can do is construct a model, and see if it stands up to scrutiny.  Ergo, my version of the truth is as good as yours.”  It is, arguably, a Cartesian notion.  The only thing Descartes was sure of was his own existence.  “Cogito ergo sum.” 

But I don’t think that people who are guilty of deliberate “terminological inexactitude” can really claim that they are following in a revered philosophical tradition.  There is a difference between the idea that the truth is out there, even if we can never with certainty access it, and the idea that the truth is inaccessible, therefore we may be indifferent to it; the truth, if you like, can be anything you want it to be.  G. K. Chesterton once said that the trouble with ceasing to believe something is that you start to believe everything.  Prof. Frankfurt makes the point that the purveyor of bullshit doesn’t really care whether what he says is true or not. 

Does it matter?  One of the things most of us learn very early on in life is that the truth is, indeed, out there.  As we toddle around, we learn that if we are not careful we fall over.  If we don’t look where we are going we crash into hard objects.  We discover that there are limitations to our omnipotence.  We rebel against this.  This attempt to retain absolute power is what characterises that difficult phase of life, “the terrible twos”.  But if we are nurtured, and guided, and loved, we learn to accept that limitations exist, whether we like them or not.  Prof. Frankfurt makes the point that if we don’t accept this, then we find it hard to discern the boundary between ourselves and the outside world.

Sometimes I wonder if this is what underpins the President of the United States’ refusal to accept that he lost the 2020 Presidential election.  The irresistible force meets the immovable object.  This cannot be!  There has to be a mistake!  Therefore he allegedly called up an official and asked him to find all the uncounted votes that surely had to be there.  And he allegedly blew a dog-whistle that resulted in the storming of the Capitol on January 6^th, 2021.  And now that he is returned to office, and apparently vindicated, he has issued virtually a blanket pardon to the imprisoned Capitol insurgents. 

I’m very puzzled by this notion of pardon, just as I am by the notion of the president’s executive orders.  Pardons occasionally get issued on this side of the Pond, but the word “pardon” is usually a misnomer.  The recipients of the pardon have usually been shown to be innocent of the crime they allegedly committed; therefore they should not be pardoned, they should be exonerated.  The innocent don’t need a pardon; they need an apology, and compensation.  But if the pardoner is indifferent as to whether a conviction has been “safe”, then the distinction hardly matters.  I thought that the founding fathers in 1776 were trying to escape the omnipotence of the monarchy.  And I thought there was supposed to be a separation between the executive, and the law.  No doubt some silken-tongued lawyer could explain the rationale behind it all, but I bet it would be bullshit.  And that’s the point.  Once you deny the existence of objective truth, anything, indeed everything, is possible.                                                 

The USA, as I write, is waking up to the day in which “45” will morph into “47”.  A butterfly flaps its wings in Washington, and apparently precipitates a hurricane in London.  Keep calm, and carry on.  The world continues to turn.

Last Thursday was the first day of the new term at the Goethe Institut in Glasgow, and I attended my class Deutsch für Alltag as usual.  Not quite as usual.  We have a new teacher.  Change is always a little unsettling, but as it turned out it was fine, she was good, and as ever there was lots of laughter.  We also had some new faces in the class, so as is common in language classes we went round the table each divulging something of our potted autobiographies.  A language class must be the only “safe” space left where you can ask prying questions like, “Where are you from?”  I seem to recall a lady-in-waiting to the late Queen got into a spot of bother at a reception by asking this question of a person of colour, and following it up with, “Yes, but where are you really from?”  That reminded me of another reception, in Buckingham Palace, captured on TV in a fly-on-the-wall documentary, when in response to the “where are you from?” question, the guest mentioned the place in question, an outpost of old empire, and asked the interlocutor if she had been there.  “Been there?  I gave you your independence!”  This particular tin-eared individual was oblivious to the fact that the sole purpose of the programme was to ridicule the aristocracy.

But in a language class you are permitted to be uninhibited, even politically incorrect.  Where are you from?  Where do you live?  Are you married?  How many children do you have?  It all sounds quite prying, but the get-out clause is that you don’t have to tell the truth.  Just make it up.  After all, it’s just language practice.  The conversation shifted to family attributes, and the person on my right said his family were all musical.  I asked him if he played a musical instrument, and he said no, he and his family weren’t musical at all!  The teacher gave him a thumbs-up.  We went on to family-related idiomatic expressions:  it runs in the family; it stays within the family; it happens in the best families…  Did we know any others?  I thought of the opening sentence to Tolstoy’s Anna Karenina:

Alle glücklichen Familien gleichen einander, aber jede unglückliche Familie ist unglücklich nach ihrer eigenen Art.

Or words to that effect.  All happy families resemble one another, but each unhappy family is unhappy in its own way.  I have a notion that that is not true; in fact, that quite the opposite is true.

Opening sentences to novels tend to stick in my memory.  When I was a student I once got a postcard from a friend on holiday, composed entirely of first sentences of novels, and written in stream of consciousness style, after the fashion of the end (as opposed to the beginning) of James Joyce’s Ulysses.  Something like:

It is a truth universally acknowledged that it was the best of times it was the worst of time present and time past are both on the 24^th of February 1815 there was no possibility of taking a walk that day call me Ishmael  

I suppose it was more interesting than “weather lovely, wish you were here.”  In fact I lodged it, or something like it, in my memory, and used it in the surreal chapter XXV of my latest tome, The Last Night of the Proms.  First sentences stick, last sentences less so.  It’s rather like any recurring life experience that turns out to be important – a job, a hobby, the membership of a club, a romantic relationship.  We remember the epiphanic first time, but are hazy, even oblivious, of the last.  So it is with a book’s end, with the possible exception of that beautiful close to Scott Fitzgerald’s The Great Gatsby:

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

That floats my boat!  But then, my boat is definitely going against the current.  This Brave New World which we now inhabit seems to me increasingly inimical.  I think the Luddites were on to something.  Perhaps their descendants will take the sledgehammers to the latter day looms of social media platforms and super computers.  The Prime Minister thinks that Artificial Intelligence will be good at identifying potholes.  I can’t get enthusiastic.  I heard him on the Jeremy Vine show on BBC Radio 2 last week and he was quite ecstatic at the potential of AI to solve the problems of the NHS.  AI could identify the precise location of a blood clot on the brain so much quicker than a radiologist could.  Yes, said Jeremy, pertinently, but is that important if the patient is waiting in a corridor for 50 hours?  Good point.  I find that Jeremy is rather clued up about health, possibly because his show has a weekly health slot, “Medical Monday”.  There is a concept in biochemistry, with respect to biochemical pathways such as the metabolism of glucose, the Embden-Meyerhof pathway, of “the rate limiting step”.  One particular chemical reaction will be the slowest; so it doesn’t matter how rapid the other steps are, because everything gets held up at this point.  I used to apply this concept in the emergency department to “the patient journey” (odious expression), and if I knew that a particular laboratory investigation was going to hold the patient up, I got the request in as early as possible.        

But I get the distinct impression that the Prime Minister doesn’t really have a handle on the machinations of health care delivery, and that some corporate IT/AI whizz kid, perhaps an “influencer”, has bent his ear.  AI is a method in search of an application, and it has its baleful eye on the NHS.  I hope somebody in the medical profession puts his or her head above the parapet and tells the tech companies where to go.  But in the UK, that can be tantamount to professional suicide.  They’ll take back your gong.  Who cares?  I wouldn’t.  Ich bin der Welt abhandengekommen.

I wonder if it is possible to apply the diagnostic models we usually utilise with respect to individual patients, to entire communities, and societies.  Of course, pathophysiologically, we recognise epidemics, and pandemics, typically bacterial, like the plague, or viral, like flu or covid.  Then we may talk more loosely about an epidemic of obesity, often conjoined with hypertension, hyperlipidaemia, and diabetes, a suite of disabilities that has previously been dubbed Syndrome X, long before Mr Musk gave his social media platform the same name. 

Could there also be an epidemic of psychiatric illness?  I read somewhere the other day (fake news for all I know) that 15% of the adult population of the UK is on antidepressant medication.  Mid-January, it is quite credible that we are all a little low.  Is low mood contagious?  And perhaps, other mental states?  Anger, desperation, dysphoria, even psychosis?

Reading the letters page of the Herald makes me think so.  This is how I start my day, with a cup of coffee.  Maybe I had rather go out for a walk.  Yet I read all the letters.  There are, for example, nine letters in today’s Herald.  I occasionally write in, but not today.   The total word count is usually about 2,500, so people can be quite expansive in what they say.  By and large, the letters are well written.  But the prevailing mood is not good.  Let’s take an inventory:

1. Both the US and the UK are in a state of decline, mired in corruption.
2. Never mind Musk.  The UK itself is mired in corruption (again).  Brexit a disaster.
3. Labour has hoodwinked us.  “Savings” affect Society’s most vulnerable.
4. An expression of fear at the prospect of Scottish Independence associated with bankruptcy, the slump of world markets, and the coming of war.
5. Hypocrisy of the UK paying lip-service to a “two state solution” in the Middle East, while effectively supporting Israel in obliterating Palestine. 
6. The lack of public conveniences an absolute disgrace.
7. Scottish education has collapsed, replacing the love of knowledge with the pursuit of a means to lucrative employment.  Lamentable.
8. Transient Visitor Levy a bad idea.  Tourism industry already faced with substantial rise in staff costs. 
9. (By way of light relief) A Lampoon of Burns’ Address to a Haggis.

Fair fa’ your honest, sonsie face apart, it doesn’t make for light reading.  The prevailing mood is one of anger.  It’s bad enough on the printed page.  Heaven knows how much worse it is on social media.  But I never look.  And there is desperation, a sense that the common man, and woman, are helpless in the face of overwhelming external forces, market forces, the machinations of the rich and powerful.  Constructive ideas are few and far between.  The state of the Health Service, for example, may be bemoaned, but creative solutions are not forthcoming.  Elsewhere in the paper, I see that nurses are being trained for a specific role working in corridors.  This is universally recognised as being completely unacceptable.  Yes, but what is to be done?  Hand-wringing, apparently.  The collective mental state we all share arises from a sense that the individual is impotent.  And oddly enough, this mental state seems to affect even people who appear to exercise a degree of clout.  My impression of the Labour Government is that they have come to realise that the leverage they have available to affect the “change” they trumpeted before the election, is extremely limited.  We seem to be in the grip of sinister external forces.  It’s an antique view.  Our fate is in the lap of the gods.        

Internationally, the situation is even grimmer.  The Middle East, Ukraine, Sudan etc.  A week today, Mr Trump commences his second term in the White House.  He has his baleful eye on Canada, Panama, and Greenland.  He wants to open up the north-west passage to trade.  Once the Greenland ice cap has melted, he can mine for nickel and cobalt.  Drill, baby, drill.  Meanwhile, Pacific Palisades is reduced to ashes.  The Grand Old Party doesn’t see a connection there.  LA is apparently burning because the fire hydrants were poorly resourced and maintained.

With respect to “the world stage”, there is another highly relevant report in today’s Herald.  The Royal Mint is issuing a £2 coin to commemorate the 75^th anniversary of the death of George Orwell.  The coin depicts the image of an eye, which on closer inspection is a camera lens.  This is encircled by the quote, “Big Brother is watching you”.  There is another inscription round the coin’s edge that is surely an animadversion on the current Zeitgeist: “There was truth and there was untruth”.

It is salutary to think that, but for the publication of Animal Farm and 1984 at the end of Orwell’s short life, he would have been remembered as a minor novelist, essayist, and political pamphleteer.  Yet now, 1984 still grows more prescient by the day.  I recall the depiction of three huge power blocs across the world – Air Strip 1, Eurasia, and East Asia.  Or perhaps, US/UK, the EU, and China? 

The darkness in 1984 is unrelenting.  We should take it as a warning, but not succumb to it.  “If there is hope,” wrote Winston Smith in his diary, “it lies with the proles.”  And although Winston became rather disillusioned by the proles, I think he was right.  Hope lies within the hearts of ordinary, individual men and women, trying to work together in concert, and in harmony.  So next time I write into the Herald, I hope to have something positive, and constructive, to say.              

To be honest, I don’t know where last year has gone.  Gone in a flash.  The acceleration of the seasons.  It seems no time at all since, in the twilit zone twixt Christmas and Hogmanay, 2023, I was drawing up some absurd catalogue of resolutions, a bucket list, while fully conscious at the time that the definition of insanity is to repeatedly indulge in behaviours that have never produced a desired result.  There is a first person narrator in a Graham Greene novel – I think it might be Fowler in The Quiet American – who reminisces about a time “when I still took my future seriously”.  Evelyn Waugh thought Fowler was a despicable creature, yet I rather identify with him.  Michael Caine played him beautifully in film.      

I recall I described “the daily bread” under 7 bullet points:

• Pray
• Read
• Write
• Play a musical instrument
• Speak a foreign language
• Get some exercise
• Look out!

Or something along these lines.

Well, how did that go? 

Actually, not too badly.  I always start the day with a muttered consecration.  Here I feel the need to self-deprecate.  I don’t wish to be ridiculed for speaking to an Imaginary Friend.  But you see, He once sat with me, on Ninety Mile Beach at the outlet of Te Paki stream, and told me that everything was going to be okay. 

I read voraciously, if in an undisciplined fashion.  This week I read Sarah Rainsford’s wonderful, if harrowing, Goodbye to Russia (Bloomsbury 2024 – signed by the author – it’s a terrible signature, but at least she has dated it, Oct. 2024).  Reading it on the back of the late Alexei Navalni’s Patriot, I have the sense of a country that has changed little from the one depicted through the music of Dmitry Shostakovich, the music of a lunatic asylum. 

And I’m currently reading Andrew O’Hagan’s Mayflies (Faber and Faber 2020).  It was given me as a gift.  I probably wouldn’t have bought it for myself, but is not this the beauty of an unsolicited gift?  It offers you something you ordinarily would never experience.  It is funny, touching, intensely Scottish, and full of humanity. 

And yes, I scribble away.  Last year I published The Last Night of the Proms.  A friend emailed me the other day and asked, is this worth reading?  I resisted the (intensely Scottish) impulse to say “No!”, but informed him that it was the greatest thing since sliced bread.  And now I am embarked on publication No. 5 – if spared.  People I know kindly ask me what it is all about, but I am coy about that, fearing that giving the game away will in some sense burst a bubble.  So the most I tell them is that it is in form “epistolatory” – you know, like Richardson’s Clarissa.  Aye, right. 

An die Musik.  In November, in the Dunblane Chamber Orchestra, we played Quilter’s Children’s Overture, Prokofiev’s Peter and the Wolf, and Beethoven’s Eroica Symphony.  The conductor, himself a violist, keeps saying to me, “James!  Play nearer the bridge!  You play like a folk musician.”  I took that as a compliment.  But I think it may be a bridge too far.  Old dog, new tricks.  Schwanengesang? 

Ich spreche Deutsch.  Nur Anfängers Kenntnisse.  Aber… I continue to attend the class Deutsch für Alltag in the Goethe Institut in Glasgow.  I’m not at all sure that I have any gift for languages, but anyway I enjoy it.   

I walk every day, and swim maybe every other day.  I need to be a little bit more “aerobic” – as the personal trainers say – when actually they mean “anaerobic”.  That is, get out of breath.  Sometimes I go on the treadmill, though the joints are beginning to complain.  It’s as easily done walking up a hill, or indeed in the pool.  I keep exercising because I don’t want to develop atrial fibrillation.  Then I’d have to go on an anticoagulant, and no doubt the medics would find good cause to put me on a suite of antihypertensives, statins, and medications for “pre-diabetes”.  I would be treated for a whole series of conditions I do not have.  I have a deep distrust of the medical profession. 

Look out!  I struggle to articulate.  I mean, stop navel-gazing.  (Is that what this is?)  I need to do something that is not inward-looking, but rather communal, collegiate, outgoing, even altruistic.  Here, I have a bad track record.  On the last two committees on which I served, I lasted two hours before I resigned.  I guess I’m not a committee man.  Sometimes I try to salve my conscience by reminding myself that I am retired, and that I spent my professional life tending the sick and needy.  But it doesn’t really work. 

Still, at the end of the day, maybe the thing to do is to identify a vocation, that which you are called upon to do, and then to do it with all your heart and all your might.  I’d better get on with the epistolatory novel.  Love, and do as you will.                       

I once attended a lecture given by an expert in stroke management who asked the audience what was the definition of a transient ischaemic attack (TIA).  Somebody volunteered a traditional definition, that it was a “cerebrovascular accident” (there’s an archaic term) whose symptoms and signs resolved completely within 24 hours.  “Too long,” said the lecturer.  Somebody else suggested resolution within one hour.  “Too long.”  “We give in,” said the audience.  The lecturer said, “Three minutes, four at the most.”

It makes sense.  We know that the success of cardiopulmonary resuscitation in the context of cardiac arrest drops off drastically with each passing minute of delay.  A neuron deprived of oxygen will die in a few minutes.  Therefore a TIA that lasts longer than a few minutes is not a TIA; it is a stroke.  The deficit may be subtle, but it will be there.  Nature may be said to be kinder to us in the context of myocardial infarction.  Heart muscle deprived of oxygen will survive for longer.  But “time is muscle”.  We talk here of “the golden hour”. 

I thought of this on Friday when a retired GP told me she had been with a patient who was clearly suffering a heart attack.  She phoned for an ambulance.  She came up against a call handler who was clearly working through an algorithm.  “Is the patient conscious and breathing?”  “Look.  I’m a doctor.  The patient is having a heart attack and needs a blue light ambulance immediately.”  “Is the patient conscious and breathing?”

In the event, the golden hour elapsed without the ambulance arriving, and the patient died.

This story has become painfully familiar.  Sometimes an episode like this is described as an “anecdote”, as if it were some kind of amusing after dinner entertainment.  But the anecdotes mount up.  Just before the lockdown I was in a restaurant in Glasgow when somebody collapsed.  I phoned for an ambulance.  Four times.  But the ambulance never came.  It was a Saturday evening and they were too busy.  Earlier this year I tended a patient who had collapsed in the street late one evening.  Another 999 call, for an ambulance that never came.

What’s the problem?  I’m told that the ambulances convey patients to hospital, but cannot offload them, because the hospital is full.  There is no room in the inn.  So the patient stays in the ambulance, parked at the hospital’s front door, until space is found.  The patient in the ambulance is said to be in an environment which is “safe”.  That may be so, but it is the next patient out in the community who is not safe.  The ambulance is out of action because, in turn, in-patients cannot be discharged via the hospital’s back door, because there is no viable social care service.  So the entire system is constipated.  I’m reminded of a piece of whimsy from the number theorists.  If a hotel has an infinite number of rooms filled by an infinite number of guests, can the hotel accommodate another guest?  Yes.  You move the guest from Room 1 to Room 2, and the guest from Room 2 to Room 3 (or is it 4? – a subtlety that eludes me), and so on, thus freeing up Room 1.  Actually, you can accommodate an infinite number of new guests this way.  However, hospitals are not like this hotel because the capacity is finite.  You really need to discharge people, but it seems that hospitals are like the Hotel California, or Heartbreak Hotel, from which there is no escape.

An immediate, makeshift solution to the ambulance problem seems obvious; you create an emergency holding bay which mirrors the safe environment of the ambulance.  Why has this not been done?  I can only assume that hospital managers don’t consider that something adverse happening out in the community is their problem. 

I’m intrigued by the lack of a sense of urgency that is often shared by people occupying senior roles in many walks of life.  You certainly see the same thing in the justice system.  It does not appear to bother purveyors of justice, that justice delayed is justice denied.  Here, a police investigation has been rumbling on for years now concerning certain alleged financial irregularities within the Scottish National Party.  Operation Branchform.  (For some reason I keep wanting to call it Operation Trench Foot.)  A report has been, or perhaps shortly will be, or perhaps never will be, submitted to the Procurator Fiscal.  It sits there, static, like an ambulance parked outside the Emergency Department; or like a mobile home parked beside a suburban garden lawn in which has been pitched a tent of the sort you see when forensic scientists start digging up the bodies.

But sometimes, when the Establishment gets a fright, they move with extraordinary rapidity.  When there was civil unrest earlier this year following a series of murders at a Taylor Swift-themed dance class, summary justice saw the perpetrators tried, found guilty, sentenced, and jailed, almost overnight.  National emergencies call for quick action.  In 1982, when Argentina invaded the Falklands, a cruise ship, the SS Uganda, was commandeered in the Mediterranean, emptied of school children, sailed to Gibraltar, and converted into a hospital ship virtually over the course of a weekend. 

But when it comes to the constipated NHS with its protracted waiting times, outside ED in the short term, or on an elective surgical waiting list in the long term, while people certainly get exercised, the great and the good don’t seem much bothered.  Yes, the politicians knock spots off one another, but they don’t really have any original ideas, and sadly, the medical profession has not offered much by way of leadership.

With respect to the queuing ambulances, I believe that hospitals need to be “front loaded”.  Patients should not be transferred to some diminutive, miserable “Cas”, but rather to an extensive and well equipped, well-staffed Department of Emergency Medicine which should be the hub of the hospital.  All medicine is acute. 

I once wrote into the Herald to say that I thought that Emergency Medicine and Acute Medicine (two putatively disparate specialities) should dump the silo mentality, bury the hatchet, and amalgamate.  Some wag wrote in to say the newly formed specialty would be the Scottish College Royal of Emergency & Acute Medicine, or SCREAM.  Well in a way that’s quite funny, but you know, it betrays a profoundly British sense of cynicism and hopelessness.  How often do I hear it?  That’s pie in the sky.  It’s not going to happen. 

We should make a conjoined, societal New Year’s Resolution, to dump negativity.  There’s nothing worthy that cannot be achieved, if men and women of good faith set their minds to it.  But, especially in medicine, time is of the essence.  Carpe diem.          

My Autobiography

Charles Chaplin

(The Bodley Head, 1964)

Meeting Churchill, A Life in 90 Encounters

Sinclair McKay

(Viking, 2023)

I often notice when reading two apparently unconnected books in parallel, that there is some point of intersection, that one book informs the other, and vice versa. 

I picked up the handsome, hardback first edition of Chaplin’s autobiography in a second hand bookshop last week.  I can’t say I ever found Charlie Chaplin on film, in his persona as the tramp, terribly amusing.  Maybe humour – think of these clunky cartoon captions in nineteenth century Punch magazines – doesn’t travel well through time.  I saw the Richard Attenborough biopic, Chaplin, and again it didn’t make much impression.

But Charles Chaplin, the autobiographer, is completely fascinating.  You could hardly conceive of a more starkly contrasted rags-to-riches story, from a childhood of extreme poverty in late nineteenth century London, through the harsh grinding struggle in theatrical Vaudeville.  This was hardly alleviated by a move to the United States.  But then came the rise of the silent movies in the motion picture industry.  He moved to LA, and might have continued to struggle, but for the fact that the movers and shakers of that world began to notice that Charlie Chaplin was box office.  Then he was moving in a world of fantastic glamour, the world of Douglas Fairbanks and Mary Pickford, and socialising with august luminaries like Melba, Paderewski, Nijinsky and Pavlova, and later Rachmaninov, Stravinsky, Schoenberg, Heifetz, Shaw, Thomas Mann, Churchill…  And of course, William Randolph Hearst.  Hearst’s enormous pile on the west coast sounds even more surreal than the Xanadu depicted in Orson Welles’ Citizen Kane. 

Then of course the talkies came in, and Chaplin realised that the tramp could not be given a voice.  It would change his persona.  The talkies signalled the twilight of Chaplin’s career on screen, and his attention shifted more towards directing.  The world was changing in the 1930s, in more ways than one.  Then came the rise of the extreme right in Germany, leading eventually to the Second World War.  This is where the book really takes off.  Chaplin was always – hardly surprising considering his humble origins – left-leaning.  When Hitler attacked Communist Russia on June 22^nd 1941 in Operation Barbarossa, Chaplin had sympathies with the Russian people and was advocating the opening of a second front even before Pearl Harbour.  It was from this point that the USA began to harbour the suspicion that he was a Communist.  In the 1950s, during the Cold War, America fell out of love with Charlie Chaplin.  Inevitably, he fell foul of the House Committee on Un-American Activities.  People were out to get him, on a variety of fronts.  He had to get out, hiding in his cabin on the Queen Elizabeth as it left New York for Europe, waiting until the pilot disembark, lest the Feds slap him with a court summons.  He made it.  He settled in Switzerland with his beautiful young wife Oona, daughter of Eugene O’Neill, and lived happily ever after. 

The point of intersection with Churchill is of course that they met frequently.  Churchill was a fan.  Sinclair McKay’s is a clever idea, to see the biography –  yet another one – of Churchill through the prism of 90 encounters with other people, 90, presumably, being one for each year of his life.  In fact Charlie Chaplin is mentioned in despatches twice, in 1929, and then in 1956.  He first met Churchill in Marion Davies’ beach-house when they were introduced to one another by William Randolph Hearst.  They met frequently in Hollywood, and subsequently in London, and at Chartwell.  Chaplin was then due to meet Gandhi.  It may be said that Churchill’s and Chaplin’s political differences caused some strain. 

In 1956 they met in the Savoy Grill, in London.  Churchill had resigned from his second premiership the previous year.  On this occasion, Chaplin was about to meet Khrushchev.  There is again a sense of strain, a frigid politeness.

It seems to me there is an irony, and a paradox, in the way these two individuals expressed political views at different times, that landed them both in some hot water.  Chaplin and Churchill both supported Russia in 1941, at a time when many people both in the UK and the US wished that Germany and Russia should be allowed to knock spots off one another.  Chaplin espoused a second front, but Churchill, mindful of the trench warfare of the western front in the First War was more circumspect, much to Stalin’s fury.  But he had rather go for the “soft underbelly”, through North Africa and Italy.  That policy was also not without risk.  Churchill might well have thought of a similar strategy he advocated a quarter century before when he was First Lord of the Admiralty, leading to the catastrophe of the Dardanelles, and Gallipoli. 

Then in 1946 President Truman invited Churchill, now out of office, to Fulton Missouri to give a speech, not knowing what Churchill was going to say.  This of course was the famous “Iron Curtain” speech which might be said to have signalled the start of the Cold War.  Here, Chaplin was on the side of the US because he did not think this speech was helpful.  In the US at that time, Uncle Joe was in good odour after the great patriotic victory, and people thought, again, that Churchill was a sabre-rattling war-monger.  So on the one hand, Chaplin was essentially forced out of the US because he sided with Russia, and on the other, Churchill was black-balled because he did not.  It’s all a question of timing.

When I was about nine years old, my father gave me a present, either a birthday or a Christmas present – can’t remember which – of a typewriter. It was an ancient office Barlock that weighed a ton. I think it was being thrown out of the Chief Constable’s Office in the City of Glasgow Police, where he worked, and he got it for £1. It was, and remains, the best present I have ever received. It was astute of him. He knew I had a fascination with words, and I loved “composition”, an opportunity every Friday afternoon in Primary School to wax eloquent in prose. On many other occasions as a present he would give me, and my many cousins, a book. When I won a prize at the end of Primary School he suggested that I ask for Roget’s Thesaurus of English Words and Phrases, a tome I still possess. He had a friend, one Elphinstone Dalglish, who loved exuberant language; he described any form of humbug, or waffle, as “a farrago of heterogeneous irrelevancies”. For better or worse, I collected expressions like that.

I got quite adept on the Barlock typewriter. I was quite fast, though I can’t say I could touch-type. But I started writing stories. They were of course extremely derivative. They were modelled on Ian Fleming’s Bond novels, and I can blame my father for that as well. He borrowed Dr No from Partick Borough Library. I opened it, read that first astonishing sentence, and was immediately hooked.

Punctually at six o’clock the sun set with a last yellow flash behind the Blue Mountains, a wave of violet shadow poured down Richmond Road, and the crickets and tree frogs in the fine gardens began to zing and tinkle.

Waow!

I suppose it was unusual at the time for somebody to be so familiar with the QWERTY keyboard at such a young age. You might say now that I was way ahead of my time. But no. It really was a different age, the age of carbon paper and Gestetners. Now anybody with a mobile phone is familiar with a QWERTY keyboard, but may be less skilled in calligraphy, or what used to be called “real writing”. It could even be that the habit of putting pen to paper is dying out. The scrawl has given way to the scroll. Perhaps paper will become obsolete, as people spend untold hours staring at smart phones, ipads, and computer screens. I resist this. I love the ritual of reading the physical entity of my broadsheet morning paper.

Talking of The Herald, I wrote in on Friday. Two articles caught my eye, and they seemed to me to share a common thematic thread. A software company supplying IT systems for GPs has gone into administration. Meanwhile another company is currently wooing the NHS with promises of the enormous potential benefits of robotics. I was moved to write.

Dear Sir,

I don’t think our GPs should get too upset if they can’t transition from EMIS to Vision (Software supplier to Scots doctors goes bust, Herald, December 13th). Personally while in practice I was never so happy as when the computers crashed. We never really needed them. All a GP needs is a quiet room, and the ability to take a history and conduct an examination.

Of much more concern is the latest threat to the sanctity of the medical consultation – robotics (Robotics could transform our NHS, Agenda, Herald December 13th). Robotics are “the arms and legs of AI” according to the Tony Blair Institute, in delivering “real world impact”. This is a mirror image of the rise of Information Technology 30 years ago. It’s not that a doctor is seeking a technical solution to a clinical problem; rather that a new technology is seeking a market place. AI has its baleful eye on the NHS. It’s a hard sell. If we don’t embrace the new technology, we will be overtaken by competitors. That sort of argument is why teenagers are addicted to smart phones – fear of missing out.

But do we really want the kettle of an isolated, elderly patient to inform an enormous data base that it has not recently boiled, so as to send a robot round to make a cup of tea? That sounds like hell on earth to me. We are not robots. I don’t doubt they have a place; some of them are good at certain surgeries, albeit under supervision. But what the NHS really needs to invest in is people, doctors, nurses, and allied professionals who don’t think algorithmically but who utilise knowledge and skill with wisdom and compassion, who adopt a technology when it is needed, but will, I trust, refuse to have one imposed upon them.

Yours sincerely…

So there you go. All these years later, still typing away. We will see if it appears in tomorrow’s Herald. I have this theory that I continually write to the papers because I have a perverse desire to be castigated, to be told to wake up and smell the coffee. Dr Campbell’s latest Luddite tirade is nothing more than a farrago of heterogeneous irrelevancies…

I had a brief interchange with a church organist in Aberdeen on Saturday evening.  He, on hearing that I am a viola player, immediately told me a viola joke.  But I have had it up to here with viola jokes.  So, to use a grotesque phrase currently in vogue, I “pushed back”.  What a horrible, pussy-footing expression.  You hear it on Any Questions, when panellists disagree politically.  “I would push back on that.”  Why not just disagree?  Not that you are likely to alter your opponent’s mind set.  On the contrary, they are most likely – to use another ghastly contemporary expression – to “double down”. 

Anyway, I pushed back on the viola joke.  “Viola jokes are finished.  Gone.  History.  Kaputt.”  But no! The organist doubled down, and told me another, particularly tasteless one.  Well, I can utilise tired, outworn clichés as well as the next man.  I reminded him of the Church of Scotland minister who once asked, “What’s the difference between an organist and an international terrorist?  You can negotiate with a terrorist.” 

I can’t remember ever hearing a viola joke that made me laugh.  A member of the RSNO, recalling my brief professional career, asked me, “When were you in with us?”  I replied that it was so long ago that, at the time, viola jokes had not been invented.  He smiled and said, “That in itself is a viola joke.”

People in minority groups are often subjected to so-called “banter”.  And the viola section can certainly be a minority group.  I heard Sir Simon Rattle on the radio the other day saying that as a student he put on Mahler’s Resurrection Symphony with one viola.  As a species we can appear as endangered as the tenors are in the choir.  But as a viola player I no longer feel vulnerable.  That is because I now realise that the viola section is the power house of the orchestra.  Cinderella has found that the glass slipper fits.  I’m no longer offended by viola jokes.  I’m impatient with them, and dismissive of them.  I feel sorry for the purveyors of the jokes because they do not know that they are tin-eared.   

Now talking of pushing back and doubling down, this is the time of year when lexicographers announce the latest linguistic trends, in particular the word of the year.  In Germany the Jugendliche have gone for “Aura”.  Aura is cool, the charisma perhaps associated with movie stars and rock legends.  But German youth now apply it more generally.  It has become a currency.  “Thank you for helping me out.  Plus 50 Aura to you!  I slipped on the stair and smashed a cup and saucer.  Minus 500 Aura to me!”

Here, the word of the year is apparently “brat”.  In its restyling, it lacks a pejorative sense.  A brat is a mover and shaker.  He is looked on with a degree of admiration, perhaps envy.  He is somewhat outrageous.  Wicked!  Not likely to be a viola player.  Thank heavens.  But I’m not convinced.  A brat is still a brat.            

I told a musical joke in my German class at the Goethe Institut a couple of weeks ago.  I’m not very good at telling jokes.  Like George VI in The King’s Speech, “Timing is not my strong point.”  But it seemed to go down well.  I hardly know why I am embarking on this iteration, because it was an audio-joke, therefore this is not so much the gag itself, as an explanation thereof.

Beethoven would fly frequently into terrible rages, and if his soup was cold, he would throw it over his long-suffering butler.  Eventually the butler had had enough and said, “Maestro, I can’t stand it any longer.  Too much Sturm und Drang.  I resign.”  Beethoven muttered, “What is this ill tiding that I can barely hear, like the distant, fateful tolling of a bell?”

“I quit.”

“You can’t.  You must stay.  You see, you are my inspiration.”

The butler sarcastically and sardonically harrumphed, “Huh – huh – huh hmmmm…”  (as in quaver rest followed by three quaver G naturals followed by one minim E flat).

It’s the way I tell ’em.  You had to be there.               

Saturday, St Andrews Day, was the 150^th anniversary of the birth of Winston Churchill.  I didn’t hear much about it.  Maybe the British Empire has fallen into such a state of disrepute that people would rather brush it all under the carpet.  But surely they can’t cancel Winston.  Anybody who can write as sublimely as he could, can’t be all bad.

Towards the end of his life, increasingly frail and decrepit, he once said, “I have done my work.  I should be allowed to depart.”  I always thought of this as a plea to Mother Nature, or indeed the Almighty, to let him go, but in view of Friday’s debate in Westminster, perhaps Winston was still thinking legislatively.  For on Friday, the Assisted Dying Bill survived its first reading (or was it the second?) in the House of Commons.  Irrespective of one’s point of view, the tenor of the debate seems to have gone down well with the general public.  “Ya-Boo” politics were put to one side.  People on both sides of the debate were listened to in silence, and with respect.  The debate was expansive; many members spoke movingly.  In the end, when the “ayes” had it by a margin that was substantial if not overwhelming, there were no partisan cheers; rather respectful silence.  This, said the parliamentary reporters, was Westminster at its best.

That seems to me to say more about the normal state of affairs in Westminster, than about this particular debate.  It should surely be de rigueur, that participants in any debate should listen to one another respectfully, and in silence, not only out of courtesy, but out of genuine curiosity, and on the off-chance that they may hear an argument they have not considered, which might persuade them to change their minds.  Friday’s debate was unusual in that it ended with a “conscience vote”.  Nobody was under the whip.  The members could vote according to the dictates of their own conscience. 

But wait a minute.  Shouldn’t every vote be a “conscience vote”?  Is there any matter that comes up before parliament that is not a matter of conscience?  Whatever the issue might be, be it about the economy, health, education, defence, is there any issue that would justify an MP voting against that which they thought was right?  Why would an MP wish to vote for something they didn’t believe in?  Party discipline, I suppose.  Esprit de corps.  The whips, or shadow whips, tell the members, on one side of the house or the other, how to vote.

Much of Friday’s debate centred on the vexed issue of coercion.  Relatives of a terminally ill patient might apply pressure on the patient to request assisted dying.  This could be a blatant attempt to acquire the patient’s assets.  Most likely the coercion would be subtle, a hint, a gentle reminder that the patient had become a burden.  Champions of the bill insist that safeguards are in place.  Two doctors and a judge will ensure that coercion does not take place.  But what if it is the doctor who exhibits coercive behaviour?  There is the possibility that the assisted dying option would be proposed to patients by GPs.  A patient is given a fatal diagnosis with prognosis of life expectancy less than six months.  What are my options, doc?  Apparently the GP is free to discuss available therapies, or indeed absence of therapy, but will be prohibited from raising the assisted dying option, unless the patient first raises it.  Some GPs are not very happy about that.  Why should they be muzzled, gagged, in what they may or may not be permitted to discuss?    

I think there is something profoundly ironic in the notion that Members of Parliament should pontificate on the subject of coercion.  I can hardly think of a more coerced group in our society.  You will vote according to the three line whip, or if you don’t, you will lose the whip, not to mention the ministerial stipend, and the ministerial car.  Perhaps there will be added coercion from one’s spouse.  How are we going to afford the children’s school fees?  Those parliamentarians who told us on Friday that rigorous safeguards will be in place don’t seem to be aware that they themselves are the victims of coercion.  But that is the subtle thing about coercion.  It is invisible.  Coercive behaviour (Latin coercere: to shut in) is at its most effective, and harmful, when the victims are not aware that they are trapped.  It’s the obverse of the coin of Richard Lovelace’s “Stone walls do not a prison make, nor iron bars a cage.”  I’ve just finished reading Alexei Navalny’s extraordinary memoir, Patriot (The Bodley Head, 2024).  Having survived an assassination attempt, and having received treatment in Germany, he returned to Russia fully aware of the possibility, indeed probability, that he would be sent to jail.  He endured the harshest conditions, helped by memorising Christ’s Sermon on the Mount.  Incarcerated, he remained to the end in some profound sense free, because he refused to be coerced.    

Anyway, with the start of the new week, no doubt the ya-boo politics will return.  Personally I can’t stand it.  When John Prescott, erstwhile Deputy Prime Minister died last week, I heard an anecdote about what he had to put up with in the House of Commons.  He had a working class background and had been, before politics, a ship’s steward.  When he entered the chamber, the posh toffs on the other benches would taunt him: “Another gin and tonic, Manuel!”

Says it all, really.