jamescalumcampbell

When the Glasgow School of Art went up in flames last week I thought, “That’s odd!”  Actually I thought of the quotation on the contents page of Goldfinger, that says once is happenstance, twice is coincidence, but the third time it’s enemy action.  In 2014 a major fire in the Art School destroyed the Mackintosh Library which was being meticulously reconstructed at considerable expense.  And now this.  Once the fires were extinguished I took a walk up Renfrew Street which is parallel to and immediately north of Sauchiehall Street.  The block was cordoned off and there was a considerable police presence, but I got close enough to ascertain that there is nothing left of the building but a shell.

It’s all reminiscent of the destruction by fire in 1962 of Glasgow’s concert hall, the St Andrews Hall.  After a boxing match, somebody threw away a cigarette without stubbing it out.  The St Andrews Hall was situated less than a mile to the west of the Art School, just beyond Charing Cross and behind the Mitchell Library.  Now all that remains of it is the very impressive façade on Granville Street.  The first orchestral concert I ever attended as a child was a performance of Beethoven’s Ninth Symphony in St Andrews Hall, and I do have a reasonably clear recollection of the hall, which was much admired by musicians from all over the world.  I don’t think a reconstruction of St Andrews Hall was ever seriously considered.  Its destruction occurred more or less simultaneously with the ripping up of Glasgow’s tram lines, shortly followed by the ripping up of the UK’s rail system.  In 1960, Ernest Marples, the Transport Minister in Harold Macmillan’s government, had commissioned Prof Sir Colin Buchanan et al to study the effect of the motor car on UK cities. The Buchanan Report, Traffic in Towns, was duly published.  Prof Buchanan said with respect to the car, “We are nourishing at immense cost a monster of great potential destructiveness, and yet we love him dearly.”  So at least some “strategic planners” envisaged the traffic congestion and air pollution that lay ahead, yet the concept of global warming from the production of greenhouse gases would largely have been unknown to them.  I recall once championing the Buchanan Report in a schools’ debating event held in some anonymous municipal office in Glasgow city centre.  As with many such reports, it was much lauded, and then buried without trace.  For the next thirty years Glasgow’s city fathers concentrated on turning Glasgow into an asphalt jungle dominated by the motor car jammed solid on overpasses, underpasses, and huge freeways cutting a swathe through obliterated neighbourhoods.  The one surviving facade of the St Andrews Hall is now the back entrance to the Mitchell, itself sitting on the lip of a roaring Grand Canyon through which the M8 runs south to the Kingston Bridge.  With the recent devastations (there was another big fire in March), Sauchiehall Street is a ghost town; you can almost see the tumbleweed.  At least at its east end sits the fine Glasgow Royal Concert Hall, home of the RSNO.  It took Glasgow 28 years, following the demise of the St Andrews Hall, to build it.

There has been a lot of coverage about the Art School in the newspapers, and much correspondence expressing a mix of sorrow and anger.  Questions are being asked.  Why hadn’t a fire suppression system, a sprinkler system, been fitted?  What was the significance of a series of loud bangs some local residents reported shortly before the outbreak of the fire?  Why was the fire so ferocious (“like a volcano”, said the firefighters)?  Those who might be in the know are keeping tight-lipped.  Most people seem to favour another attempt at restoration, although some have ventured to suggest the money might be better spent on health and social care in Glasgow’s east end, and one journalist has levelled a scathing attack on the liberal élite of Glasgow’s west end for crying crocodile tears into their hazelnut lattés for their beloved “Mack” (I never heard the Art School being described as the “Mack”, before it went up in smoke).  But I don’t think the attack on the gentrified west end is justified; I think the dismay is real.

I’ve never been inside the Art School although I know plenty of people who studied there.  The Art Department was very strong in my school (in Glasgow’s west end).  I had a sense of that, although I personally had absolutely no talent for art whatsoever.  I didn’t envy the pupils who could design and paint and sculpt, but I did venerate them.  I thought of them as being a little removed from the academic mainstream.  They were very mature.  They seemed to know their destiny from an early age, that they were going to the Art School, so they did enough in other subjects to secure their entry, all the while devoting themselves entirely to their art.  They seemed to be given a great deal of latitude.  Their relationship with the staff of the Art Department was not so much teacher and pupil, as master and apprentice.  It is to the teachers’ credit that they didn’t simply ignore the rest of us, but did try to instil in us a sense of art appreciation, and curiosity.  Glasgow is an arty place.  The Art Galleries in Kelvingrove is a much loved, much visited venue.  I often pop in and revisit the work of the Glasgow Boys and the Scottish Colourists.  Charles Rennie Mackintosh’s Hill House in Helensburgh (currently under refurbishment) has an extraordinary interior, well worth a visit, although I admit I would not have cared to live in it.  The Glasgow School of Art was Mackintosh’s masterpiece, and any time I walked past its entrance I had a sense of that, so all that exposure to art in my school days must have had an effect.

Isn’t it strange how an event of significance can occur in an area of your life you consider arid and devoid of interest?  I would have dumped art at the earliest opportunity.  Yet I knew the art teachers at school were all rather impressive figures.  They never had any discipline problems in the classroom because they were respected.  They carried with them an aura of worldliness, the sense that they enjoyed a rich life outwith the classroom.  At least two of them were eminent in the art world.  One of them we called Dirty Dick (because of his apparent predilection for the study of the nude).  He was tall, slim, sophisticated, and grey.  An éminence grise.  He occupied a magnificent studio with huge windows on the top floor of the school’s Old Building.  One day when I was about fourteen I got the summons to that grand studio.  Dirty Dick wanted to see me.  He had a small coterie of his serious art pupils with him.  It turned out they needed a subject.  I said, “Why me?”

“I need somebody who isn’t going to keel over.”

I was gratified.  I thought, fair enough!  So long as they don’t want me to take off my clothes.

And yet there was a sense of being stripped naked.  I stood bathed in white light.  The artists were merely shadows lurking behind easels.  I had thought it would be easy to stand motionless for forty minutes but I could feel my features crumbling under the scrutiny.

“You see this young man.”  Dirty Dick addressed his class in discursive tones.  “He is clearly on a mission.  He is on a journey.  He is all curiosity and eagerness.  Yet cautious, too.  Haunted.  Hunted perhaps.  Can you capture it?”

How did he know that about me?  It never occurred to me he might have been describing any adolescent boy.  It was like reading your horoscope and saying, oh yes, that’s definitely me.

“What do you intend to do when you leave this august institution?”  I noticed Dirty Dick was sketching me, too.

“Go to university.”  That was a given.  Taken as read.  My father, who left school when he was 14, had the highest respect for higher education.

“And what will you read?”

“English I suppose.”

“You suppose?”

I shrugged.

“What do you want to be?”

I hated that question.  I’d already died of embarrassment owning up to my aspiration to write, and I vowed I’d never divulge that piece of information again.  Yet I hated the schoolboy trick of hiding behind sullen silence.  So I said, in a fit of boldness of the sort that would occasionally overtake me, “I haven’t a clue.  What would you recommend?”

It was like consulting the oracle at Thebes.  I wondered if I should elect Dirty Dick to be my mentor.  If he could give me an answer that would show me the way, then I would appoint him.

There was quietness for the space of five minutes.  Dirty Dick carried on sketching.  Then he punctuated the silence.

“I think you need to rebel.”

 

“You boy,” said the Vamp, sticking his pointer into Brian’s sternum, like a bayonet.  “What book are you reading just now?”

I knew Brian would tell the truth, and it would be his downfall.  I sent him a telepathic message.  Just make something up!  The White Company, Henry Esmond, anything!

“None, sir.”

“What?”

He was the deputy headmaster.  He took very few classes.  You would see him swooping around in his gown along the outside corridors above the playground (designed thus so we wouldn’t all succumb to tuberculosis), hamming it up, a camp Count Dracula.  Sometimes he would come on the blower at morning break.  “This is the deputy head-maahsta speaking” and we would start giggling in a terrified, hysterical way.  One day we congregated after lunch in Miss Watson’s maths class and found, to our amusement, that somebody during the lunch break had written a legend in Anglo-Saxon on her blackboard commencing, “Some girls need…”  None of us volunteered to rub it off with the duster for fear of being implicated.  Miss Watson arrived unexpectedly early, impassively pushed up the blackboard’s moveable surface until the legend was out of sight, and then went and got the Vamp.  They stood on the floor in front of us and had a protracted conversation in an undertone.  We sat in dead silence thinking, this is the end of the world as we know it.  Then the Vamp sloped off and Miss Watson went back to y = mx + c as if nothing had happened.

“And you boy.”  Now the bayonet was upon my own breast.  I could feel a surge of precocity sweeping over me.  It sometimes happened.  I would blurt, and later be doubled up with the embarrassment of reminiscence.

“I don’t so much read books, as plunder them.”

There was a pause.  The bayonet was withdrawn.  “Indeed?  And to what purpose, such an act of plunder?”

“Ideas.”

He looked at me, thoughtfully.  “Do you write?”

“Try to.”  Now I felt myself going red.  Sometimes I hated my own destiny.  Why couldn’t I have been a centre forward?  I should have done a Brian.  Kept mum.

“And upon which work are you currently wreaking your act of rapacity?”

“1984.”

The Vamp frowned.  Another thought had occurred to him.  “Are you a plagiary?”

“No, sir.”

“But is not this act of piracy you allude to, a plagiary act?”

I shrugged and said coldly, “You can’t write in a vacuum. Read Eliot.  Tradition and the Individual Talent.”  I thought, leave it at that for God’s sake.  I could feel the rest of the class growing restless.  I said to myself, next time, keep your mouth shut.

The Vamp was still gazing fixedly at me, wondering whether to reward me for chucking my hat in the ring, or castigate me for impertinence.

“Do you have a publisher?”

“No.”

“Mm.  Always remember the words of Dr Johnson.  ‘No man but a blockhead ever wrote, except for money.’”  He subjected me to the chilly vampire grin.

“Coconut or a cigar?”

It was true, though.  I did plunder.  I was a very indiscriminate reader.  I read the way an idiot savant reads the telephone directory.  Right at break of day, there I’d be, Yesterday in Parliament on the Home Service, reading the Kellogg’s Cornflake wrapper.  Or the blurb on the HP sauce bottle:

  Cette sauce de haute est un qualité mélange des fruits, épices, et vinaigre de malt…

When you are young your enthusiasms are completely anarchic.  They are almost entirely random.  You turned on the radio and happened to hear a piece of music; you idly picked up a volume as you passed a book shelf.  My mentors told me to read Charles Dickens and listen to Mozart.  I read Aldous Huxley and listened to Ralph Vaughan Williams.  And they didn’t know.  Consequently I was incomprehensible to them.  And to myself.  Why should an urban Scottish waif born into a landscape of dilapidated tenements, of bomb sites full of nothing but nettles and docks, parched, be slaked by an evocation of the gentle green leas of Down Ampney?  Why should I have been in the least bothered by the foppish fantasies of an oversized, oversexed Oxon galoot inhabiting such improbable hamlets as Bole, Tritton, Spavin Delawarr, Knipswich for Timpany, West Bowlby, Camlet-on-the-Water?  Yet I gobbled them up, the Collected Works, in the beautiful Chatto and Windus editions in their cellophane-wrapped russet covers.  But I hated myself for it.  I thought, I am effete.  I am turning myself into a refined and precious artistic buffoon of the sort John Buchan parodied in Mr Standfast with his depiction of the artistic community of Biggleswick.  I am Biggleswicked.  A galoot at moot.  I could turn out reams of pseudo-Huxley, the smart-arse post-prandial rantings of smug intellectuals with queer names, saturated in gin and Art, stuffed like a Strasbourg goose with indiscriminately acquired knowledge, the A-Z of Encyclopaedia Britannica.

The Count said to me, “This is good stuff!  It’s nearly publishable!”  (Ah – the curse of the writer manqué, slain by the morganatic compliment.)  “I don’t know where you get it from.”

Don’t you?

I shrugged.  A strange look, part rueful smile and part irritation came over his face.  “You don’t seem to care.  Why are you so sad?”

“It’s nothing.”  I remembered Clifford’s body of work in Lady C, smart, intellectual, up-and-coming, sought after, and on the brink of success.  Yet it was nothing.   I knew mine was the same.  It was nothing.  Definitely dead from the waist down.

No man but a blockhead ever wrote, except for money.  I just thought it was a cynical throwaway remark.  Now I feel it conceals a profound truth.  You absolutely must get out of your garret and go and experience the heat and dust of the arena.

There are crossroads in your life.  You pause at them for a moment and take in the view, hardly aware that questions are being asked of you, that you are required to give an answer, to make a decision.  You are at a meeting of ways outside Thebes.  Mark this.  It is only in retrospect that you realise you might have taken an alternative path.

The Count was a wonderful man.  A born teacher.  Tall, urbane, cultured, and sophisticated.  He was steeped in Art.  Literature, opera, theatre, film.  He opened the partition at the back of room 17 and expanded his empire into the next classroom and turned his domain into the school library, there for us all.  He formed a Film Club.  We watched Citizen Kane.  He took us to The Close Theatre to see Ibsen and Strindberg.  He taught us Shakespeare and Shaw, Greene, Pinter.  He taught us literary theory.  He taught us fantastic concepts such as The Fallacy of Imitative Form, the Objective Correlative, F. R. Leavis’ notions of concreteness, the mind-boggling idea that the meaning of a work might be independent of the author’s intention.  He might have been my mentor.  I might have said to him, there and then, “Thank you for your kindness and encouragement.  But I need more.  I need your help.  The fact is, while it reads well enough and is at least, as they say, ‘prose-competent’, it’s empty.  Doris Lessing once said that the difficulty for the writer is not in writing, but in leading a life.  Teach me how to live.”

But I didn’t.  Instead I shrugged and shut him out, with all the callousness and brutality of youth, and said, “It’s nothing.”  I cut him dead, with a device of patient lacklustre.

 

 

Saturday being a beautiful day of high summer, and faced with the choice of either writing this blog, or getting some fresh air and exercise, I decided to do both simultaneously, and walked the seven hills of Edinburgh while letting my mind roam free.  On the way in, the traffic signs said, “Yellow warning: heavy rain expected”, but I hoped to get round before the deluge.

Depending on your choice of route, it’s a twelve mile walk with about 3,500 feet of ascent -something like a Munro with a long walk in.  I like to start in the north-west with Corstorphine Hill which is a bit of an outlier.  It’s sufficiently far out from the city centre that you can park your car without paying an exorbitant parking fee.  Then I take in the seven, anticlock, in a broad circle: Corstorphine, Craiglockhart, Braid, Blackford, Arthur’s Seat, Calton, and Castle Hill.  I walked west up Ravelston Dykes past Mary Erskine’s, the school rumoured to be the model for Muriel Spark’s The Prime of Miss Jean Brodie, took the lane that bisects Murrayfield Golf Course, and half an hour after starting I reached the radio mast, abeam Clermiston Tower, atop Corstorphine Hill, or, because it is fenced off, as near to it as I could attain.  Then I left the hill in a southerly direction to cross Edinburgh’s main drag at Balgreen and head for Craiglockhart.  I thought, what shall I write about?  Write about something that nobody is talking about; write about the Mastodon in the Auditorium.

Last week, while clearing out a drawer in the never-ending struggle to offload junk, I came across an ancient essay I wrote under exam conditions in the fair city of Edinburgh, in First MB.  Bacteria and Bacteriophage.

Bacteria are unicellular, prokaryotic, haploid organisms which replicate as quickly as once every twenty minutes.  Thus they are potentially able to produce a vast number of progeny in a very short time.  What happens in fact is that they very soon exhaust the medium in which they find themselves – in the lab, this might be a petri dish with a layer of nutrient agar on which the bacteria is (sic) initially placed, perhaps in colonies, or as a lawn across the total surface of the agar.  Before all nourishment has been extorted from this medium, the bacteria will pollute their own surroundings by excreting poisons – say, alcohol – by diffusion.  Thus the typical bacterial life-cycle is as follows…

(hand-drawn graphs follow)…

Poison enters the medium, growth stops, and often an equilibrium is attained, or the vast majority of cells die. 

It occurs to me: here is the Mastodon in the Auditorium.  We know it’s there; yet we pretend we don’t see it.  Here is our essential predicament.  Aside from the fact that a bacterium is unicellular and homo sapiens is multicellular, we are all inhabiting a petri dish of finite dimensions and finite resources.

(I took Balgreen Road and hung a right on to Gorgie.  This is where you can get lost in the suburbs in a maze of streets and lose time.  I took Chessar Avenue to Slateford Road thereby negotiating both Slateford Rail Junction and the Union Canal.  Then I turned southeast at Craiglockhart Avenue and headed for Napier University.  I crossed Colinton Road and passed the old Craiglockhart Hospital building, its frontage unchanged, where Wilfred Owen met Siegfried Sassoon during the Great War.  Once again I left the hustle and bustle of the city traffic for the peace and tranquillity of parkland.  It seemed that out of battle I escaped…)  I went round the back of the Craiglockhart University Campus, found a gap in a hedge, accessed the path, and then abruptly turned left up a steep grass slope toward summit number two at Wester Craiglockhart.)

The Mastodon in the Auditorium is overpopulation.  The petri dish is planet earth, and the bacteria, are us.  Last month, the human population of the world was estimated to be about 7.62 billion.  The population of the world is projected to increase in 2018 by 92,157,695.  This means that the world needs to create a city of London, with all its amenities, goods and services, once a month.  This is pretty startling, yet, so far as I can see, it is completely off the political agenda.  You can see why.  It’s dynamite.

(Next stop, Braid Hills.  More subtle route planning.  I cut down through the Merchants of Edinburgh Golf Course and emerged on to Greenbank Drive.  It doesn’t look promising on the map, but there is a pedestrian pathway that allows you to cut through to Greenbank Road, then if you take Greenbank Park you can access another path that lets you cut through Braidburn Valley and up on to Comiston Road.  Don’t be tempted to take Riselaw Road or Place, take the Crescent up onto Braid, cross over and enter Braid Hills via a bridle path that will take you up on to the golf course.  There’s a trig point, which I touched, but I also went on to the radio mast which is the truer summit.)

Population Studies, for example from the United Nations Department of Economic and Social Affairs’ Population Division, boast a considerable literature, which is seldom reported.  I’ve been listening to epidemiologists and public health gurus of one sort or another for a lifetime, but I can only recall one on the lecture circuit who made an impact with respect to overpopulation – John Guillebaud, the Emeritus Professor of Family Planning and Reproductive Health at UCL.  That he holds the only chair in the UK in his chosen discipline suggests that Prof Guillebaud is out on a limb, perhaps something of a maverick.  He spends a lot of time giving lectures on sexual and reproductive health to health professionals.  He is an expert on contraception.  He believes in contraception as a force for public good.  I have seen him in a lecture contrasting two slides – one showing an array of contraceptive devices, the other showing an array of weapons, and asking which one is the more palatable way of keeping the population at a reasonable level.   He thinks of contraception as a potential means of tackling the problem of the Mastodon in the Auditorium.  I nearly said “controlling the population”, but Prof Guillebaud specifically asks us not to juxtapose the words “population” and “control”.  To the western liberal democracies, any kind of state intervention in this regard is anathema.  Article 16 of the Universal Declaration of Human Rights states that “men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.”

Prof Guillebaud is a patron of Population Matters, formerly the Optimum Population Trust.  Other patrons include the broadcaster Sir David Attenborough, economist Sir Partha Dasgupta, biologist Prof Paul Ehrlich, and primatologist Dr Jane Goodall.  Population Matters has called upon government to develop a sustainable population policy.  In 2013, controversially, this body called for a UK zero-net migration policy, and the curtailing of child benefits to families of more than two offspring.  These policies were abandoned in 2017.  Here, tax relief benefits are available to parents.  The Scottish Government has a flagship policy of doubling free childcare hours by 2020.  Presumably this is so that both parents can go out to work.

(Blackford Hill lies to the north east of Braid but it is best to resist the temptation to make a beeline towards it straight across the golf course.  You only get tangled up in a welter of broom.  You can head for the club house and get back on the bridle path to a suitable point to cross Braid Hills Drive.  Or, as I did on Saturday, take a slalom of paths through the Braid golf course with a more direct route on to Hermitage Golf Course.  Now you need to cross the stream running through the wooded gully of Blackford Glen.  Left, right, left, right, left over a footbridge, left again, right and upwards, and you’re into the skirts of Blackford Hill.  Cross a meadow, through a gate, turn left and right, and ascend via wooden steps towards the Royal Observatory, round the shoulder of the hill to access the trig point from the south east.)

We might see ourselves as bacteria on the petri dish reproducing in vast numbers and polluting our environment so extensively that we can no longer exist in a toxic environment, and the environment becomes sterile.  But of course it is not as simple as that.  Even on the petri dish, it’s complicated.

Nonetheless, there may be in the culture of bacteria a single mutant which has immunity from the particular poison being excreted into the medium, and this mutant will continue to replicate and produce its own strain.  If we think of the “poison” of the medium as being, not alcohol, but phage particles parasitic on the bacteria, then the same result is apparent.  A culture containing, say, a billion bacteria, infected by five or six times as many phages, will be almost totally destroyed, but a handful of individual mutants may survive, unaffected by the phage. 

Ah.  The survival of the fittest.  The strong over the weak.  What a grim business.

This mutation was shown by Delbruke and Luria not to arise as a result of contact with phage, but to be the result of a random event which may happen in the absence of phage.  Their proof of this fact – a demonstration by an indirect approach – has been verified by experiments involving replica plating.  A mutation along the length of the single bacterial chromosome, happens to give immunity.  Such an event can happen with probability of perhaps one millionth to one billionth, for a mutation at any particular gene location.  If such a mutation does occur, the phage are somehow prevented from penetrating the bacterium and directing the DNA of the cell in the production of replica phage.  In the more usual event however, a phage particle alights on the surface of the bacterium, the phage cylinder contracts and injects its DNA complement into the bacterium.  Here, the phage DNA takes over control of the replicating processes of the bacterium, somehow overseeing its own replication.  Several phage generations are reproduced, the cell lyses, and phage disappear out into the medium ready to attack more bacteria. 

(Now run past the observatory and down to the bottom of Observatory Road and then – and this is important – don’t turn left, turn right.  That’s the trick; then take first left on to Lussielaw Road, then it’s just a little jink across Mayfield on to Suffolk Road and Craigmillar Park Road.  When Craigmillar Park Road changes its name to Minto Street turn right on to Salisbury Road and head for the Royal Commonwealth Pool.

I stopped for a diet Coke.)

So we have this scenario.  A vast human population is running out of sustenance.  The environment is being turned into a huge rubbish tip (Mr Trump is the only person in the world who doesn’t think so).  Sea water levels are rising and land masses are diminishing.  Vast numbers of people are on the move because the land is shrinking and because they are so impoverished anyway that their homeland holds nothing for them.  The wealthy countries of the world see this emerging threat and are fast pulling up the drawbridges and dropping the portcullises, terrified that the defences are going to be broached by the teeming, marauding millions.  In terms of political manifestos, drawbridges and portcullises seem to be the only options.

(Now for the biggest hill, Arthur’s Seat.  From the Commonwealth Pool I crossed Powderhouse Corner and steered a course straight for the summit, crossing Queens Drive and leaving it at the Hawse, choosing a rough path above Hunter’s Bog.  This took me to the path rising above Haggis Knowe and the remains of St Anthony’s Chapel.  Then I had to dig deep for a steeper climb, to access the twin peaks of Arthur’s Seat from the North.  Lots of tourists atop, with lots of languages in different accents.  And what a view!)

I have a notion that the people holding the levers in charge of the drawbridges and portcullises think they have things under control.  Yet the race does not always fall to the swift, nor the battle to the strong, but that time and chance happeneth to them all.  How far can I push the metaphor of the petri dish?

(From Arthur’s Seat I headed north over to Calton Hill, dodging the tourists round Holyrood Palace and the Scottish Parliament, and instead slipping past Holyrood Abbey and Croft-an-Righ to Regent Park, Regent Terrace by the old Royal High School, St Andrews House, and thus on to the hill.  I headed for the summit at Nelson Monument.  Six down.

Sometimes, however, a phage enters a bacterium and does not kill the organism.  But another sort of life cycle ensues.  The genetic complement of the phage this time becomes attached to, and indistinguishable from, the genetic complement of the bacterium.  Now the bacterium replicates as usual and a new strain is produced.  Cell lysis can at this stage be induced, for example, by action of ultraviolet light.  Phage within the bacterium acting in this way are known as prophage, and the phenomenon is called lysogeny.

So perhaps we can survive the cataclysm after all, but only if we are prepared to change, and to accommodate.  I think I’ve stretched this metaphor to breaking point.

Back down off Calton I reached the east end of Princes Street and turned south on to North Bridge.  I stopped at a Prêt for a Smoothie, and I couldn’t resist popping into Blackwell’s opposite Old College, but I didn’t buy a book.  Then I retraced my steps to the Royal Mile and headed up past St Giles towards the castle.  Outside the Camera Obscura there was a guy floating in mid-air.  He was dressed in saffron robes and his only contact with the ground was through a slender stick held in a wizened hand.  How do they do that?  I’m a pushover for magic.  The Castle Esplanade was fairly heaving but I slipped up the left side under the stanchions of the temporary seating for the International Military Tattoo, reached the castle moat, touched the wall, and thereby knocked off the seven.

Then the heavens opened.  And I’ve still got a blog to write.

 

 

 

 

 

 

To the Glasgow Royal Concert Hall on Saturday night and the last concert of the Royal Scottish National Orchestra’s 2017-18 season, which also happened to be the last concert in Scotland of the RSNO’s principal conductor, Peter Oundjian.  The sole work on the programme was Mahler’s Ninth Symphony.

I’ve been listening to Mahler 9 for a long time.   When I was a teenager I heard Otto Klemperer conduct it at the Edinburgh Festival.  I used to listen endlessly to the Bruno Walter recording with the Columbia Symphony Orchestra.  I was particularly enamoured of the last movement, the Adagio, and its passionate writing for strings with these shifting Wagnerian cadences which, like Tristan, never seem to settle and resolve.  Hearing it on Saturday reminded me of my last day at school.  It was the day of my Grannie Campbell’s funeral in Skye, aged 93, but I couldn’t attend as I had to make a speech at prize-giving.  The rest of the clan headed north out of Glasgow.  I must have been a sober youth as it never crossed my mind to tell my friends I had an “empty”.  In fact I went back to beautiful Caroline’s and we sat on the floor and played records.  It felt poignant and sad.  Still I was already a bit semidetached from the world of rock and pop because I eventually got back to my deserted home, and listened to the last movement of Mahler 9.  Sad music is a bit of an indulgence to the young.  It is only later that you sometimes feel it might better be avoided.

That Mahler 9 should be associated in my mind with a funeral seems apposite, in that the number nine, symphonically, seemed to be a figure many composers were unable to get past – Beethoven, Dvorak, Bruckner, Vaughan Williams, and of course Mahler.  It is said – perhaps this is apocryphal – that Mahler cast his song cycle Das Lied von der Erde in symphonic form in order to elude the curse of number nine, but that it didn’t work; his tenth symphony had to be completed by somebody else.  The Deryck Cooke performing version is an example.  Das Lied was another obsession of mine as a youth.  Again it was the last movement, and the Walter recording.  The soloist was Kathleen Ferrier.  Walter said – and this is not apocryphal – that the two greatest experiences of his life were knowing Kathleen Ferrier, and knowing Gustav Mahler, in that order.  Listening to Ferrier sing the last movement of Das Lied, one can hear why.  The intensity of the expression is beyond description.  Ferrier was apologetic that she got a bit carried away, though Walter reassured her.  But then, Walter was besotted.  The thing about the voice of Ferrier is that this is the voice of a soul.  She cannot open her mouth but that she establishes an instant connection with her audience, and she also seems to have some sort of profound connection with the inner core and meaning of the music.  Menuhin had that same quality; he is another soul.  People like that don’t come along very often.  With Ferrier, the connection between late Mahler and death remains.  She developed metastatic breast cancer that proved intractable to treatment.  She actually broke a bone while on stage singing the role of Lucretia which Benjamin Britten created for her, and somehow managed to continue.

The RSNO’s performance of Mahler 9 on Saturday was magnificent.  I think everybody in the hall knew they were present at something very special.  I cannot remember a more attentive or a more appreciative audience.  During the protracted pianissimo coda, to me always reminiscent of the close of Schubert 8 (if closing the Unfinished isn’t an oxymoron), the audience held its collective breath and you could have heard a pin drop.  Maestro Oundjian acknowledged the contributions of all the principal players and all the orchestral sections in turn, and I wasn’t surprised that first horn Christopher Gough received a standing ovation.

Peter Oundjian’s association with the RSNO is not quite over.  On September 6^th they travel to London and the Royal Albert Hall for the BBC Proms and Benjamin Britten’s War Requiem.  I might make the trip south.  But tomorrow I head north.  For me, the association of Mahler 9 with funerals continues.  On Tuesday Clan Campbell will be on the Isle of Skye to attend the funeral of a dear cousin, famous for her generosity of heart.  When I came back from New Zealand she lent me her croft in Camustianavaig, and I ensconced myself there and wrote a book, a precursor to that which won me the Impress Prize for new writers.  So I head north to pay my profoundest respects and express my gratitude.

In memoriam, EM, d. 25/5/18.

On Saturday I was back in Aberdeen.  The Granite City sparkles in this glorious weather.  A friend was celebrating a very important birthday with a ceilidh.  It was a very sweet occasion.

Ceilidh is an interesting word.  Chambers: in Scotland and Ireland, an informal evening of song, story and dancing.  But in Gaelic, ceilidh has a more general meaning.  Dwelly: gossiping, visiting, visit.  These definitions remind me of the world of Jane Austen.  You might say her six novels are a depiction of a series of ceilidhs.  She says of Mrs Bennet’s life, “its solace was visiting and news.”  I confess on Saturday I did rather more gossiping than Scottish country dancing.  Terpsichore, the Muse of the Dance, gave me the body swerve.  I’ve never mastered the intricacies of the Eightsome Reel and Strip the Willow, especially the Orcadian variety.  There’s a Cary Grant – Ingrid Bergman film in which Grant finds himself floundering around in a Scottish country dance.  It’s very amusing.  I am Grant, minus the elegance.  I did however manage the occasional shuffle.  I would not wish to be Mr Darcy, hanging around, aloof.  Who is that haughty man?  Miss Bennet would tease me remorselessly.  Alas Mr Darcy, there will be dancing.  That’s the thing about a Ball.  And it would be appalling not to celebrate Auld Lang Syne, even if the occasion under the Millennium Dome, when Mr Blair joined hands with Her Majesty, was excruciating.

Meanwhile the result of the Irish referendum confirmed Friday’s exit poll with a two to one yes vote in favour of the repeal of the eighth amendment to the constitution.  Now there is pressure on Northern Ireland to follow suit in revising the most conservative abortion laws in Europe.  Because the Northern Ireland Assembly has been suspended for nearly a year and a half, this pressure is being put on Westminster.  Interestingly enough, one of the main stumbling blocks to reconvening Stormont is that Sinn Fein and the DUP can’t see eye to eye over the Irish language.  Language gets politicised.  In Scotland, Gaelic evokes similar antagonism.  People write angry letters into the newspapers complaining about the expense of producing bilingual signs at railway stations.  The Scottish Government recently put a modest sum behind a particular promotion of the Gaelic language, and an article appeared in the Herald asking the question, “If Gaelic is dying does it deserve a £2.5m kiss of life?”  In the article, the writer compared the sound of somebody speaking Gaelic to that of somebody gargling with Irn Bru.

That remark really pulled me up short.  Imagine if somebody had said that of Urdu, or Yiddish.

(Incidentally, I see that Mr Trump has banned Irn Bru from Trump Turnberry.  He says it stains the carpets.  Maybe he’ll impose a similar embargo on red wine.)

But to return to the ceilidh for a moment, I was gossiping with a couple who the previous day had spent fifteen hours out on the hill and had climbed the five Munros of the Fisherfield.  There used to be six, but Beinn a’Chlaidheimh got demoted in 2012.  The remaining five are: Sgurr Ban, Mullach Coire Mhic Fhearchair, Beinn Tarsuinn, A’Mhaighdean, and Ruadh Stac Mor.  Most of us have difficulty pronouncing these names.  Most of the 282 Scottish Munros have Gaelic names, and we can’t read them.  We find we are illiterate.  Our ancient homeland has become strange to us.

An analogous situation exists in New Zealand.  Most of the place names are Maori.  I am convinced that the predominant New Zealand national culture is Maori.  The difference is that in New Zealand this culture is held in reverence, and protected through the Treaty of Waitangi.

Even a writer as profoundly English as George Orwell recognised the value of protecting Gaelic culture.  Read “As I please, 73: Poles in Scotland; Scottish Nationalism”: “At one time I would have said that it is absurd to keep alive an archaic language like Gaelic… Now I’m not so sure…  If people feel they have a special culture which ought to be preserved, and that the language is part of it, difficulties should not be put in their way when they want their children to learn it properly.”

If you lose the language, you lose the culture.  If you lose the culture, you lose – well – everything.  Then you can say: “Now there’s ane end a’ ane auld sang.”

But not yet.  It was a wonderful ceilidh.  And we are alive and well.

Ceud mile fàilte!                                          

To Edinburgh on Thursday, for lunch with two second cousins.  Nurse, and doctor.  The nurse’s father, (the doctor’s uncle, and my mother’s cousin) was a GP in Paeroa, in the Thames Valley at the foot of the Coromandel Peninsula in New Zealand’s North Island.  I once did a locum for him and it became evident that he was held in high regard by the Maori community.  When he died, there was a tremendous outpouring of grief and a huge funeral.  I was privileged to be a pall-bearer.  The body lay in the local marae for a tangi lasting three days.  He was laid to rest to a pibroch played on pipes that had also been played at the Battle of the Somme.  There was a chant from the Maori, and the combination of Ceòl Mòr and the ululation of the Maori women was overwhelming.

In Edinburgh, we joked about the douce mores of the inhabitants of the New Town.  “I’ve only once been to Glasgow – to the opera.”  Was I going to watch the Royal Wedding?  No.  I asked my cousins what the attraction was.  The dress.  It’s a girlie thing.

Sunday was The Day of Pentecost.  In Acts chapter two St Luke records that on the day of Pentecost, the eleven were filled with the spirit of the Holy Ghost and were able to speak to men of every nation in their own tongue.  On the other hand, some people thought the disciples were just pissed.  Surely the best rendition of this episode comes from Lorimer’s Translation into Scots of “Acks”.

They war aa ‘maist by themsels, no kennin what tae think, an speirin at ilk ither, “What’s this o’d avà?” tho there wis some geckit an said, “They’r lippin fu o new wine.”  But Peter stuid up wi the eleivin aside him an, takkin speech in haund, said tae the croud: “Aa ye Jews an dwallers in Jerusalem, this is something at ye maun ken; tent ye weill what I am tae say tae ye.  Thir men isna fu, as ye jalouse: it is but the mids o the forenuin.”   

The diametric opposite to this strange tale occurs in Genesis with the description of the Tower of Babel, that absurd ziggurat and monument to man’s hubris.  When it all came tumbling down, everybody started talking gibberish and nobody could make himself understood.  So we may conclude that if we are full of pride we will be cut off from our fellow beings, but if we are full love we will be one with them.  Or, to quote that great chestnut of wedding texts: (Lorimer again)

Gin I speak wi the tungs o men an angels, but hae nae luve i my hairt, I am no nane better nor dunnerin bress or a ringing cymbal.

That I think was the essential message from the Most Reverend Bishop Michael Currie to the Dumbartons on Saturday.  Not that I watched.  Bah humbug!  Instead, I walked round Loch Leven, where they locked up Mary Queen of Scots in 1567-68.  I went, as the mathematicians say, in the positive direction, anticlock.  It’s a half marathon, a walk full of variety.  The insecta are less pestilential on the outgoing, western side of the loch.  After forty five minutes I made the gentle ascent to a lookout point which affords a splendid view of the RSPB sanctuary, and on the hour I stopped for refreshment at the RSPB centre.  It was quiet.  Apparently everybody was either watching the wedding or one or other of the cup finals.  Half an hour later, at the south east perimeter of the walk, I became aware of a breath of air and a soft fluttering of wings over my head.  An elegant glider, so close that I felt I could have reached up and touched it, passed almost silently over my head and landed on the grass strip at Scotlandwell.

Next there was a woodland walk occasionally through teeming clouds of insects so dense the air was turgid.  I thought of turning away from the loch towards the inviting Loch Leven Larder.  “Two roads diverged in a yellow wood…”  But a gentle breeze helped and I stayed the course.  Back by the water’s edge the vista opened up again and I made the long walk to the sandy cove at the northern end of the loch, before turning west and then south to complete the circuit on the wharf at Kinross.  Robert Frost’s The Road Not Taken reminded me of another lunch I recently enjoyed with friends in my local, the Lion & Unicorn.  A Professor of Statistics, another statistician (retired), a mathematician who teaches in prison, and me.  In the words of Alexander Pope,

Here let us feast, and to the feast be joined

Discourse, the sweeter banquet of the mind.

Incidentally, throughout that entire meal nobody once took out their phone, tablet, or “device” (device! – it’s like some sort of therapeutic appurtenance, a prosthesis).  What a blessed relief.  The conversation turned, after the fashion of Robert Frost, to what each of us might have done, if we had not pursued our respective disciplines.

This is a strange question for me, because I have the strange notion that, in fact, I did choose the other path.  I was always a writer.  I read Eng Lang & Lit and then I went off at a complete tangent and became a doctor.  I think it was in Why I Write that George Orwell said that if he had not been a writer, he would have done violence to his basic personality.  And when I read that, I thought, that’s what I did.  Yet I can’t say it didn’t work out for me.  I guess I just got lucky.  Life is unfathomable.  But, with respect to the world of letters, I always knew I’d come back.

In the Lion & Unicorn I said I would study modern languages.  I have no German, yet when I hear German spoken, I have a sense that I nearly understand it.  I am with the eleven in the upper room.  I admit that’s absurd.  I sound like Lady Catherine de Burgh in Pride and Prejudice who says of the fortepiano, “I could have been a great proficient!”

Back home in the evening, I flicked on the telly and encountered the nuptials at Windsor.  I was about to mutter bah humbug again when I chanced to see the beautiful white apparition of the Countess of Dumbarton entering the west door of St George’s Chapel while a treble sang exalted Handelian music.  Some sort of mysterious transfiguration occurred.  I was completely undermined.

Yesterday at a traffic light in Glasgow I pulled up behind a car whose rear windscreen bore what at first glance I thought was a “Baby on Board” sign, but which turned out to read:

Sorry!  Black box on board.  How do you think I feel?

I think this tragic and pitiful message needs to be dismembered.  The driver of the car was a young woman and I take it the black box was a necessary prerequisite of her insurance policy.  Thus she was obliged to adhere to the speed limit, and this was why she felt the need to apologise to the other road users.  She was holding them all back, because they all wanted to speed.  Moreover, the message indicated that the young driver was as frustrated by this as everybody else.

Black box technology has been borrowed from the world of aviation.  Imagine you have just fastened your seat belt in an Airbus A380, with your seat back upright and your tray table stored, and the captain makes an apologetic announcement that he is going to have to adhere to the strictures of Air Law.  And he adds, “How do you think I feel?”  All of a sudden you might want to deplane.  The aviation industry learned a long time ago that with regard to safety there is no place for a cavalier attitude, that checking the nose wheel pressure by giving the tyre a kick, then flying on a wing and a prayer, is not good enough, and that at the end of the day “the right stuff” is definitely not the right stuff.  In other words, the aviation industry has developed a safety culture.  You adhere to the rules of the air, conscious that you are making a positive contribution to the creation of a safe environment.  Bending the rules, or breaking the rules, is just poor airmanship.  Or airwomanship.  Imagine your A380 captain is directed by air traffic control to proceed from the apron to the holding point, number two to a 747.  He gets frustrated, guns the engines, pulls out, and overtakes the 747 to get to the holding point first.  Air Traffic Control would think the A380 pilot was certifiable.

By contrast, drivers on the road who adhere to the speed limit appear to be the ones manifesting aberrant behaviour, because they are in the minority.  I know this from personal experience because – call me eccentric – I try to observe the speed limit.  Consequently I get overtaken a lot.  I noticed this again yesterday on my way into Glasgow.  As the M80 approaches Glasgow’s east end there is a 50 mph speed limit.  Very few people adhere to it.  There’s lots of tailgating, jinking and weaving.  It pays to listen to the Radio Scotland travel reports en route.  “There is a fifteen minute delay westbound on the M80 at Stepps due to an ‘accident’ (sic).”  Funny, that.

I took the last exit before the river and pulled up at traffic lights to hang a right on to the Clydeside Expressway.  The lights turned green and I saw the car in front of me give a lurch and remain stationary.  The driver had stalled the engine.  She had difficulty restarting.  I was quite content to allow another traffic light cycle to elapse, and listen to Michael Barclay’s Private Passions on Radio 3.  Not so the queue behind me.  People started blasting their horns in an irate fashion.  Naturally the lady ahead of me got flustered.  (This is another thing the aviation world, air traffic control in particular, has understood for a very long time.  Never lose your temper on the radio.  It’s very counterproductive.)  She had a little difficulty identifying which lane she wanted to utilise.  Well!  The demented mob behind went completely berserk.  Is there anybody more self-righteous, more Pharisaical, than an angry driver who blasts his horn and makes arm gestures of despair (usually by taking both hands off the wheel)?

Occasionally you find the person being blasted gives as good as they get and blasts back.  It becomes unseemly, like two men conducting a brawl in the street.  People who blast away on their car horn remind me of toddlers who sit down in a supermarket aisle and have a screaming tantrum.  I think road rage is definitely getting commoner.  I used to think some metamorphosis occurred to people when they got behind the wheel of a car.  They would be aggressive towards somebody slow to move off at the lights, when they wouldn’t dream of being aggressive towards an elderly person struggling to count change at a Post Office counter.  Now I’m not so sure.

We all need to calm down.  I have a suggestion to make.  When you embark on a car journey, first estimate the time needed for the journey.  Now add half as much time again.  I call this the Cahoots Doctrine.  (Campbell Adds Hours On Over The Schedule).  Then drive below the speed limit.  Then, when you get delayed for a while behind a tractor, your blood pressure will not go through the roof.  Will you join me in this?

As an example, I drove up to Aberdeen for lunch on Saturday.  It’s a two hour journey.  I allowed three.  I listened to Villa-Lobos’ Bachianas Brasileiras, complete (1 – 5 up, 6 – 9 back), and stopped at Finavon for coffee.  It was a sun-kissed day of rare quality.  John Buchan might have said, “The air was tonic.”

There are average speed cameras on the A90.  I’m a fan.  They actually work.  People actually adhere to the limit, and there is evidence that road carnage is reduced.  This should not surprise us, as there is a clear relationship between kinetic energy and trauma.  Now kinetic energy is not merely proportional to mass and velocity, but to the square of its product.  It is a grave misfortune to apprehend this law of physics only when you come to a sudden and abrupt halt.

I will now get off my high horse-power Lamborghini.  It is better to arrive than to travel hopefully.

In Aberdeen we dined al fresco.  My friend the Viking is a virtuoso cook.  She prepared a South African dish, bobotie.  Truly scrumptious.  She is a great fan of cooking programmes.  She asked me if I can cook.  I said, well I can boil a potato and fry a steak.  How hard can it be?  Food-wise, I’m a complete philistine.  Yet even I can appreciate classy bobotie when I taste it.  Oddly enough, I get mistaken for a foodie.  I’m told I have a passing resemblance to Michel Roux Jr.  Can’t see it myself.  One day in the Glasgow Royal Concert Hall the gentleman sitting on my left actually informed me that I was Michel Roux Jr.  He confronted me after the fashion of Stanley meeting Livingstone in the jungle.  I denied it but he wouldn’t take no for an answer.  He laid a comforting hand on my sleeve as if to say, “Don’t worry Michel, I will protect your anonymity.”

There is an off-shore wind farm rising up outside Aberdeen Harbour.  I think it would upset Mr Trump.  When I heard that Mr Trump was being touted for a Nobel Peace Prize I was reminded that Caligula made his horse a senator.  Wouldn’t it be great if wonderful things happened on Mr Trump’s watch?  Things look hopeful on the Korean Peninsula.  Maybe after that, he will go on to secure peace in the middle-east.  On the other hand, if he gets the gong from Sweden, maybe all the other laureates, Mr Obama, Mr Kissinger et al, will send theirs back, just as the retired colonels from Tunbridge Wells did when the Beatles got the OBE.  Now Ringo has his knighthood and Sir Paul has just been made a Companion of Honour.  That’s very high.  To go much further, you really need to acquire lands after the fashion of the aristocracy.  Last week in Dunblane Cathedral the minister prayed for the Earl and Countess of Strathearn (aka Duke and Duchess of Cambridge).  Strathearn is very beautiful.  I wonder what great tract of Scotland Ms Markle might acquire?

Yet she could avoid all of that.  There’s still time.  She and Harry could do what my grannie and grandpa did – elope.

This week I won £580,000.00 on the Euromillions Commonwealth Lottery.

The letter looked very official.  The address was a Head Office in Zurich but the letter had been sent from within the UK, franked Royal Mail, second class.  My address within the envelope’s window was accurate.   The letter bore a number of logos in technicolour and was covered in serial numbers and reference numbers of such prolixity that I will not weary you with their detail.  (Incidentally, didn’t the letter to the PM from SPECTRE say precisely that, when the Special Executive stole two atomic bombs and held the world to ransom for £100,000,000?)  Perhaps the PM, and M, and 007, might have reached the conclusion I have reached and decided the whole thing was a scam, and rather an amateurish one at that.

In my case, the following awkwardly constructed sentence seemed a bit of a giveaway:

Please to help us proceed with your claims, this information must be kept away from public to avoid unwarranted abuse of the program or fraudulent acts from criminal minded and unauthorized person(s).

I am invited to make contact to claim my prize.  The contact is an 0161 number.  Where’s that?  Manchester?  It crossed my mind to take the letter to my local police station and ask them if they would be interested in investigating it.  I rather imagine the policeman at the desk would raise his eyes to the ceiling.  Perhaps I’d be done for mischievous misuse of police time.  What’s that expression used to describe people who make nuisances of themselves, for example, with outlandish requests under the Freedom of Information Act?  Vexatious.

I remember one night in Auckland getting home just past midnight to find I’d been burgled.  I called the police.  “We’ll try to get round to you, sir.  But you are the sixth tonight.”  I was being vexatious.  A relative in Glasgow had a similar experience, phoned the police, and said, “I’d like to report a burglary.”

“Not a burglary, sir.  In Scotland, the offence is house-breaking.”

It’s hard to impress the police.  They’ve seen everything.  One evening a few years back I conducted a GP home visit to a remote cottage in a rural location, where lived an eccentric and reclusive gentleman.  I had often visited patients living in conditions of neglect, but I’d never seen squalor quite like this.  I wondered if he was suffering from the hoarder’s obsessional condition, Diogenes Syndrome.  Basically, he was sitting in the middle of a tip.  He was boiling up some water in a billy-can balanced precariously on a gas canister and a naked flame.  He was surrounded by several tons of newspaper.  He also had, within easy reach, a .22 rifle.  I asked him what the rifle was for.  He said it was to protect himself against unwelcome guests.  I offered to arrange hospital admission for him; it seemed an appropriate way to get him out of this dire situation.  He politely declined, pointing out that there was nothing wrong with him.  It crossed my mind to have him sectioned under the Mental Health Act, but the process would take forever and in any case the psychiatrists would probably agree with the patient’s own assessment.  I suppose I might have concluded that the patient was quite entitled to live life as he saw fit, provided he wasn’t harming anybody else.  But sometimes as a doctor I think you have to put your middleclass liberal instincts to one side in favour of common sense.  After all, he was to all intents and purposes sitting in his own funeral pyre.

I decided to call the police.  In medicine, when you want something to happen, you learn to press the right buttons.  If my patient had been willing, I would have known how to persuade the ambulance to pick him up and the hospital to receive him.  But how could I persuade the police to act as an ambulance?  This was where the rifle came in.  They would not be able to ignore the rifle.  I went outside and made the call on my mobile.

There was a protracted silence, followed by a sigh.  I was reminded of the Two Ronnies sketch in which Ronnie Corbett and an attractive young lady are served in a restaurant by Ronnie Barker’s remarkably cheesed-off waiter.  There was nothing on the menu but rook.  My policeman was Ronnie Barker.  I was being vexatious.

“Is the gun loaded?”

“I don’t know.  I didn’t check.”

“Ah.”

But I knew I had him.  The rifle was the clincher.  If he ignored it, and it all went pear-shaped…

Anyone whose profession involves dealing with the public has to be mindful of the potential pitfall of sneering at that which is apparently trivial.  Doctors, particularly primary care doctors, have to be especially on their guard.  First up, we should never call a complaint “trivial”.  It begs the question, trivial to whom?  It can’t be trivial to the patient otherwise he wouldn’t bring it along.  Of course, many medical conditions are self-limiting and for those, the best possible treatment is reassurance.  A doctor who is overwhelmed by a plethora of self-limiting conditions can actually stop believing in the existence of serious pathology, and start believing it’s all in the patient’s mind.  I can well imagine a policeman could develop a similar lack of respect for the endless complaints of the public.  When a policeman, or a doctor, starts to think that everybody is just bonkers, it’s time to take a sabbatical.

So I’ve decided not to burden the harassed police force with my Euromillions.  I imagine the paperwork involved would be enough to furnish the slum of the man with Diogenes Syndrome.  And yet, I’m leaving a tiny gap in the crime statistics.  And I suspect that the millions of unreported scams that occur every day, millions of tiny gaps, must add up to a giant lacuna in our understanding of the world of lies and deceit we have somehow unwittingly created.  Sometimes I’m tempted to think the whole of human interaction is nothing but One Great Scam.  Maybe governments are the biggest scammers of all.  Aaron Copland has a song – Everyone’s a Dodger.  Even the parson’s a dodger.  What a thought.

Such accidie.  I am become the cynical doctor and/or policeman who stops believing anybody.  I’d better take a sabbatical.

 

Last Thursday evening I had the privilege of addressing the Friends of Aberfoyle & Buchlyvie Medical Practice and I talked about some personal experiences of off-duty or “opportunistic” medicine.  Three of these experiences involved bystander cardiopulmonary resuscitation or Basic CPR, which was serendipitous as this patient group is very involved in community “heart start” and “heart smart” initiatives.  I wanted to express the idea that knowledge of CPR and skill in its delivery is a gateway to every other type of First Response.  So with your indulgence, I reproduce here this segment of my talk.

Does bystander CPR work?

In 1988 I attended the 2^nd International Conference on Emergency Medicine, held that year in Brisbane, Queensland, Australia.  I know the fair city of Brisbane quite well because I worked there for a GP locum service in 1985.  The 1988 conference was very good.  It culminated with a lively debate entitled, “Does bystander CPR work?”  This was before the days of community automatic external defibrillators like the one in the phone box at Arnprior, and many people believed that to invest in CPR training and to create the necessary infrastructure would not be cost-effective.  I had some sympathy with that view because in 1985 while driving to a GP surgery in Brisbane’s northern suburbs I encountered a major road crash and attempted unsuccessfully to resuscitate a young woman.  I can remember her quite clearly, and I still remember her name.  I was upset.  But if I was partly upset at my own inability I shouldn’t have been.  This girl had suffered what is known as “blunt trauma arrest”, and the outlook for that condition remains dismal.

I don’t remember the conclusion reached by the 1988 Brisbane debate, but I do remember what happened after the conference had adjourned.  I stepped out into the Queensland sunshine and went for a walk over the Brisbane River to the Cultural Arts Centre, via the Victoria Bridge.  On the bridge, a man walking in front of me collapsed with a cardiac arrest.  I commenced basic CPR with cardiac compressions and was immediately joined by a nurse from the conference who provided mouth-to-mouth respirations.  An ambulance came – I don’t know how it was summoned because mobile phones then were a rarity and looked like bricks of the sort John Wayne used on Omaha Beach.  But the paramedics arrived quickly, successfully defibrillated the patient, and transported him to hospital.

I don’t know what the final outcome was in that case, but I can tell you what it was the next time I carried out bystander CPR.  Flash forward to Auckland New Zealand a few years later.  In Auckland – actually about this time of year – they hold a huge road-run called “Round the Bays”.  It starts on the wharf in downtown Auckland and proceeds east for about 9k round the Waitemata Harbour to end in the suburb of St Heliers.  I took part many times.  On the occasion in question the field was about 80,000 runners.  After about 3k something in my left calf went “twang”.  I debated whether to run through the pain, slow to a walk, or just stop.  The decision was made for me when the runner in front of me collapsed.  I stopped.

He was non-breathing, pulseless, and unconscious.  I commenced CPR.  I was joined again by a nurse who undertook mouth-to-mouth respirations.  With 80,000 people on the road, the paramedics understandably took a long time to reach us.  We continued basic CPR for some 30 – 45 minutes.  During this time a large number of doctors and nurses running by asked, “Need any help, James?” to which I replied, “Not unless you’ve got a defibrillator.”

When the paramedics finally arrived the defibrillator duly shocked the gentleman back into normal heart rhythm.  He woke up, but because of the hypoxic insult to his brain – lack of oxygen – he was what we call “combative”.  I gave him a little intravenous sedation and accompanied him in the ambulance to the emergency department of Auckland Hospital.  He was admitted to the Department of Critical Care Medicine and walked out of hospital a week later, as we say, “neurologically intact”.  He was entirely well.

So if you are asking me, I think bystander CPR works.

Yet this issue doesn’t go away.  In the British Journal of General Practice of January 2010 a GP wrote an article questioning the cost-effectiveness of CPR training.  I wrote a letter in defence of CPR training which the journal published in February 2010.  In the letter, I pointed out that the benefits of CPR training extend far beyond the particular scenario of a cardiac arrest.  If you can respond effectively to a cardiac arrest, you carry with you the conceptual armamentarium to respond to any medical emergency.  If you undertake a course of First Aid – an undertaking which I strongly recommend – you will, or you should, be taught basic CPR.  Allow me to put on my pedagogic hat for a moment and share with you this one visual aid which I would suggest, if you have an interest in being a first responder, you memorise and hold in your head, heart, and gut.

Here it is:

 

The Emergency:

Breathlessness, Shock, Coma

The Response:

Patient safe?  Am I safe?  Extrication?

Primary Survey:

Airway, Breathing, Circulation, Disability, Exposure & Environment

Vital Signs:

Respiratory rate, Oxygen saturations, Pulse/Blood Pressure, GCS, Temperature

 

Professors of Medicine are wont to put up masses of data and say, “I apologise for this busy slide.”  So I’ve kept it simple.  This is all of emergency medicine on the back of a postcard.  This is what an emergency physician does every single time he – or she – approaches a patient.  The doctor works through this mantra.  On first laying eyes on the patient, the doctor asks, “Is this patient fundamentally well, or fundamentally ill?”  A very sick patient will have at least one of these, the triad of decompensation.  Breathlessness, shock, coma.  Breathlessness: some people call it respiratory embarrassment, but I’ve never seen a breathless person look embarrassed.  Shock – shock isn’t what the daily papers think it is; shock is circulatory collapse, characterised by low blood pressure.  Coma – unconsciousness.

So you see your patient is very ill and you rush to help.  But don’t rush headlong.  Have a care for the situation in which both you and the patient find yourselves.  You may need to move the goal posts.  People fall ill in awkward places.  You may need to shift the furniture.  You may need to move the patient.  Is there a science of extrication?  We will pass over this huge subject this evening.

Next comes your initial assessment of your patient, known as the Primary Survey.  First Aid is as easy as ABC.  Airway – breathing – circulation.  Fix them in that order.  Make sure the airway is open and make sure, if you can, that oxygen gets to the lungs, and that way the circulation has something to transport.

Disability stands for “neurological disability”.  I always think it’s a bit of a lame mnemonic.  “Diminished consciousness” would be better.  You ask, how diminished?  Well, we can quantify it, using the GCS or Glasgow Coma Scale.  Yes, worldwide, Glasgow is home of the coma.

Notice also the way that the vital signs, pulse, blood pressure, temperature, respiratory rate and GCS marry up with the triad of decompensation and our response to it.  To the vital signs we may add oxygen saturations if we have a pulse oximeter, an ingenious device the size of a memory stick which, when attached to a fingertip, or an ear lobe, will tell us the percentage of haemoglobin, the blood’s oxygen- carrying molecule, that is saturated with oxygen.

I say this slide encapsulates all of emergency medicine.  In a sense it informs every medical consultation.  I’m fond of stating that “all medicine is acute”.  By that I mean that every time a doctor goes to the waiting room to summon the next patient he is looking at the patient as he steps forward and, albeit unconsciously, he is going through this mantra.  We doctors sometimes, rather self-servingly, say we have a mysterious “sixth sense” for detecting a patient who is very sick.  But there’s nothing mysterious about it.  It’s a skill that can be taught and can be learned, and it is encapsulated in this mantra.

 

 

 

 

 

 

 

 

In Middlemore Emergency Department in the 1990s we introduced lightning packs.  Their first use was in extreme emergencies, when we wished to rush a patient from ambulance to resuscitation room, and to medical or surgical intervention, with absolutely no delay.  The pack was an envelope containing a form in triplicate to serve as a handwritten clinical record, an array of x-ray and laboratory investigation request forms, principally biochemistry and haematology, an accompanying array of specimen bottles, and a hospital identification wrist-band.  The pack, the wrist band and all the other articles were tagged with a “sticky label” which shared the same unique hospital patient identification number.  Thus an unknown unnamed patient could be identified by his or her unique number and the task of recording patient demographics could be deferred.

We thought we would only use lightning packs occasionally but they were seen to be immediately useful in a variety of situations.  For example it was clear that they would be invaluable if a major incident unfolded and the department received a sudden influx of a large number of patients.  They became an integral part of the hospital’s Disaster Plan.  Initially we held 150 packs in readiness.  We had a low threshold for using a pack in an isolated situation because it was essential that all clinical and clerical staff be familiar with the packs and how to use them.

Then the digital world, the world of the internet and email and information technology erupted, and it became clear that the process of becoming more electronic while going paper-light would be inexorable.  But the lightning packs became all the more important to us.  The systems at the front desk kept crashing.  The front desk would revert to paper, pen and ink, but if we were in a hurry we would just use a lightning pack.  We increased the number of packs held in readiness so that if the lights went out we had a system that could identify and track a 24 hour patient load.  The system was low-tech and that was its power.  It could not be sabotaged.

I thought of lightning packs in May last year when NHS Scotland was targeted by hackers who disrupted IT systems and demanded ransom in Bitcoin.  The attack was named “WannaCry”.  Another attack, “BitPaymer”, was launched in August.  It came in the form of a piece of spam email.  On both occasions patient appointments and procedures were cancelled.  As a result, much money was spent shoring up cyber defences, and more cyber security specialists were recruited.

Now I read in the Sunday Herald that the UK’s National Cyber Security Centre (NCSC) are warning of the possibility of future state-sponsored offensive operations.

Computing power is now very important in clinical medicine.  You can’t run a CT or an MRI scanner without computing power.  That is why it is vital that these systems be quarantined from any potentially malignant outside influence.  But aside from that, there are sound reasons why a Health Service of all things should be particularly robust in the face of a cyber-attack.  In order to function, doctors and nurses might find computers, at least when they work, a convenience, but fundamentally, they are not really needed.  In terms of the trafficking of information they don’t serve any function that can’t be fulfilled by paper and pencil and a telephone.  The beauty of the diagnostic medical consultation is that it relies mostly on the knowledge, skill, wisdom and kindness of the attending physician.  I can’t think of a reason on earth why any general practice or hospital department should cease to function simply because the computers have crashed.  All it takes is for the clinicians to put their heads together and come up with a low-tech plan and a modus operandi for working under such conditions.  Make up some lightning packs and stay open for business.

Meanwhile today’s (Monday) Herald front page is dominated by two headlines:

Protect workforce from the rise of robots, warn unions.

And:

NHS staff taking early retirement doubles in eight years.

Scottish Health Secretary Shona Robison is under huge pressure just now.  NHS Tayside (Ms Robison’s constituency) has come under fire over its use of charity cash to cover general running costs.  This includes the financing of an IT project.

South of the border, I see that Jeremy Hunt is warning the big Social Media empires that if they don’t do something to sort the content on their respective platforms that is damaging the mental health of young people, he will step in and do it for them.

Most people will take a nuanced approach towards the digital world and say that there is nothing intrinsically good or bad about it; it all depends how you use it.  I suppose I must agree with that; why else would I write this document on Word and then post it on my blog?  Yet sometimes I wonder.  I’m beginning to think there is something inherently malevolent about this Brave New World in which we find ourselves.  Clearly we are not in control of it.  Like the Sorcerer’s Apprentice, we are floundering.  It seems to me that IT is a bit like alcohol.  It might be safe and even beneficial in small doses.  (Actually the medical profession is now even questioning that.)  But take too much of it and it will destroy you.  Remember Tiger Tanaka’s remark to Mr Bond in You Only Live Twice concerning saké, that the man drinks the first flask, the second flask drinks the first, then the saké drinks the man.  That truth must be recognised cross-culturally because it is almost exactly replicated in a proverb in Scottish Gaelic which roughly translated says, “One drink: the better of it; two drinks: not the better of it; three drinks: the worst of it!”

So it is with the lap top and the tablet and the desk top.  Remember, you always have the option of switching the contraption off.  I was never so happy in medicine as on the days when the computers crashed.  Suddenly I was no longer under the baleful cyclops eye of the computer screen, and I found I could communicate with my patient without the intrusion of a malevolent third party.  So Log Off! You can have the satisfaction of knowing that the cyber moguls of the great multinational conglomerates won’t like it.

I’m beginning to think the Luddites were right.