John Keats makes the case for social prescribing

No, no, go not to Lethe, neither twist

Wolf’s-bane, tight-rooted, for its poisonous wine;

Nor suffer thy pale forehead to be kiss’d

By nightshade, ruby grape of Proserpine;

Make not your rosary of yew-berries,

Nor let the beetle, nor the death-moth be

Your mournful Psyche, nor the downy owl

A partner in your sorrow’s mysteries;

For shade to shade will come too drowsily,

And drown the wakeful anguish of the soul.

 

 

But when the melancholy fit shall fall

Sudden from heaven like a weeping cloud,

That fosters the droop-headed flowers all,

And hides the green hill in an April shroud;

Then glut thy sorrow on a morning rose,

Or on the rainbow of the salt sand-wave,

Or on the wealth of globed peonies;

Or if thy mistress some rich anger shows,

Emprison her soft hand, and let her rave,

And feed deep, deep upon her peerless eyes.

 

melancholy

The compexities of taking a Covid-19 test at home: the fragile base on which track-and-trace is built

Like millions of others every day I have “done my bit” by entering into an app my symptoms and whether I’ve had a test for Covid-19, and day after day I had no symptoms and had not been tested. Then I developed epigastric discomfort and dutifully entered my symptoms into the app. Days later I was sent an email offering a test and thought I should accept as one point of the research is to identify all the symptoms associated with Covid-19. So began a miserable process.

Now that I’ve written the account it’s become absurdly long—because there are many steps in testing and many places at which it can go wrong. As you may not have the patience to read all the way through, I’ll give you a summary now: I suspect that many results from tests conducted at home are wrong and that a fair few people must give up.

As you read this through (if you can be bothered) imagine an 85-year-old with limited education, little experience of computers, and slow access to the internet following the same process—or somebody with limited grasp of English.

I accessed the website to get a test and was told that I could go to a test centre or ask for a home test. I started by think that I could go to a test centre and so tried to book a slot. There were two slots available, both in the next hour on the North side of Hyde Park. It would take me about 30 minutes to cycle there, but I couldn’t go in the next hour. I tried booking one for subsequent days but was told nothing was available for the next four days. It seems highly unlikely that tests were available in the next hour but not for the next four days. Perhaps I should have simply gone to the website later and try again, but I didn’t. I ordered a test online.

Not one but two tests arrived several days later delivered by Amazon. I opened one of the boxes and out fell a 12-page instruction booklet, a swab, a vial, a plastic bag, a sheet of absorbent material, a biohazard bag with a silver seal, and a return box. I learnt from the instructions that I had to post my test in a priority postbox an hour before the post was collected, and step 1 of 5, including a 3B, is to find your nearest priority box. To find the priority box I had to go online to the Royal Mail website, and I was confused because the link took me not to priority boxes but to delivery/post offices. But then I saw where I could link to priority boxes.

There was a priority box close to where I live, but the instructions point out that if you are unable to get to a priority postbox then “you should not take the test at this time.” I received my test on a Saturday and there was no collection until Monday, so I had to wait. By Monday it would be about six days after I requested a test.

On Monday afternoon I sat down to take the test. In the morning I received an email saying that some people had been having difficulty registering their test. Step 2 is to register your home kit. I went to the link given in the instructions and arrived at a site with about 2000 words of information, but I could not find where to register my test. I tried various links, but they took me back to ordering a test. I also used the search function several times, but that never took me to the right place. I remembered the email that I had received that morning, and it provided a link that did take me to a place where I could register my test.

But this didn’t go well. I had to have my Order ID. This ID was included in the email I’d been sent saying I was being sent a test. I searched for the email and found it eventually. After answering a few questions I had to either scan a barcode or enter the numbers under it. I tried scanning, but I’d never done this on my computer and failed after several attempts of waving the barcode in front of my camera. The kit has two barcodes, and I entered the wrong one first. Eventually I submitted the right one. Then I was taken to a screen that worried me: it said that I had one kind of test when I had another. I tried entering the barcode several times, but it never worked.

Now I was reduced to ringing the helpline. I went through several of the usual “press-one-or-two” questions, and after about a wait of a minute or two I spoke to a woman who was clearly elderly, quite possibly older than me (I’m 68). I explained the problem, and she said there had been a change in the system that day. We went back to the beginning of the process and eventually managed to enter all the bar codes. I asked whether I should take the test now, recognising that it was close to the cut-off time for the post.

“I’d wait until tomorrow, love. I’ll put you down for 9am tomorrow.”

“But the post isn’t collected until 5.30.”

“Ok, I’ll make it the afternoon.”

“Should we register the other test?”

“What other test?”

“I’ve been sent to two.”

“You shouldn’t have been. Just throw it away.”

“That seems a waste. Shouldn’t I do one test now and try to get it in on time and then do the other one tomorrow?”

“No, just throw it away.”

“Oh well thank you for your help.”

“Don’t worry, love, I’ve been putting people right on this all day.”

The next day with at least an hour to before I had to post the test I prepared to take the test. You have to “gently rub the swab” over both tonsils for 10 seconds each. A diagram shows the site of your tonsils, and you are warned that: “This may be uncomfortable, and you may feel like gagging, but it should not hurt.” You are also told: “Take care not to touch the soft end of the soft end of the swab on anything apart from your tonsils and nose.” Perhaps if you have large, inflamed tonsils this is not so hard, but I had my tonsils removed in 1959. I found it hard, and I fear that I did touch both my tongue and my teeth. Next you must put the swab into a nostril and rotate it for 10-15 seconds. This was easier, but rereading the instructions now I realise that I forgot to blow my nose before inserting the swab as I was supposed to do.

Once I’d taken the test I had to insert the swab into a vial and break off the end. This was easy. The final stage was to insert was to insert the vial into the biohazard bag, pack the bag into the box, and post it. Assembling the box was not easy: the instructions were like those in an IKEA kit where arrows point everywhere and there is no text. I did it well enough, stuck it down with sellotape to be sure, and posted it.

I posted it on the Monday, and at 6am on Thursday I got a text that the test was negative. This was now more than a week after I’d requested a test.

The antigen test has a false negative test of about 30%, and I’m not surprised. The 30% figure includes tests conducted in hospitals and test centres as well as at home, and I suspect that the false positive rate from home tests is higher. To determine whether it is higher would mean letting people do the home test and having them professionally tested at the same time, which is probably not a priority. The much criticised track and trace system obviously depends on tests being done reliably, and I worry that home tests may give unreliable results—and I wonder how many people just give up.

Then why was I sent two tests? The government has set itself targets for the number of tests and been criticised for counting not successfully completed tests but the number of tests sent out. Is that why I was sent two?

Any dataset is only as reliable as the quality of each datapoint, each test result, and I fear that with home tests the result may be unreliable. The whole track-and-trace system may have a shaky base.

Covid test

White power

Like many other people after the murder of George Floyd I am reading Reni Eddo-Lodge’s book Why I’m No Longer Talking to White People About Race, and two sentences from the blog that led to the book grabbed me. She writes: “Worse still [than the person who cannot accept the idea of structural racism] is the white person who might be willing to entertain the possibility of said racism, but who thinks we enter this conversation as equals. We don’t.”

I seem to be that person, and it’s time to change.

The idea that we are all equal—kings, emperors, doctors, dustmen, old, young, men, women, black, white—is highly attractive, and seems to be so in the face of God and death. But it is, of course, an illusion.

I think of my many conversations with my friend, Pritt, who is brown not black. He’s younger and smatter than me, and we first met when he was a student and I was the editor of the BMJ. Perhaps we were not equal then, even though I’d like to pretend that we were, but that was long ago and surely we are equals now.

Pritt talks a lot about “white, middle class privilege,” which opens many doors that those with the privilege do not grasp are closed to others. I am white and middle class, and Pritt too is now middle class. We both come from humbler origins, but the biggest difference is that Pritt’s parents were immigrants from India.

Thanks largely to Pritt I am learning about agency and power. I learnt something about power at business school, and I learnt that a person in a position of power—like an editor—will increase his or her power by sharing it. My favourite quote about leadership is that “Great leaders have the strength to abandon themselves to the wild ideas of others.” Surround yourself as a leader by people smarter than you and the power of the organisation you lead will grow, increasing your personal power as the leader of a powerful organisation. In contrast, surround yourself by “yes people” too scared to disagree with you, and the power of your organisation (or nation) will fade—ask Donald Trump.

But I’ve had too narrow a concept of power. The fact is that simply being white gives me power because I live in a racist society where white is deemed superior. Eddo-Lodge calls it “never-questioned entitlement.” So when I talk to a black or brown person we are not equal.

But power—or agency, they are I think now the same—is also access to money, education, knowledge, connections, and other tangibles and intangibles. Structural racism means that black people have less access than I do to these benefits.

We are not equal, I get it.

White

 

 

A lynching in Britain

Like, I suspect, most white British people I associate lynching with the Southern United States. I don’t associate lynching with Britain, but that simply shows my ignorance.

A lynching is murder, usually by a mob, without any legal process. Many definitions add that it’s the murder of somebody suspected of a crime. It doesn’t necessary involve hanging, although the classic image of lynching is a black man hanging from a tree—Billie Holiday’s “Strange fruit.”

Britain has seen many murders of people by colour by mobs, and they are lynchings. But we don’t tend to use that term. The case that is most often discussed in Britain is the murder of Stephen Lawrence, a black teenager, in 1993. He was murdered by a white mob in Eltham, in a street I visited regularly as a child. The police made a hash of the investigation, and a public inquiry introduced the idea of “institutional racism.” I haven’t thought of Lawrence’s murder as a lynching, but that’s what it was. There was no question of Lawrence having committed a crime.

But today I’ve read about a lynching in Britain–in Reni Eddo-Lodge’s book Why I’m No Longer Talking to White People About Race. I didn’t know the story of Charles Wooton, but I should have done. I know a lot about the Ancient Greeks, the Renaissance, the Wars of the Roses, and the two world wars, although I wasn’t as aware as I should have been about the big contribution by soldiers of colour in the two wars, but I didn’t know about Charles Wooton. This is an example of what Eddo-Lodge calls “structural racism.”

Wooton was a 24-year-old black seaman who was caught up in a riot in Liverpool in June 1919. Black men had lost their jobs after white men refused to work with them, and a Caribbean man had been stabbed by two white men. Fights followed, and the police were bursting into the homes of black people. Wooton was caught up in this, and a white mob threw him into King’s Dock. As he tried to swim and get out of the dock he was pelted with bricks until he sank and died. “It was,” writes Eddo-Lodge, “a public lynching.”

Nobody was questioned about the lynching, and the inquest, which was held a week later and lasted one day, did not reach a verdict of unlawful killing. Atrocities against black people continued for days after the lynching.

Wooton

 

Insights into the failing of American democracy and reassurance that Trump will not be re-elected

Trump (or the “authoritarian kleptocrat,” as he called him) will not be re-elected, said David Frum, former speech writer for George W Bush, registered Republican, and author of Trumpocalypse, a book that argues for the restoration of American democracy. High unemployment and Trump’s mismanagement of the pandemic make his loss almost inevitable, said Frum in a talk to Intelligence Squared last night.

In response to a question on how Trump might possibly win, he said it was only by stepping up measures on stopping the poor, people of colour, and the young voting. He thought it shameful that the Republicans can win only by suppressing democracy, proving to him that the party has to change if it wants a future.

Even if Trump were to win the Electoral College he will lose the popular vote by even more than he lost it to Hillary Clinton. Such an outcome, said Frum, would lead to tremendous political instability and result in massive Democrat gains in the mid-terms.

How important will be Joe Biden’s choice of vice-president? Political science is clear that choice of vice-president doesn’t have meaningful impact in the election. Frum argued that Biden should chose a vice-president who would make a good president. Talking to politicians about mortality is a hard conversation, said Frum, but Biden will be the oldest president ever elected—and he’ll be elected in the middle of a pandemic. Frum advised choosing a vice-president with knowledge of foreign affairs, the knowledge that is the hardest to master, and he named Susan Rice.

Might the Republicans dump Trump as their candidate? Frum didn’t think this would happen as Trump isn’t doing badly enough.

Frum was also asked whether Trump might refuse to accept defeat. Trump, although at times an inspired tactician, is, he answered, neither rational nor a strategist. There is likely to be a delay before the result of the election is declared, and Republicans might argue with the Electoral College and the counting of votes by Congress; but Frum couldn’t see Trump being able to ignore a clear vote.

One of the many defects of American democracy is that a third of the population now elects half the senate, and the continuing move of people from the middle of the country to the coasts could mean that those less densely populated states will soon elect two thirds of senators. Frum said that it’s almost impossibly hard to change the US constitution (itself a democratic deficit), but he proposed making the District of Columbia a state (guaranteeing two Democratic senators, at least one of them black) and stopping filibustering. (I think I understood this correctly: it requires 60 votes to stop a filibuster—even when a vote on the motion itself would need only 51 votes to pass.)

Lastly, Frum was asked about the chances of Britain signing a trade deal with the US before the election. The Trump administration, he answered, isn’t competent enough to get it signed, and, he added, Trump is no friend of Britain. I can’t imagine, he said, any other American president who would have supported Brexit, the division of our allies, and once the vote was cast Trump turned predatory. Britain, Frum said, eats a billion chickens a year, and Trump wants that market—because chickens are produced in the states that support him, particularly Arkansas.

Frum, a Republican I repeat, was impressive. He answered questions clearly, intelligently, and directly, revealing for me lots of things that I didn’t know about the US.

Treumpocalypse

 

How to become a great writer

Youth is a bleak as well as a beautifully written and funny book. J M Coetzee has fled South Africa for London both to escape his country and to find himself, become a writer, ideally a poet. Nothing goes well. He doesn’t like London and England, does tedious jobs, has no friends, can’t find a woman to love, and by the end of the book hasn’t written anything. Yet in writing this “fictionalised memoir” in 2002, when he was a internationally acclaimed writer, Coetzee says a lot about becoming a writer.

“South Africa,” he writes, “is a wound within him…It is like an albatross around his neck. He wants it removed, he does not care how, so that he can begin to breathe.” As his visa for Britain runs out, he imagines himself having to justify being accepted as a refugee. The authorities will ask him: “From what are you fleeing? From boredom, he will reply. From philistinism. From atrophy of the moral life. From shame. Where will such a plea get him?”

Yet, as in Boyhood, there is one part of South Africa to which he is deeply attached, where his heart is, where he would like to be buried (will he be, I wonder?): the Karoo. He finds old books about South Africa: “But even more than by accounts of old Cape Town is he captivated by stories of ventures into the interior, reconnaissances by ox-wagon into the desert of the Great Karoo, where a traveller could trek for days on end without clapping eyes on a living soul. Zwartberg, Leeuwrivier, Dwyka: it is his country, the country of his heart, that he is reading about.”

It is a fantasy that brings him to London: only in Paris, London, or Vienna can you have the experiences that a poet, an artist must have and learn to write: “London may be stony, labyrinthine, and cold, but behind its forbidding walls men and women are at work writing books, painting paintings, composing music… The artist must taste all experience, from the noblest to the most degraded. Just as it is the artist’s destiny to experience supreme creative joy, so he must be prepared to take upon himself all in life that is miserable, squalid, ignominious. It was in the name of experience that he underwent London – the dead days of IBM, the icy winter of 1962, one humiliating affair after another: stages in the poet’s life, all of them, in the testing of his soul… It is a justification that does not for a moment convince him. It is sophistry, that is all, contemptible sophistry.”

Although an Afrikaner, Coetzee spoke English as a child, loved and taught English literature, and wrote his wonderful books in English. But he liked neither England nor the English: “How can anyone in England understand what brings people from the far corners of the earth to die on a wet, miserable island which they detest and to which they have no ties?”

He is no fonder of himself than he is of England and the English. He excoriates himself: “His sole talent is for misery, dull, honest misery….Generally he is better at tests, quizzes, examinations than at real life.” I felt that the list might have included writing books if he had written any by that time. He doesn’t understand himself, which he thinks a problem: “If he is a mystery to himself, how can he be anything but a mystery to others?” But it is because he is a mystery to himself that he can spend his life writing books in which he searches for himself. (Summertime, the third volume of “his fictional memoirs” is a good example. More later.)

One essential to be coming a great writer is to find a great love: “The right woman will see through the opaque surface he presents to the world, to the depths inside; the right woman will unlock the hidden intensities of passion in him.” Instead, he has a series of miserable affairs with women he cares little for and who care little for him. He has overrated his value: “Is that his problem, and is it as simple as that: that all the time he has been overestimating his worth on the market, fooling himself into believing he belongs with sculptresses and actresses when he really belongs with the kindergarten teacher on the housing estate or the apprentice manageress of the shoe store?”

Although he doesn’t in Youth succeed in becoming a writer he does describe well how you do become one. He finds a model that appeals: “Watt is quite unlike Beckett’s plays. There is no clash, no conflict, just the flow of a voice telling a story, a flow continually checked by doubts and scruples, its pace fitted exactly to the pace of his own mind. Watt is also funny, so funny that he rolls about laughing. When he comes to the end he starts again at the beginning.” That description– “the flow of a voice telling a story, a flow continually checked by doubts and scruples”—seems to me to fit Coetzee’s writing as well as that of Becket; and Coetzee’s writing is also funny, although I did not laugh out loud when reading this book.

“He is afraid is afraid: afraid of writing, afraid of women.” The way to become a writer (or an artist of any kind) is to overcome your fear, start creating your art, and have the courage to accept rejection after rejection. In the same way you find a woman to love. This makes me think of my comedian brother’s account pf becoming a stand-up comedian: you need courage to start and the capacity (courage again) to continue after experiencing the horror of complete silence as you try to make a room full of people laugh.

“Of course in his heart he knows,” Coetzee writes, “destiny will not visit him unless he makes her do so. He has to sit down and write, that is the only way… rather, many words will come, but not the right words, the sentence he will recognize at once, from its weight, from its poise and balance, as the destined one.”

Writers “squirmed, but then finally they pulled themselves together and wrote as best they could what had to be written, and mailed it out, and suffered the humiliation of rejection or the equal humiliation of seeing their effusions in cold print, in all their poverty. In the same way these men would have found an excuse, however lame, for speaking to some or other beautiful girl in the Underground, and if she turned her head away or passed a scornful remark in Italian to a friend, well, they would have found a way of suffering the rebuff in silence and the next day would have tried again with another girl. That is how it is done, that is how the world works.

What more is required than a kind of stupid, insensitive doggedness, as lover, as writer, together with a readiness to fail and fail again?”

It’s typical of Coetzee that he calls it “stupid, insensitive doggedness,” but it’s also courage, bravery.

Youth

 

The perplexing pursuit of an economy that promotes wellbeing not growth

Our economy, said John Maynard Keynes in 1933, “is not a success. It is not intelligent, it is not beautiful, it is not just, it is not virtuous–and it doesn’t deliver the goods.” Katherine Trebeck https://www.katherinetrebeck.com/, Advocacy and Influencing Lead for the Wellbeing Economy Alliance https://wellbeingeconomy.org/, began her Patrick Geddes Lecture of the Royal Town Planning Institute with this arresting quote. She followed it with another quote from Keynes: when we consider “what to put in its place we are perplexed.” Trebeck argued that almost a century after Keynes’s quote we have a much better idea; and the Covid-19 pandemic has given both urgency and impetus to finding our way through the perplexity to an economy that is sustainable and promotes wellbeing and equity.

A first step, Trebeck said, is to end the mindless pursuit of growth in trying to increase the Gross Domestic Product (GDP), a measure that is increased by cleaning up oil spills, making rubber ducks and cigarettes, and counselling people who are getting divorced. As Robert Kennedy said in 1968, GDP “measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile.” Trebeck pointed out that GDP favours treatment, which is counted, rather than prevention, which offers nothing to be counted: indeed, increased safety and health might well lead to GDP falling.

Pursuing growth in GDP has simply not delivered wellbeing and equity, as Keynes observed in his quote. Trebeck also noted that growth in GDP leads to diminishing returns. Increase in life expectancy is a good example: it increases rapidly as low income countries move out of poverty but flattens off dramatically at a level of wealth well below that, for example, a country like Britain enjoys.

The second step to an economy that promotes wellbeing is to recognise that a wealthy country like Britain already has enough wealth. “Growth,” said Trebeck, “has done its job.” This is illustrated by the simple fact that even in Scotland (where the lecture is based) the wealthiest 1% own as much as the poorest 50%. She added that the top 10% globally are responsible for 50% of carbon emissions. The challenge is not to grow the economy but to share and cherish what we already have.

Trebeck outlined the five principles that make for a wellbeing economy: connection, so that everybody feels they belong; participation in decision making; recognising that we are part of nature and that it is not an unlimited resource we can exploit; fairness; and dignity.  We need to move from “fixing, healing, and redistributing to getting it right in the first place.”

Patrick Geddes, whose lecture Trebeck was delivering, is described as “the father of town planning.” A biologist, sociologist, geographer, and philanthropist as well as town planner, he lived from 1854 to 1932 and conducted multiple social experiments, many of them in Edinburgh. He was what today would be called a “systems thinker,” and he demanded consideration of “primary human needs” in every act of planning.

Trebeck had studied his work and picked out seven lessons from his work.

The first was to “see the whole.” We need to recognise how systems are interlinked, and our emphasis on specialisation works against this. “Each of the various specialists remains too closely concentrated upon his single specialism,” said Geddes, “too little awake to those of the others. Each sees clearly and seizes firmly upon one petal of the six-lobed flower of life and tears it apart from the whole.” When thinking about the economy we should think about wellbeing, and when thinking about health we must think beyond health care, recognising that health has many components and that health care is only a small part of health.

Geddes urged people to see beyond “squirrel millionaires,” people who hoard wealth. Trebeck argued for predistribution not redistribution, and a problem with a few owning so much is “political capture”: those few having disproportionate power in the political process. She quoted a study that found of the 2000 billionaires in the world a third had made their money through entrepreneurship, but the wealth of two thirds came from inheritance and “crony capitalism.”

A third lesson from Geddes was the importance of local context. He was an advocate of working locally and regionally, and a related fourth lesson was that community involvement was essential for improvement. Trebeck is a supporter of deliberative democracy, and citizens’ assemblies, where a random sample of the population discuss issues and possible actions after being given substantial and unbiased information.

Another lesson that Trebeck drew from Geddes’s work was “beyond examinations.” This fitted with her arguments against pursuing growth in GDP, stock markets, productivity, and the value of real estate. She argued for a much more meaningful measures like the number of girls who ride their bikes to school.

I particularly liked the sixth lesson from Geddes the importance of “magnificent failures”—or, in other words, being bold. There are thousands of local experiments in promoting a wellbeing economy, and we can learn from those experiments, including those that fail. Geddes himself, Trebeck observed, might be described as a “magnificent failure.”

The final lesson was “follow your heart” not narrow orthodoxy. Trebeck quoted the five top regrets of the dying from the book of Bonnie Ware, a nurse who cared for the dying and collected their last regrets. https://bronnieware.com/regrets-of-the-dying/ They are:

  • I wish I’d had the courage to live a life true to myself, not the life others expected of me
  • I wish I hadn’t worked so hard (Ware said this was true of all her male patients)
  • I wish I’d had the courage to express my feelings
  • I wish I had stayed in touch with my friends
  • I wish that I had let myself be happier

In the questioning that followed her lecture, Trebeck made a point about the importance of collective institutions, like the NHS, supporting community initiatives. She ended by arguing that creating a wellbeing economy is like doing a 2000-word piece jigsaw, the result of thousands of local initiatives.

 

The lecture will be put online and available for free. Katherine Trebeck is the co-author along with Jeremy Williams of The Economics of Arrival: Ideas for a Grown Up Economy.

 

 

 

 

 

 

 

 

A collection of consistently hilarious (but also pointed) columns from the BMJ

Jim Drife, the singing professor of obstetrics and gynaecology from Leeds, wrote a hilarious, teasing column in the BMJ over many years. His columns have now been collected together in a book called “This Medical Life,” which can be bought through Amazon (a bargain at £12.99 for 352 pages) and which I thoroughly recommend. He asked me to write an introduction, and it’s below. It gives you a flavour of his wit, but I urge you to buy the book (I’m not getting a cut).

“Medical journals are dull; I don’t think that there is any doubt about that,” wrote Richard Asher, the doyen of medical writers of his era, in the British Medical Journal (renamed the BMJ when Britishness became suspect) in 1958. Asher condemned the wrapping, presentation, typeface, dreadful titles, lack of colour, and capacity to make the interesting boring, but he most condemned the way that doctors’ journals are filled with “pudder” and “gobbledygook” or what Michael O’Donnell, editor of the much-missed World Medicine,called “decorated municipal gothic.” Asher complained that doctors “clog their meaning with muddy words and pompous prolixity.”

What then can medical editors do to make their journals less dull? Asher, a physician, is longer on diagnosis than cure, but he does end by advising that “medical articles should, like after-dinner speeches, finish before the audience’s interest starts to wane.” His article, which I suggest is a little too long, was based on a talk, and was clearly intended to be funny. It is amusing in places, but oddly he doesn’t mention in his article the lack of humour as one of the worst failings of medical journals. A few funny articles, especially if short as Asher advised, can do marvels to lift the appeal of medical journals, which are prone to pomposity and taking themselves and the world too seriously. What’s more, humour can often address deadly serious subjects with more impact and insight than straight writing—as Juvenal, Shakespeare, and Swift have shown.

Editors of the BMJ, of whom I was one, thought that a few funny articles would make the journal more attractive, but where could we find a doctor who could write funny articles? It is much harder to write funny than straight pieces, and many attempts at being funny fall flat; and even if you can write a few funny articles it’s an art that is hard to sustain.

Some of us knew Jim Drife. I was at medical school with him, and we sat together on the Medical Students Committee in Edinburgh, insisting in seconds that Lyndon Johnson get out of Vietnam and debating for hours whether we should pay for a football for the medical school team. Jim was senior and I was junior, but I remembered his wit, beard, bounce, and bowtie.  I remembered as well that he sang comic songs with Walter Nimmo, another doctor. Jim, we thought, could be just what we needed to lift the BMJ, and so began his series of columns in 1988.

I’ve had a marvelous time reading my way through this collection of Jim’s columns. I regularly laughed out loud, which is something I rarely do. Jim manages to sustain the humour across more than 100 columns, a considerable achievement. It may seem fanciful, but his writing reminds me of P G Wodehouse: Jim has not only the humour of Wodehouse but also his gentleness, lightness of touch, readability, self-deprecation, and gallery of fearsome aunts (politicians and senior managers in Jim’s case). Jim is more Bertie Wooster than Jeeves but also with a touch of Lord Emsworth.

Some of Jim’s columns have stayed with me for decades, and it was a great pleasure to reread them.

I have never been able to see the acronym BMA without thinking that it means not only British Medical Association but, as christened by Jim, the British Misery Association. Jim mimics perfectly the tone, mixed metaphors, and clichés of a BMA letter to all doctors:

“The BMA is seriously concerned that some doctors (very few, I grant you) are happy in their work, and it is my urgent task to stamp this out….

Much as I prefer hewing at the bread and butter of clinical work, it has fallen to me to fight your corner against Whitehall mandarins, Westminster apparatchiks, and Brussels bureaucrats…

Next, a stern word to all you consultants. On the train the other day I overheard a consultant saying that life wasn’t too bad. Admittedly he had drunk half a bottle of Chateau Intercity Cote de l’Est Privee but I did have to change my seat and reason with him. Careless talk costs salary increases….

The BMA has successfully demonised every Health Secretary since Bevan and rubbished all their initiatives, well intentioned or otherwise. Nevertheless, we cannot rest on our laurels. The moment we relax our vigilance, contentment may break out and spread like some foul contagion from practice to practice. This must not happen. We at the BMA are the leaders of Britain’s GPs and your morale is in our hands. If it ever rises, it will be over our dead body.”

 

Jim in his satire makes a serious point also made much more ponderously by Enoch Powell, who was once minister of health—that the only way to get more money into an NHS funded through taxation is to complain to the government that everything is dreadful.

Humour can, of course, get you into trouble, and another column of Jim’s I have remembered for decades was entitled “Are breasts redundant organs?” It was a column where the seriousness was dialed up and the humour down, although comedy is always there with Jim:

“Sometimes when I’m lecturing I point out how easy it would be to abolish breast cancer. My suggestion tends to outrage the men in the audience and I have to reassure them that my proposition is philosophical, not practical. Women listeners, however, usually react more thoughtfully.

Breast cancer becomes more common with age and will eventually affect at least one in 17 women in Britain. Screening may improve survival rates but does not aim at abolishing the disease altogether. The way to eradicate breast cancer is to remove the breasts before the cancer develops…

The audience eyes me warily, no doubt feeling there is something weird about a man who talks about removing normal breasts. They may be right. Perhaps all this is a distorted grief reaction to the deaths, over the years, of relatives, friends, and colleagues, killed painfully by glands they didn’t need.”

Jim advanced this idea years before the discovery of the BRCA genes, which mark an increased risk of breast cancer and have led some women—like actor Angelina Jolie—to have both breasts prophylactically removed. The column created a media storm and provided material for a later column, in which Jim described touring media outlets and how “a tabloid carried my sinister picture – lip curled, eyes shifty” and another paper “made me ‘Wally of the Week.’”

And on the rare occasions that I’ve worn a bowtie I always think of Jim’s observation that “Bowtie wearers are never left alone with other men’s wives.” What, I always wondered, did that say about Jim, a man famous for his bowties? The same column on how doctors should dress advised on the tricky subject of blood stains:

“Next, a word about bloodstains. It is all too easy to overdo these. The aim is to show that you still carry out practical procedures, but you don’t want people to think that you are clumsy. Bloodstains should therefore not be seen on the body area, collar, or spectacles and should never be more than 2 mm in diameter. The cuff is the ideal place for most doctors, though for obstetricians the socks are a possible alternative.”

A true satirist, Drife mocks widely—not only the BMA but the Committee on Safety of Medicines, the General Medical Council, royal colleges, NHS managers, evidence based medicine (using Animal Farm as his model), conference organisers, public relations companies, and, of course, editors (“I don’t mean grandees like ED, BMJ, who I imagine spends most of his time in full evening dress being chauffeured from embassy cocktail party to college power dinner”), and journals.

He satirises the questionnaires used in newspapers and increasingly medical journals to try and brighten them up:

“How do you relax? I swim with a friend who happens to be a dolphin [that line makes me laugh every time]

What is your greatest fear? Losing my humility.

What are you currently reading? Nietzsche’s Die Geburt der Tragödie, Unzeitgemässe Betrachtungen and Menschliches, Allzumenschliches.

What is your greatest regret? Not learning German.”

Or the award schemes that are money-spinners for journals:

Hospital cyclist of the year—Because cycling is healthy, exponents feel empowered to walk around the hospital dressed like extras from Star Trek, glaring at people they suspect of being motorists. The prize will go to the cycle parked in the most outrageous place within the hospital grounds. (Last year’s winner: inside the MRI scanner.)”

And inevitably obituaries, which were the bane of my life as editor of the BMJ in that they were the only submissions we couldn’t reject, were written in code (“he was a bon viveur” meaning he was a drunk, and “he was a true Celt” meaning he was a Scottish drunk), and whereas all doctors had faults while alive they became saints at the moment of death:

“For the first two decades, Drife’s career was that of a conventional medical academic. At 48, however, he published the first of his racy Euronovels under his anagrammatic pseudonym, Jason de Merwife. His style, aimed unashamedly at the translators, was described by one critic as “like a dubbed film without the pictures.” With plots drawn from his experience on the editorial board of the European Journal of Obstetrics and Gynecology, Drife pioneered the “shopping and refereeing” style of fiction now familiar on bahnhofbucherstanden throughout the continent.”

If only any of our obituaries had had such swagger.

Jim touches on many serious subjects in his columns—maternal mortality, teenage pregnancies, pill scares, poverty, sectarianism, inequalities, complaints, the agony of phoning hospitals, and the tax on sanitary towels—but all are done with a light touch and humour, which you might think impossible if you have not read the columns.

Many of the subjects he touches on are bugbears of doctors, particularly hospital doctors, and the comedy lightens their load and—importantly for editors—makes the journals seem less remote and arrogant and more in touch with the concerns of their readers.

One subject guaranteed to irk many doctors is managers and their instructions, guidance, and pathways.

“A colleague recently calculated that, as lead for obstetrics in his hospital, he had received 3825 pages of advice, guidelines, and reports about maternity care from various bodies. I should point out, in case anyone from top management is listening, that “recently” means a year or two ago. Rest assured that he is on target, and his total must be well over 5000 by now.”

“Comedians mocked the news that it took 247 steps to change a light bulb in an NHS hospital, but I felt cheered. In these difficult times, the fact that somewhere in the NHS a light bulb has been successfully replaced is surely a cause for celebration. Doctors involved in management, however, were gobsmacked that this change was achieved in only 247 steps. We need to know more about this thrusting, no-nonsense hospital.”

This collection of columns might perhaps appeal most to doctors and others who work in health care, but I think that anybody will be able to find much that will bring them a smile and even, as with me, a belly laugh. I hope that Jim feels proud of what is not only funny but a magnificent body of work.

James_Drife

 

A powerful account of growing up in a beautiful but divided land

A reviewer in the Times described J M Coetzee’s book Boyhood as “probably the best description of childhood I have ever read.” I think the same, although that may be a failure of memory; and Coetzee’s childhood was very different from mine. The book is described as a “fictionalised autobiography” (but aren’t all autobiographies and biographies fiction to some degree?), and it avoids all the traps of autobiography—predictability, tedium, and indulgence. As you’d expect from such an honoured writer, the writing is marvellous: fast paced, evocative, full of tiny stories, insightful, and funny.

From the very beginning of the book Coetzee is “convinced that he is different, special.” He is not normal and he doesn’t want to be normal. “Rude, unsocialised, eccentric,” he “flees polite talk because its formulas” and is impatient “with the tame patter of genteel conversation….His heart is old, it is dark and hard, a heart of stone. That is his contemptible secret.”

He is living in Worcester, a predominantly Afrikaans town, some 75 miles north east of Cape Town. Both of his parents are Afrikaans, but they speak English at home. He is in the English part of the school, but one of his deepest fears is that he will be transferred to the Afrikaans part. He is always top of the class, and Afrikaans boys bully him. He has a complicated love for his mother but despises his father.

Coetzee was born in 1940, and apartheid began in 1948. He becomes steadily more aware of the racial divisions in South Africa. The division that most directly affects him is that between the Afrikaners and the English-speaking South Africans.  Although he describes Afrikaners as “angry and obdurate and full of menaces,” he writes that “when he speaks Afrikaans all the complications of life seem suddenly to fall away. Afrikaans is like a ghostly envelope that accompanies him everywhere, that he is free to slip into, becoming at once another person, simpler, gayer, lighter in his tread.” He commands the English language “with ease” and is loyal to “everything that England stands for…But more than that is required, clearly, before one will be accepted as truly English: tests to face, some of which he knows he will not pass.” Reflecting on the Boer War “he prefers to dislike the Boers, not only for their long beards and ugly clothes, but for hiding behind rocks and shooting from ambush, and to like the British for marching to their death to the skirl of bagpipes.” (There is here a touch of the humuour that runs through the whole book but I’ve failed to reflect in this blog.)

The racism of South Africa is captured in a story a paragraph long: what to do with a teacup that a coloured man, a solicitor, an official, has drunk from.

“After he has left there is a debate about what to do with the teacup. The custom, it appears, is that after a person of colour has drunk from a cup the cup must be smashed. He is surprised that his mother’s family, which believes in nothing else, believes in this. However, in the end his mother simply washes the cup with bleach.”

Yet in his limited contact with “Natives,” he recognises that “not only do they come with the land, the land comes with them, is theirs, always has been.” He is delighted when his mother describes a Black as “a wise old man…. It is the only time he can remember her using the word wise; in fact it is the only time he can remember anyone using the word outside of books. But it is not just the old-fashioned word that impresses him. It is possible to respect Natives – that is what she is saying. It is a great relief to hear that, to have it confirmed.”

He sees the relationship among the racial groups in terms of a story:

“In the stories that have left the deepest mark on him, it is the third brother, the humblest and most derided, who, after the first and second brothers have disdainfully passed by, helps the old woman to carry her heavy load or draws the thorn from the lion’s paw. The third brother is kind and honest and courageous while the first and second brothers are boastful, arrogant, uncharitable. At the end of the story the third brother is crowned prince, while the first and second brothers are disgraced and sent packing.

There are white people and Coloured people and Natives, of whom the Natives are the lowest and most derided. The parallel is inescapable: the Natives are the third brother.”

Although he couldn’t be called sporty, he has a passion for cricket—devising a machine that allows him to play by himself. The way he describes playing cricket says a lot about him:

“This is cricket. It is called a game, but it feels to him more real than home, more real even than school. In this game there is no pretending, no mercy, no second chance. These other boys, whose names he does not know, are all against him. They are of one mind only: to cut short his pleasure. They will feel not one speck of remorse when he is out. In the middle of this huge arena he is on trial, one against eleven, with no one to protect him.

Cricket is not a game. It is the truth of life. If it is, as the books say, a test of character, then it is a test he sees no way of passing yet does not know how to dodge. At the wicket the secret that he manages to cover up elsewhere is relentlessly probed and exposed. ‘Let us see what you are made of,’ says the ball as it whistles and tumbles through the air towards him. Blindly, confusedly, he pushes the bat forward, too soon or too late. Past the bat, past the pads, the ball finds its way. He is bowled, he has failed the test, he has been found out, there is nothing to do but hide his tears, cover his face, trudge back to the commiserating, politely schooled applause of the other boys.”

Much of the time it seems tough being Coetzee, but the thing he loves the most is to take the train to the Karoo, “the only place in the world where he wants to be,” and stay at his uncle’s farm. The chapter that describes his stay on the farm is the most lyrical.

“He must go to the farm because there is no place on earth he loves more or can imagine loving more. Everything that is complicated in his love for his mother is uncomplicated in his love for the farm….The farm is called Voëlfontein, Bird fountain; he loves every stone of it, every bush, every blade of grass, loves the birds that give it its name, birds that as dusk falls gather in their thousands in the trees around the fountain, calling to each other, murmuring, ruffling their feathers, settling for the night. It is not conceivable that another person could love the farm as he does…. The secret and sacred word that binds him to the farm is belong. Out in the veld by himself he can breathe the word aloud: I belong on the farm. What he really believes but does not utter, what he keeps to himself for fear that the spell will end, is a different form of the word: I belong to the farm.”

A paragraph near the end of the book might serve as a summing up of this first phase of Coetzee’s life:

“Nothing can touch you, there is nothing you are not capable of. Those are the two things about him, two things that are really one thing, the thing that is right about him and the thing that is wrong about him at the same time. This thing that is two things means that he will not die, no matter what; but does it not also mean that he will not live?”

I enjoyed this book greatly and read it in just a few days. I have already read Youth, in which Coetzee is lost in England groping his way to being a writer, and am about to start the final Summertime.

Karoo

 

A novel that with my hatred of superlatives I unhesitatingly call “astonishing”

I didn’t know that From Here to Eternity was a novel, and I’ve discovered that I’m not alone in Britain—none of my reader friends know it’s a novel. People know of the film, but few people in Britain of my generation and younger have seen it. We simply know the famous scene of Deborah Kerr, a classic English rose, and Burt Lancaster romping and kissing in the surf. I was thus surprised and intrigued when my American friend Tracey Koehlmoos listed it as her third favourite novel. The New York Times, I later found, included it in the great 100 novels of the 20th century. I decided I had to read it, and despite my hatred of superlatives I unhesitatingly call it “astonishing.”

Initially I was taken aback to discover that the novel is 962 pages long, but by the time I finished—after about three weeks—I wished it was longer. In many ways the novel is brutal, filled with cruelty, violence, swearing, drunkenness, and whoring, but it’s also stuffed with wisdom. I have taken 5000 words of quotes from the novel covering love, sex, death, being human, marriage, men and women, the army, war, music, religion, communication, reading and writing, politics, and medicine (in full below). I’ve grouped the quotes into those subjects, and the longest section is on love, although there’s not a sentimental sentence in the novel. I should make clear as well that the book is funny, not often laugh-out-loud funny but consistently funny.

The novel is centred on the Schofield barracks in Hawaii in 1941 and was published in 1951. Everybody reading the book knows that the bombing of Pearl Harbour and America’s entry into the war are coming, which gives tension and provides the setting for the climax at the end. The soldiers are not expecting the bombing, but they are from the beginning of the book expecting America to enter the war. The bombing does not start until page 827, and the novel, which I found started slowly, finished with a great flourish as the main characters move to the next stage of their lives. (I probably shouldn’t say the book starts slowly; what I really mean is that it takes a while to adjust to the prose, dialogue, and rhythm of the book—but that’s true of most great books.)

The book could be read just for its story, but that would be a terrible waste. The pleasure of the book is more in the reflections and insights, but you care about the characters and particularly the relationships. Tough but moral Prew who was a bum for years during the Great Depression falls in love with the whore Lorene, who is actually Alma Schmidt from rural Oregon making as much money as she can before hiding her past and becoming respectable. Hard bitten, cynical, extremely competent Milt has an affair against his best judgement with Karen Holmes, his superior’s bored wife; the affair brings out the best in both of them.

Jones, who based the novel on his own experiences, had great battles with the publishers over the swearing and the descriptions of how the soldiers would go with the queers for money but also beat them up to take their money, knowing they would never go the police. Much of the swearing and scenes with the queers were cut from the first edition, but they are back in the Penguin Modern Classics version that I read.

As Jones covered almost everything in the novel, outdoing the coverage of most 19th century novels, I wondered if I could find accounts of his thinking about the novel within the novel. These two quotes came closest:

“It was the kind of story Prew liked too, weird and unreasonable and senseless, almost occult, yet with a thread of hope still running always through it that maybe his theory that all men were basically alike, all hunting the same phantasmal mirror, was true.”

And:

“The way to get recognition in this world is to startle people. Somebody once said that bad publicity was better than no publicity. But I say, bad publicity is better than good publicity. Shock people and they remember you. Any dumb son of a bitch can get good publicity.”

All in all, it’s a great and hugely enjoyable book, and I urge British friends to read the book and spread the word.

Quotes from From Here to Eternity by James Jones

Being human

And it seemed to him then that every human was always looking for himself, in bars, in railway trains, in offices, in mirrors, in love, especially in love, for the self of him that is there, someplace, in every other human. Love was not to give oneself, but find oneself, describe oneself. And that the whole conception had been written wrong. Because the only part of any man that he can ever touch or understand is that part of himself he recognizes in him. And that he is always looking for the way in which he can escape his sealed bee cell and reach the other airtight cells with which he is connected in the waxy comb. And the only way that he had ever found, the only code, the only language, by which he could speak and be heard by other men, could communicate himself, was with a bugle.

There are times every man must be alone and in the squadroom there is no aloneness, only loneliness.

That other part of his mind that never entered into anything and always stood outside himself observing, made a mental note.

A man himself is nothing.’ ‘Well in a way,’ Stark said, ‘thats true. Because its who he knows and not the man himself that counts. But in another way its not true either, not true at all. Because listen: what a man is, Sam, is always the same. And nothing in God’s world, no kind of philosophy, no Christian Morals, none of that stuff, can change it. What a man is just comes out in a different channel, thats all. Its like a river that finds the old channel dammed up and moves into a new channel where the current’s just as strong, only it moves in a different direction.’

‘Look: we livin in a world thats blowin itself to hell, as fast as five hundred million people can arrange it. In a world like that, theres ony one thing a man can do; and thats to find something thats his, sam, really his and will never let him down, and then work hard at it and for it and it will pay him back. With me its my kitchen …’

In this world, any more, with things like they are, the hardest of all hard things was to know the real from the illusion, to meet one other human being breath to breath without the prefabricated soundproofed walls of modern sanitation always in between and know in meeting that this was this human and not this human’s momentary role;

Only in the bad spells did life frighten him with its unbelievable cruelty, its inconceivable injustice, its incredible pointlessness.

‘Every man has the right to kill himself,’ the big man said gently, appropriating the subject as if there was no question to his right to it. ‘Its the only absolute inviolable right a man does have, the only act he can commit which nobody else has a sayso in, the one irrevocable deed he can execute without outside influence. The old Anglo-Saxon term of “freedom” came from that: “free” and “doom,” with the idea that every man always had that last final resort that nobody could take away from him, if he wanted to avail himself of it.

‘In our world, citizens,’ the big man said gently, ‘theres only one way a man can have freedom, and that is to die for it, and after he’s died for it it dont do him any good. Thats the whole problem, citizens. In a nutshell.’

You cant take one subject, like economics, and with it escape the problems of all the rest of the subjects, like sex.

You have a strong sense of right and wrong. Thats why you got in the Stockade in the first place,

‘It seems like life is made up of saying hello to people we dont like and good-by to people we do.’

‘Thats horse shit,’ Jack Malloy said. ‘Sentimental horse shit. Dont ever let me hear you say a thing like that again. You just happen to be going through a period of the goodbys. Every man has them to go through at different times. Now shut up with that crap.’

‘In the Stockade it was easy, it was simple. You had somebody over you that you hated and plenty of time to hate them, and plenty of help hating them, and you did what they told you and just hated them, without having to worry about hurting them any because you couldnt have hurt them anyway.’

‘A mans got to decide for himself what he has to do,’ Prew said. ‘Everybody decides for themself,’ Warden said. ‘And always wrong.’

Theres no other way for it to be. Whenever a menace is conquered, a new more subtle menace arises. There is no other way it could be.’

The good thing about that Stendhal, he understood the very important place that misery and tragedy played in the making of a full happiness.

Marriage

There must be more, there must be, something told her, some place, somewhere, there must be another reason, above, beyond, somewhere another Equation beside this virgin + marriage + motherhood + grandmotherhood = honor, justification, death. There must be another language, forgotten unheard unspoken, than the owning of an American’s Homey Kitchen complete with dinette, breakfast nook, and fluorescent lighting.

Thats the way they all feel, all the men who finally get married. Like Dhom felt. On one side they see their freedom, and on the other they see a piece of ass right there where they can always get it, without all the bushwhacking buildup, always there handy to be reached, without the months of preparation, or the sluts that are the other alternative.

Army

It is the knowledge of the unendingness and of the repetitious uselessness, the do it up so it can be done again, that makes Fatigue fatigue.

There are times every man must be alone and in the squadroom there is no aloneness, only loneliness.

Good generals had to have the type of mind that saw all men as masses, as numerical groups of Infantry, Artillery, and mortars that could be added and subtracted and understood on paper. They had to be able to see men as abstractions that they worked on paper with.

Since I cannot forget what the truth is, I gravitated, naturally, along with the rest of the social misfits who are honest into the Army

‘Officers,’ he snorted. ‘West Point socialites. Learn to play polo, poker and bridge and which fork to use, so they can mingle with society and marry a goddam wife with money who can entertain and teach the gook maids how to serve English style and copy the colonial Britisher and be goddam professional soldiers with a private income, just like Lord-Kiss-My-Ass.

There were so many who prided themselves on being misfits, rebellion for rebellion’s sake, a sort of inverse sentimentality, romance in reverse. You do it some yourself. But on the other hand, what? The officers. How to choose between a false success and a fake failure? between a fake God and a false Devil?

‘I think he was nuts. He loved the Army. Anybody who loves the Army is nuts. I think he was crazy enough to have made a good paratrooper, if he wasnt so small, or commando. He loved the Army the way most men love their wives. Anybody who loves the Army that much is nuts.’

War

We, with all our industrial power will sit back and vacillate (when everybody knows war is inevitable) until somebody or other attacks us and makes us fight – and incidentally gets a great big drop on us.’

While it might be years off yet it did something to a man to see the future run up to, and stop at, the blank wall of a war. It made him aware that he had better get all he was going to get out of his life now, and it made him want his afternoons.

A thirty-year-man’s got to take advantage of his wars; he’s ony liable to get one or two. If he gets two he’s damn lucky.

Men and women

To a man who lives his life among the flat hairy angularities of other men, all women are round and soft, and all are inscrutable and strange.

Climbing the darkened stairs, feeling the maleness in him, the maleness that was denied, hushed, denounced, hedged in, scourged, damned, condemned, and used, feeling the heavy pendulous maleness of the testes in their sac, loaded now to bursting, distended, swinging full bellied as he moved his legs, feeling the excess that overflowed rancidly, burning acidly all through his blood and settling finally in his throat, a thick acidulous phlegm,

She had smiled sadly with the great sadness of a Christian martyr who forgives the Romans, and accused herself of how she always messed things up and ruined everything she touched, and how she guessed she just wasnt an outdoor girl, although it had seemed fine when they had talked about it, in the bedroom, back at Schofield, and she really truly thought it would be better if he would get some other woman for it, she wouldnt mind.

It was easy for her, she wouldnt care if they carried on their love affair entirely by correspondence. She would probably prefer it.

And they called them the weaker sex! That was prone to crack up and cry at every crisis! Like hell. The women ran this world; and nobody knew it better than a man in love.

…aware that they had reached the absolute end of sane verbal conversation without having explained a single damned thing to the other, overwhelmed by the eternal semantics of the sexes.

Communication

And the only way that he had ever found, the only code, the only language, by which he could speak and be heard by other men, could communicate himself, was with a bugle.

Where theres smoke theres fire and where theres platitude theres liar.

The way to get recognition in this world is to startle people. Somebody once said that bad publicity was better than no publicity. But I say, bad publicity is better than good publicity. Shock people and they remember you. Any dumb son of a bitch can get good publicity.’

Reading and writing

What the hell good does reading do you?’ he demanded angrily. ‘The thing is to live, act, do. You read all your life and what have you got?’

‘I dont know,’ Prew said. ‘What?’

‘Nothing,’ Slade said. ‘Thats what. Not a damn thing.’

‘As you grow older, you will find imagination sometimes produces a truth that is greater than any fact.’

It was the kind of story Prew liked too, weird and unreasonable and senseless, almost occult, yet with a thread of hope still running always through it that maybe his theory that all men were basically alike, all hunting the same phantasmal mirror, was true.

He had always kept on reading. And of it all, all the places, all the jobs, all the experiences, all the women, he still wanted the USA.

Music

And the only way that he had ever found, the only code, the only language, by which he could speak and be heard by other men, could communicate himself, was with a bugle.

The music came to him across the now bright, now dull, slowly burning cigarette of each man’s life, telling him its ancient secret of all men, intangible, unfathomable, defying long-winded descriptions, belying intricate cataloguings, simple, complete, asking no more, giving no less, words that said nothing yet said all there was to say.

He raised the bugle to the megaphone, and the nervousness dropped from him like a discarded blouse, and he was suddenly alone, gone away from the rest of them.

The first note was clear and absolutely certain. There was no question or stumbling in this bugle. It swept across the quadrangle positively, held just a fraction longer than most buglers hold it. Held long like the length of time, stretching away from weary day to weary day. Held long like thirty years. The second note was short, almost too short, abrupt. Cut short and too soon gone, like the minutes with a whore. Short like a ten minute break is short. And then the last note of the first phrase rose triumphantly from the slightly broken rhythm, triumphantly high on an untouchable level of pride above the humiliations, the degradations.

The notes rose high in the air and hung above the quadrangle. They vibrated there, caressingly, filled with an infinite sadness, an endless patience, a pointless pride, the requiem and epitaph of the common soldier, who smelled like a common soldier, as a woman once had told him. They hovered like halos over the heads of the sleeping men in the darkened barracks, turning all grossness to the beauty that is the beauty of sympathy and understanding. Here we are, they said, you made us, now see us, dont close your eyes and shudder at it; this beauty, and this sorrow, of things as they are. This is the true song, the song of the ruck, not of battle heroes; the song of the Stockade prisoners itchily stinking sweating under coats of grey rock dust; the song of the mucky KPs, of the men without women who collect the bloody menstrual rags of the officers’ wives, who come to scout the Officers’ Club – after the parties are over. This is the song of the scum, the Aqua-Velva drinkers, the shameless ones who greedily drain the half filled glasses, some of them lipsticksmeared, that the partyers can afford to leave unfinished.

This is the song of the men who have no place, played by a man who has never had a place, and can therefore play it. Listen to it. You know this song, remember? This is the song you close your ears to every night, so you can sleep. This is the song you drink five martinis every evening not to hear. This is the song of the Great Loneliness, that creeps in like the desert wind and dehydrates the soul. This is the song you’ll listen to on the day you die. When you lay there in the bed and sweat it out, and know that all the doctors and nurses and weeping friends dont mean a thing and cant help you any, cant save you one small bitter taste of it, because you are the one thats dying and not them; when you wait for it to come and know that sleep will not evade it and martinis will not put it off and conversation will not circumvent it and hobbies will not help you to escape it; then you will hear this song and, remembering, recognize it. This song is Reality. Remember? Surely you remember?

Day is done …

Gone the sun …

From-the-lake

From-the-hill

From-the-sky

Rest in peace

Sol jer brave

God is nigh …

Religion and belief

‘I believe the only sin is a conscious waste of energy. I believe all conscious dishonesty, such as religion, politics and the real estate business, are a conscious waste of energy. I believe that at a remarkable cost in energy people agree to pretend to believe each other’s lies so they can prove to themselves their own lies are the truth, like my brother. Since I cannot forget what the truth is, I gravitated, naturally, along with the rest of the social misfits who are honest into the Army

The clerks, the kings, the thinkers; they talked, and with their talking ran the world. The truckdrivers, the pyramid builders, the straight duty men; the ones who could not talk, they built the world out of their very tonguelessness – so the talkers could talk about how to run it, and the ones who built it.

But how can you, with your past experience, take anybody else’s judgment? You who’ve seen so many of the sure ones proved so wrong so many times? Conviction and intensity are not the coin of truth, they alone can never buy it.

Every man’s supposed to have certain rights.’ ‘Certain inalienable rights,’ Stark said, ‘to liberty, equality, and the pursuit of happiness. I learnt it in school, as a kid.’

‘Not that,’ Prew said. ‘Thats The Constitution. Nobody believes that any more.’

‘Sure they do,’ Stark said. ‘They all believe it. They just dont do it. But they believe it.’

Life dont fit no gospels? Life makes gospels – afterwards.

‘You think religions are constant things? inflexible and solid and born full-grown? Religions evolve. They grow out of a need, just like any other natural phenomenon, and they follow the same natural laws. They are born, grown, have sons, and illegitimate sons, and die.

A guy named Spinoza wrote a sentence once. He said: Because a man loves God he must not expect God to love him in return.

Prew sat by himself and wondered wildly if he had not already met the new Messiah of the new faith Malloy had also prophesied. A Messiah who refused a following and preferred to work alone. Met him, and lived alongside of him, and failed to recognize him.

Love

And it seemed to him then that every human was always looking for himself, in bars, in railway trains, in offices, in mirrors, in love, especially in love, for the self of him that is there, someplace, in every other human. Love was not to give oneself, but find oneself, describe oneself. And that the whole conception had been written wrong. Because the only part of any man that he can ever touch or understand is that part of himself he recognizes in him. And that he is always looking for the way in which he can escape his sealed bee cell and reach the other airtight cells with which he is connected in the waxy comb. And the only way that he had ever found, the only code, the only language, by which he could speak and be heard by other men, could communicate himself, was with a bugle.

What happens to love?’

‘Did you, personally, ever see any of this love?’

‘I dont know. Sometimes I think I did, and then sometimes I think it was imagination.’

‘It seems to me,’ Stark said, ‘that people only love the things they can get something they want out of. And that they dont love anything they cant get what they want out of. Love, it seems to me, is a matter of expediency.’

He wished furiously a lot of things. Once he even wished furiously he was dead and in hell. He knew then that he was in love.

Those afternoons, those hot bright swim-cool afternoons, that seemed to be more dream than reality and that he wanted to go on like that forever. The future was too vague of an investment to risk all the capital he had. Let the future look out for itself, like everybody else. It was of age, wasnt it? To hell with the future, as long as these afternoons go on like this forever.

He had worked at every kind of job from bartender to tourist-guide between berths. And he had loved every kind of woman from bony Jap geisha to featherbed German barmaid.

‘I’ve never laid a woman that I didnt love. Maybe she made me dislike her afterwards, for some other reason. But at the moment of screwing her, I was in love with her. I offer that as an observed fact, without attempts at explanation or justification. It is a thing that I have found true of most men, if you can get them to talk and admit it.’

Prew, mulling this one over and applying it to himself, was a little shocked to find he had to admit it was true of him too.

Did you ever truly love some body, or some thing? A woman; did you ever love a woman? If you ever really truly loved a thing, you never even considered forgiving it something, did you? Anything it did was all right with you, wasnt it? No matter how much it hurt you. You dont have to forgive something you love. You forgive the ones you dont love.

Jack Malloy was able to love the human race because he expected ahead-of-time to be let down by his friends and hurt by his enemies and betrayed by his leaders. He saw these things as natural reactions to be anticipated, instead of perfidies to be decried.

The same thing has happened to me all my life. I’ve tried to teach people things I saw but they always take them wrong and use them wrong. Its because theres something lacking in me. I preach passive resistance and a new kind of God with a new kind of love that understands, but I dont practice it. At least not enough. Sometimes, I dont think I’ve ever loved anything in my life.

They told you love was the end. But love wasn’t the end. But they didnt tell you where to go next. If only they could stop and not go on creating. But who ever saw a human being who could stop and not go on creating?

My point, his mind said, the apex of my conclusions, is that the illusion of romantic love, being an illusion grounded on the principle of you build me up and I build you up, cannot last through the years of you tear me down and I tear you down. Thats why the men step out and the women take to religion.

But as long as you can keep the illusion, he argued grimly, you can love. And if you’ve got the illusion, then by god you do love. Reality or no reality.

True, his mind said, coolly. And marriage is the great illusion breaker. You don’t believe me, try it.

You see, it said, the foundation principle behind the illusive principle of Romantic Love – the Reality, in other words, behind the Fantasy – is Love of Self; which, up to the time of this paper, has remained undiscovered.

Probably, Warden said, thats because the illusion has received such general recognition and acceptance through the medium of commercial advertising?

Yes, it said indifferently. Now, to get back. What you really love, then, is Milt Warden. As long as she builds you up and makes you love Milt Warden more, because he is such a fine outstanding man, you love her too, naturally. Because she makes you a finer better man. But, when she begins to tear you down and make you love Milt Warden less, because he’s such an obvious no good son of a bitch, you naturally dont love her near so much any more. Because you arent such a nice person any more. And eventually, when it keeps on long enough, you dont love her any more at all. Its really very simple, once you understand it.

It was not true that all men killed the things they loved. What was true was that all things killed the men who loved them.

He felt that way about everything about her. Not envy so much, not jealousy, as just a tremendous hunger to have shared.

Love either starves to death and becomes a shadow, or else it dies young and remains a dream.

‘Two people who have meant as much to each other as we have dont fade out of each other’s lives,’ Karen said.

Sex

He could see it all in his mind, just the way it must have happened, with Stark holding her, her lying on the bed as he himself had seen her, every secret open and unveiled, the heavy breathing like a distance runner, the eyelids shuddering closed at that moment when you went clear out of your own body and you knew nothing and knew everything, you a long ways off with only a slim silver cord attaching you to yourself back there.

The high well lighted room gave them the secret and anonymous solitude that only a hotel room can give as outside the locked door he heard rug-muffled footsteps passing along the corridor and whispered voices coming to him faintly and keys rattling and doors slamming shut with secret finality, finality finality finality of finalities saith the Sergeant all is finality what profit hath a man of all his probabilities under the sun one probability passeth away and another probability cometh all things are full of probabilities man cannot utter it but finality abideth forever in a hotel room there is no remembrance of former probabilities neither shall there be anticipation of probabilities that are to come with those that come after thus spakest I the Sergeant who was king over Israel in Jerusalem where I dwelt in the valley of the shadow of a hotel room with my beloved who is the rose of Sharon and the lilies of the valley of the shadow of a hotel room where there is no inconsistency where there is no probabilities where there is finality remain remain O Shulamite remain remain that ye may give me to drink of the spiced wine of the juice of thy pomegranate in a hotel room where nothing is inconstant finality is all is one and is all and abideth for ever and ever and ever amen days without number while all the probabilities run down to the world yet the world is not full.

‘Its pretty hard to want to sleep with a man who prefers other women.’

Death

You always wondered just how it would come. You always thought it would somehow be special. What you couldnt imagine was how it would have this just everyday quality. Like taking a crap. Or getting your socks off. Or rolling a smoke. Just common, ordinary, everyday. You sweated and sweated it out, and waited and waited on it, all your life you waited on it, and then finally it came, and all the time you had hoped you would be able to do it well, and then it came, and there it was, and now you would see if you would do it well. You did not guess it would be everyday, though. It would have been a lot easier to do well if it had been special.

He was sliding down a long skislide of long snow, like. And he could feel himself beginning to go clear out of himself. And the cord he had seen that time in the Stockade that looked like it was made of come kept stretching and stretching as he coasted. Then he slowed and stopped coasting, delicately like, as if something hadnt quite made up its mind yet, and then began to come back in a little. So this was the way it was, hunh. Who would of guessed it was like this.

All go right on. He was selfish. He did not want it all to go right on.

You wouldnt think it would take so long. Even all tore up, it took so long. My body’s all tore up. My body. He did not want his body to be all tore up. You can let go if you want to. They’d never know.

You cant speak. You cant move. And its taking too long. And my body’s all tore up. Tore to pieces. Tore all up. It’s a shame. And they’d never know.

But you’d know. You got to do it right. It wont take very long. Just a minute more now. And you want to do it good. Even if nobody will know it. Just another minute. Then it will end. Then it will be over.

If you could just say something. Just a word. If you could just even move a little. If you could just do anything, besides just lay and look at them, and look at it. Christ, but the world was a lonesome place.

Politics

You’re going on the idea of the world as people say it is, instead of as it really is. In this world, no man really has any rights at all. Except what rights he can grab holt of and hang on to. And usually the only way he can get them is by taking them away from somebody else.

He threw it on the ground with all his strength, throwing with it all the overpowering injustice of the world that he could not stomach nor understand nor explain nor change.

he had learned from all those pictures to believe in fighting for the underdog, against the top dog. He had even made himself a philosophy of life out of it; they had taught it to him well; it was ingrained. It was too ingrained to be dropped later after ’37 when everything began to change, leaving him an anachronism. So that he had gone right on, unable to stop believing that if the Communists were the underdog in Spain then he believed in fighting for the Communists in Spain; but that if the Communists were the top dog back home in Russia and the (what would you call them in Russia? the traitors, I guess) traitors were the bottom dog, then he believed in fighting for the traitors and against the Communists. He believed in fighting for the Jews in Germany, and against the Jews in Wall Street and Hollywood. And if the Capitalists were top dog in America and the proletariat the underdog, then he believed in fighting for the proletariat against the Capitalists. This too-ingrained-to-be-forgotten philosophy of life of his had led him, a Southerner, to believe in fighting for the Negroes against the Whites everywhere, because the Negroes were nowhere the top dog, at least as yet.

It, unlike other philosophies of life, had only one simple danger to look out for. And that was that in fighting for the underdog you do not ever let yourself become top dog, or else you would cornhole your own philosophy.

The dying British school of Paternal Imperialism, the school that would never work the Colonial natives to death unless there was a missionary there to give them their last rites.’

There was a singular quality about Jack Malloy. When he looked at you with his unembarrassed-dreamer’s eyes and talked to you with that soft powerful voice, you began to labor under the delusion that you were the most important person on this, or on any other, planet; and you believed you could do many things you never would have thought you could.

Medicine

“God knows what the medical profession would do if it didnt have its hysterectomies and their hystero-derivatives. Probably all go broke and vote for socialized medicine after all, I guess.”

Powerful images and sayings

Preem looks like a man who either seen a miracle, or was hit at the base of the skull with a rubber hammer.’

‘As you grow older, you will find imagination sometimes produces a truth that is greater than any fact.’

The joyously unhappy tragedy of this earth

‘Never put things off,’ Slade said, almost frantically. ‘You’ll wake up and find them gone.’

Its stupid to live all your life in the future when there may not be any.

Work without purpose, work without end, work without pride.

Almost a criminal, almost an artist, but not either …’ [Jones’s description of Prew—and others in the book?]

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