In England Now

1
439 orre-elected; of the 4 Senators identified as "benefit busters", only 1 squeezed in and the other 3 lost their seats. Volunteers supplied valuable help-manning telephones, canvassing voters, compiling lists, and publicising the score cards. The elderly are becoming a major force in US politics and form one of its largest political action committees. Others may have millions of dollars: the elderly have millions of votes and are a force to be reckoned with. Much of the committee’s success sprang from a feeling among the elderly that the Reagan Administration was indifferent or hostile to their needs, raiding Social Security funds, and letting Medicare deteriorate, especially with the "discharge quicker and sicker" legislation which is hurting some of the elderly. In England Now IT has been a bit chilly in Britain recently. Those of us with money and sense in equal proportions have had the central heating on full blast and the thermal-lined curtains drawn, as we bask in the self-satisfied knowledge that we have a full 6 inches of lagging in the loft. Well, almost 6 inches. All right, 2 inches actually, which is why I have to have the central heating on maximum and wear a woolly hat in the bathroom. But I do have one ancient luxury: an open grate which suffuses the sitting room with an atavistic glow and puts the faceless modem radiator quite literally in the shade. In the interests of economy and ecology (how many trees are sacrificed per copy of the Times, I wonder?) I have been burning my carefully hoarded supplies of newspapers, colour supplements, and the like. I offer the following scientific observations for your consideration. Newsprint and plain paper burn with a glorious intense flame-Fahrenheit 451, if I remember my Ray Bradbury-and leave a quantity of flaky ash, which would go on the compost heap if only I could bear to venture into the frozen garden. Glossy magazines craze and blister, producing Technicolor flames but little heat. The Lancet does not burn at all, unless fed to the coals page by page, when a sinister blue-green flame crawls reluctantly across the close-printed paragraphs. The blackened exoskeleton of the page is preserved with the type still legible and has to be destroyed with the poker. I prefer to think this is the result of the deathless nature of the prose therein, rather than an indication of its indigestibility. * * * THE VILLAGE SHOP SELLS CAVIARE HE went out at night to draw pictures of foxes. He did not go to school, because he no longer felt need of what "they" had to offer. The cottage, the property of a stockbroker-farmer, was derelict and damp, a primitive shelter for the boy, his baby sister, and his parents. With Tunbridge Wells not far away, they had their own reasons to profess themselves "disgusted", amidst the renowned affluence of the south-east comer of this divided island. Once a week, when he could spare an hour or two from caring for the stockbroker’s cattle, the father took the tractor to the nearest town to shop at the supermarket. "Why not use the village shop?" I asked naively. The reply was prompt and dismissive: "The village shop sells caviare!" The law requires that doctors like me, social workers, teachers, and education welfare officers must strive to ensure that children attend school regularly. When I arrived to see this particularly intractable school refuser he was reading Under Milk Wood. I was not expected. Some earlier callers representing "them", the authorities, were said to have been stoned, but I received a pleasant enough welcome. A literate and artistic child of 14, happy, it seemed, with parents and sister. A great help to father and mother in tural isolation. Not many friends, but no enemies either. At school his clothes were wrong: jeans were forbidden, and he had nothing else. "Standards must not be allowed to slide. Where will it all end if we don’t stick to white shirts and ties, grey trousers and blazers? I make it a firm rule", declared the headmaster. So did the parents really, in their hearts, want him to go to school at all? What indeed did "they" have to offer? * * * "WHAT is all this clinical budgeting really about?" asked Giles. He had just returned from a meeting of the senior medical staff with the new unit general manager. I explained the principle as best I could. "Do you mean we can keep what we save?" he said. "Not really," I replied. "Most of it goes back to the health authority. But you can retain a proportion of it." "Me, personally?" said Giles. "Well, no," I responded. "The unit gets the money." "For better wages all round?" he asked, hopefully. "Certainly not," I declared. "But you can always buy a piece of equipment that you need." "Well, that is something," he said. "Provided," I continued, "that there are no resource implications." "What does that mean exactly?" said Giles. "It means," I expounded, "that you do not receive money to staff it, run it, or create a place to house it. Electricity is reasonable but that is about all." Giles looked hopeful. "Of course," I pointed out, "you have to watch for maintenance costs, health and safety precautionary measures that require adaptations, and the need for increased nursing support." "Would a new sphygmomanometer be acceptable?" said Giles, somewhat sarcastically. "Well, yes," I agreed cautiously. "But you must put money aside for its replacement in the years to come." Giles was silent for a while. "If you ask me," he said at last, "all this talk of clinical efficiency and savings is no more than the thin edge of a white elephant." * * * I AM a great believer in the value of paintings in hospitals and am delighted at the way so many administrators respond to the friendly overtures of local artists. Some care is required, of course, in deciding what is to be hung where. A highly emotive representation of a bull surrounded by matadors and picadors, swords and lances at the ready, we did not think went well with the surgical day room. Nor did the pale sickly urchin blend in with the new paediatric outpatient clinic. Nevertheless, most are a welcome addition to the walls of our wards and I am convinced they do the patients a power of good. A few weeks ago we received a batch of paintings from the local art club. The standard was exceptionally high and the subjects suitable for our various departments. Unusually, the artists said that one painting could be chosen by each of the senior nursing staff for his or her own office. I arranged a show in the recreation hall where the exhibits could be inspected. Reactions varied. One senior lady took umbrage at a semi-abstract collage of a dog. It was made up with bits of material, rags, string, thread, and beads. She went on at some length, saying her nephews and nieces could do better; if that was a dog she could fly in the air; why could the animal not have been painted as dogs really were; and so on. Came the day of choosing. The senior nurses sat in a row rather like the selection committee of the Royal Academy summer exhibition. Each had drawn lots for the order of their personal choice. When my friend’s turn came, she went forward slowly, almost against her will, passing the landscapes, seascapes, and still lives until she arrived at the ragged dog. "It’s no use," she said, turning to me almost in despair. "I can’t get it out of my mind. It is the only one I want to have." * * * I LEARNED a lot in the RAMC. For example, my place in the scheme of things. Within my own small hospital I was accorded a degree of deference and respect, at least to my face, which I have rarely encountered since. Indeed, shortly after I secured an NHS appointment on leaving the Service, I happened to arrive a trifle late for the grand ward round. "What time is this?" inquired the senior consultant irritably. "And what would they have said to you in the Army if you were this late?" "Actually sir," I replied, "they would have saluted, asked if I were quite well, and made me a cup of tea." I I changed jobs fairly soon after that. On the other hand, I remember being posted to a rather up-market regiment for a few days so that their own MO could take some overdue leave. I presented myself to the commanding officer, who made some small talk about my school, parents, and university. Having ascertained that I did not hunt, ride, or play squash, he escorted me, somewhat reluctantly, to the mess. Some officers approached us. "This is..............." said the colonel, his voice trailing off. "Dammit," he continued. "I’ll be forgetting the names of me hounds next."

Transcript of In England Now

Page 1: In England Now

439

orre-elected; of the 4 Senators identified as "benefit busters", only 1

squeezed in and the other 3 lost their seats.Volunteers supplied valuable help-manning telephones,

canvassing voters, compiling lists, and publicising the score cards.The elderly are becoming a major force in US politics and form oneof its largest political action committees. Others may have millionsof dollars: the elderly have millions of votes and are a force to bereckoned with.Much of the committee’s success sprang from a feeling among the

elderly that the Reagan Administration was indifferent or hostile totheir needs, raiding Social Security funds, and letting Medicaredeteriorate, especially with the "discharge quicker and sicker"legislation which is hurting some of the elderly.

In England NowIT has been a bit chilly in Britain recently. Those of us with

money and sense in equal proportions have had the central heatingon full blast and the thermal-lined curtains drawn, as we bask in theself-satisfied knowledge that we have a full 6 inches of lagging in theloft. Well, almost 6 inches. All right, 2 inches actually, which is whyI have to have the central heating on maximum and wear a woollyhat in the bathroom. But I do have one ancient luxury: an open gratewhich suffuses the sitting room with an atavistic glow and puts thefaceless modem radiator quite literally in the shade.

In the interests of economy and ecology (how many trees aresacrificed per copy of the Times, I wonder?) I have been burning mycarefully hoarded supplies of newspapers, colour supplements, andthe like. I offer the following scientific observations for yourconsideration.

Newsprint and plain paper burn with a glorious intenseflame-Fahrenheit 451, if I remember my Ray Bradbury-andleave a quantity of flaky ash, which would go on the compost heap ifonly I could bear to venture into the frozen garden. Glossymagazines craze and blister, producing Technicolor flames but littleheat. The Lancet does not burn at all, unless fed to the coals page bypage, when a sinister blue-green flame crawls reluctantly across theclose-printed paragraphs. The blackened exoskeleton of the page ispreserved with the type still legible and has to be destroyed with thepoker. I prefer to think this is the result of the deathless nature of theprose therein, rather than an indication of its indigestibility.

* * *

THE VILLAGE SHOP SELLS CAVIARE

HE went out at night to draw pictures of foxes. He did not go toschool, because he no longer felt need of what "they" had to offer.The cottage, the property of a stockbroker-farmer, was derelict anddamp, a primitive shelter for the boy, his baby sister, and hisparents. With Tunbridge Wells not far away, they had their ownreasons to profess themselves "disgusted", amidst the renownedaffluence of the south-east comer of this divided island.Once a week, when he could spare an hour or two from caring for

the stockbroker’s cattle, the father took the tractor to the nearesttown to shop at the supermarket. "Why not use the village shop?" Iasked naively. The reply was prompt and dismissive: "The villageshop sells caviare!"The law requires that doctors like me, social workers, teachers,

and education welfare officers must strive to ensure that childrenattend school regularly. When I arrived to see this particularlyintractable school refuser he was reading Under Milk Wood. I wasnot expected. Some earlier callers representing "them", theauthorities, were said to have been stoned, but I received a pleasantenough welcome. A literate and artistic child of 14, happy, itseemed, with parents and sister. A great help to father and mother intural isolation. Not many friends, but no enemies either. At schoolhis clothes were wrong: jeans were forbidden, and he had nothingelse. "Standards must not be allowed to slide. Where will it all end ifwe don’t stick to white shirts and ties, grey trousers and blazers? Imake it a firm rule", declared the headmaster. So did the parentsreally, in their hearts, want him to go to school at all? What indeeddid "they" have to offer?

* * *

"WHAT is all this clinical budgeting really about?" asked Giles.He had just returned from a meeting of the senior medical staff withthe new unit general manager. I explained the principle as best Icould. "Do you mean we can keep what we save?" he said. "Notreally," I replied. "Most of it goes back to the health authority. Butyou can retain a proportion of it." "Me, personally?" said Giles."Well, no," I responded. "The unit gets the money." "For betterwages all round?" he asked, hopefully. "Certainly not," I declared."But you can always buy a piece of equipment that you need.""Well, that is something," he said. "Provided," I continued, "thatthere are no resource implications." "What does that mean

exactly?" said Giles. "It means," I expounded, "that you do notreceive money to staff it, run it, or create a place to house it.Electricity is reasonable but that is about all." Giles looked hopeful."Of course," I pointed out, "you have to watch for maintenancecosts, health and safety precautionary measures that requireadaptations, and the need for increased nursing support." "Would anew sphygmomanometer be acceptable?" said Giles, somewhatsarcastically. "Well, yes," I agreed cautiously. "But you must putmoney aside for its replacement in the years to come." Giles wassilent for a while. "If you ask me," he said at last, "all this talk ofclinical efficiency and savings is no more than the thin edge of awhite elephant."

* * *

I AM a great believer in the value of paintings in hospitals and amdelighted at the way so many administrators respond to the friendlyovertures of local artists. Some care is required, of course, indeciding what is to be hung where. A highly emotive representationof a bull surrounded by matadors and picadors, swords and lances atthe ready, we did not think went well with the surgical day room.Nor did the pale sickly urchin blend in with the new paediatricoutpatient clinic. Nevertheless, most are a welcome addition to thewalls of our wards and I am convinced they do the patients a powerof good.A few weeks ago we received a batch of paintings from the local

art club. The standard was exceptionally high and the subjectssuitable for our various departments. Unusually, the artists said thatone painting could be chosen by each of the senior nursing staff forhis or her own office. I arranged a show in the recreation hall wherethe exhibits could be inspected. Reactions varied. One senior ladytook umbrage at a semi-abstract collage of a dog. It was made upwith bits of material, rags, string, thread, and beads. She went on atsome length, saying her nephews and nieces could do better; if thatwas a dog she could fly in the air; why could the animal not havebeen painted as dogs really were; and so on.Came the day of choosing. The senior nurses sat in a row rather

like the selection committee of the Royal Academy summerexhibition. Each had drawn lots for the order of their personalchoice. When my friend’s turn came, she went forward slowly,almost against her will, passing the landscapes, seascapes, and stilllives until she arrived at the ragged dog. "It’s no use," she said,turning to me almost in despair. "I can’t get it out of my mind. It isthe only one I want to have."

* * *

I LEARNED a lot in the RAMC. For example, my place in thescheme of things. Within my own small hospital I was accorded adegree of deference and respect, at least to my face, which I haverarely encountered since. Indeed, shortly after I secured an NHSappointment on leaving the Service, I happened to arrive a trifle latefor the grand ward round. "What time is this?" inquired the seniorconsultant irritably. "And what would they have said to you in theArmy if you were this late?" "Actually sir," I replied, "they wouldhave saluted, asked if I were quite well, and made me a cup of tea." I Ichanged jobs fairly soon after that.On the other hand, I remember being posted to a rather

up-market regiment for a few days so that their own MO could takesome overdue leave. I presented myself to the commanding officer,who made some small talk about my school, parents, and university.Having ascertained that I did not hunt, ride, or play squash, heescorted me, somewhat reluctantly, to the mess. Some officersapproached us. "This is..............." said the colonel, his voicetrailing off. "Dammit," he continued. "I’ll be forgetting the namesof me hounds next."