I’ve five books to mention for October, all by authors I’ve never read before.

Teen Couple Have Fun Outdoors by Aravind Jayan

I picked this up after seeing a positive review in the TLS. It is a 200-page first novel, a comedic middle-class family drama set in the Indian city of Trivandrum. The older brother of the narrator has been covertly filmed engaging in “sex-adjacent activities” with an acquaintance / girlfriend, and the video quickly spreads online. Our narrator is left to arbitrate between his brother and his parents as their relationship essentially breaks down. At heart, the book seemed to be about the collision between the modern world and traditional social values.

I found it easy to read, but the melodramatic aspect of focusing almost entirely on the relationships within one family was a little wearing after a while. Given the grandeur of the theme, I think I would have enjoyed seeing it explored on a larger canvas. Jayan’s exploration of the personal, family effects had its impact lessened for me by the humour which ran throughout.

Yet, I still enjoyed this novel, and I found it interesting to see the similarities in family values and relationships between India and the UK.

With thanks to The London Library for lending me a copy.

Acts of Service by Lillian Fishman

I picked up this recently published novel after seeing a review in the TLS. The opening line is, “I had hundreds of nudes stored in my phone, but I’d never sent them to anyone.”

I have no nudes in my phone, and no desire whatsoever to set about changing that; I knew immediately I was in for an intriguing journey into the life and mind of a character with an entirely different outlook on life. This book is the story of an extraordinarily complex web of sexual and/or romantic relationships. Girl 1 is in a relationship with girl 2, seeks a bit on the side with girl 3, who invites her into a threesome with her boyfriend and boss, boy 1, girl 1 leaves girl 2 for boy 1 (or possibly for girl 3 or possibly for both or neither). And that’s only about the first quarter of the book.

There’s a lot in this book about power and consent and gender dynamics, but really, at its heart, this is a book about belonging, understanding, and the different qualities and needs that develop when we spend time with different people. Fishman has wise and interesting things to say on these subjects, which make this first novel worth reading, though I wonder if her plots might become a little less complicated over time and allow the main themes a bit more space to breathe.

With thanks to Newcastle Libraries for lending me a copy.

Trick Mirror by Jia Tolentino

This is a 2019 collection of nine essays rooted in the author’s personal experiences and loosely connected by the theme of self-delusion. Tolentino is a Canadian-born writer who lives in America. She is in her thirties and contributes to a variety of periodicals, including The New Yorker and websites such as Jezebel. I picked up this book because the Amazon algorithm pushed it at me, and because I saw it had been so widely praised in the press (as both a Times and Guardian ‘Book of the Year’).

I enjoyed most of the essays in this collection, but especially enjoyed Tolentino’s essay on marriage (“I Thee Dread”), probably because her views roughly align with my own. I was particularly struck by her observation about how traditional gender-segregated celebrations of engagement remain common in modern Western society: I’d never viewed hen/stag parties in that light.

I also especially enjoyed Tolentino’s reflections on the interaction between social media and self-delusion (“The I in the Internet”). Her account of how her own memory of participating in a reality television show differed from the filmed, documented reality (“Reality TV Me”) was a novel twenty-first century take on the much-explored difference between reality and recollection.

I think these essays are best enjoyed as standalone pieces: I’m not convinced that they coalesce into a particularly coherent whole. Some of the cultural references were also beyond me (I couldn’t pick Gwyneth Paltrow or Winona Ryder out of a line-up, let alone understand what it meant by being “a Winona in a Gwyneth world”) but that’s hardly the author’s fault.

With thanks to The London Library for lending me a copy.

Empireland by Sathnam Sanghera

Published in January 2021, this is an account of the history of the British Empire, with a particular focus on how that history continues to influence the country today. I know Sanghera best from his writing in The Times.

This book introduced me to a lot of history, and Sanghera’s reflections on how little of this is taught in schools resonated with me… though as I stopped studying history somewhere around the age of 13, my knowledge of all things historical is a bit sketchy.

Sanghera’s discussion of the ways in which Empire continues to influence our political classes echoed other books I’ve enjoyed lately, such as Richard Beard’s Sad Little Men, and there were a few references to Fintan O’Toole’s excellent Heroic Failure.

I particularly liked Sanghera’s rejection of simplistic narratives of whether the Empire was good or bad:

It is puerile to reduce imperial history to a matter of ‘good’ and ‘bad’: trying to weigh up the positive and negative in this way is like defending the morality of kicking a random old man in the shins one afternoon because you helped an old lady across the road in the morning.

Sanghera’s tone often seems to me to be one of justifiable (and justified) personal anger at our failure to reconcile or even recall the ‘bad bits’ of British history. The last section of the book, though, is surprisingly uplifting and optimistic: in this part, I particularly enjoyed the reflection that expanding history curricula to include more Imperial history is basically arguing for more complete history, not something special or siloed from everything else.

With thanks to Newcastle Libraries for lending me a copy.

The Kingdom of Sand by Andrew Holleran

This is a novel about loneliness and death. I decided to read it after seeing a positive review in the TLS.

You may know that Andrew Holleran is a much-celebrated American author, credited with several classic works of American gay literature. I haven’t read any of them, and wasn’t previously aware of the author.

The Kingdom of Sand concentrates on an American man described as being in the later part of his life, though given no specific age. He has moved from New York to Florida, and tries to come to terms with his own loneliness and mortality. He finds connections in slightly seedy locations, like pornographic video stores. He ultimately befriends another gay man, twenty years his senior, with whom he spends time watching old movies.

Holleran’s novel has been well-received, and I can understand that it is an unusual portrait of a character and situation not often discussed in literature. However, I didn’t really enjoy it. I found the narrator’s sarcastic tone a bit off-putting. The narrator has very different perceptions and preferences to my own (redolent of his very different life experience) which meant that I struggled to see the generality in some of the broader observations Holleran made, particularly around universal themes such as death and dying.

I’m glad this book exists, but I don’t think it will live long in my memory, and I wouldn’t particularly fancy re-reading it.

With thanks to The London Library for lending me a copy.

A few things I’ve been thinking about this week. The forty-third post of a series.

The ninth Prime Minister of my lifetime was appointed this week. The first four served over my first 25 years on the planet. Prime Minister Sunak must serve until 2035 if the other five are to match that record. This seems unlikely.

Both the longest and shortest serving Prime Ministers of the last 100 years have been women.

As Helen Lewis put it: “Britain now has a Christian king, a Hindu prime minister, a Muslim mayor of London, and a leader of the opposition who married into a Jewish family. That’s huge!”

I’ve been lecturing in person again this week, a measles session which I do annually. There are typically about 350 people in the group, which is normally the biggest crowd for any of my annual sessions. This year is the first time since 2019 that I’ve delivered it in person to the usual-size audience. I was caught off-guard by the applause at the end, which is something that doesn’t happen when delivering sessions online.

All of the above feels like it was months ago, not this week, and that reflects the pace of life at the moment. October has been my busiest work month in a long while, with only five days (three Sundays and two Saturdays) away from work. I know I’m lucky to be busy… but I also wouldn’t mind a break.

Between May 2014 and October 2017, I placed a series of 28 bets on mostly political issues, many of them fairly long-range predictions, though there were also bets on The X Factor and Wimbledon, so don’t assume this was highbrow stuff.

I started with a stake of £30, and re-wagered the wins for a total of £91.79 in bets placed. The last of the bets settled a few weeks ago, though I had forgotten all about it until I rediscovered my spreadsheet this week.

Of the 28 bets, I won 15, lost 12, and one was refunded as the terms were contingent on something that didn’t happen. My biggest ‘win’ was a profit of £7.50 on a £3 stake for correctly predicting the outcome of the 2016 EU referendum, while my biggest ‘loss’ was £5 for incorrectly predicting Clinton’s victory in the 2016 US election. For the world at large, the ‘wins’ and ‘losses’ accrue differently.

According to the Bank of England’s inflation calculator, £30 in 2014 is worth £37.14 today. After my 28 judicious bets, my £30 stake has grown to… £30.90.

My last bet was five years and three weeks ago. I don’t think I’ll bother again.

The images in this post are all AI-generated images for the prompt “digital art of Rishi Sunak delivering a lecture on gambling” created by OpenAI’s D-ALLE 2.

A few things I’ve been thinking about this week. The forty-second post of a series.

A great post on the LRB blog this week by Liam Shaw makes the fundamental point that “prescribing a course of antibiotics shouldn’t be an isolated consumer transaction; rather, treatment should be part of an integrated system with continuity of care”.

On one of its front pages this week, alongside a headline reporting that “Truss was a disastrous dalliance who served only to remind us what a real leader looks like,” the Daily Mail claimed to offer “unrivalled reports and analysis.”

Only 79 days previously, one of their headlines informed the readership that “Liz has the boldness, vision and strength of conviction to build on what Boris began.”

Only 45 days previously, their banner headline celebrating Liz Truss’s selection by the Tory membership screamed, “cometh the hour, cometh the woman.”

Only 27 days ago, their front page proclaimed the disastrous mini-budget to be “a true Tory budget” offering the “biggest boost for 50 years.”

There’s only one way in which these reports and analyses are unrivalled: their distance from reality.

“The possible return of this unscrupulous leader who damaged the moral credibility of the Conservative Party is causing a lot of concern,” says Cécile Ducourtieux in Le Monde, with understatement.

And this editorial is stinging:

Still traumatized by the shock of Brexit and the never-ending negotiations and extreme division it brought about, the UK is struggling to point to its exit from the EU as the trigger for the downgrading and destabilization impacting the country. Growth and investments are at half speed, with exports slowed, and there is the renewed risk of secession by Scotland and Northern Ireland. For a while, Covid masked the damage of Brexit, which has become the elephant in the room that few people, even those in the opposition, want to see. From this perspective, Ms. Truss’s time in office, which claimed to “take advantage of the freedoms of Brexit,” looks like a terrible crash test.

Learning the lessons will be long and painful. But it is hard to see how the UK can return to stability and prosperity without escaping from the denial and silence about the consequences of a decision that has isolated it and cut it off from neighbors and natural partners on the continent.

Eshe Nelson in the New York Times:

Since Brexit, the nation has had more barriers with its largest trading partner, the European Union, business investment has been lackluster and companies have lost easy access to a large pool of workers. The National Health Service is overburdened, and the immense backlog of patients needing care is keeping many of them out of work.

In addition, like many nations, Britain is enduring the highest pace of inflation since the 1980s, taking the momentum out of consumer spending and economic growth.

While Britain shares some economic problems with other advanced economies, its outlook for inflation is particularly painful. Consumer prices in the country rose 10.1 percent in September from a year earlier. with the annual inflation rate returning to its fastest pace since 1982.

Tom McTague in The Atlantic, even before this week’s events:

For the first time in my adult life, there is a genuine sense of decay in Britain–a realization that something has been lost that will be difficult to recover, something more profound than pounds and pence, political personalities, or even prime ministers. Over the past three weeks, the U.K. has been gripped by a crisis of crushing stupidity, one that has gone beyond all the turmoil of Brexit, Boris, even the great bank bailouts of 2007, and touched that most precious of things: core national credibility.

None of this is fixed by changing Prime Minister. It’s hard to imagine our country side-stepping some kind of fundamental constitutional reform after this level of destruction, probably beginning with the break-up of the nation.

Wendy and I have been visiting someone in Berwick-upon-Tweed this week, in only our second visit to the town, despite speeding through on the train many times. We particularly enjoyed a stroll around the town walls, only a few weeks after I did the same in York. We also popped to Bamburgh on the way back, though the world-renowned majesty of the Northumberland coast was enveloped in fog, so really we could have been anywhere.

A few things I’ve been thinking about this week. The forty-first post of a series.

One of the sillier apps I have on my phone is Conqueror Virtual Challenges, which takes the distance I walk and plots it along a given “challenge” route. This is qualitatively absurd: schlepping from the sofa to the fridge for more chocolate is not sensibly comparable to trekking a few metres further up a mountain.

It therefore feels mildly fraudulent (but also a little bit lovely) to have received this medal this week. It commemorates having walked the length of Route 66, a total of 2280.5 miles, since September last year. I’ll happily confess that I’ve made no special effort, it’s just my normal, everyday steps.

I think I’ve only bought two of the top 20 biggest-selling debut albums in UK history, both on CD, though there are another two that I might have bought. I can’t remember for certain, and I’ve no idea where any of them are now.

I shop at IKEA more than most people. I tend to consider it to be an easy place to shop. It’s painless to check stock before visiting, it’s easy to pop in and pick up the needful, and if you want to view something before purchase, the layout is logical and well-signposted. They’re far from perfect, but they are at least thoughtful about their impact on the environment. I pop in just to use the restaurant occasionally.

I’m therefore always tickled by articles about it being a labyrinth. These often seem to be based on the more common experience of wandering the entire store at the busiest time of the week, trying to make stressful decisions about large furniture purchases, all in a novel and unfamiliar environment. The articles are frequently very funny tales or analyses of stressful experiences—but not at all like my experience of IKEA.

Tory MPs are telling us again that they are ruthless about getting rid of leaders, less than six weeks after they finally dispatched Boris Johnson following a psychodrama that dragged on and on and on for years. Facts needn’t hinder party mythology.

The thirteenth Chancellor of the Exchequer of my lifetime was appointed this week. The first six served for my first 25 years on the planet. Jeremy Hunt must serve thirteen years if the second seven are to draw level that record. This seems unlikely.

A few things I’ve been thinking about this week. The fortieth post of a series.

I’ve been reading Andrew Holleran’s The Kingdom of Sand this week. About a third of the way through the book, the narrator reflects on his decision to continue living in his parents’ house:

I liked the idea of keeping the same post office box, the same bedroom with the same books I’d had to read in high school lined up in the headboard of my bed, in a little compartment whose sliding door I merely had to push back to pull out my well-worn paperbacks of Hamlet and The Great Gatsby. I liked never having to write the alumni magazine to say I had a new address, never having to switch banks or have to ask my dentist to forward my records to a new town. I wanted to stay in one dear, perpetual place. I wanted to watch what happened to it over time.

Even the act of reading that makes me feel a bit claustrophobic, a bit suffocated. I couldn’t disagree more.

I went to my quarterly appointment to give blood this week. I look forward to it: I enjoy the unusual experience of being able to lie back in a public place, undisturbed, and just spend time with my own thoughts for ten minutes or so.

It makes me think of a passage in the sixth edition of Oxford Handbook of Clinical Medicine which made a big impression on me as a Foundation Doctor. I used to think about it almost daily.

This is not one of those passages about how you should be kind to the patient, explain in full what you are going to do, talk him or her through venepuncture, label the bottles carefully, and make a plan for communicating the results. Be all this virtue as it may, there is something else which needs communicating about the most menial of our tasks: the act of taking blood. It is partly to do with the fact that as blood is life, and, because, as Ruskin taught us, ‘there is no wealth but life’, we are led to the conclusion that what is special about taking blood is that for once we are being given something valuable by the patient. What is this wealth? The answer is time. For while the blood is flowing into our tube we cannot be disturbed. We are excused from answering our bleeps, and from making polite conversation (a few grunts in reply to patients’ enquires about the colour of their blood is quite sufficient)—and we can indulge in that almost unimaginable luxury, at least as far as life on the wards is concerned, of being alone with our own thoughts. Thinking of this sacred time as a sort of hypnotic holiday is excellent. For however many nights we have been awoken, and through however many wards we have traipsed to this bedside, this little holiday will be worth an hour’s sleep—if our mind is furnished and ready to empty itself of all objectivity. The best sight in haematological practice is, during venepuncture, to watch for those occasions when, owing to some chance characteristic of flow, the jet of blood streaming into our tube breaks up into countless globules, and before coalescing again, these globules jostle together like the overcrowded chain of events which led us to this bedside.

I’d forgotten, until I looked it up, that this passage leads into eight lines from William Blake’s Milton, complete with a footnote explaining some of Blake’s imagery and the completely unconnected influence of Blake’s editor on breast cancer surgery. That’s a whole other level of authorial indulgence.

But back to my blood donation… it was with mild dismay that I noted that the patient information sheets have been updated to include a section on things patients can do if they fear boredom during their ten-minute donation. Top of the list is playing with their mobile phone.

Having got my vintage 2004 OHCM off the shelf (well, Wendy’s copy, actually) I wondered what bon mots it may have about my current specialty. It didn’t disappoint:

Many of the diseases which preoccupy consultants in infectious diseases are new—food-borne E. coli, waterborne Cryptosporidium, airborne Legionnaire’s disease, blood-borne hepatitis C, and sexually transmitted HIV have come to the fore only in the last 30yrs. Why have these years been so tumultuous in the ID world? The short answer (at least for some of these) is greed, and our desire to exploit nature. For example, economic drive builds dams (increasing breeding grounds for vectors by orders of magnitude) and forces land development, putting people closer to vectors, eg ticks, mosquitoes, and rodents. Intensive farming is also making it easier for infectious agents to jump the species barrier (think of CJD).

Can we win? No: we cannot win against infectious diseases. All we can do is live with them. To help us do this in ways which are not too destructive, we need robust public health surveillance institutions, political will, quarantine laws, and above all, openness and cooperation. SARS and its spread underline these facts in a particularly graphic way: as the Chinese and other less-than-open societies have found out, when it comes to reporting infectious diseases, lying means dying.

I gave a conference presentation and an in-person MSc lecture this week. I’m not certain, but I think this is the first time since the start of the pandemic that I’ve done either of those things. I think I’m rusty, and that neither was as good as it could have been. Yet, the sheer number of thoughtful and caring messages of appreciation I received following the former gave me a bit of a boost this week.

The images in this post are all AI-generated images for the prompt “a junior doctor taking a blood sample in a hospital ward, oil painting” created by OpenAI’s D-ALLE 2.

A couple of things I’ve been thinking about this week. The thirty-ninth post of a series.

I gave a presentation this week to prospective public health trainees. I’m told that my enthusiasm for my job was “obvious and infectious”, which is a surprise after the last three years.

Eleven years and five months ago, Wendy and I spent ages browsing shop upon shop, trying to find two decent sofas. This week, we’ve been doing it again.

Now, as then, only a tiny proportion of sofas are to our taste. There are frequent exclamations of “Who would want that in their house?!”