Twenty years ago yesterday, I passed my practical driving test. It was not my first attempt: I had more than 100 lessons over a period of more than a year, and still failed on my first go. Spatial awareness and physical co-ordination have never been my strengths, so the ultimate success is probably more surprising than the initial failure.

Since then, I’ve owned two cars.

For the first six-and-a-half years of my driving ‘career’, I drove a Vauxhall Astra which used to be my mum’s. It served me well, but I decided that the time had come to replace it when fumes started leaking into the passenger cabin.

For the last thirteen-and-a-half years, I’ve driven a Toyota Aygo, which I still think of as my ‘new’ car. I’m still surprised by how fuel efficient it is in comparison to the old car, and how small its petrol tank is.

In the twenty years I’ve held a licence, I’ve been caught committing exactly one motoring offence: I drove through a red light. The circumstances were unusual: I was in a queue of traffic, and thought I had passed the light. In fact, the law is clear that no axle may pass the stop line once the light has changed to red, so my rear wheels saw me break the law. I should have known better.

I’ve never driven in another country, except for the Republic of Ireland, where I drove earlier this year.

From this history, you might surmise that I’m no great fan of driving: you’d be right. I’m glad that I learned to drive: it’s a skill I use at least monthly, and which makes my life easier. It’s a means to an end, but not an activity I derive pleasure from. If my car were magically made self-driving tomorrow, I’d have no qualms about giving driving up.

Roll on the future.

The image at the top of this post was generated by Midjourney.

In his most recent piece for The TLS, hospital doctor Druin Burch writes:

The optimum amount of medicine to have in your life is the minimum possible, and private healthcare lacks the essential spirit of parsimony. A fee-for-service system rewards those who do as much as possible, not the thoughtful minimum. Those who can pay for everything run the risk of getting it.

As so often with Burch’s writing, I find myself both agreeing and disagreeing.

First, the disagreement: the optimum amount of medicine is not the minimum possible. This is self-evident. It is perfectly possible to live your life without a measles vaccination. Most unvaccinated people will not catch measles. Yet failing to get a measles vaccination is far from ‘optimal’: it forgoes the tiny risks associated with vaccination in favour of the much greater risks of acquiring disease, and it puts others at unnecessary risk.

But the wider point—that too much medicine is bad medicine—is a truism that’s too little discussed. I was amazed to read recently about Zoe, a programme that uses real-time blood glucose monitoring, genetic sequencing of gut bacteria, standardised meals with associated blood tests to create a diet plan. Perhaps medicalising one’s diet to that degree is helpful for some, but it’s not something I’d sign up to.

My gut reaction to all of this is that I don’t want to be unnecessarily investigated for anything, nor screened without good reason and evidence. Most incidental findings are unhelpful, resulting in further investigation and sometimes treatment which is entirely unnecessary—and where the benefit doesn’t come close to outweighing the harm.

My view on this is, in theory at least, pretty firm. But theory is not reality: as I type this, I can also see my Apple Watch, silently and continuously screening me for atrial fibrillation. I have scales at home which screen me with each use for peripheral neuropathy. My bed monitors me for sleep apnoea. I occasionally take my body temperature, even when I’m feeling well. This stuff is insidious, and it’s not necessarily good for overall health.

I don’t think I’ve ever heard anyone in real life refer to the Apple News app. It seems to me that it has virtually no social cachet. And yet, it’s an app I use every day, and which I really appreciate: it took a little while to get into, but once you give it some signals (giving articles a ‘thumbs up’ or ‘thumbs down’ and following or blocking sources of stories) then it quickly comes to learn one’s preferences.

I have Apple News+ and, in addition, the app syncs with my login credentials for a number of providers (like The Economist), which means that I get access to quite a bit of subscription-only content through the app.

But there’s one ‘killer feature’ in the Apple News app which keeps me coming back, and it’s one I’ve never seen discussed elsewhere. Unlike some apps, where the ‘top stories’ are driven entirely algorithmically, Apple News has editors who curate the news in various ways. They select ‘top stories’, but also promote notable feature articles, and even curate collections of articles on topical themes.

One advantage of this is that they use ‘breaking news’ push notifications extremely judiciously. I think it was Jeff Jarvis who once said that the threshold for ‘breaking news’ notifications should be ‘news you’d interrupt a meeting for,’ and I think they get that about right. It’s the only news app whose notifications I haven’t blocked.

But the ‘killer feature’ is how they handle curated news stories from sources you have blocked. The temptation—perhaps even the logical option—would be to hide them, but Apple News doesn’t. Instead, it shows a grey tile with the headline in the curated position, along with a message that the user has blocked the source.

This is a wonderful way to stop people becoming trapped in filter bubbles. It says, ‘hey, you might not want to hear about this, but we have judged that it’s objectively important.’

Showing that level of confidence in the editors’ professional judgement is admirable, particularly in our ever-more divided culture. The combination of human-curated news and algorithmically driven sections on topics that the system thinks I’m interested in makes a compelling combination.

The image at the top of this post was generated by Midjourney.

Three years ago, I enjoyed Naoise Dolan’s first novel, Exciting Times. Her second, The Happy Couple, is a rather different novel in scope and setting, but is no less enjoyable.

The Happy Couple begins with the engagement of Celine, a professional pianist, and Luke, whose exact occupation I can’t recall, but it was something like investment banking. The novel then follows the couple as their wedding approaches, with the central question being whether they will actually end up marrying.

The narrative perspective shifts several times through the novel between different members of their friendship group and the wedding party. Archie, the best man and Luke’s ex; Phoebe, the bridesmaid and Celine’s sister, who is uncertain about Luke; and Vivian, a wedding guest and another of Luke’s exes. This isn’t nearly as complicated in practice as I’ve made it sound.

As with her first novel, Dolan’s writing is razor sharp, and yet still warm. The characters—and especially the way they relate to one another—feel true to life, and the novel feels very current.

I thoroughly enjoyed this novel.

I noted down far too many quotations to paste in this post, but here’s a selection. The first is a lovely line from the acknowledgements, the rest are from the main body of the text:

As a child, I read hundreds of novels before it even occurred to me that people had written them, let alone that I could be one such person. I learned my craft from fellow authors, most of them long-dead. So thank you to fiction, my favourite thing, my thing that I somehow get to do.

I only ever say good morning if someone else has decided that we’re doing this. Sleeves up, let’s deem the morning good. But all mornings are good to good morning people, making it really a statement of pessimism. We give the day that greets us a participation trophy because we assume it can’t do better.

Both parents were from Dublin, but I was born in London when my mother’s plan to go off to England and get an abortion had been executed partly but not fully.

I find it irksome when book blurbs say right at the end: ‘It’s also very funny’, as if humour were an afterthought and not the central force that prevents us from killing a) each other, and b) ourselves.

Loneliness wasn’t having no one. Loneliness was the gap between what you hoped for and what you got.

‘I don’t want you to fuck off for months at a time without checking if I mind.’

‘Okay, yeah, sorry,’ Luke said.

Confirmed: truly impossible to make Luke fight.

Archie said: ‘Sorry and you’ll change, or sorry and you won’t?’

‘Sorry, I won’t, Luke said. I mean, I probably won’t. I’m not good with relationships.’

‘But that’s not a mysterious… you’re talking about your own actions like it’s a weather forecast. You’re you. You’re management. You decide if you’ll be “good with relationships” or not.’

They did not, as a rule, ‘share feelings’.

Celine’s family had never taught her how. To see the tint of your internal mood ring as warranting disclosure, and to expect a rapt audience—no, no.

Ever since those prep classes, the phrase ‘Jesus died to save our sins’ has bothered me. I mean even just the grammar. Shouldn’t it be ‘save us from our sins’? If the sins themselves were the subject of salvation, wouldn’t that mean Jesus died to save your gambling addiction, i.e. to keep you gambling? Wouldn’t that make him an enabler? Or Him, if you’re into that sort of thing.

I’m only happy when doing something that makes me forget I exist.

As a result of being based in a shared regional office, I’m in the strange professional position that my desk is about 30 miles away from the geographical area I cover. This setup results in a fair amount of unavoidable travel from the office to the people and places that my eyes need to see.

For my first few years in the role, I tackled this by driving a lot. This was convenient, especially because my parked car could often become a ‘mobile office’ where I could catch up on work, chair teleconferences, and even sometimes deliver online teaching sessions. I even bought a desk that clipped onto my steering wheel to assist with this.

I came to realise, though, that this wasn’t great for a person whose job is focused on protecting the health of the public. I drive a small car, but I was still no doubt emitting more carbon than I needed to be. I therefore made a special effort to start using public transport whenever possible… but there were two problems with this.

The first was that I wasn’t all that convinced that this was truly helping the carbon issue. Typically, it meant taking a diesel-powered train or bus, often as one of only a handful of passengers. But I decided that this was out of my control, and I had to trust the system to do the right thing: if I adopt the ‘right’ behaviour, then it’s up to others to make sure that it counts.¹

The second was that it didn’t seem to be possible all that often. I’d either have back-to-back meetings, or there would be a teleconference straight after a meeting, or the transport timing didn’t line up, or the venue wasn’t especially accessible. Basically, I still ended up driving quite a lot.

I’ve noticed something interesting, though: post-pandemic, I’ve found this transition to public transport somewhat easier. I’ve taken public transport much more often. As I sat on the train back from James Cook this week, I was pondering why this was. I think there are maybe five factors.

The first is that in-person meetings have become much rarer these days. Online meetings have become the default option, even for things where they were previously considered impossible. This means that I don’t feel so bad about taking slightly longer to travel to and from them, and that the occasions where I have back-to-back in-person meetings at poorly connected places have become far more unusual.

The second is that I’ve genuinely adopted a mindset of public transport being the default, which has been helped by the break in physical meetings occurring. This has resulted in a subtle but significant change in my thinking: if I can’t do two meetings because they are geographically incompatible, then I’ll have to miss one of them. If I’m supposed to be chairing a meeting when I’m scheduled to be on a bus, then the meeting is going to have to move or find another chair. The option of driving has become a last resort, whereas it was more of a second-preference before, despite my intentions.

The third—possibly related—is that I’ve become phlegmatic about public transport disruptions. If I am supposed to be somewhere, but public transport lets me down, then I no longer feel a sense of responsibility about that. I plan my days with reasonable buffers to account for predictable problems, but if exceptional events disrupt it, then that’s out of my control. The same was always possible when driving, in any case.

The fourth is that technology has moved on. I can now do a lot more when I’m on public transport than I could before. Most of these changes are relatively ‘soft’. People often default to chatting to me on Microsoft Teams instead of phoning, which turns out to be much easier to handle on a noisy train. More services have moved to the cloud, which means that I can do more work on my phone rather than having to try to balance a laptop on my knee on the bus.

Finally—and I’ve only realised this belatedly—I have a responsibility to role-model behaviour that accords with an understanding of the threat posed by the climate crisis. I’m not claiming to be an environmental saint by any means: my overall patterns of behaviour are probably quite poor. Yet, it doesn’t really inspire change if the doctor in charge of protecting the public from environmental hazards is happy to drive everywhere. I realised this after I recently gave some junior colleagues an email address, and the only thing I had to hand to write on was a used bus ticket: they looked at it as though they’d never been on a bus before, and it set me thinking.

It will be interesting to see whether this changes over time.

1. This is a position I also adopt on recycling. I sometimes read about questionable recycling practices, such as allegations that plastic recycling ends up in landfill or in the ocean or whatever. But I’m not in charge of that. If I’ve reduced and reused as much as I can, and presented my recycling according to the supplied guidelines, then I just have to trust that the ‘system’ will do the rest.
   

I’m currently reading Solider Sailor by Claire Kilroy. Early in the book, her narrator says this:

The Virgin Mary, of all people, came to mind. I ask blessed Mary, ever virgin. Having never given her a moment’s consideration in my life, it then struck me that she was real. Not real as in there beside me—don’t worry, I wasn’t having a visitation—but real as in there had once been a girl, a living girl, a child in fact, called Mary, Maryam, Mariam; a child who had given birth in a stable at the age of thirteen or fourteen or possibly twelve. Where was her mother, was my question. Where was the poor kid’s mother? How could you let your child go through that without being by her side?

This was a thought that festered. From a modern perspective, this idea seems unimaginably cruel, not to mention negligent. Unlike Joseph’s father, the Bible doesn’t name Mary’s parents, known traditionally as Ann and Joachim.¹

By the time of the birth, Mary was, literally, the property of Joseph, hence the need to tote her along to Bethlehem for the census. A man claiming ownership of a child and separating her from her family while she gives birth in a stable to the first of at least seven children seems, again, abhorrent to modern eyes.

One might be tempted to conclude that we can’t judge the behaviours and mores of people two millennia ago by modern standards, and that we live in very different times. Regrettably, not everyone sees it that way.

1. Lest you worry that this Ann gets all the flak in the quotation, the narrator goes go on to criticise Joachim in similar terms a couple of pages later.

The picture at the top is, fairly obviously, a detail from Raphael’s Sistine Madonna, probably better known these days for the Putti at the bottom of the frame.

In 2005, I was just starting to be released onto the wards in the third year of my medical degree. One of the dullest weeks focused on orthopaedic surgery. The operations were life-changing for the patients but struck me as a sterile version of Meccano. The techniques were ingenious, but their application to a conveyor belt of patients felt depressingly repetitious. Give me a knotty, intractable problem to tilt at (and fail to solve) any day.

The specialty wasn’t right for me, and I wasn’t right for the specialty: I have neither the ego nor the bravado to be an orthopaedic surgeon. I sincerely hope things have moved on in the past two decades, but the male orthopaedic surgeons’ changing rooms were Lynx-Africa, Page-3, clothing-on-the-floor hellholes ripped from straight from a sleazy gym. No thanks.

My over-riding memory of that week, though, is not the surgery: it’s a specific patient. She was in her late 80s, she lived alone, and she was fiercely independent. She had never married and was proud of the fact: woe betide anyone who prefixed her surname name with ‘missus’. She had fallen a couple of years previously and broken her hip. She was in hospital because, unfortunately, the nail which was holding her femur together had fractured following another fall.

I met her shortly after her admission, when I was allocated to her to practice my history-taking and examination skills. We fell into a long chat about her fascinating career, an area of work I knew (and know) nothing about.

One thing she was keen to tell me was how ‘miraculous’ the NHS was. She grew up in a poor household. She talked about her experience of TB in her youth, and of being isolated in a charitable sanatorium with no contact with her family for months on end. She talked movingly about one of her younger brothers becoming very unwell when she was a teenager, her parents being unable to afford to call a doctor and having instead to seek help from the church. Her brother died, having never seen a medic.

I remember going with the occupational therapy team to see this lady’s house: a standard part of their practice to see what home aids she might require, or what trip hazards might be lying around. The house was immaculate, not a thing out of place. I could scarcely believe that someone in their late 80s could keep a house so beautifully.

Her surgery turned out to be more complicated than was initially expected. The broken nail proved difficult to remove—by virtue of being broken, it couldn’t just be cleanly pulled out of the hole it had been driven into. Once it had been quite traumatically extracted, the patient required a plate to be screwed in to hold her femur together, with something like a dozen screws. It wasn’t a light undertaking, and this lady ended up spending quite some time in intensive care.

By rights, my story should end there: I moved onto other training weeks. But I kept popping back to see this lady. Every time I saw her, without fail, she talked about the ‘miracle’ of the NHS. She talked about how, when it was first introduced in her twenties, people were terrified to call a doctor as they couldn’t believe there would be no bill. It took a long time and countless leaflets and word-of-mouth until people really trusted that they could use the service. She talked more eloquently than I ever could about how it transformed the life chances of those around her: how gradually, over time, illness came to lose its life-changing significance, and became more of an irritation than a life event. She lamented the loss of her brother.

She talked, too, about her concern for the future of the NHS. She thought that those who hadn’t lived without it didn’t appreciate it. For some reason or other, NHS waiting lists were in the news at the time. She saved a newspaper clipping for me, and when I went to visit, remonstrated with me: why did these people not realise how lucky they were to be on a waiting list for free care? Would they complain if they were on a waiting list to win the lottery? People won’t realise what they’ve got until it’s taken away again.

Over the course of about six weeks, her tenacity and drive—plus support from nurses, physiotherapists, occupational therapists, and pain management specialists—resulted in a truly astounding recovery. My last memory of her is of her being wheeled off the ward—backwards, for some reason—with a massive grin on her face, arms waving in the air, thanking everyone she passed (even the other patients). Remarkably, she was going back to her own home, to continue living independently.

Clare Gerada, the president of the Royal College of GPs, once wrote:

One cannot see patients, day in day out for years, without being profoundly affected by this experience and the struggles we witness. Even now, as I write this chapter, I see the faces of my patients and hear their words, some long deceased. I see their ghosts as I walk my dog, shop in the supermarket or walk past their old homes. Many of my patients still live in my mind.

I agree, and today—the 75th anniversary of that day in 1948 that this patient remembered so well—this patient is making her unique presence very well known to me.

Of course, her reflections aren’t really about the NHS as it is currently structured: her point is about the value of care which is free at the point of use, funded through general taxation. Politicians like to politic about the specifics: organisational structures, social insurance models, completely free care¹ versus co-pay models, the level of involvement of the private sector. At it’s founding, NHS hospitals were made into a single organisation. These days, there are countless separate organisations, many operating in competition with one another, mostly on the basis of finance rather than quality of patient care.

But sometimes, and particularly on an anniversary like this, it’s worth taking a step back and realising what we’ve got: the NHS is a miracle. We shouldn’t forget that it wasn’t always like this, and won’t necessarily be like this forever.

The NHS is under extreme pressure at the moment: it feels like it’s falling apart in front of our eyes. But at least we still have an NHS which strives to deliver its founding principles. Sadly, these days, political rhetoric around the NHS has become entirely about patching it up, about making it live within its means—as though those means are not entirely determined by us.

How wonderful would it be if we used the 75th anniversary to invent the same thing for social care? To have the vision to say “the whole of society will take the risk” instead of the individual? To proceed with visionary boldness to meet the need, not balance-sheet-driven timidity. To prioritise compassion over efficiency.

My birthday wish for the NHS is that, perhaps, we’ll have moved in that direction before it reaches its century.

1. We don’t have completely free care in England: there are prescription charges, dental charges, optical charges, and so on and so forth.
   

The image at the top of this post was generated by Midjourney.

As well as his outstanding journalism over the past thirty years, including many years as Diplomatic Editor for Sky News, Tim Marhsall has written a couple of books which I’ve previously devoured. 2016’s Prisoners of Geography presented ten maps and explained how the geography displayed influenced the development of nations and the political relationships between countries. I was enthralled, so much so that I read 2017’s Worth Dying For the very next month. This was an utterly brilliant exploration of different flags and the ideas they intend to communicate—not just those of countries, but also institutions like the United Nations and the Olympic movement, and even ideas, like the white flag of surrender.

I skipped 2019’s memoir Shadowplay, mostly because it was described as ‘harrowing’, and I wasn’t in the frame of mind to cope with that. And the news of 2021’s The Power of Geography—a return to the ‘ten maps’ format—entirely passed me by until I came to write this review.

Back in April, Marshall’s latest book—The Future of Geography— was published. I was in two minds whether to buy it. It was sold as an exploration of geopolitics in space, or ‘astropolitics’ as it’s known, and I thought that maybe this would be a little removed from Marshall’s area of expertise and interest. I worried that the book might be a disappointment. In the end, Wendy convinced me to buy it.

Wendy was right. I thought this was an absolute tour de force, my favourite of the three Marshall books I’ve read. This was a fascinating account of the history of space exploration to date and the underlying international politics. Marshall has a real gift for bringing such apparently dry subjects to life, and to squeeze a little humour out of them. I felt like I learned loads from this book, and gained a whole new insight into an aspect of space exploration which I’ve never really thought about before. It’s never occurred to me, for example, that attacks on satellites which have the effect of ‘blinding’ nuclear early-warning systems have the potential to precipitate nuclear war.

I was particularly fond of Marshall’s frequent references to the early days of seafaring, and his comparison of space law to maritime law. Casting early spacefarers as equivalent to early seafarers helped me to think much more clearly about the issues which space exploration is likely to raise. It also helped me to better orientate myself as to where humanity finds itself in ‘space history’.

It was also just really refreshing to read a book on space which isn’t primarily concerned with technology, but rather with some of the wider societal issues the technological developments precipitate.

Without a doubt, this is one of my favourite non-fiction books of the year so far, and I’d highly recommend it.

I’ve incorrectly predicted the death of Twitter more than once: I clearly don’t have good powers of prediction.

Yet, I can’t help but feel that the latest change—not allowing people to even view tweets unless they have signed up and are logged in—must be one of the final nails in the coffin.

It seems an unsustainable position for the BBC to produce content which cannot be seen except to those willing to give their email address or phone number to Elon Musk. It’s not reasonable for emergency services to use Twitter to give important safety messages when these aren’t publicly accessible. It’s not right for the Government to share messages exclusively via a closed platform.

This must surely be the beginning of the end for Twitter’s relevance in the UK.

The image at the top of this post was generated by Midjourney.

I’ve mentioned Newcastle’s Town Moor many times on this blog, most recently as it was the site of The Hoppings only days ago. Walking across it to the city centre today, those scenes feel like they might have been from a fever dream, so different are my surroundings. What a difference a fortnight makes.

As this ruminant pulled its tongue at me as I passed, I was reminded of an occasion where some friends from London visited us and remarked on how lifelike the ‘cow sculptures’ on the Town Moor seemed to be… and also of this Sunday Times article from a couple of weeks back.