I recently had occasion to travel from Newcastle to Amsterdam. This is a journey I’ve taken a few times in the past, sometimes by DFDS ferry and sometimes flying with KLM.

This time, I decided to take the train.

My options were limited.

I couldn’t travel with DFDS as my trip fell during one of their ship’s maintenance periods, meaning that departures were occurring only ever other day.

I could have taken a direct flight with KLM. This would have departed at 0925 and arrived at 1125. The snag was that the economy fare was quoting at £391, which I baulked at.

I could have taken an indirect flight with BA. This would have departed at 0940 and arrived at 1925, with a six-hour layover at Heathrow. I’m not averse to a long layover when the price is right, but at £334 in economy, it wasn’t.

I could have taken a train down to King’s Cross with Lumo (£50) and a Eurostar from St Pancras (£172), which at £222 is a pretty hefty saving over the aerial options.

And the latter is almost what I did, except I decided to take a seat in LNER first class to King’s Cross (£100), break my journey in London for a few hours, and book myself into Eurostar standard premier (£229). At £329, the upgraded train journey still undercut economy flights, and it would be much less environmentally damaging.

Geoff Dyer once wrote:

The best thing to be said about travelling by train is that it’s better than being on a coach.

In the years when I did it more often, the best thing about taking a first class morning seat from Newcastle to King’s Cross was the breakfast: the trolley of fresh pastries, the yoghurts, and most of all the delicious porridge with honey. Porridge is something I eat almost exclusively on trains.

These days, it seems the service has paled a little. There were no pastries on my train. Yoghurt was offered only as an alternative to a hot option. And the porridge was served not with honey, but with maple syrup. What has the world come to?

On the upside, the green tea wasn’t bad, which is high praise indeed, for most green tea served on modes of transport is borderline undrinkable (though substantially better than the typically stewed black tea or coffee). On BA, green tea always involves an extensive rummage in the galley, as though there might be a tea bag somewhere in the back of a tray, possibly first loaded in 1994.

When I made this journey with Lumo a few weeks ago, I noted that they were strict with seat reservations, and I attributed this to their “LumoEats” service. However, for the first time in all the years I’ve been travelling on LNER and its predecessors, the staff on this service were also militant about reservations, even in first class. When tickets were checked, passengers sitting in seats apart from those they had reserved were politely asked to move.

I approve, even though this did screw up the food orders for those who had placed them before the ticket check took place. They won’t make that mistake again, one hopes.

The age of Zoom means that the First Class quiet carriage is more missed than ever.

Along with many more important things in Britain, Brexit has ruined the Eurostar station experience—at least at St Pancras. The combined security screen and passport checks used to be so quick as to be negligible. With passport stamping and suchlike now required, it took the better part of 35 minutes to get from the station concourse to Eurostar departures.

I suppose receiving a ‘Londres’ stamp from French border agents is novel, at least.

The Eurostar train staff make all their PA announcement in three languages. I know this is common all over the world, but on British soil it makes my personal inadequacy in speaking only English feel even more acute.

This was my first journey on one of Eurostar’s newish e320 trains, having always been on e300 trains before. I couldn’t really tell you the difference.

The seats were comfy enough, the stewards kept plying me with free alcohol, there was a socket to charge devices, and we sped along through the UK, France, Brussels, and The Netherlands at nearly 200mph. Even the free wifi was alright. All Eurostar trains are a little wider than standard British trains, so they immediately feel comparatively spacious.

As with all Eurostar journeys, the best bit was arriving in the centre of Amsterdam, a stone’s throw from my hotel, and moseying out of the station: no need to worry about passport checks, baggage reclaim, taxis or transfers.

Bliss.

So, having travelled to Amsterdam by train, plane, and ship, a good blogger would plump for one of the three and say they’ll always travel that way from now on. But not me.

I’d have no hesitation in hopping on the train again when circumstances allow, but that isn’t going to work for a day trip.

The ferry is nice for travelling while asleep and saving on a night’s accommodation, but there’s only one sailing per day, so the timing has to work out, and the carbon footprint isn’t exactly exemplary.

And the plane’s fastest, but it’s also often expensive, and comes with a dose of flygskam.

So… it’s horses for courses, innit.

This 2022 book by the noted palliative care physician from Kerala in India was highly praised by my Goodreads friend Richard Smith, and sounded like a book which would be up my street. I found it somewhat hard to get hold of a copy, but eventually tracked on down online.

I very much hope that this book becomes more widely available because Rajagopal gives some clear and important messages. His writing considers the limits of medicine, its potential to do net harm by focusing more on diseases than patients, and the fundamental importance of holistic care. While entirely different in tone, the messages reminded me a little of Ivan Illich’s Limits to Medicine.

Rajagopal was a pioneer of palliative care in India, and that aspect of this book was also fascinating. He tells us his story, from first recognising a substantial lacuna in the care of patients (a lack of proper pain management) to building a coalition of likeminded colleagues to ultimately transforming medical practice. This aspect of the book reminded me of Misbehaving by Richard Thaler, his account of how he transformed the field of economics by integrating human behaviour. In some ways, Walk with the Weary is an account of how Rajagopal transformed the field of medicine, especially in India, by integrating human compassion.

Rajagopal’s view is that palliative care ought not to be restricted to those who are dying, but that it should be there for ‘all illness-related suffering.’ I had never conceived of palliative care in that way before, but found the argument inspiring. It encapsulates something important about how medicine is best practised.

One of my regrets about the way public health is practised in the UK is the siloed nature of the work. I work in health protection and mostly deal with the acute response to cases of significant infectious diseases. Often, the people who are suffering with these diseases have myriad other needs, but there is no overall coordinating ‘sorter of problems’ to tackle that. I found Rajagopal’s account of overcoming broadly similar structural barriers in his work inspiring.

Some notable quotations I took away from this book:

Imagine a researcher, a few centuries from now, going through the history of ‘Modern Medicine.’ What would her verdict be on healthcare in the early twenty-first century? What would she feel about the healthcare system in which, despite all the accumulated medical knowledge, 80% of the world continues not to have access to basic pain relief? Would she not ask herself—how could they be so senseless to invest so much time, energy, and money in research on ‘conquering’ diseases but not focus on channelling that knowledge so as to provide relief to those in suffering?

No therapeutic scan has yet been created that can measure happiness. There is no medical intervention yet that can generate joy, but the love that I give and the love I receive may be able to do that. If I am made physically comfortable within reasonable limits, this love could well be the only thing that matters as death approaches.

The world over, pain seems to be poorly understood and taught. Diseases are given importance; pain or suffering is ignored.

Many people, including many medical and nursing professionals in India, fail to realise the depth and nature of pain. It can be beyond the average person’s imagination. If severe, it affects your personality and changes you from a sociable human being to a selfish being, caring about nothing other than one’s own pain. It fills the mind space, leaving no space for rational decision-making.

This change in behaviour is immediate when a sudden, agonising pain occurs, but generally resolves completely when the pain is relieved. Sadly, and more tragically, long-term pain, such as low back pain, often irrevocably changes a person. The person may manage to put on a normal front to the world at large, but once back in the privacy of his or her own home, the façade crumbles. The irritability surprises, others; and at some point, it wrecks relationships – between spouses, between parents and children, and eventually with colleagues too. 

There was a lot of food for thought in this book.

This is an odd little 1922 novella in which the central character’s wife is mysteriously transformed into a fox. They initially continue almost as if nothing has happened, the vixen wearing clothes and sitting at the table to eat.

Over time, her vulpine nature overtakes her human tendencies. The couple drift apart as she moves into a den, though maintain a close affection.

I enjoyed this mostly as a brief curiosity.

A couple of quotations:

Wonderful or supernatural events are not so uncommon, rather they are irregular in their incidence. Thus there may be not one marvel to speak of in a century, and then often enough comes a plentiful crop of them; monsters of all sorts swarm suddenly upon the earth, comets blaze in the sky, eclipses frighten nature, meteors fall in rain, while mermaids and sirens beguile, and sea-serpents engulf every passing ship, and terrible cataclysms beset humanity.

This story was made up by his neighbours not because they were fanciful or wanted to deceive, but like most tittle-tattle to fill a gap, as few like to confess ignorance, and if people are asked about such or such a man they must have something to say, or they suffer in everybody’s opinion, are set down as dull or “out of the swim.”

My thanks to the London Library for lending me a beautiful 1922 edition of this book with the original woodcuts by Garnett’s then wife—even though the book is dedicated to Duncan Grant, with whom he’d had an affair. Life was complicated among the Bloomsbury set.

Some people speculate that the novel is about the affair with Grant; others that it’s about the relationship with his wife. Both strike me as perfectly plausible, but then so does virtually every other interpretation, including the idea that it’s just a fantasy story with no allegorical meaning whatsoever.

This 2019 coming-of-age novel is narrated by Lucy. She grows up in a working-class household in Sunderland, goes to university in London, and moves to rural Ireland following her graduation.

The novel is written in fragments which are mostly, but not completely, arranged chronologically. The style reminded me a lot of Jenny Offill’s novels, though I found Andrews’s writing more immediately relatable.

This is Andrews’s first novel, though she has published another since. Her writing is beautiful, almost poetic at times. I think she captures particularly well the North/South relationship, and the way that people from the North are often “othered” in London.

Andrews is also good at needling the class divide and the different frames of reference privilege brings: there is one closely observed section where she is challenged about working in a bar while also preparing for her A-Levels.

I wasn’t completely won over by the plot of this novel: it’s a coming-of-age novel, and I’m uncertain whether I got the sense that the character was really developing. There was a whole plot about Lucy’s relationship with her father that seemed designed to do the heavy lifting on this, but felt a bit ‘tacked on’ to me.

However, I was so thoroughly taken with the writing that I didn’t honestly mind about the rest, and I’ll certainly look out for Andrews’s second book.

Some particularly striking quotations from Saltwater:

London is built on money and ambition, and I didn’t have enough of either of those things.

I would like to have something to believe in, but it is difficult. Everything my generation was promised got blown away like clouds of smoke curling from the ends of cigarettes in the mouths of politicians and bankers. It is hard not to be cynical and critical of everything, and yet perhaps there is an opening, too. When the present begins to fracture, there is room for the future to be written.

High-rise tower blocks and the despondency of stale, squat houses are aesthetically pleasing when you are removed from them. Middle-class architects with utopian ideals might be able to appreciate the solidity and the magnitude of a huge hunk of concrete with lives carved unapologetically into it, but when that becomes your reality and you have no choice and no way out, when you’re living every day under the shadow of someone else’s vision, it becomes oppressive, the weight of their dreams crushing the life out of you.

Many thanks to Newcastle City Library for lending me a copy of this book.

This is a beautiful, singular, short novel published in 2022, which I decided to read after seeing good reviews on Goodreads.

It is in two halves: in the first, we follow the recreational swimmers at a local pool, getting to know each of their habits and motivations. We also follow the response of the swimmers as a crack appears in one of the lanes. This section is particularly beautifully written. I am a recreational swimmer, and Otsuka’s writing is so insightful that she seemed somehow to have a better understanding of my motivations than I have.

Only one of the swimmers is named: Alice.

In the second part of the book, we follow Alice’s development of dementia, mostly from the perspective of her daughter. Alice is admitted to a care home, and Otsuka’s account of this has emotional depth and close observation. The main focus of this section is on Alice’s experience of memory loss, including the effects of this on her relationship with her daughter.

The reader is left to draw the parallels between the events described in the swimming pool, and people’s reactions to them, and the story of Alice’s decline.

The Swimmers was unique, poetic, and beautiful.

When I did a stint on an elderly care ward a decade or so ago, it wasn’t uncommon to send older people to a care home or similar seeing for “a period of convalescence.”

I remember discussing this with my consultant supervisor and suggesting that it seemed strange that we did this for elderly patients, but not for younger patients. I reflected on how I thought I’d benefit from a period of convalescence if I were ill, but that the hospital would want me back on the ward as soon as I was capable of maintaining an approximately vertical position.

I’d forgotten all about that conversation until I saw Richard Smith’s review of Recovery, a short book published last year by Edinburgh GP and writer Gavin Francis. His review inspired me to buy the book.

It’s possible that in one of those feedback loops of reading at the moment: Francis references Suzanne O’Sullivan’s It’s All in Your Head which I very recently read, and Denise Riley’s Time Lived, Without its Flow which I read relatively recently.

Francis’s argument in Recovery is that we all need time to convalesce and heal following illness.

The medicine I was trained in often assumes that once a crisis has passed, the body and mind find ways to heal themselves – there’s almost nothing more to be said on the matter. But after nearly twenty years as a GP I’ve often found that the reverse is true: guidance and encouragement through the process of recovery can be indispensable. Odd as it seems, my patients often need to be granted permission to take the time to recover that they need.

This much seems reasonably obvious, even if society pretends to have forgotten it (and certainly doesn’t practise it). Francis argues that we all need time following illness to regain as much independence as we can, and to find a balance in life.

Francis goes on to logically develop his argument, firstly making a case for convalescence even in chronic illness (we still need time to regain independence and balance), and even suggests that we would benefit from sabbaticals every seven years or so to convalescence from work. I think he is probably right.

Francis also talks about the importance of nature to recovery. I was particularly taken by his image of doctor-as-gardener:

A doctor who sets out to ‘heal’ is in truth more like a gardener who sets out to ‘grow’ – actually, nature does almost all of the work. Even when I stitch a patient’s wound the suture material itself does not knit the tissues – that thread is simply a trellis to guide the body in its own work of recovery.

This is well worth reading.

Boy Parts is Eliza Clark’s first novel. It was published in 2020. I thought I’d give it a go after it was mentioned in passing on the radio.

The novel, largely set in Newcastle, is narrated by a Royal College of Art graduate, Irina, who is also working in a bar to make enough money to survive. Early in the novel, she is offered the opportunity to exhibit at a fashionable London gallery, which leads her to look through an archive of her work to date, as well as throwing herself into production of new work. Her art involves taking explicit photographs of average-looking men she scouts in everyday life.

This is one of those novels that hits the reader full-square in the face from the first page, and doesn’t slow down. Some have described it as a horror and some as a thriller, but I think it defies straightforward categorisation. It explores questions about the connection between art and mental illness, about gender norms in contemporary Britain, about the nature of consent, and about the attitudes of cluelessly disconnected people based in London to those in “the North”. I note that Clark is a Newcastle-born novelist living in London, and the last of these elements is so hilariously / depressingly pitch-perfect that it must surely be drawing on her own experience. (Irina’s “Is your dad a miner?” query recalled my own ”I’ve never met a doctor from one of the Northern medical schools!” moment when working in London.)

There are some moments of quite graphic violence in this novel, which would often put me off, but here they are integral to the character-building, and so didn’t seem unnecessary or gratuitous. There is some mention of Newcastle-specific details, including a paragraph riffing on the possible routes that a character could take when driving between two locations, but this seemed to parody assumptions about geographical familiarity made in books set in the capital—which I found hilarious.

All things considered, I thought this novel was exceptional, and I look forward to Clark’s future work.

I’m grateful to Newcastle City Library for lending me a copy of this book.

This 2021 novel by Jasper Gibson has been on my “to read” list since publication. I have been nervous to start it because I thought I would have a strong reaction to it, one way or another. And I was right: I thought it was brilliant.

The novel is a first-person account of living with schizophrenia, set in present day leafy East Sussex. Our narrator, Tom, has a first-class degree in law, and also hears the distinctive voice of the “Octopus God,” Malamock. Malamock also has the power to cause Tom to feel sensations, sometimes painful and sometimes pleasurable.

The central portion of the novel concerns Tom’s admission to a mental health ward. A doctor attempts to recruit him to a drug trial, possibly convincing or possibly coercing him to take part. There is a lot to reflect on the challenges of consenting to research, and also the complex decisions psychiatric patients must make about their treatments. Not everyone wants the voices to go away.

And what are the side effects? I don’t want any more side effects. They’re not usually on the side, are they? More in the middle. Slap bang.

There was also quite a bit in this novel about the fine line between religion and mental illness—always fertile ground—as well as reflecting the paucity of social and financial support for those with psychiatric illnesses.

Doubt is an article of faith and not its opposite.

I had expected this to be a fairly reflective novel, ruminating on mental illness—but actually, it is plot-driven with lively writing and plenty of humour. It was much the better for this.

I thoroughly enjoyed this, and Tom and Malamock will live long in my memory.

Thanks to Newcastle University Library for lending me a copy.

Published in 2022, this is a brief history of sixteen cathedrals. I decided to read it after seeing a review in The Spectator. As I’ve previously reflected, one of the major things the book made me consider was that—at least traditionally—cathedrals have had functions which span way beyond the sacred. As Wells puts it,

Between them, the cathedrals featured tell a narrative faith, intellectual culture, art, politics and economy.

In her introduction, Wells drew a comparison between buildings and books:

We can argue, quite plausibly, then, that buildings are books without words—and through their stones the dead may speak.

What I failed to realise before embarking on this tome is that while buildings may be books without words, I’m not necessarily all that interested in what they have to say. Most of this book was detailed histories of buildings with which I have no particular relationship. Therefore, while I’m sure these histories represent years of detailed research, if I’m honest, I found it all a bit dull. However, it did still give me some tangetial food for thought. This was, in part, because this isn’t normally the sort of thing I read.

Wells has a short section about the devastating fire at Norte-Dame de Paris in 2019. In the context of the histories of these 16 cathedrals, a devastating fire does not stand out at all: nearly all of them have suffered over the years. However, the response to the fire—to replicate and rebuild as closely as possible to what went before—is truly exceptional. In the history of these grand historic buildings, fires have generally been followed by modifications befitting the social and architectural mores of the time. This trend is also true of the York Minster fire of 1984, also briefly covered in the Wells’s book.

I remember feeling a tinge of disappointment when President Macron announced the plan to rebuild exactly what was destroyed. The announcement came after fevered speculation about possible new additions, and it felt a little dull. It wasn’t until I read this book that I also reflected on how historically anomalous it was.

I was reading earlier this year about an inspired campaign to introduce a new Grade III listing for buildings on ecological grounds: “The status would apply automatically to every building and it would come with just one rule: the property may only be demolished if it is structurally unsafe, or is given special dispensation by the local planning authority.”

It strikes me that preserving old building often means modernising them, not dunking them in aspic. And I think that’s what Wells made me reflect on most. Cathedrals were once ever-changing hubs of both religious and secular activity, adapting to serve society as the world changed. These days, they typically feel frozen in time, suspended in antiquity, serving more as curiosities than as community hubs.

Given the opportunity to redefine one of the world’s greatest Cathedrals for the 21st century, with a dash of modern relevant architectural flair, society shrugged its shoulders and said, “put it back like it was before.”

And maybe that means Cathedrals are over.

Thank you to the London Library for letting me borrow this book.

Published in 2015, this was Suzanne O’Sullivan’s first book, and it’s the first of her books that I’ve read. I was motivated to seek a copy after seeing excellent reviews of all of her books.

O’Sullivan is a neurologist, and in this book she discusses patients she has seen with psychosomatic neurological presentations, such as seizures, paralysis, and—in one particularly memorable case—blindness. Based on my experience, O’Sullivan is right to say that psychosomatic illness is not discussed in any great length during medical training. I took a lot away from this book as a result. In particular, it is always useful to be reminded that psychosomatic illnesses are no more under the patient’s control than those with organic causes.

The book is beautifully written, and I found O’Sullivan’s deep reflections on her practice and her uncertainties especially valuable.

Some quotes that I particularly liked:

Modern society likes the idea that we can think ourselves better. When we are unwell, we tell ourselves that if we adopt a positive mental attitude, we will have a better chance of recovery. I am sure that is correct. But society has not fully woken up to the frequency with which people do the opposite – unconsciously think themselves ill.

If you take one hundred healthy people and subject them to the exact same injury you will get a hundred different responses. That is why medicine is an art.

Anger has a purpose. It tells others we are not alright. It also has a lot in common with psychosomatic symptoms. It can be misleading because often it is something else in disguise – hurt or fear repackaged. It is easily misinterpreted, both by those who feel the anger and those at the receiving end. And its effect may be detrimental. It is frightening. The person at whom the anger is directed may well be compelled to flee, possibly just when they are most needed. Anger can destroy the relationship between patient and doctor. The doctor escapes or avoids or ends up treating the anger and not the patient.

There is a terribly delicate balance in the investigation of benign-sounding symptoms. One must investigate to rule out a physical cause if it seems necessary, but the line where investigations should be stopped is drawn very faintly. Primum non nocere. First, do no harm. If you investigate and find something incidental, what do you do? And when do you say no more tests?

Laughter is the ultimate psychosomatic symptom. It is such a normal part of the human experience that all its facets are universally accepted. Now all we have to do is take the few short steps to a new realisation. If we can collapse with laughter, is it not just as possible that the body can do even more extraordinary things when faced with even more extraordinary triggers?

I look forward to reading more of O’Sullivan’s books—especially her most recent one, The Sleeping Beauties, about mass hysteria events, as this crosses neatly with my professional interest in public health.

Thanks to Newcastle University Library for lending me a copy.