A few things I’ve been thinking about this week. The final post of a series of fifty-two.

Yes, this is a day early, but I’m starting something new tomorrow, and it would seem weird to finish a 2022 series on the first day of 2023.

So, we’ve finally limped to the end of the year of two monarchs, three Prime Ministers and four Chancellors.

And while the NHS is on its knees—or perhaps having collapsed—the Department of Health and Social Care has seen four Secretaries of State for Health this year, seven Ministers of State and seven Parliamentary Under Secretaries.

We can’t go on like this.

I can’t go on like this.

I had a moan about the Council cutting down trees a few weeks ago, so I feel it’s only proper to give credit where it’s due: I counted fifteen newly planted trees in green spaces on my way to work recently. We can but hope there will be more next year.

This article in Le Monde about EU nutrition labelling warmed my heart. It’s extremely difficult to summarise the complexity of the nutritional value of a foodstuff in a single letter. Any straightforward formula will inevitably throw up anomalies like the olive oil discussed in the article.

Yet, that very complexity is the reason that a simple indication is worth fighting for. It’s good to see the political effort going in to making it work, and also good to see people standing their ground and thereby helping to improve the end product.

The picture at the top of this post is an AI-generated image for the prompt ‘new year fireworks above a long queue of NHS ambulances, dramatic art’ created by OpenAI’s DALL-E 2.

A few things I’ve been thinking about this week. The penultimate post in a series of fifty-two.

On Christmas Day, I hope you’re finding peace and happiness in whatever you are up to, and whether or not you are celebrating.

One of work’s national leaders tied himself in such knots this week in his attempts to be religiously inclusive that he ended up robotically “wishing you all a wonderful set of end-of-year activities.”

No other Christmas greeting has ever made me laugh so hard and, while not his intention, perhaps that makes it the best greeting of all.

This week, I’ve been reading Heaven on Earth by Emma J Wells. In her section on the Notre-Dame de Paris fire of 2019, she talks about Father Jean-Marc Fournier running into the burning building to rescue

the Blessed Sacrament: the consecrated wine and host used in the Eucharistic ritual, which literally was, to Fournier, an act of saving Jesus himself from the flames.

How awesome his faith must be to risk his life for some bread and grape juice. And how fine the line between religion and madness.

Christmas is Alan Bennett’s diary in The LRB, but as it always appears in the New Year issue, this is (I think) the first year I’ve read it on Christmas Day. I enjoyed Richard’s Christmas morning walk, too.

The picture at the top of this post is an AI-generated image for the prompt ‘a robot in a Christmas scene, oil painting’ created by OpenAI’s DALL-E 2.

A few things I’ve been thinking about this week. The fiftieth post of a series of fifty-two.

For most of this week, the temperature in Newcastle has remained stubbornly subzero all day long. Our front door froze shut a couple of times and needed a good shove. Some of our outside pipes required defrosting more than once after icy blockages tripped the boiler. The wheelie bin was so firmly iced shut that I couldn’t persuade it open.

The layer of ungritted ice across most footpaths prevented me from walking to work for fear of slipping. One benefit of the local electric buses is that they’re heated before they’re sent out, so even the first services are pleasantly toasty. I’m not someone who typically feels the cold, but it’s been… cold. And I’m lucky enough to be able to afford to put the heating on.

On days when we have broken freezing point and some of the ice has melted, I have walked home from work. One wander was in freezing fog. I can’t remember ever experiencing that magical phenomenon of being surrounded by floating specs of ice glinting in the light before, but I surely must have.

While watching a medical education session online this week, I had the disconcerting experience of a question being put in the “Q&A box” by a “Simon Howard” that wasn’t me. It was, at least, a good question. There are three of us on the GMC register, so I wonder if it was my GP doppelgänger or my neurologist doppelgänger? From the question, I’d guess the former… but then perhaps they were in an allied profession. This wasn’t a session exclusively for doctors, and from misdirected emails to our very similar NHS mail addresses, I know there are non-medical Simon Howards out there too.

A few things I’ve been thinking about this week. The forty-ninth post of a series of fifty-two: I’ve decided not to continue writing weeknotes next year.

I want to do something a bit different for 2023, though I haven’t quite settled on what. The blog will turn twenty years old in May. This feels significant, though mostly reflects time plus inertia.

I’ve been reading Zadie Smith’s Intimations this week.

Writing is routinely described as ‘creative’ – this has never struck me as the correct word. Planting tulips is creative. To plant a bulb (I imagine, I’ve never done it) is to participate in some small way in the cyclic miracle of creation. Writing is control.

I’ve also been writing plenty of emails and briefings which boil down to “it’s under control, panic is the enemy here”.

When I am writing, space and time itself bend to my will! Through the medium of tenses!

I’ve long known and used the fact that “writing is control”, but never had such an elegant phrase to describe it. And in describing it so well, Smith has helped me to see for the first time the now obvious connection between creating control through writing at work, and marshalling my thoughts through writing at home.

Note to Paul McCartney: you may be one of the most celebrated lyricists in history, and you’re welcome to the singular ‘they’, but really I must insist on agreement between singular subjects and their associated verbs.

The choir of children sings their songs.

If you could record a small retake 43 years on, it’d really help me to have a wonderful Christmastime.

The backspace key on my wireless keyboard became a bit mushy this week. I prised it off to clean it, and in so-doing, snapped one of the retaining clips.

I got my spare wireless keyboard out, and was irritated to find that it wouldn’t charge.

But get this: replacement clips and keycaps are available cheaply for the first, and the batteries in the second can be easily changed.

After all the talk lately about ensuring consumer goods are repairable, not least for ecological reasons, it finally seems to be actually happening.

The images in this post are all AI-generated images for the prompt ‘computer keyboard with Christmas decorations’ created by OpenAI’s DALL-E 2. You’d have thought that a computer would have a better idea of what a computer keyboard looks like.

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

Having enjoyed the Channel 5 version twenty years ago, I decided to watch the Netflix take on the international game show format The Mole this week. I felt it lost something in the slickness of the production.

There was a baffling decision to include an obviously staged shot partway through the series, which all but confirmed the identity of the mole. I assumed this was being included solely to be back-referenced in the finale—the Channel 5 version had a whole ‘how did viewers miss that clue?!’ episode. But it wasn’t mentioned, so I’ve no idea why they included such a blatant spoiler.

I’d still watch another series, though.

It’s a while since I ranted about “whilst”. This week, I’m being involuntarily irked by people writing “utilise” when they mean “use”. Many would say that this is grammatically fine, but it nevertheless gives a similar sense of someone trying to complicate their language for effect, which is almost always a mistake in expository writing. Why obfuscate? What have you got to hide?

I’d also like to propose a ban on the phrase “just some of the”—as in “just some of the things in this issue” or “just some of the photographs from this event”. The “just” and “of the” are both unnecessary, their rhetorical function outweighed by the irritation caused by this phraseology being insufferably twee.

Public health bodies need stability and institutional memory. Their recent history in the UK shows little of either. UKHSA became fully operational in October 2021 as part of reforms to replace Public Health England (PHE). The government had introduced it under a different name, then spent £560,000 on consultants to provide it with a ‘vision and purpose’ – suggesting to some observers that ‘policy makers did not have a clear plan in mind’.

Indeed.

The images in this post are all AI-generated images for the prompt ‘The word “utilise” crossed out on a piece of paper’ created by OpenAI’s DALL-E 2. Every so often, the results are surprisingly inaccurate.

I’ve nine books to tell you about for November, some of which were better than others.

Sombrero Fallout by Richard Brautigan

Before picking up this book, I’d never heard of Richard Brautigan, the American author who died the year before I was born. I decided to read this 1976 novel of his after an acquaintance told me that this was the book they used to judge the quality of a bookshop: only shops stocking Sombrero Fallout were worth visiting. I’ve since learned that this is something Jarvis Cocker says in the introduction to the recent Canongate edition, so not quite as quirky and original as I’d imagined.

Yet quirky and original this short novel certainly is, one of the most singular and enjoyable books I’ve read this year. The eccentric plot concerns an American humorist who has recently split up from his Japanese girlfriend. He starts a new absurd story about a sombrero falling from the sky in a small American town, but discards it after a few paragraphs. However, the story takes on an increasingly preposterous life of its own within the waste paper basket. The book interleaves this developing story with chapters about the humorist and chapters about the Japanese girlfriend. The chapters are rarely longer than a couple of pages, and frequently much shorter.

The writing is surreal and very funny. Brautigan makes some quotable and yet delicate observations about the nature of life, love, longing, and loss. The overall effect is utterly beguiling.

There is something about Brautigan’s writing in this book that reminds me of Italo Calvino, whose worked I loved. I’ll be seeking more.

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

Small Things Like These by Claire Keegan

My sole reason for picking this up was the Booker prize long-listing. Being nominated for a Booker doesn’t necessarily mean I’ll enjoy a book. But, with a book as short as this, and one with themes of ‘compassion’ and a ‘stern rebuke of sins committed in the name of religion’—the sort of thing that’s right up my street—it seemed worth giving it a go. I’m glad I did.

This short book was brilliant. It’s about morality, and in particular the contrast between the morality of the ordinary person contrasted with the morality of the Catholic Church. It excoriates the latter for its treatment of unmarried women.

The novel is mostly set at Christmas, in 1986, in Ireland. The central character is a coal merchant with a wife and five daughters. He knows that he could have expected much less as the son of an unmarried servant, especially one whose mother died young. His own experiences and moral attitudes are brought into sharp contrast with those of the local convent and Magdalen laundry after an experience while making a coal delivery.

The style of writing is beautifully concise and precise, and the novel as a whole packs a punch far beyond that which its page-count would suggest.

I will definitely be seeking more of Keegan’s work.

With thanks to Newcastle Libraries for lending me a copy.

Islands of Abandonment by Cal Flyn

This much-recommended book by the Scottish investigative journalist, published in 2021, examines areas of the world which have been abandoned by humans for a wide variety of reasons. From this, she tries to imagine the future of Earth post-humanity (or as Flyn sometimes proposes, after the ‘mammalian era’), and also tries to understand how the end of humanity might arrive.

This sounds terribly depressing, but this is actually a book rooted in hope and beauty, celebrating the power of nature to rebound and adapt. There’s also a fair about of interesting public health stuff in Flyn’s discussion: I was particularly struck by her understanding that after the Chernobyl disaster,

Overall, poverty-linked ‘lifestyle diseases’ and poor mental health pose a far greater threat to affected communities than radiation exposure.

I also especially liked this line from her conclusion, which crystallised many vague thoughts I’d had while reading:

Faith, in the end, is what environmentalism boils down to. Faith in the possibility of change, the prospect of a better future – for green shoots from the rubble, fresh water in the desert. And our faith is often tested.

This was beautifully written, hopeful, and taught me a lot that I didn’t previously know on a whole gamut of topics, from supervolcanoes to how feral cows behave. It was superb.

Foster by Claire Keegan

I picked this up as a result of enjoying Small Things Like These by the same author. It’s another very slim, single-sitting novel set in Ireland which explores societal themes. In this case, the main theme is family.

A young girl is sent from her large, struggling family to stay with foster parents for a few months. We see, through the eyes of the child, the differences between the two family settings, and watch as—over the course of a few short months—she grows and matures.

Like the other novel, this is beautifully written with precise language, the author clearly having weighed every word. The plot here is simple and unremarkable, but Keegan’s eye for detail and realism turn it into something extraordinary.

I think I enjoyed Small Things Like These a dash more, but perhaps that’s only because I read it first and so Keegan’s remarkable style was new to me. Foster is definitely to be recommended, too.

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

Under Pressure by Richard Humphreys

This 2019 memoir of serving onboard a Polaris nuclear submarine has been on my ‘to read’ list since it was published. It was pure prejudice that meant that it languished on the list: I imagined it was going to be an interesting account of an unusual occupation, but probably written from the exhausting point of view of a navy-lifer with a proselytising view of military service. I was wrong.

Humphreys’s account of his training and subsequent service was illuminating and insightful. His reflections on his mental health, and that of fellow servicemen, particularly in the context of unacceptable bullying and humiliating behaviour from those higher up the chain of command are arresting.

Humphreys also writes elegantly about the philosophical aspects of serving on a nuclear submarine, and the duty to carry out actions which would almost certainly lead to the end of humanity. These are fascinating debates in the abstract, but Humphreys personal experience offers a unique, novel perspective.

I never imagined I’d race through any memoir of military service, but this had me hooked.

With thanks to Newcastle Libraries for lending me a copy.

Summerwater by Sarah Moss

I chose to read this short novel, published in 2020, because I previously enjoyed Moss’s Ghost Wall. Summerwater is a similarly atmospheric novel, and I think perhaps I enjoyed it slightly more.

The novel is set on a single rainy day on a Scottish caravan park, near a loch. Each chapter follows a different character staying on the park. While each narrative occasionally mentions the other characters and groups, the whole ‘population’ doesn’t come together until the final section. Between each of the chapters is a short section of writing about the surrounding natural world.

Moss’s crisp writing evokes a claustrophobic, oppressive, tense atmosphere, that somehow also felt entirely relatable.

I don’t think it’s a spoiler to say that the final five words, as ordinary as they are, sent chills down my spine and will stay with me for a long time.

With thanks to Newcastle Libraries for lending me a copy.

The Prison Doctor by Amanda Brown and Ruth Kelly

This memoir of a GP’s decision to leave her village surgery and pursue a career in prison medicine has been on my ‘to read’ list since it was published. I put off reading it for a few years because too much of my health protection day job had come to involve prison outbreaks, so I thought it might be too close to home. Two sequels have been published in the meantime, which gives some idea of the book’s commercial success.

The book has three parts: the first covers Brown’s decision to leave general practice, and—in some ways—I found this the most interesting section. Although the change was different, the process and feelings Brown described reminded me of my experiences of moving from hospital medicine into public health. The second section discusses Brown’s early prison career in young offender institutes and men’s prisons, including clinical stories of some prisoners alongside her training and career development. The last section concentrates on her time working in a women’s prison, and concentrates almost exclusively on the clinical vignettes.

I was left with mixed feelings. The book had a certain ‘fictive sheen’, with events and stories feeling neatly contained and complete in a way that’s rarely true in medicine. I’m convinced this is a consequence of changing details to anonymise cases and perhaps creating compound characters, but it just felt a little false. The dialogue also felt awkwardly written, without any ring of authenticity.

On the other hand, this neatness of story and writing made this an effortless read, and Brown and Kelly still gave interesting illustrated insights into the lives of prison medics and their patients… so maybe the slightly ‘glossy’ writing is worth it.

The Red Notebook by Antoine Laurain

This 2014 French novel was translated by Emily Boyce and Jane Aitken, two of the three translators of Laurain’s The President’s Hat, which I previously enjoyed.

This novel is in the long tradition of blind love stories. A woman is mugged and left in a coma. A man finds her discarded handbag and, using its contents, tracks her down and falls in love with her, without ever having met her.

I found this a bit inauthentic and twee. It has the warm tome of The President’s Hat, but is a little too humdrum and unimaginative to have the same charm. The plot was too predictable to be truly engaging, and the behaviour of the central character seemed to me to cross the line into being creepy rather than romantic.

With thanks to Newcastle Libraries for lending me a copy.

Bittersweet by Susan Cain

I have long had a theory that melancholy is under-appreciated in modern British society. I feel especially strongly about this in connection with Christmas. I think Christmas is naturally a time which combines happiness and melancholy, but increasingly, the infantilisation of British society sees it treated exclusively with childlike chirpiness.

All of this led me to believe that I’d find much to enjoy in Bittersweet, Susan Cain’s recent book on the place of sorrow and longing in society, especially as I’d enjoyed her previous book, Quiet.

However, I was a bit disappointed. This felt too focused specifically on American cultural norms for me as a British reader, and it felt focused on a particularly narrow slice even of that society. It felt like there was a certain credulity in the author’s quoting of messages shared on retreats and at narrowly focused conferences.

Bittersweet felt like a memoir of a personal journey into understanding various broadly New Age concepts, presented as popular science—and as a result, it just wasn’t up my street.

With thanks to Newcastle Libraries for lending me a copy.

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

I experienced my first frosty, occasionally slippery walk to work of the season this week. I didn’t fall, but given my level of clumsiness, this is unlikely to last.

Newcastle City Council has an appalling reputation for felling trees in questionable circumstances. It shames the city. I feel much more strongly about this after reading The Overstory by Richard Powers and The Island of Missing Trees by Elif Shafak; fiction sometime has unexpected consequences.

There’s a beautiful mature tree that I walk beneath on my route to work, so eye catching that I snapped a photo from underneath it back in May:

This week, it’s lost a little of its lustre:

This particular tree isn’t in an area managed by the Council, but by Urban Green, and perhaps there was a good reason to kill it. Yet, perhaps for the first time in my life, I feel a bit sad about the death of a tree.

If I’m honest, I’m not 100% sure it’s the same one as in the earlier photo: but even if not, it’s a close neighbour, and next May’s walk through leaf-filtered dappled sunlight will have an unfortunate gap.

Some days, I’m subjected to the 0830 “birthday” slot on Heart radio with Jamie Theakston and Amanda Holden. The sentiments are always overwrought and a little nauseating, but I can’t help but be impressed by how tightly produced it is. The scripting flows beautifully, the handoff between presenters and pre-recorded phone calls and voice notes is always flawless, and the segment is always neatly wrapped. They seem to do it live: if they do, then it is a feat of live radio production that exceeds anything else I hear all week.

I was in Leeds this week: it rained, as it does every time I visit, but at least I now know why. It rained orographically… probably.

I’ve changed my mind on something this week.

I’ve always maintained that it’s operationally impossible and democratically undesirable to remove the NHS from any form of political control. The NHS accounts for a considerable proportion of public spending, democracy is how we influence public spending, politics is how we choose to do democracy, and so all are irretrievably connected.

But I’ve come to realise that the sole hope for the survival of the NHS is insulating it from politics. Over a day of my working week as a doctor this week has been spent in meetings trying to work out how Integrated Care Boards (ICBs) should / do work. Also this week, the Secretary of State for Health has been pontificating about the NHS having too many ‘bureaucrats’.

ICBs are a Tory innovation introduced this year, replacing CCGs, which were a Tory innovation in 2012. We’re in a situation where a populist politician is criticising and disavowing their own Party’s approach to the Health Service, even as doctors are spending time trying to enact it. This is no way to run any essential service, but least of all a health service.

We need a new approach. We need independent management coupled with independent evidence-based prioritisation of cost-effectiveness, in the manner of NICE. We need some democratic input into that evidence base, to work out how to value what outcomes, perhaps through some sort of citizen jury. We need the Government to simply set the funding level, the consequences of which could be independently described by a health service equivalent of the Office for Budget Responsibility.

In other words: make the politics about the level of funding, have an element of non-political democracy in the value judgements which inform prioritisation, and let the service be independently managed.

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

This week has felt a little relentless… and there are still five days of this twelve-day stretch to go. I took my brother’s birthday present to the Post Office earlier this week but had forgotten to write the address on it: this is a measure of how fried my brain has become. Luckily, they were willing to lend me a Sharpie.

The Jehovah’s Witnesses on my local high street have been promoting a course called “Enjoy life forever!” this week, and I can’t help but think that this sounds more like a threat than a desirable outcome.

It’s been seven months this week since—after much dithering—I abandoned paper notebooks completely and dived into an electronic alternative. It’s been fine.

I think the secret to my success this time has been simply to replicate my paper-based habits. I’ve previously tried to tag and file things in logical ways, which just creates additional mental load for only marginal benefit.

Finding things by “flicking back” as I used to in paper notebooks is mostly adequate. Having the ability to search electronically is a clear additional benefit, as is the ability to jot something down in my notebook by whipping out my phone on the walk to or from work.

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

Wendy and I went to see Norwegian favourite Sigrid this week. She’s remarkably talented. She seemed a little taken aback by the warmth of the Geordie welcome.

We also went to see Kazuo Ishiguro’s new film, Living. It’s adapted from the 1952 Japanese film Ikiru (which I’ve never seen), which was in turn adapted from the Tolstoy novel The Death of Ivan Illych (which I’ve never read).

It’s the first film I’ve ever been to where the usher offered tissues as we left. Wendy said it was a little like having one’s heart ripped out and stomped on for a while, but that it was also a quite uplifting. I was surprised by quite how similar the film was to Ishiguro’s novels—possibly moreso than the films of his novels.

I’ve been trying over the last few months to attend training events on things that I know nothing about and which are tangential to my day job. My theory is that knowing a little bit about things that might one day cause major problems in my work is probably better than total ignorance.

To that end, I’ve recently been to a fascinating Met Office session on space weather, and this week have been to a frankly terrifying session on lithium-ion batteries and a remarkably jargon-free one on PSTN switch-off. All three are linked by inducing a similar feeling of “this is a disaster waiting to happen, and nobody has thought it through.”

Which, I suppose, shows the value of attending.

I’ve been trying to buy myself some new glasses this week, but can’t find any that fit my oversized head. This is always an issue, but I don’t think it’s ever been quite this bad before: there are whole websites and high street shops which don’t stock any frames whose legs are as far apart as my temporal bones. At this rate, I’m going to have to go 1880s-style and procure some pince-nez.

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

My car had its sixteenth MOT this week, if you count each of the five failed tests which were repeated after repairs. These precious failures were attributable to an expired light bulb (twice), a worn tyre, a damaged valve stem, and a corroded brake pipe. I could tell a light bulb from a tyre, but not a valve stem from a brake pipe.

This week, for the first time since 2019, it passed without requiring any repairs.

I visited the celebrated exhibition of the Lindisfarne Gospels at the Laing this week.

The loan of the Gospels from the British Library has been frequently described as a ‘homecoming’. This invites consideration of whether this artefact ought to be returned to the region, a sort of in-country version of the endless debate about return of the treasures the British have stolen over the centuries. The bespoke film installation by Turner Prize winner Jeremy Deller seems to play on that theme, and Ruth Ewan’s collection of local ‘treasures’ also seems surprisingly provocative in that context.

I’m not convinced that a Lindisfarne relic being kept in a display case 60 miles from its ‘home’ is all that morally different to it being on display 350 miles from ‘home’. I’m not certain that displaying a religious relic in a secular setting is quite right. But I’m also not certain that modern British Christianity has much in common with the ‘dragons and sea monsters’ version brought to these shores a millennium ago. So, I’m not sure what the answer is to any of this.

Wendy and I inadvertently caught five minutes of the BBC series The Repair Shop this week. It’s an enormously popular programme I really don’t enjoy: it seems to encourage an object-driven sentimentality and nostalgia that I find depressingly backward-looking.

It often feels like the opposite of using the lessons of the past to build the future; it feels like wallowing in rose-tinted recollections, trying to live in a sanitised version of the past, and weirdly accepting credit for things in which only people’s ancestors were involved. This obviously isn’t always true for every item, but (based on my very limited sampling) it does seem to be the dominant tone of the programme.

The bit we saw involved a couple being presented with a restored spinning wheel. Neither of them knew how to use it nor had any practical need of it. Would the world not be a smidgen better if it had, instead, been given to a science museum to support knowledgable presentations on the Industrial Revolution that supplanted it? Would the programme not have been a little more worthy if it looked forward, and talked about protecting our natural resources by managing our old technology responsibly rather than leaving it in a house to degrade for 100 years? Or made a point about the energy intensity of the production of thread, and encouraged us to recycle used textiles?

The skill of the restorers featured in the programme is undeniable, but I find the tone and sentimentality of the programme unappealing.