War stories…. World War Two edition (2)

Buried in the jungle

I’m trying to find the quote from an old writer about the things that a fulfilled man must do with his life. It included going to war**, yet many people who have been in actual combat found it horrible and suffer still, despite the intensity of the experience and the irreproducible camaraderie induced by your lives being dependent on each other. They are a smaller group than everyone who actually served in uniform- for every single combat marine in the US Pacific campaign there were about 19 other members of the armed forces in logistics, engineering, supplies, catering, transport and so on.

So this is the second, in a short series

The Chindits in Burma, 1943 –

At the time of writing, today’s patient is still alive – 99 going on 100. A tall distinguished looking fellow, he had a relatively ordinary job back in civilian life, and is pretty healthy, despite the need for various operations. He is always quite happy to reminisce about his time in Burma with the Chindits.

If you want to know how tough these guys were, and what they suffered behind enemy lines, mostly in the jungle, read John Masters’ quite extraordinary – and horrific – account of having to shoot their own wounded. My man has numerous stories – fighting naked because of the damp and the ever present dysentery (this is different from their slightly crazy founder, Orde Wingate’s, propensity for wandering around naked); waiting for air drops knowing that the Japanese would also benefit from these clues to their location; having, amazingly, colleagues killed by an airdrop landing on them; hand to hand fighting with knives, in the jungle; blowing up Japanese installations when you’re a long, long way from safety….how do you return to ‘normal life’ after experiences like these?

..it might look nice, but…

And they were pretty effective, not just for morale at a time when Japan was looking like a most formidable enemy. This excellent account of the 1943 Operation Longcloth tells you what you need to know. Although David Stirling started developing the unique capabilities of the SAS in 1941, Wingate’s not dissimilar long range, behind enemy lines work – with the added challenge of much larger numbers of men – was pioneering and not universally accepted. As he said at the time “If we succeed, we shall have demonstrated a new style of warfare to the world”.

The Japanese were the most brutal of opponents, as everyone knows these days – although I believe that Japanese schools still play down the extent of this – and compared to urban fighting in Europe against opponents with possibly similar values, the risk of capture was too much to contemplate – hence Masters’ impossible decision – not unlike ISIS in recent times. To quote John Hutchin, a veteran of the campaign, on how he was left behind by his fellow soldiers suffering from exhaustion with three days’ rations and a clip of ammunition.

“I’ve only got one nightmare left, and that is being left”

Hutchin in fact made it, but many didn’t. To contemplate that as my patient does, and the near impossible nature of their mission, from a vantage point of  74 years later, as one heads for centenarian status is something that I – as someone who has never been to war – can barely comprehend.

A risky airdrop


**though this quote from Ilya Radozhitskii’s  campaign memoirs, relating to Napoleon’s disaster in Russia, resonates here:  A military career, thus, occasionally presents experiences that do not exist in civilian life. The war reveals all of the human horrors and miseries that make our souls tremble, but they also elevate us amidst these dangers. He who has not been to war has not learned how to despise death. The ordinary tribulations of civilian life are nothing compared to the calamities of war where neither sighs nor tears could change anything. Their source soon runs dry and the warrior’s heart hardens like steel with which he brings death to the enemy.


War stories…. World War Two edition (1)

A 400kg bullet ridden bronze nazi eagle, anyone?

When I graduated in 1986 I spent a lot of time as a junior doctor admitting elderly patients to hospital. So if my patient was 90 they were born in the Victorian era, and the men would frequently have served in the First World War, with the stories to go with that. The last WWI veteran of the trenches, Harry Patch, died in 2009. They’re all gone, along with their astonishing oral histories.

These days the average Second World War veteran is 90ish. There are still plenty of them, but they’re disappearing rapidly. A few years ago in the US, it was estimated that they were dying off at 600 per day.  So when I get in a patient – male or female – in their late 80’s or 90’s, I always ask them what they did in the war, and they certainly have stories to tell.

I thought I’d summarise just a few of them. These remarkable pensioners are living history. Bear in mind that these are the most ordinary and unassuming of elderly citizens, living out their retirements without much money, in an average British town. You would not notice them in the street.

The Battle of the River Plate, December 1939

Here’s the Wikipedia summary:

 The German panzerschiff Admiral Graf Spee had cruised into the South Atlantic a fortnight before the war began, and had been commerce raiding after receiving appropriate authorisation on 26 September 1939. One of the hunting groups sent by the British Admiralty to search for Graf Spee, comprising three Royal Navy cruisersHMS ExeterAjax and Achilles (the last from the New Zealand Division), found and engaged their quarry off the estuary of the River Plate close to the coast of Uruguay in South America. In the ensuing battle, Exeter was severely damaged and forced to retire; Ajax and Achilles suffered moderate damage. The damage to Admiral Graf Spee, although not extensive, was critical; her fuel system was crippled. Ajax and Achilles shadowed the German ship until she entered the port of Montevideo, the capital city of neutral Uruguay, to effect urgent repairs. After Graf Spee’s captain Hans Langsdorff was told that his stay could not be extended beyond 72 hours, he scuttled his damaged ship rather than face the overwhelmingly superior force that the British had led him to believe was awaiting his departure.

My patient was on HMS Ajax, I think. He recalls the early skirmishing and the battle, but his fondest memory was something different. When the ships got into neutral Montevideo – which then and now had various links with Britain, the sailors all piled into the bars to get hammered. The surviving crew of the Graf Spee did the same thing. After all, they had 72 hours to kill.  With the tension out of the situation he recalls just how jovial it was, and how well the Germans and the Brits got along. A sort of “Christmas in the trenches” in sunny South America. He told me all this about 70 years after the event, and the memory was still vivid.

hl1The Graf Spee is still there. Its captain, Hans Langdorff, a decent man in the way he treated prisoners, shot himself 6 days later, lying on his boat’s battle ensign in a Bueno Aires hotel room. The bronze eagle from its stern has been salvaged, and to my knowledge, no-one knows what to do with it.

The NHS: decline and fall?

I’ve worked in the NHS for 32 years, man and boy, so to speak.

I don’t do private work, though I don’t have an issue with it ideologically.

I admire Bevan and Beveridge who kicked off the whole enterprise in 1948, although I’m pretty sure that they’d be horrified by what much of the NHS and the associated welfare state has become.

We do seem however, to be approaching an NHS End of Days scenario, by which I do not mean the ludicrous cry of “they’re privatising the NHS”. ‘They’, generally speaking, are not capable of such sophisticated thinking, and ‘they’ are unable to tame the behemoth of NHS spending. It’s probably not possible under the current provision. The answer is not more money.

It’s always interesting to gauge what outside healthcare providers think of the NHS. When I get tourists and similar in as emergencies, they often can’t believe that all this is ‘free’. It isn’t of course, if you pay tax, but you know what they mean. The unappealing spectacle of billing and insurance checks is absent from our clinical areas. But what seemed free, high quality and good value, has been overtaken by hangers on, from the shop floor to the upper tier of government. Everyone wants a slice of the pies – both the goodwill and ‘nobility’ associated with providing healthcare, and also the financial rewards*** embedded within its now enormous bureaucracy.

Here is Ted Noel, a retired US anaesthetist, musing on the problem:

Bevan succeeded, but his victory is being erased by the Law of Subsidy**. What was sold as a boon to the poor has become a subsidy for bureaucrats. The Law of the Bureaucrat declares that while a bureaucracy may have been created to deal with a perceived problem, the bureaucrat’s Prime Directive is to ensure that he has a job forever. And because he was appointed to solve the problem, he’s smarter than everyone else and should be paid accordingly.

Perversely, the bureaucrat can never solve the problem, or his job would disappear. So he continues with the language that created him, trying to sell greater and greater funding for his failed enterprise. And when it fails more dramatically, he blames anyone but himself, and gets rewarded with a bigger budget. Ultimately, as Margaret Thatcher famously quipped, “The problem with liberalism is that eventually you run out of other people’s money.”

The Law of Subsidy has killed the NHS. It just doesn’t realize that it is dead. But thousands of those it was created to care for are dead, because it simply cannot fulfill its promised goals.

He may be right.

…good times


**The Law of Subsidy says that “When you subsidise something, you get more of it and it gets more expensive.”

*** subsequent to this blog post, here’s a nice confirmatory piece from the estimable Max Pemberton

Ash Wednesday

I usually blog on this with a painting – Goya, Bruegel, Spitzweg (genius) and more. I was prompted today to look at Rembrandt’s** late work, The Return of the Prodigal Son, which, if you know the parable, is highly apposite for Lent. Wikipedia is good on this. Kenneth Clark called it “a picture which those who have seen the original in St. Petersburg may be forgiven for claiming as the greatest picture ever painted” –  a fairly high bar, I’d say.

Henri Nouwen had a more overtly human and religious take on it, expressed very poetically: “Rembrandt is as much the elder son of the parable as he is the younger. When, during the last years of his life, he painted both sons in Return of the Prodigal Son, he had lived a life in which neither the lostness of the younger son nor the lostness of the elder son was alien to him. Both needed healing and forgiveness. Both needed to come home. Both needed the embrace of a forgiving father. But from the story itself, as well as from Rembrandt’s painting, it is clear that the hardest conversion to go through is the conversion of the one who stayed home”

We’ve all been there, and we will be again.

Rembrandt, The Return of the Prodigal Son, 1668. The Hermitage, St Petersburg


**The Knife is in awe of a few painters, Rembrandt is one of them: 1, 2, 3, 4

“Brava, la Fallaci. Brava.”

…she even made selfies look cool…

Eight years ago, in one of the earliest pieces in this blog, I wrote what was effectively a fan’s homage to one of the great women of our time, writer and journalist, Oriana Fallaci. I think it still reads well. Fallaci was something of a prophetess, of an uncompromising and ballsy kind, who could write and argue with great vigour and effect. She was a populist in the tackling of difficult (and dangerous) issues, such as Islamic terrorism. Here is Christopher Hitchens’ profile of her, in some ways a kindred spirit.

She died of cancer in 2006, happily dismissive to the end, of some early social justice warriors who were trying to get her prosecuted.

The people who use the word ‘populist’ in a contemptuous way now, would likely hold Fallaci in contempt too. I doubt though, that they would express it to her face.

All this is a preamble to an excellent piece by the Fallaci of our time (sort of), the tireless Douglas Murray, in the enduringly excellent magazine for the brainiacs of Western Civilization, Standpoint. Feel free to read my blog post too, but here, describing one of her most famous encounters, is Murray:

In the early 1970s she had conducted an interview with the Shah of Iran, in which he discussed the visions he believed he had received. The resulting piece was so damaging that when Ayatollah Khomeini came to power he granted Fallaci the only interview that any Western journalist would ever get with him. They met in Qom in 1979, where the Ayatollah discovered that just because Fallaci disliked your enemies it did not follow that she would like you. When the Ayatollah claimed that the Iranian revolution which he was heading was animated by love she replied, “Love or fascism, Imam? It seems like fanaticism to me, the most dangerous kind: the fascist kind.”

The full version of the Khomeini interview remains one of the greatest pieces of reportage of the 20th century. Not just for the scoop, or the intricately revealing lead-up to the encounter, but for what Fallaci did during it. Forced into a chador in order to enter the Ayatollah’s presence, she ended up in a row about why women should be forced to wear such a garment, and became so enraged that she stood up and ripped off “this stupid medieval rag”, letting it fall to the floor “in an obscene black puddle”. At which “like the shadow of a cat . . . he rose so quickly, so suddenly, that for a moment I thought I had just been struck with a gust of wind. Then with a jump that was still very feline, he stepped over the chador and he disappeared.”

It should be noted though, that the newly labelled fascist fanatic Khomeini later reappeared and finished the interview.

She certainly had something.

Knifonomics (part 39): we’re all the same


I haven’t blogged in this area for more than a year. What is there to say, other than Trump’s tax cuts will be interesting to watch, given the positive precedents of Kennedy, Reagan and Thatcher .

However, public spending brings out the worst in politicians, in terms of pandering to various interest groups – at all points on the political spectrum – and the persistent inability to cut back. Cutting back, not because of a desire to hammer ‘the poor’ etc, but more because the fabled future generations will be saddled with the potentially unpayable bill.

The can is always licked down the road (see also NHS management techniques).

However, here in Western Europe, there is a view that the USA is different, and that greedy capitalists have failed to apply a welfare state type of safety net. Not so however. Virtually everything in this passage on the new bipartisan US budget deal applies to pretty much all developed economies in Europe and North America. Singapore, not so much.

Of course, last week’s agreement has some virtues. You can’t spend so much money and get nothing in return. We may be spared another government shutdown over the budget, because the agreement sets spending levels for two years. Similarly, the agreement suspends the federal debt ceiling — how much the government can borrow — through early 2019. This presumably postpones another self-destructive debate over whether the government should default on its debt, damaging its credit rating and flirting with a financial crisis.

In truth, much of the spending authorized by the agreement is desirable. Future deficits have been wildly underestimated, because projections for defense and non-defense “discretionary” spending were unrealistically low. On defense, Obama’s budgets reduced readiness, left the services too small and made it harder to counter new technological threats, most notably cyberwarfare. There was a similar squeeze on many vital domestic agencies, from the Internal Revenue Service to the National Parks.

To some extent, the new agreement represents a catch-up from this stringency. Meanwhile, so-called “entitlement” programs such as Social Security and Medicare — for which people automatically qualify — were largely untouched. They represent about 70 percent of federal spending. Together, costly entitlements and expanded discretionary spending produce enormous deficits, exceeding $1 trillion a year, as far as the eye can see. 

That’s a huge gap — roughly 5 percent of our gross domestic product — to close or shrink. Most politicians are can-kickers. They want nothing to do with the necessary tax increases or spending cuts, including possible reductions in Social Security, to curb the out-of-control deficits.

Ignoring them seems to involve few economic or political costs. The extra borrowing caused by deficits hasn’t sent interest rates sky-high. Indeed, after the Great Recession, deficits helped the economy recover. Now, despite our political and social problems, foreigners still seem happy to hold U.S. Treasury securities as “safe” financial assets. In general, the public doesn’t seem aggrieved by big deficits, especially when compared with the alternatives.

How many people know that 70% of US federal government spending goes on social security and healthcare? I’m not sure exactly how the two compare, but in the UK it’s half that, 34%. The single biggest chunk is on pensions, of course. And the public, by and large, are happy with it.

We are indeed, all in the same boat. Except Singapore.


Twattish comments: an occasional series – Gerry Adams

How do you intend to remember famed terrorism enabler, liar and hypocrite, Gerry Adams, as he heads for an overdue retirement? Here is Gerry’s own take:

“I am a very good dancer, I sing extremely well, I am a half-decent cook, I have written a wee bit, I like walking, but I’m comfortable in my own skin and I am surrounded by some wonderful people, a great family, my wife, people who love me.”

A walk down memory lane with Gerry might take you to Omagh

In fact, Gerry’s only positive achievement is probably that he once made Eddie Izzard seem funny, for the first and last time:

…he has a point…


Great Landscapes: when near Rome..

Thomas Cole was an American painter of the famous Hudson River School, though slightly bizarrely, he was actually born in Bolton, Lancashire. Famous and successful in his day, he did the obligatory Grand Tour to Italy in 1842, six years before he died at the age of 47. He had the requisite technical skills, certainly, but if you had to pin down what made him special, it was, I think, a sense of grandeur and otherworldly numinosity. A kind of large scale American version of Caspar David Friedrich, with a touch of the classicism and ethereal light that Turner and Claude Lorrain had mastered.

To a degree he is the victim of the kind of snobbery that relegates him to second tier status in the art world. If you were to dilute him down to the most basic elements, you might end up with someone like the gifted commercial sentimentalist, Thomas Kinkade.

In any event his Italian paintings are terrific, and here’s one of them:

Thomas Cole, Ruins of Aqueducts in the Roman Campagna, 1843. The Wadsworth Athenaeum, Connecticut

Which came to mind when I stumbled upon a magnificent landscape by Edward Lear, ‘nonsense author’, of the pyramids at Giza. I had no idea what a great artist he was. Having explored his stuff a bit, I found this:

Edward Lear, In the Campagna Near Rome, 1844

I’m not sure where it’s held these days, but note that it’s almost contemporaneous with Cole’s work. Lear had a long life and spent about 5 decades travelling on and off, mainly in Europe, at a time when that was obviously a bit more arduous than today. Both paintings are magnificent.

Before them both though, in 1826, was Camille Corot, with a much simpler style, but the same magical effect:

Jean-Baptiste-Camille-Corot, The Roman Campagna with the Claudian Aqueduct, 1826. The National Gallery, London


You can of course still see this scene, at the Parco degli Acquedotti, only a few miles from the city centre. The Roman engineering of the Aqua Claudia and associated structures is astonishing, but the photographs can’t compete with painters.

The statue of Christ being transported in the opening scene of Fellini’s La Dolce Vita
The Porta Maggiore in 1896, the Aqua Claudia is the upper channel
The Aqua Claudia in the Campagna


How to write (an occasional series: 2)

A nice profile in the FT, of a writer that I’d never come across, Denis Johnson, who died last May. Sounds like his stuff is worth a try, but I’m quoting his description of a writer’s life here. A lyrical ode to his modus operandi. Sounds kind of fun, and blogging is, perhaps, its pale imitation:

Denis Johnson

“Writing. It’s easy work . . . You make your own hours, mess around the house in your pajamas, listening to jazz recordings and sipping coffee while another day makes its escape . . . Bouts of poverty come along, anxiety, shocking debt, but nothing lasts forever. I’ve gone from rags to riches and back again, and more than once. Whatever happens to you, you put it on a page, work it into a shape, cast it in a light. It’s not much different, really, from filming a parade of clouds across the sky and calling it a movie — although it has to be admitted that the clouds can descend, take you up, carry you to all kinds of places, some of them terrible, and you don’t get back where you came from for years and years.”

It seems appropriate to add a little jazz.

1001 things wrong with the #NHS (998): Committees

Pretty simple, and universally applicable

The Knife has done lots of formal hospital management, though on the principle of ‘quit while you’re ahead’, I voluntarily stepped down quite a while ago. I don’t hate it, usually, but I prefer clinical work by far, and if I leave this earth having done any good, it’ll be in the latter sphere, by a long way. If you step too far away from the clinical stuff, you start to act and think differently, ego takes over and your peer credibility dies.

That’s guaranteed.

That said, it’s an interesting milieu, not least because of the subterfuge, inconsistency and indecision that abounds, usually combined with declarations of ‘caring’. The much hated private sector – which happens to constitute most of the healthcare in the developed world – would never tolerate the crap that goes on. (For the record, I do no private work.)

And today, as it happens, was one of the most gruesome** management meetings that I’ve ever attended – I won’t bore anyone with the details, but it was actually depressing. It was an absurdly large group attempting to share a process that neither needed it, nor was amenable to it.

Where to go for solace, some reassurance that my negative feelings are in fact appropriate?



….the author is talking about restructuring the playing season for American football. The key quote is “committees are what insecure people create in order to put off making hard decisions”. It’s nice to be inclusive, if possible, but it’s no surprise that the phrase ‘design by committee’*** is never used in  complimentary way.

Even worse than that is that such large unwieldy groupings always contain people with nothing to lose, no axe to grind, and indeed no expertise worth having. As any endocrinologist will tell you, a negative feedback loop is an essential regulatory part of a well functioning system. You need people with what Black Swan author and polymath, Nassim Nicholas Taleb calls ‘skin in the game’ (1, 2). I don’t want my clinical practice parameters decided by a committee of people without skin in the game. Nor would they, if it was their area, and nor would my patients want it.

What’s the answer to this?

Well, here is the same author. I agree wholeheartedly with it, not least that it’s coming on the back of a riff about the uselessness of management consultants (who should be barred from the NHS)…


…for money, read clinical practice.

You can guess the author, I would imagine


**if you want to know how gruesome the NHS can be, this vivid account (spoiler: bad language), gives a fair appraisal of a bad spell. I did not write it!


***As advertising pioneer and author of Confessions of An Advertising Man, David Ogilvy said: ‘Search your parks in all your cities. You’ll find no statues of committees.’