The logo that spells discord

We’re getting terribly excited in London about the forthcoming Olympics, now less than a year and a half away. The place is being absolutely plastered with the logo.

Ubiquitous logo

Those Olympics are already proving a tremendous success. As is well known, the primary purpose of the Olympic movement is to foster discord between nations. These particular Olympics set the right tone from the outset, when the French had their noses put completely out of joint by not winning the competition to the stage them. I mean, then President Chirac knew it was in the bag for Paris, so he went round irritating other nations on the International Olympic Committee. For instance, he made some derogatory comments about Finnish cooking. After all, who cares about the Finns? Poor old Chirac. The Finnish delegation’s votes turned out to be pretty essential.

There was never any danger of our behaving that way, of course. I mean, given the traditional delights available in English cuisine, we were never going to cast aspersions on others. Not even on the Finns. Dried reindeer meat? Bring it on. It can’t be worse than smoky bacon crisps.

More recently, the Iranians have got upset about the logo itself. They reckon the it spells the word ‘Zion’. Funnily enough, the US television presenter, Glenn Beck, who has left no doubt concerning the moderation and liberalism of his views, agreed with them.

The Iranians feel that the logo demonstrates that the international Jewish conspiracy has been exerting its malign influence. Again.

Now this is obviously rubbish, and on at least three counts.

1. I don’t believe there’s any such a thing as an international Jewish conspiracy. Or if there is, let me just point out to the people behind it, that my mother is Jewish which automatically qualifies me for membership. So I deeply resent the fact that no-one has ever tapped me on the shoulder and said ‘hey, want to join this conspiracy?’ World domination – I’d be into that like a shot. I could become a banker and get paid a hell of a sight more for doing a lot less work.
2. If there were such a conspiracy, no-one with the brains to organise it would ever waste their time getting the word ‘Zion’ into the London Olympic logo. What? You think they might feel that words like ‘Zion’ and ‘Zionism’ aren’t getting enough exposure in the world press already? That Jews don’t get enough publicity?
3. The word is obviously not ‘Zion’ anyway. If it’s anything, it’s ‘Zior’. My guess is that ‘Zior’ is a word in some long-lost language meaning ‘bloody ugly logo’

The worst of it? It’s plastered all over London.

Is the legacy of the IRA a load of old rubbish?

The central problem in Anglo-Irish relations is that the Irish remember too much, and the English forget too quickly. Most Englishmen barely remember who Oliver Cromwell was. In Ireland, his armies might as well be rampaging through the land still, slaughtering the people in an orgy of self-righteous fury.

The same forgetfulness afflicts us now. We’re losing sight of how things were only twenty years ago. Throughout the 1980s, when I regularly travelled into Central London from the suburbs, it became a routine to check for abandoned packages on the overhead shelves or under the seats every time I got into a train. While I never saw a bomb go off, I twice heard them: it wasn’t Belfast, far less Beirut, but London was an uneasy place.

Today, practically no trace remains of those troubled days. People, and above all politicians, love to whip up anxiety over Moslem terrorism, but they’re not even in the same league as the IRA. Why, apart from the casualties, the IRA regularly shut down the main stations or other public places by the simple expedient of phoning in a bomb warning, sometimes without going to the trouble of actually planting a bomb. You had to admire their economy of effort, to say nothing of their sheer deviousness.

Still, if there is little trace of those times today, they have at least left one small legacy. I’m reminded of it every time I go through the glorious, airy and brilliantly constructed main hall of St Pancras International station, something I’m obliged to do a couple of times on most days. The architecture is wonderful, the layout charming, the atmosphere uplifting – but there isn’t a single litter bin.

Now this is a direct result of the IRA campaign. Bins were far too easy places to plant bombs, so in the course of the eighties, they were done away with throughout London. In recent years, they’ve been gradually coming back, usually in the form of clear plastic bags, in which I presume it would be relatively easy to spot a bomb (if, say, it comes with trailing wires or perhaps a helpful label ‘bomb’).

But St Pancras is hanging on grimly to the tradition of the last two decades and resisting the reintroduction of waste bins. I asked a cleaner once ‘so where do I leave my coffee cup?’

‘On a table or a chair, anywhere you like,’ came the answer, ‘we’ll clear it up.’

So that’s what I do. I dump my rubbish any old where in the station, and each time I think of the IRA.

My personal tribute to the IRA

A fitting monument, I’d say.

A day in two lives

As a District Nurse, Susan (not her real name) started work at 8:30 by popping into the health centre for messages and to deal with any urgent problems that might have come up. She and her colleagues then met to check work allocations for the day.

Andrew (not his real name either), head of the investment branch of a major bank, also started his day at 8:30 when he met his closest associates. They had been researching the financial standing of various rivals that were beginning to show signs of weakness. He was proud of these bright young people and the reports they had prepared, insightful, concise and closely argued, just as he had trained them. He knew, however, that the closer they studied their targets, the more enthusiastic they would have become about them. He would have to allow for the distortions to which this might lead. He would also have to rein them in during the meeting if they were to stick to the scheduled time.

Susan visited three patients in the course of the morning. Two were terminal and she was particularly careful over their treatment, above all to ensure they had sufficient pain relief. One, a man not out of his fifties but who would never see 60, was nearing the end of a long but hopeless fight against MS. Usually highly controlled, he surprised her by a sudden outbreak of fury. Though he could no longer use his legs, he showed that his arms still retained some strength when he flung his chamber pot at her. Fortunately, he missed and it was empty. He then broke down in tears and she had to delay her departure, overcome her own anger at his behaviour and comfort him back to calm. She had to remind herself that he was divorced and estranged from his only other relative, his son.

One of the presentations Andrew heard that morning caught his attention. The views of the young man who had prepared it betrayed the partiality that Andrew expected, but even after allowing for that, there was a kernel to the argument that felt like the real thing. The target was a prestigious name from the world of merchant banking, the kind of organisation which would boost the standing of any acquirer. It had been made vulnerable by recent financial difficulties and was probably open to an approach. Andrew had an intuition this was the right target, and while he knew better than to be carried away by a hunch, he also knew better than to ignore one. He cleared his diary for the morning and held a series of further meetings to probe and test the advantages and difficulties of the project.

The delay with her last patient meant that Susan had little time for lunch, so she stopped at a local supermarket and had a sandwich over a cup of coffee, taking the opportunity to phone occupational health to see whether a new mattress could be provided for one of the patients she had visited that morning and whose bed, too old and damaged, was seriously adding to his pain. She also took a call asking to add one more visit to her round that afternoon.

Andrew’s meetings had left him little time for lunch, so he had sushi brought into his office to share with the associate whose project he was now inclined to take up. Together they finalised the paperwork for the proposed acquisition and a presentation that he would put to the executive board of the bank that afternoon. He found the time to make a call to the Chief Exec’s PA to ensure that his presentation could be added to the agenda, even at this late stage. His associate had had the forethought to include mochi as a dessert to their lunch, a particularly tasteful touch.

Susan called first on the patient who had been added to her schedule for the afternoon. He was in the final stages of cancer. One look at him was enough to tell her that he wouldn’t be making it to the evening. His daughter was by his bed, holding his hand while tears coursed down her face. Susan sighed and stepped outside to phone in and ask the receptionist to reschedule her appointments. It would be a blow to her colleagues who would have to cover for her, but there was no way she could leave now. She felt sorry, too: she knew like any professional that an emotional bond with her terminal patients was not an investment likely to give much in the way of dividends, but this one had shown such courage and good cheer in the face of great suffering that she was going to feel real sadness at losing him.

Andrew’s executive board meeting went superbly. The case he had built with his associate was ironclad and the chief exec was more than predisposed to be convinced, so the other directors were quickly won round. After the meeting, he had time to brief his associate again and start the process of acquisition. Informal contacts were made that very afternoon and were met with warmth, not to say alacrity, promising an easy negotiation and an advantageous price. The day called for a celebration and the meal that the chief exec and several directors shared with Andrew later was a fitting gesture to the scale of the achievement. He particularly enjoyed the St Estèphe they drank with the main course, one of his favourite wines.

Susan spent her patient’s final hours doing what she could to make the end as easy as possible. She remade his bed, made sure that catheters were working and she kept the flow of painkiller high. He died soon after 6:00 and she stayed a little while helping his daughter prepare the body for the undertakers, not because it was necessary or part of her job, but because the work might give the daughter a little comfort too. By the time Susan had returned to the Health Centre and finished her paperwork, it was too late for her bridge evening. Her partner was polite but clearly disappointed when Susan rang to tell her. She then phoned home. Her husband had eaten the dinner she had left for him, so she called in for fish and chips on the way home, and ate them in front of the television before heading to bed early, to be ready for the next day. At least she knew that a few people were in slightly less pain, were slightly less disconsolate thanks to her efforts, probably including the patient who had turned aggressive: at least he had got something off his chest.

Returning late meant that Andrew owed some explanation to his wife but she had long since grown used to the high-pressure existence he led. He sent her to bed and booted up his laptop, knowing that even at 11:00 at night he had to prepare some documents before he could turn in himself. He did so satisfied in the knowledge that though a substantial proportion of the staff in the bank they were acquiring would inevitably lose their jobs, a number of people in his own would be made a great deal richer by his efforts, and he would be one of them.

For his work, Andrew was rewarded with more than £30 million worth of shares over five years on top of salary payments totaling in excess of £5 million. Thanks to a promotion, Susan made a little more than £160,000 over the same period.

Heavy plant and identity confusion

Signs at two gates to the same industrial compound, a few metres apart, suggest a degree of confusion over identity.

OK, but which of you is in the plant sales business?

Still, if I've understood anything about existentialism, and I can't pretend to have understood much, the key principle seems to be that what you are is what you do. At least the signs suggest that Mr Gill knows what he does.

Come to think of it, what he does isn't that straightforward, is it? I mean, not linguistically at least. I see 'plant sales' and I think 'garden centre' rather than heavy machinery. That in turn puts me in mind of a road sign I've seen a few times 'Caution: heavy plant crossing'.

Sounds like a warning against triffids, doesn't it?

Meanwhile, I wish Mr Gill well with his business. Perhaps someone to proof read and edit his display material might be a good investment?

The Spring of Human Kindness

It took me over an hour to buy the newspaper today, and not just because I’m an exceptionally slow walker or unusually tired.

The main reason was that Janka likes to get a good walk on a Saturday. She likes me to take her down to the park where she can terrorise the ducks and try to nick the bread left for them. I do my best to stop her, though she’s usually much too smart for me. I wish she wouldn’t do it. It may be natural for a dog to want to eat a duck, but a bit shabby to try to steal its bread.

The second reason that I was out so long is that spring seems at last to be here. It doesn’t officially start till Monday so it’s great to have it early, something for which I feel I can legitimately claim a measure of credit. I’ve been travelling to work without a winter coat for a couple of weeks now, despite the bitter cold that has often left me shivering at bus stops. Somewhere inside me lurks a belief that behaving as though spring had already started will usher it in more quickly. This morning, with glorious sunshine and temperatures in the mid-teens, though it's still only the 19th of March, it was obvious my sacrifice had worked. And been worth it.

Wardown Park willows in the spring, with duck bread thief

 The third reason I go so far for a paper is to avoid a surly individual in my nearest shop, less than half as far away. Every time I’ve been there he's been glued to a laptop computer on the counter in front of him while talking into a mobile phone jammed between shoulder and ear. He removes one hand from the keyboard just long enough to take my money and the only sign he gives of thanking me for my custom or even recognising my presence, is the briefest of curt nods.

Isn’t it curious how some shopkeepers think that incivility isn’t going to do their business any harm?

So I walk twice as far to be served by a shopkeeper who, on one occasion when I turned up just as he was locking up, immediately reopened the shop so that I could get my paper.

Both shops are run by people of Indian extraction, a striking illustration of the fallacy of racism. People can be perfectly unpleasant whatever their race. The trick is to find the ones who make up for them by their cordiality and kindness

That’s why I walk an hour to get my Saturday newspaper. Janka’s delighted. I did it even when the winter made it a bit of a daunting proposition, preferring external cold to cold behaviour in the shop.

Today, of course, with a real touch of spring in the air, it wasn’t just the shopkeeper’s smile and civil greeting but the walk itself that made the experience pleasurable.

If only the conditions would last…

Not so much a death wish as a death data wish

A terribly exciting development at work: I may soon be able to count hospital deaths. Properly.

End point. And the starting point for some interesting work.

This fulfils a bit of a longstanding ambition. For years, I’ve watched people who really ought to know better abusing mortality statistics to assess the quality of hospitals. This hospital, they tell us, has a far higher death rate than that one, so it must be a lot worse. When you object, ‘but that hospital is basically a baby factory, delivering thousands of children a year, while the other one is a major cardiac centre’, they sometimes come up with ‘risk-adjusted’ figures, which sounds great except that no-one’s ever proved that risk adjustment methodologies actually adjust for risk.

At least the ones who make adjustments are trying to be conscientious. I know of one consultant who submitted a report to a hospital showing that a cardiac surgeon had a one in three death rate for a particular procedure, which was frighteningly high compared to national values. It turned out that the surgeon had carried out just three of those operations in a year and one patient had died. So it was a meaningless statistic and the report demonstrated nothing but the incompetence of the consultant.

Besides, in doing these studies, people generally base themselves on in-hospital mortality. You may know the story of the man walking home one night and finding another on his hands and knees underneath a lamppost.

‘What’s the problem?’ asks the first man.

‘I’ve lost a contact lens and I’m looking for it,’ replies the second.

‘OK , let me help.’

After twenty minutes of fruitless searching, the first man says, ‘are you sure you lost the contact lens here?’

‘Oh no,’ says the second, ‘it was nowhere near here. But this is the only place with any light.’

In-hospital mortality is like that. Hospitals record deaths meticulously, so the figures are there. But that doesn’t mean that they’re a good place to start looking for answers.

First of all, they're a lousy indicator for something like Obstetrics. In the developed world, deaths in childbirth are now incredibly rare (though there are indications of a worrying tick upwards in the United States) so the numbers don’t tell you much. On the other hand, in palliative care, mortality is extremely high, but that’s the nature of the discipline, so again the rates aren't particularly helpful.

Mortality is only useful when you apply it to areas where there is a relatively high risk of death, but specifically of avoidable death. Stroke care. Cardiology. Various types of organ failure. That kind of thing.

But also it’s no good using just in-hospital deaths. Cases get transferred between hospitals. A general hospital might move a particularly ill patient to the specialist centre up the road. If the patient dies, which hospital should be concerned, the first or the second?

Incidentally, it’s a curious peculiarity in England at least, that if the patient dies in the ambulance between the two hospitals, neither gets the death assigned to it.

Again, some hospitals keep their lengths of stay low. This is a good thing from the point of view of financial efficiency and may even be good for patient care: hospitals are dangerous places (full of sick people) and the sooner you get home the less likely you are to pick up an infection. But, if a patient is discharged quickly and then dies at home, that death won’t be recorded against the hospital either.

What has got me enthusiastic recently is that a body in the NHS, the Information Centre, has for two or three years been linking English hospital data with general records of deaths held by the Office of National Statistics. This means that they can now make available information about patients who died following hospital treatment, whether or not the death took place inside the hospital.

So we can get a clear idea of how many people are surviving or dying after hospital treatment for a stroke or an aneurysm, even though the death took place after the hospital discharged the patient.

I'm about to apply to be given access to the information. That may give me some better ways of understanding how well individual hospitals are delivering specific types of care for specific types of condition.

It’s a bit sad to admit, but that’s the kind of thing that makes me excited about the work I do.

A sign of the (passing) times

Amazing how a simple shop sign can set a whole train of thought going.

A sign to conjure up dreams. Or nightmares

It happened the other day when I walked past the ‘Little Beirut’ sign in Luton town centre.

Ah, Beirut. They used to call it the Paris of the Mediterranean. My mother loved the place when she was there for some weeks back in 1947.

Her hotel was on the beach, with sun during the day and the sea breezes at night, and it took only fifteen minutes to drive into the hills and Lebanon’s emblematic cedars. Further up in the mountains, you could go skiing while watching bathers swimming from the beaches below.

There were two unusually harsh winters in England immediately after the end of the Second World War. Just to enjoy more merciful weather must have been a blessed relief, to say nothing of the pleasure of a gentle and friendly welcome into a city of charm and elegance. ‘It was a lovely, clean, pleasant city,’ my mother recalls, ‘a tourist town.’

But she adds ‘I was privileged to see it before it got ruined.’ The golden days of Beirut weren't going to last. As she tells me, ‘there were murmurs of things not being as they should be, but we weren’t really aware of anything.’ The murmurs turned into something much louder just a few months after her visit, when a bomb exploded in the Jewish quarter, though it caused no casualties.

Beirut: appealing...

...and rather less so

Since then there have been many more bombs and they have caused innumerable casualties. The Jews have gone, those who could heading south into what was Palestine then and is Israel now. They've been replaced by many thousands of Palestinians living in the refugee ghettos of the city. Christians have fought Moslems, different groups of Moslems have fought each other, peace keepers have come in, been blown up and gone, Syria has sent forces and so has Israel (again and again), Palestinians have been massacred and have fought back. If you haven't seen the Israeli film Waltzing with Bashir, the most powerful cartoon I know, watch it and see how far the Paris of the Mediterranean has been plunged into carnage and shame. 

So I hesitated when I stood in front of ‘Little Beirut’ in Luton. What would I find if I went in? It would have been wonderful to recapture the atmosphere of the city my mother visited and loved half a century ago. But what if it had conjured up the bloodied bodies and the heaps of rubble?

And how disappointing if it simply turned out to be yet another of the countless kebab shops that keep cropping up on our street corners.

Best just to walk past and meditate on how difficult we find it to preserve peace and harmony if we can even build them in the first place.