A.J.Cronin (1937) The Citadel.

I read this years ago. Probably, the beginning of the 1970s. Mrs Bell our next door neighbour was on her throne. She kept a firm grip on her son, Pete(r). TV Times, Reader’s Digest, Sunday Post and borrowed our Sunday Mail. All was right in her world. She admitted she skipped the boring bits in books. Descriptive stuff. A.J.Cronin was one of her favourites. No boring stuff and everything was black and white. There were good guy and bad guys. Just when the bad guys looked like winning—you know what happened next, Mrs Bell lit another cigarette.

Let’s talk about the hero, Dr Manson.

Late one October afternoon in the year 1924, a shabby young man gazed with fixed intensity through the window of a third class compartment in the almost empty train labouring up the Penowell Valley from Swansea. All that day Manson had travelled from the North, changing at Carlisle and Shrewsbury, yet the final stage of his tedious journey to South Wales found him strung  to a still greater excitement by the prospect of his post, the first of his medical career, in this strange, disfigured, county.  

I was also in a disfigured country and stood in for another of A.J.Cronin’s heroes, Dr Findlay—not of Facebook—but Casebook fame. One of the wardrobe staff, a gay man, was quite taken with me. Unshaven and hungover I was put into a tweed coat and got to play the back of Dr Findlay’s head. I wasn’t that interested in the fame, but £75 for less than two hours work as an extra appealed enormously.

But here we begin with Dr Manson, in his coming-of-age and romantic drama. The reader knows he’s poor, because he’s travelling third class. Perhaps rather than saying he was shabby, Cronin should have described his off-the-peg suit, only people with money could afford bespoke suits. His journey is described as tedious, yet Dr Manson is described as brimming with excitement. Mrs Bell would have approved, description is done by numbers.

Characters have flaws, it’s in their surnames. Mr Boon is obviously a bad guy. Listen to the names. Doctor Thoroughgood, well, we know what to think of him. Nurse Sharp, whom Dr Manson, hires in a later incarnation. You know what she’ll be like and it won’t be pretty.

Mr Stillman, sounds like a good guy, still-man. Hope, with his lab work, is a great friend. What about Robert Abbey? I’ll let you decide, but let’s just say the prestigious doctor has very understanding eyes. At one point the distinguished gentleman flipped back to his own humble background, all the better to understand Dr Manson. Granny, what big eyes you’ve got.

Con? Well, usually, that would be a negative. But he’s Mr Funny man, a dentist who lives in a ramshackle house and fixes cars. Poor, but happy. So joyful his daughter, Mary’s lung disease is just another way of giving Dr Manson a chance at redemption. Mary might be the mother of God, but here there’s a shadow on her lung.

There was a shadow on Mrs Bell’s lungs. All that smoking. Dr Manson also smokes. Everybody did in those days, well apart from Christine. Dr Manson marries her. She’s a school teacher and Manson behaves abominably badly. He admits it, and they laugh and make up.  

Later, whisper it, he had an affair. He returned to Christine like a dog with his tale between his legs. Yep. Lots of clichés. No sex. It was left to the reader to work out whether Dr Manson went beyond the kissing stage. I shouldn’t really spoil the story, but Christine should have paid less attention to being poor, but happy, keeping her house sparkling clean—dirt being the enemy of a good, virtuous woman—and more attention to buses.

Dr Manson in Aberlaw, with all the modern facilities, knew how to deal with patients who ‘swung the lead’.

‘Certificate,’ he said, without minding his manners.

‘What for?’ Andrew asked.

‘Stagmus.’

The tone alone caused Andrew to look at Chenkins with quick resentment.

Beer on his breath. Piggy eyes. Ben Chenkin Not to be trusted. Not like his alcoholic friend Denny. He’s a surgeon. Down on his luck. Who wouldn’t be after his wife—whom he was madly in love with—left him for another man. Of course Denny drunk. Any man would in those circumstances. Crawling blind underground and breathing in dust that ages a man to provide the fuel that drove the industrial revolution—salt of the earth type need only apply and be prepared to die, shouldn’t swing any lead.

Christine counts the pennies. They’re poor but happy. Then rich and unhappy. Medicine is set up to favour the rich and connected. As it is now, but it is more of a meritocracy. Manson’s constant claim that he’d be reduced to nought and poverty, is matched by, for example, Adam Kay, of This Is Going to Hurt fame. Both claimed there’s no money in it, medicine. They did it for love.  Yet the monthly salary of a doctor would be the six monthly salary of a 1920s miner and a yearly salary of the poorest worker.  

Miners used penny whistles to shame black legs and Ben Chenkin, when Manson decides to leave Aberlaw for London. Whenever there’s a point of principle in the room, Manson is sure to trip over it. He never just leaves, he always leaves with his head high—over a point of principle.

When, for example, Manson leaves London to set up a mini-NHS based on democratic principles with his good friend and ally Denny, of the non-piggy eyes and his other good friend Hope, well, you know a point of principle is going to turn up.

I do it myself when writing, I always fling the main character (or his wife) under the bus. But there’s a hole in his storyline which makes it unbelievable. Miners might be portrayed as the salt of the earth types (apart from piggy-eyes, signing on while he didn’t work, Ben Chankins) but a rudimentary approach to any kind of history would pinpoint the 1926 General Strike epicentre was in the coal fields. Welsh coal fields.  History of any kind seemed to have bypassed Dr Manson, perhaps he was studying too hard, trying to get on. The 1929 Stock Market Crash? The Hungry Thirties? The Great Depression. Mass unemployment. Lockouts at the pits. Nowt taken out. Or put in. A bit like the affair, of the non-affair.

Dr Manson nobly battles against the Citadel of the Medical profession, charlatans, bureaucracy and vested interests. Manson prefigures the need for a National Health Service. Mrs Bell would have approved. Why bother with all the boring details when you can have a good story?   

Adam Kay (2017) This is Going to Hurt: Secret Diaries of a Junior Doctor.

adam kay.jpg

I loved this book. It should really be read in conjunction with Jed Mercurio’s debut novel Bodies. Yeh, that Jed Mercurio that writes scripts for the BBC, Bodies and Line of Duty. Adam Kay is following a similar trajectory, half way between the drama of Jed Mercurio and the upbeat chortleness of Harry Hill. You’re probably thinking why should the tax payer should spend all that money training junior doctors, indirectly subsidising the Australian and Canadian health services, which is bad enough, but now it’s a straightforward path –albeit a long medical apprenticeship—to write for the BBC.   The answer is going to hurt.

Simply, we are screwing the NHS into the ground and junior medics are on the front line. That’s always been the case, but the pressure is more intense. Aneurin Bevin talked about needing ‘to stuff the consultant’s mouths with gold’ in order to get a National Health Service. Consultants then were treated as a rung below God. Not much has changed. In a note Kay sent to a GP, 21st October 2010,  as a Registrar in Obstetrics and Gynaecology wrote, ‘if  you have any questions whatsoever, please do not contact me.’ It was a typo, what he meant to say was don’t hesitate to contact me, but it worked. The GP didn’t contact him. Kay had this to say about Prof Carrow, theoretically ‘on call for the labour ward.’ But ‘as much use as having a cardboard cutout of Cher’. ‘You don’t see Professor Carrrow during the day, you don’t phone him at night.’ Like a mighty liner navigated by junior staff, which changes every six months, when they change secondment, they learn on the job by that old maxim, see one, do one, teach one. Kay started 14 years earlier as a fresh-faced student and was a veteran of muddling through. So when Prof  Carrow appeared during the day Kay wondered what the occasion was. No doubt when David Cameron’s children were being treated there would have been a consultant monitoring every NHS bed the Prime Minister passed as there was for an extremely wealthy Saudi family. Here it was quite simple. A documentary camera crew was following behind Prof Carrow as he did a ward round. On camera Prof Carrow tells Dr Kay, ‘Sounds like you’ve got it under control Adam. But if you’ve any problems at all during the night, just call me.’ When the camera crew stop recording he acts more like the typical consultant, telling Adam, ‘Obviously, don’t.’

Kay, ad-libs, that one of the problems he faces is that patients don’t really see doctors are being human. His points about low pay and overwork are valid. He looks to his cohort, people he went to school with making six-figure salaries, while the parking meter in the hospital grounds makes more money than him. He suffers burnout (post-traumatic stress) when one of his patients dies. He’s not god, only human and a doctor advises him by the time he’s finished there’ll be a bus full of patients, who have died on your watch. It’s the nature of the beast. He moans about having to take a sideways or backwards step and retrain in another speciality. It would mean a loss of income.

That’s where I’ve less sympathy with Kay. Life seems sharper and speedy when you’re younger and full of seismic spasms, but it recedes like male-pattern baldness no matter how you try. Both his parents are doctors and he tells us his sister has accepted a place in a medical school, but let’s not forget middle-class parents,   getting their kids into medical school is a status thing and a mercenary operation that would make King Herod look like a lightweight.  Working class kids have more chance of playing for Barcelona than being a junior doctor. The moneyed middle-class expropriation of the means of education is a given without the need for banner waving, what Herbert Marcuse called ‘repressive tolerance’.

No meritocracy here. Kay jokes the ideal entry for medical school has A grades and plays rugby, ideal candidates such as Harold Shipman.  I’ll not bother googling how much a senior registrar gets paid. Kay should look below him, try living on the split shifts and gig economy of the hospital cleaners. His joke about the public not thinking doctors are human applies equally to those that have nothing and can expect not much more. Grenfell Towers taught us that. The NHS is staffed by the low paid, so I’m not buying into that the parking meter in the car park makes more money, poor me, I’m skint argument.

His open letter to The Secretary of State for Health is a walk in my shoes argument, ‘you, or your successor should have to work alongside junior doctors’. He makes an analogy ‘If the President wanted to press the big red button and kill hundreds of thousands of innocent people, then first he’d have to take a butcher’s knife and dig it out of a volunteer’s chest himself; so that he realizes what death means first-hand, and understand the implications of his actions.’

Absolutely, but the moron’s moron in the White House isn’t really like that. He’s got flunkeys to do that kind of thing. Draft dodger Trump guilty of having a spurious bone spur on one of his feet and now with the biggest arsenal in human history, we have a spurious President Tweeting policy on the hoof. A no-brainer, reality is no obstacle to his egotistical whims. A straight choice between blowing up thirty million Koreans and starting an apocalyptical nuclear winter or being seen as being a weak-fall guy that doesn’t get bogged down in too much (or any) detail, then it’s goodbye world.

Poor people don’t really exist for him and his ilk. The NHS is an aberration and abomination because it doesn’t work for them. Nicholas Timmins wonderful book The Five Giants: A Biography of the Welfare State sums it up, the Americans used to run to us and try and work out how through cooperation and not competition we could provide such an efficient and low-cost service, now we run to America and look at  model that doesn’t work. Cannot solve the problems they create and in the hunt for revenues calls for more of the same, more privatisation, more trickledown economics and taking money from the poorest in society and gifting it to the richest. State subsidies as opposed to handouts for the poor. Adam Kay has nailed it, privatisation is a sham. It costs around £15 000 to deliver a child in the private sector, but when something goes wrong they use public resources. Let’s call it public theft by private means that enrich the already wealthy. That makes me mad. I’m not laughing.