Memorandum from the valley of the shadow of death
Ihad thought to spend last weekend in Paris on what the ticket-sellers call a mid- winter break, but some inner sprite decided it was time for one of my intermittent for- ays to compete with Jeffrey Bernard, and I spent it as the guest of Mrs Bottomley at Charing Cross Hospital. I would not list the medical symptoms, except that many peo- ple seem to enjoy them. Those who don't should skip the next paragraph.
After climbing the stairs to my flat in Hammersmith on Wednesday night, I found myself retching, and hoped that Wiltons had not let me down for the first time in 40 years on the freshness of its oys- ters. Cleaning my teeth a few minutes later, I noticed a strange abundance of blood in the basin but decided to overlook it in the hope that it would go away. Waking up at three o'clock in the morning, I found my mouth full of fresh blood, while more con- tinued to bubble up in my throat for an hour or so.
`Tell them it's terrible in 'ere. Don't spare them any of the 'orror,' said a male orderly in casualty. My chosen book for the spell in hospital was Fool or Doctor: the memoirs of a Sceptical Doctor by Anthony Daniels. Dr Daniels describes, among other things, conditions in the surgical and psy- chiatric wards of a black township hospital in South Africa, even as he describes the slow death of his own existential optimism and political idealism, when confronted by the great ocean of human misery and stu- pidity. I think this book, published by John Murray in 1987, may be the key text to our times, if anyone ever wants to know how intelligent, educated, sensitive citizens reacted to the arrival of the mass culture of the 1980s and 1990s.
But my purpose in taking this book was to compare medical standards in the South African townships, in the East End slums, and in the Gilbert Islands — all places where Daniels's odyssey takes him — with those prevalent in one of our great London hospitals after 16 years of ever increased funding.
I am amazed that the hospital service continues to function at all. In fact, it func- tions rather well, in an almost complete absence of bossiness or any apparent disci- pline. When I first took to the hospital ser- vice — in 1958, at the old Westminster Hospital — discipline was twice as strict as it had been in the Household Brigade, and three or four times as strict as it had been
at Downside. There was an element of ter- ror stalking the wards in those days.
Yet somehow the new system works. A brilliant young registrar diagnosed my com- plaint within an hour or two of arrival — it was called a Mallory Weiss Syndrome, she said, involving a small tear in the oesopha- gus, the result of over-exertion or retching, I was despatched to the appropriate ward for tests and confirmation. On my arrival they said, 'Oh, we were expecting a female patient,' but accepted me nevertheless. After a little time, a head popped through the curtains and said, 'Albert Hall?' No,' I said. 'It says here you are Albert'Hall. You are meant to be Albert Hall. Never mind,' he said, and disappeared again. Although the paperwork is obviously oppressive, nobody seems particularly oppressed by it. Commonsense and an agreeable American-style 'can-do' spirit prevail. Smoking is tolerated in the corri- dors. Although no doubt the fanatics will organise themselves for a crackdown before long, nobody has been bossy enough to stop it yet. Certainly, I observed less bossiness in my three days in the Charing Cross Hospital than I would expect to expe- rience from the air stewardesses on a short British Airways flight to Paris.
True, the curtains around the beds in my ward were all revoltingly dirty, splashed with blood and other fluids at which one could only guess. This was the only real evi- dence of an encroaching national collapse. There was also one Stalinist hangover from the bad old days. I was told I should give them my wallet for safe-keeping. A few minutes later, they came back, having examined its contents, and said patients were not allowed to have more than £50. The balance was being extracted from my `So you're a merchant banker - is that rhyming slang?' wallet and sent to the hospital cashiers, from whom it could be claimed on depar- ture. Needless to say, on Sunday, when I left, the cashier's department was closed. On Monday, when I made a special pil- grimage to the hospital at some inconve- nience, I was told the money could not be given to the patient, only to a nurse, and that as it was over £100 it would have to be given by cheque. It was too late to raise a cheque at 3.15 in the afternoon.
But that was the only example of a fatu- ous rule oppressively applied. Perhaps it derived from a simple, old-fashioned hatred of the rich. Health workers might be allowed such a self-indulgence, at any rate in the nursing and doctoring parts of the hospital service, because, in the absence of bossiness, which kept discipline alive in the old days, and in the absence of the greed for money which keeps things going in America where money is always related to results, it is only the goodwill and selfless devotion of these people which keeps the service ticking over at all. This will be true however much money is poured into it. Shortage of money may well bring about its collapse, but it will always be on the brink of collapse because it relies on those most unreliable of qualities, a benevolence towards the human race and a selfless dedi- cation to the job. These seem able to flour- ish only behind a heroic disregard for the cost of anything. Any day, the whole struc- ture could collapse and disintegrate into a scene out of Russia, or Rwanda, as the dirty curtains remind us.
My own conclusion is that health can never be restored to the market economy in this country as in America, because our national psychology finds the idea repul- sive. The same is probably true of the entire employment scene. Whether we like it or not, we are stuck with an inefficient, high-wage, socially protected economy, which can survive only behind a protective tariff wall, and then from month to month. The French ferrymen were quite right to put up burning barricades to prevent vehi- cles from boarding British ferries employ- ing cheap Polish labour. Just as the British were unable to accept the disciplines of the free market, they are now unable to accept the disciplines of the protected economy.
A week spent in hospital should convince anyone that our state welfarism is unsup- plantable. All that remains is to watch its gradual disintegration.