Sunday, 26 August 2018

Larkin’ About Hospitals


The essay below looks at how three alcoholic writers might have responded to the NHS' 70th birthday, if they were still alive. They all spent plenty of time in hospitals, and wrote extensively about them.  

I take a look at jottings in the jaundiced ‘Low Life’ book by the comic Jeffrey Bernard, and his acceptance of life as a professional active alcoholic to the last.  The second book I had to read, was an autobiography (2015) of the acerbic critic, A.A. Gill, who got his break in journalism by writing about rehab, defining himself as a professional recovering alcoholic, even renaming himself as such.  He was just plain old ‘Adrian’ before. Thirdly, I examine the life and works of the controversial poet Philip Larkin, positioned as Britain’s No.1 post-war writer by The Times.  Larkin lived out his final years in an alcoholic stupor, forced to turn down the honour of Poet Laureate which he had coveted all his life, because he could no longer write drunk.  All were tragic authors, sharing a specific terminal uniqueness.  In turn, they laughed at (Bernard), loved (Gill) and loathed (Larkin) - hospitals.  Which one of these three will you identify with, if any…? 

I wrote this piece during a recent stay in St. Peter’s, Chertsey, drawing on my own experiences there and the people I met.  

***

Short and stocky Bobby waltzed into our ward, full of chutzpah, ignoring the large post-quarantine warning on the door.  Bobby is a market-trader.  Three days sober, he had been transferred up from ‘Accident and Emergency’ and the interim ‘Acute Medical Unit’ to the winding corridors and long-term wards of Level Four.  Each ward further away and harder to return from.  But this is the beginning of the pleasant end of alcohol and drug detoxification. 

The sedative drugs are still potent, although the nausea, hallucinations, sleep-deprivation and physical risks are waning, as described in a previous post.  That is a very small step in rebuilding from the spiritual and emotional wreckage of the addicted life.  Reversing decades of looking outwards for any form of external stimulation, to a more peaceful reality deep down within ourselves – some spiritual calm or higher consciousness of life and truth – is the great challenge: “to be able to take a completely different direction to the one that made us what we are” as Pavras said on the Night Train to Lisbon (2013). 

But the long-term ward Bobby was entering offers a break between the pain of early detox and the harsh realities of the cold, lonely and half-destroyed flat Bobby will have to return to, very soon.  For now there’s three meals and four rounds of meds a day, loving nurses and occasional joviality.  The monumental challenge of spiritual recovery can be knocked down the ward corridor for just a little longer.  

Bobby began talking as the door to our section swung back shut behind him.  He was trying not to get excited.     



We had Norovirus in the ward before Bobby arrived


‘Afternoon all - has the meds trolley been round?’  
Continuing without pause: ‘Don’t tell me Ive missed it - I’m rattling bad, folks.’  This was a language understood only by other addicts in the room as an urgent requirement for Valium or some other sedative.  It served to bemuse the rest of the ward mates, who felt this strange little man must have escaped from the hospital’s mental health unit.
‘Which of these two beds shall I take?’
‘Is there mobile reception in here? 
I’m on Vodafone.’ Not hesitating, he switched back to the bed issue,
I’ll take the one by the window.  Anyone got a charger for Samsung? Im out of battery. Hopeless phone.  Give me back my old Nokia.’
Then greeting a large African nurse he knew from before, he exclaimed, ‘Hello Julius old fella - short time no see. Still backing losers?’  The words and questions flowed on, without time for a response from anyone. 

The rest of us were shell-shocked after five days of Norovirus which had been confined to our part of the ward.  It had claimed victims of us and now made us weak men. 

One patient was peculiarly resilient.  He was a 94 year-old diabetic Sergeant-Major called Alan.  He had won the Military Cross at Monte Cassino in Italy, one of the tougher and more gruesome battles of World War II, claiming over 50,000 allied casualties.  On a night in February 1944, American Bombers dropped 1,400 tons of high explosive on the 6th Century hill-top Benedictine abbey, rendering it a craggy expanse of rubble.  The raid failed to achieve its objective as crack German paratroopers subsequently dropped into the ruins, establishing excellent defensive positions.  After repeated failed attacks, hand-to-hand combat was required to dislodge them.  At the time, Alan was the youngest Sargeant-Major in the British Army, responsible for the discipline of 250 soldiers.  He was still a pillar of strength.  He retained the ability to keep our flagging spirits afloat during the Norovirus outbreak.  All he worried about was his bed was made correctly.



The Ruins of Monte Cassino (1944)

The ward had come to smell worse than a Calcutta Railway station khazi on a hot day.  Nurses entered as if Ebola was present, all masked up, and doctors - who can prove hard to spot in normal times - made no show at all.  We werent allowed out of that hell-hole without very good reason.  One chap, who was Yangtze yellow with jaundice from end-stage liver cirrhosis, had been removed when the virus first struck because it would have killed him.  But he died two days later anyway.

Our section had been thoroughly cleaned, involving a team of eight Romanians working hard for two hours.  They had even changed all the curtains used to divide off each bed into private units.  We were all now deemed non-infectious when Bobby joined the ward.  It was like November 1918 or August 1945.  His entrance heralded a brief interlude, as if to celebrate the end of war, or more accurately, plague.  A new levity existed - our pains and fears vaporised for a while.  We were united at least by the energy of the man.  But it wasnt to last.

Bobby confided to me – and to the rest of the ward who were now listening somewhat intently - what else was there to do – that he liked to wander around other wards, including female ones, chatting to fellow patients and nurses, and investigate items in the ward depositories. These contain toiletries and clothing items like socks and disposable pants.

True to his word, he was soon on the prowl.  He was taken by a unique pair of hospital pyjamas in a ward store that were shiny pink.  Bobby was soon strutting around in them, proud, dancing even, showing off to the nurses, unaware that they were reserved for patients with chronic fall risk.  Bobby wasnt one of those.  Yes he did have a prodigious appetite for wobble-inducing benzodiazepine drugs - obtained by fair means or foul - but he was strong-boned and never would tumble.  We didn’t see Bobby again.  He had entered like a fizzing top and left under a cloud just 12 hours later.

The meds trolley arrives four times a day.  There is no shortage of drugs in British hospitals.


Morning medicines for a cirrhotic and detoxing alcoholic. 


Bobby is of some infamy within the local Surrey hospital network.  But clearly British hospitals have had more famous patrons of different form but same ilk. 

The columnist and legendary drinker Jeffrey Bernard (1932-1997) talked often about the Middlesex Hospital in central London as his second home.  He wrote at great length about West Indian nurses (not always positively).  He made light humour of boorish hypochondriacs he had to share a ward room with, in his weekly Spectator column called ‘Low Life’ – described by Jonathan Meades as ‘a suicide note in weekly installments.’




A Young Jeffrey Bernard


An older Bernard, ravaged
by alcohol and tobacco



Bernard’s life-long underlying thesis was vast swathes of the British population are intensely dull.  Its a truth rarely spoken about, and it takes sharing a room with Mr Backbone of England to find it out for real, Bernard maintained.  You might find out hearing them in The Coach and Horses (his favourite pub in Soho), but would never know just passing them in the street or sitting next to them on the train.  The acid test is living and sleeping next to them 24 hours a day. 

The depressing revelation is reinforced when Mrs Backbone comes to visit.  This is the worst moment in the hospital experience.  To be bedded next to a wife visited bore is the cruelest cut of all.  It’s the most serious thing that can happen to you in hospital short of getting the Norovirus (or dying). The banalities, shallow sympathies, endless small talk about garden fences, new patios and the like.  The gluttonous sharing of cheap chocolates. ‘The wasteful, weak, propitiatory flowers’ – (Larkins line - more on him later.) 

Somehow the relatives have been known to camp bed-side for eight hours.  Worse, their low grade conversation reinforces another dreadful, self-pitying thought.  Certainly for me, far less so for the celebrated Bernard, visiting fatigue sets in.  There are only so many friends will keep visiting you in hospital when you are in there so regularly.  All you are left with is listening to other people’s friends, thinking…  I had better ones than them, once.

Bernard knew all this too well.  He had the added problem of journalists arriving at his bedside to write pieces unoriginally entitled,Jeffrey Bernard is still unwell.’[1]  But rather like Bobby - Bernards trick was to seek out like-minded miscreants inside the hospital for entertainment and company. 

Sometimes he would hit the jackpot and find some old Major who also liked horse-racing.  He liked military comrades because they were stoics.  I seem to remember a Newbury cottage hospital he was taken to, whilst ambulanced away from a visit to his beloved Lambourn (a horse racing orientated village in Berkshire), which had a pleasing verandah attached to the ward.  

The nurses wheeled out a black and white TV for him and this aged Brigadier he had struck up a relationship with, so they could watch ITV Seven racing, drink Smirnoffs and smoke Gauloises.  Those were the days.  Now hospitals are no-smoking zones encompassing exclusion zones so wide outside the hospital walls, that only the fittest smoker could make it to a legal smoking haven.  The walk to the hospital entrance is long enough, and multi-level, involving slow clunking lifts. 

Bernard laughed at hospitals but disliked them, and would never die in one.  Despite diabetes, an amputated right leg due to gangrene and renal collapse, which meant he spent his entire 65th year in The Middlesex, he begged doctors to let him die in his Soho flat.  ‘I will surprise God because I'm late,’ he said. ‘I'm usually very punctual.  I was always punctual with the devil.’

‘I don't mind dying,’ he once said, ‘I just don't like the idea of being dead. I'm gregarious. I shouldn't think there is a bar in heaven.’

Bernard was terminally unique, and stayed loyal to the cause of his death to the end.  He also recognised it was the cause of his fame.  He was truly professional about his drinking:

‘In the past, at my lowest ebbs, I used to think that maybe drink had destroyed my life, but that was dramatic nonsense and temporary gloom. Without alcohol, I would have been a shop assistant, a business executive or a lone bachelor bank clerk. The side effects of my chosen anaesthetic have at least produced some wonderful dreams that turned out to be reality.’

Such acceptance, good grace and humour provides quite a contrast to the death of the brilliant Sunday Times Restaurant critic, A.A.Gill (1954-2016).  Another professional alcoholic, Gill was of the recovering variety – so it was indeed tragic that he should die three years earlier than Bernard at 62.  But he never stopped smoking and that’s what got him.  Smoking is usually a slower train to the same terminus, but for Gill it pulled in first.  In 2014 he admitted he continued to smoke about 60 per day until he was 48.

Gill’s break in journalism came from derailing his relatively brief drinking career – permanently - at Clouds House rehab in Wiltshire, aged 37.  (I’ve been there too, a couple of times).  Gill wrote an article about Clouds which was published by Tatler, and who subsequently gave him his first writing job, having been a failed artist when drinking.  He even changed his name to ‘A.A.’ from ‘Adrian’ because it did sound better.  A few years later came the move to the Sunday Times where, according to Lynn Barber, ‘he quickly established himself as their shiniest star’.  Despite being dyslexic, his exceptional mind allowed him to dictate all his articles down the phone line.  From journalism alone, he was able to leave a fortune of £3.4m to his wife and children.

He once wrote caustically about hospitals, as well as most things that ever hit a plate.  What makes him interesting is his Damascene death-bed conversion to the NHS as something holy, having been diagnosed with what he memorably described as ‘an embarrassment of cancer, the full English.  There is barely a morsel of offal not included. I have a trucker’s gut-buster, gimpy, malevolent, meaty malignancy’.

Wracked by chemotherapy, Gill wrote at length on the NHS and his denial of death in his last Sunday Times article (December 11th, 2016), published a few days before his end.  He seemed to be echoing stricken Little Bob (Gene Hackman), the sheriff shot by Clint Eastwood at the end of the film Unforgiven: ‘I don’t deserve to die like this’.  Deserve has nothing to do with it’ replied Eastwood’s character.



A.A. Gill before he stopped drinking, steering the fine line between the shakes of too little and the abyss of too much.

For Gill: ‘The NHS represents everything we think is best about us…  We know it is the best of us.  You can’t walk into an NHS hospital and be racist.  That condition is cured instantly…  You can’t be sexist on the NHS, nor patronizing, and the care and the humour, the togetherness… by both the caring and the careworn is the Blitz, “back against the wall”, stern and sentimental best of us’.  Stephen Hawking was to say, similar the following year before he died: ‘the NHS brings out the best in us.’  Who could possibly speak badly of these brave titans of illness?     

They all found in the NHS institution some spiritual unifying force, beyond its powers to restore physical health.  As said, recovering alcoholics are keen on drawing on spirit not spirits – spiritus contra spiritum[2] - none less than the noisy Russell Brand.  He used the same ‘the NHS is the best of us line’ as Gill in a blog piece – twice – and going further: ‘the NHS has symbolic value, it is this country’s soul.  But it is much more than a symbol, it is carnal as well as divine’.  But does it follow that by heaping praise (and money) in external healthcare we will find some inner salvation?  I will return to this question when discussing our third alcoholic writer, Philip Larkin.    

Gill was told by his Consultant that his big hope (despite his cancer having spread like a nimble cat-burgler) was a new-fangled drug called Nivolumab.  Such was Gill’s desperation if not deserving, and his Doctor’s acquiescence, he was prepared to venture into the medical research frontier-zone of immunotherapy, beyond the ghastliness of chemotherapy, and costing £100,000 a patient (about four times as much as chemo).  He didnt get it on the NHS at first, but with all his noise he made he received it in the end after his pancreatic tumour grew to the size of a fist.  (A version of Nivolumab called Pembrolizumab is now licensed by the National Institute of Clinical Excellence – known by an acronym of the benign State - N.I.C.E.  Gill was forced to purchase Nivolumab privately). 

So how exactly did Gill’s example of his intensive interaction with the British hospital system of the NHS show up the best in him and others?  Was Gill filled with one-ness from being part of it – invigorated, fortified and more determined?   Or was he just made even more scared and desperate?

His Sunday Times piece is drained of humour and life.  It smells of fear, when its perfume was intended as bravado.  Gill is most definitely clutching at whatever life-preserver might provide ‘a stretch more life… more life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth…’.   He sounds worse than the most sentimental of dying patients you don’t want near you in hospital.   Amazingly for A.A., the descent into sentimentality gets worse.  He actually revels in it when partners shuffle in ‘to share sandwiches, talk about shopping and the cousins in New Zealand and window boxes.’ 

We know most of Gill the man from his autobiography ‘Pour Me’ (2015), before he got ill.  To him the most important thing was being frighteningly talented.  In this book, he offered stories ‘not to show off my cleverness, but to underline it’ (p.60).

He didn’t achieve it as a self-obsessed artist, but he did in later life as a sober journalist.  It is the defining trait of the alcoholic that the self-centred ego drive is dominant over any spiritual considerations about others and otherness.  (Reversing that balance is the solution to recovering from alcoholism).  Any amount of perfidy, manipulation and greed can go on to achieve false pride and satisfaction in the bottle and use of other people.  However many A.A. meetings one attends, and A.A. Gill even changed his name in honour of Alcoholics Anonymous, old defects of character can rear up like botulism on steroids.  Gill the political turncoat of Disraelian proportions was evident, for example, fliting in and out of scepticism towards the European Union as it suited, for example when courting and then marrying Amber Rudd, the Europhile Home Secretary.      

Gill was an alcoholic charlatan whose words dictated his expressed feelings rather than his feelings dictating his words.  He would gladly have written anything, however offensive, so long as it was funny (which it usually was).  He was indeed extremely clever.  Who else could write as well as he did, always down the phone through dictation because of his severe dyslexia?

But when he had to write something truly honest, about his life and death, he couldn’t do it.  He is both unbelievable and pathetic, even scared.  Any pretence to accept his fate is laid bare as false.

As a truly great critic, Gill desired to please by being horrible.  As death drew in, he understandably did not want to be remembered for example, for calling the welsh: ‘loquacious, dissemblers, immoral liars, stunted, bigoted, dark, ugly, pugnacious little trolls.’  Or saying the historian, Mary Beard, ‘should be kept away from the cameras altogether’.  His quote about the NHS bringing out the best in us British was such an attempt.  Tapping into such an obviously popular current idea, giving it a bit of intellectual shape, all shrouded in a wiff of his own bravery and struggle, he was pushing at an open door.  But at the back of that cancer addled brain, he must have known he was playing on one of the most insidious ideas of our age, and most dangerous.  Our obsession with the NHS and our 168 hospitals is far from the healthy one it may at first seem.

For sure Adrian Gill knew he was on terra firma.  Nigel Lawson once wrote that the NHS is the closest thing the English have to a national religion.  The £125 billion we will spend on it this year is over 20 per cent of public spending and 8 per cent of GDP.  In 1955 it was 3 per cent of GDP.  In 2000 it was 6.3 per cent - stealth-like growth.   However, when the chancellor stands up each year at the House of Commons dispatch box and announces yet another, seemingly obligatory small increase in NHS spending, it amounts to huge increases in the long term.  Since being founded in 1948 the NHS budget has grown 8-fold in real terms and N.I.C.E. show ever greater largesse in offering us remedies to add some extra years, just for you.  The Institute of Fiscal Studies says that the NHS budget must rise by almost 50% (£56 billion) in the coming decade to cover the costs of an aging population.  The NHS has become the fifth biggest employer in the world, with nearly two million staff.  According the British Social Attitudes Research Centre, 61 per cent of us would support higher taxes to pay for more NHS spending and over 90 per cent believe there is a funding crisis (April 2018).

Politically right-leaning Gill would have known that giant bureaucracies never make people great or even bring out the best in them.  They depersonalize, make them greedy for resources, political and lazy.  Yes, there are wonderful caring people working in the NHS, particularly nurses, who are rightly admired though abused by ill-mannered patients who think they have rights – or the plain demented.  There are also legions of volunteers in the NHS, serving for free - one just poured me a cup of tea at my hospital bed.  Any altruism in British healthcare comes from the individual consciences of decent people.  It is deeply patronising of Gill to suggest that this decency comes not bottom up - from the staff to the NHS, but top down from the faceless NHS to the staff, as if they are made good by an organisation that merits a birthday reward.  If the NHS is great - it’s because of its staff.

But Gill wasn’t just talking about the NHS bringing out the best in its employees.  He was mainly focused on us citizens; how the universalist, free-at-the-point off delivery service inculcates a decency in us all.  We all chip in and help out others when they get ill.  Again patronising - and again against every sinew in Gill’s life-long political philosophy of being a free-marketeer: nationalised industries and services are always coercive of us.  We have no choice but to pay for them through compulsory taxation - so how can we act generously (or morally) when the choice is forced on threat of jail?  This squeezes out any true generosity in health-care provision.  If anything this brings out the worst in us.  It makes people angry and resentful that they have to pay taxes to fund the healthcare of the obese, the hard-drinkers, and the smokers, when really they should have to pay more in health insurance – but only if they can afford it.  Universal provision of healthcare penalises healthy people and benefits unhealthy ones.  What would really bring out the best in people would be charitable giving for the broken, beaten and the damned.  And a bit more openness and accountability for how the NHS is funded and operates.   Examples of Billion pound wastage on huge computer systems to store our medical records have been documented, but little examples abound everywhere in such a big business unit.  At St. Peter’s, my local hospital, 35 ‘Stryker’ wheelchairs, the very latest model, were recently purchased at a cost of £1,750 each.  Over half have simply been wheeled out of the hospitals grounds since.  Little more than a dozen remain, (pictured, now padlocked).




The famous Stryker wheelchairs at St. Peter's, Chertsey.  Most have been wheeled out of the hospital.  


My last alcoholic writer on hospitals rose above the everyday noise of socio-political jostling on the NHS, from his lofty academic citadel at the Brynmor Jones Library of Hull University, where he was Librarian and I was an undergraduate.  He did however find himself writing in the middle of the vast expansion of the welfare state, well beyond the intentions of its founder, William Beveridge, as an insurance system for the poor rather than a politicised tool for egalitarianism.  And this writer, Philip Larkin (1922-1985) didn’t find that to his liking.  He reserved his most potent criticism of the expansion of welfarism to the National Health Service, providing a critique of its aggrandizement which in essence, is aesthetical and spiritual. 

Philip Larkin.  One of the most brilliant Englishmen never to be knighted.

Armed with language of deadly accuracy and beauty, he decided to assassinate the modern hospital in a poem called The Building (1972).  Larkin’s position was that the attempt to forestall death and make us less fearful of it through better healthcare - with new pills, scanners, more doctors, nurses, all framed within the functionalism of the modernist hospital - was to reduce the value we place in life here and now.  Death was inevitable and only by accepting that fact in full, without assurances of endless end-of-life support, could we really live, could we really value each day in the here and now.  Acceptance is the key – and big hospitals deny us this acceptance of living in the day for a few extra tomorrows.  And extra tomorrows aren’t worth living when they come around.  We are foolish cowards of death to think they will be.  This is to talk in spiritual terms; if one is prepared to take a further step and talk in religious terms, where exactly does this fear of death, epitomized by our own life-support machines, leave our faith in the after-life? 

The growth of the NHS has only served to make us more fearful and less faithful because it is a block on this acceptance.  In spiritual terms, it brings out the worst in us.  To get this argument, requires an understanding of the suffering endured by those who are actually being treated in hospitals which is beyond the scope of this essay.  One gets to feel it through personal experience of being inside a hospital like I am right now, long enough.  I’ve got the uneasy feeling that the processes and principles (of a big organisation) begins to trump humanity.  Patients it seems must be kept alive at all costs.  They seem to become the playthings of aspirational medics, keen to employ the latest technique, rather like the crazed New York Surgeon in the praiseworthy US television series ‘The Knick’, Dr John Thackery (Clive Owen).  He was a pioneering surgeon (and an addict), who eventually dies trying to operate on himself.  Those were the pioneering days of anesthesia and surgical operations, but medical progress is always pioneering and it goes on and on.  The human begins to resemble a totally impractical vintage car which must be kept on the road at all costs.  Give it some of A.A. Gill’s Nivolumab oil if needs be at £100k a pop, even if the back axel is about to crack with rust.  When exactly will it end?   Only could a nationalised health service behave in such away.

Selina is terminally ill.  I smoke with her, sometimes pushing her wheelchair the long distance.  She is 56 and whilst a fighter, is pretty sure she won’t make it to 57.  She has brain, lung, liver, and skin cancers.  She is on a high dose of palliative morphine.  Selina is remarkably positive.  She wants to enjoy everyday and lights up all us smokers who group together like a small reviled minority.  She wants to leave hospital because she desires to be with her family.  However she has an ulcer on her foot (she is also diabetic).  Because of the chemotherapy and radiotherapy she is receiving, the ulcer is not responding to antibiotics.  The doctors insist that the foot is treated.  So they have applied maggots to the foot, to eat away at the necrotic tissue.  These are special maggots.  They are not available at your local fishing tackle shop because they are sterile (and extremely expensive - it costs over £100 for a small bag of larvae).  One course of maggot therapy has failed Selina but the doctors think they must try again – despite Selina making polite protestations to be allowed home.  This is but one example on how our modern NHS behaves in a bullying way.



Selina with the maggots at work on her foot


I should be clear that I do not believe that the NHS is always pernicious and of course it has a role as a national provider.  My father was a doctor for many years, and I know about the goodness it did through his work.  He would make over 100 house calls a week, every week.  I simply question the NHS’ capacity to make reasonable decisions about treatment, with a dominant ethos to save life at any cost, whether pecuniary or in terms of human suffering.  It is not possible for it to be accountable to its patients in an effective way, nor its funders, the tax-payer.

Take a second example of Paul.  He is a thoroughly pleasant and rather brave patient in the next door bed to me right now.  He suffers from the same condition too – cirrhosis of the liver.  Paul’s cirrhosis causes raised blood pressure in the spleen, oesophagus and stomach called portal hypertension.  In turn, this causes in both Paul and myself, varices, which are bulging veins inside the stomach that can burst.  If this happens, the patient has a 40 per cent risk of mortality because the bleeding can be so effusive.  It happened to Paul the day before yesterday and he started vomiting blood.  The ambulance got to Paul in time and saved his life.  He has lived under a bush since losing his job as a fishmonger.  He has no ability to pay for healthcare (and often no ability to care about health) and is a prime beneficiary of the NHS.  An immediate threat to kill him was averted – and he now has another chance at sobriety.  So long as he stays sober he could live decades, with regular check-ups and banding of suspect varices.



Brave Paul in the next door bed to me.  Recovering from a variceal bleed (stomach) that had him choking on his own blood.  It was caused by raised blood pressure in the portal system (portal hypertension) caused by severe cirrhosis and his alcoholism.  A vein bursting in your stomach carries a 40 per cent morbidity rate.  The NHS saved his life after his blood pressure dropped to 60/30 and he struggled to reach the phone to call for an ambulance.


So, hospitals play a life-saving role but they are over-extended.  They can’t distinguish between worthy patients like Paul and ones who don’t even want the ridiculous treatment like Selina. 

Nothing however about our obsession with the NHS and the largesse of Governments towards it, is more dangerous than the spiritual damage it does our society.  To explain more, I now turn in more detail to the greatest poem ever written on Hospitals: The Building by Philip Larkin (1972).

Read it here:

The Building (1972) is almost certainly about the Hull Royal Infirmary which was completed in 1968.  I was hospitalised there in 1991, having become critically ill after dropping an acid tab and a bottle of Courvoisier in 30 minutes.  (I became president of the Hull Royal Infirmary Club, for student’s who had been admitted there after ‘recreational’ drug and alcohol use.) 

The Hull Royal Infirmary showing its ‘clean-sliced cliff’ face


I wasn’t sentient enough to witness the appalling modernism and size of ‘the building’ at the time.  But I went back there with Larkin’s poem and marveled how he had nailed the place with such precision: ‘here to confess that something has gone wrong’. 

And then the stark ending, so typically of Larkins morbidity:

This place accepts. All know they are going to die.
Not yet, perhaps not here, but in the end,
And somewhere like this. That is what it means,
This clean-sliced cliff; a struggle to transcend
The thought of dying, for unless its powers
Outbuild cathedrals nothing contravenes
The coming dark, though crowds each evening try

With wasteful, weak, propitiatory flowers.

Larkin isnt just being morbid, The Building is a diatribe against the ghastliness of it all. The buildings are horrendous modernist structures, the porters are scruffy, the patients get pushed around in washed-to-rags worn clothes. The places are expensive and wasteful.  One might add the really old and sick in there (maybe 50 percent of the population) are so pathetically weak and hopeless, constantly shitting themselves, surely they should just be given a healthy dose of diamorphine to send them on their merry way.  Yet when this actually happens, there is an outcry!

So, Larkin didn’t like the aesthetics of hospitals, or their pecuniary squandering, nor the way, somewhat paradoxically, they hinder our ability to embrace life.  Without them, we would have more reason to live in the day.  There is something about death that brings us closer to the spirit.  We have spiritual thirst us alcoholics, but quench it in the wrong way.  That is why others bungee jump, or run with the bulls in Pamplona.  It may also why I have played a dangerous game of brinkmanship with alcohol and its physical consequences for so long.  I can’t deny that, physically, hospitals have saved me many times.  But spiritually?  They are harmful.  They are not the best of us but a sick symptom of our material age where we still take ourselves, as human beings, way too seriously.

5,775 words.
Written: May 2018. Edited: August 2018.



South Downs, Sussex, England, May 2020.




[1] Keith Waterhouse’s play ‘Jeffrey Bernard is unwell’ originally ran in the West End in 1989 when Bernard was still alive.  He was played most memorably by Peter O’Toole.  For a clip see here.
[2] ‘The spirits against the spirit’ – a formula coined by Carl Jung in response to the founder of Alcoholics Anonymous, Bill Wilson, 1961.  See the letter in a previous post - https://alberttapper.blogspot.com/2018/06/spiritual-recovery-from-addiction.html

Friday, 4 May 2018

Book Review: The Secret Surfer by Iain Gately. Head of Zeus, 2018. £16.99 (Hardback).




Iain Gately's latest book on his quest to 'catch a tube' has been subject to rave reviews.  Philip Marsden in The Spectator writes about the 'peculiar intensity of involvement' making it so enjoyable. See here.  Surfers are obsessives with a day job.  Selling strongly, it's a nourishing read about middle of life crisis, and resurrection in the challenge of nature, both physical and spiritual.  It could be parked next to 'An Old Man and the Sea' on your bookshelf, without a trace of Hemingway's rampant egotism.  Iain is both obsessive and humble, a rare combination.  I recommend you buy a copy, whether you know about surfing or like the idea of it.

The subject matter of his previous work tells a story: the history of tobacco, global ferias (parties), and a cultural history of alcohol.  All were beautifully written, La Diva Nicotina becoming a surprise hit in the United States, reaching the Top 20 best-seller list.  Little of his writing, until now, was autobiographical. 


I know Iain, which makes this book pertinent to me.  His left hip crumbled, precipitating his return to surfing, as my liver started dissolving.  If Iain could pull it back, get a happy family, and ride a big wave then maybe there was hope for me in his book.  Indeed he charts a resurrection I would be proud of.  His physical frailties get better and worse (his right hip starts to disintegrate in 2016, in sympathy for the left one, and he is reduced to finding a surfing work-around in 'knee-boarding' for a while).  His spiritual recovery however, is a relentless upward curve of unconcealed joy.  For Iain, it's all about surfing.  Wracked as we are by the guilt and shame of the past, and fear of the future, he finds salvation in the present moment - the only moment - riding waves for what they really were, 'pulses of energy, rolling through the sea'.  With honesty (and some characteristic understatement), he reveals he had 'dedicated himself to the comforts of life long ago, at the expense of neglecting its challenges' (p.2).


'It became a game to surf (waves), and so absorbing that any lingering angst vanished, together with the myriad of niggling, quotidian trivia that usually dart around my brain...  I was surfing for the joy of it, with no thoughts for anything beyond the here and now' (p.217).  


Appealing hey?  Here is a healthy connection with nature and the present: 'the only moment of reality is right then' (p.248).  When he found himself too crippled to stand on his board, it was as if he was kneeling to God, an allegory he doesn't miss out on. 


I first met Iain at the Seville Feria back 1997.  I didn't see him again until 2002.  I was living in Gibraltar launching online poker for Ladbrokes.  We agreed to meet up again at nearby San Roque Bull-ring.  He had walked all the way from his beach home in Tarifa, a very hilly 20 miles away.  He appeared, hot, well-tanned and smiling as ever, with the same mass of thick curly hair, accentuated by his short but muscular wiry frame.  He had a dirty linen knapsack containing some bread, cheese, jamon and seven half bottles of Fino, all empty.  I wrote in my diary of that period when I saw him quite a bit:


'Iain is one of the most extraordinary drinkers I know.  It’s not so much that he drinks a lot of alcohol, it’s just he doesn’t drink anything else – apart from a solitary cafĂ© con leche with his double brandy every morning in Tarifa’s Hotel Continental.'  


As I waxed lyrical, it was Gibraltar that was proving my cirrhosis-by-the-sea, not Tarifa his.


We had good times.  I admired him hugely.  He had this immense capacity for fun and erudition, and it was amusing to keep on having to work out which one was showing its face.  No one knew how he quite wrote a definitive, rather academic and glowingly reviewed history of tobacco.  He had these beautiful Spanish girls knocking about, who supposedly were his researchers on the book.  But that was long finished and they were still there.  As was Tim (the Aussie surfer in the book), an endless production line of joints.  I never really saw any defects I would now associate with an obsessive.  In any case, those matters were not of concern to me then. 


I was hooked by the book early on in Chapter one.  I recognised the 'rare spell of objectivity'(p.4) that comes during suffering.  The gift of desperation perhaps.  For him it was during his painful recuperation from the titanium implants to his leg.  He recognised he was powerless over advancing age but suddenly 'felt all new again'.  There was 'plenty left to achieve, hang onto, or let go with good grace.'  He is struck with a thought, which he underplays 'as a hint of mysticism' - 'the surfer might be alone in a deep-blue sky, and the tube their route to heaven' (p.7).  This is the most important line in the book, because it sets up it's purpose: to show just how much zeal someone can muster in pursuit of a spiritual mission 'to add a coherence to life'.  In short to find truth and connection.  And how many great anecdotes he can ram in there, for our enjoyment.


Perhaps we are taken on one too many trips to the seaside during the rest of the book.  When Iain is off and running he is difficult to stop.  But one is left gasping for what comes of it.  That however is missing the point of living in the moment.  We live to ride and ride to live.  I think the conclusion is too short, perhaps like Chapter one.  We are told that the trick to life 'is to extract worth from our own insignificance' (p.284).  For me this means we've got to stop playing God.  By finding out who you are not, you get a better perspective on who you are.  


In the meantime we learn something about, tides, swells, bathymetry, meteorology, St Piran, surfer rivalries, and why it is not a sport fit for inclusion in the 2020 Olympics.  We learn about the ghastliness of beach officials, beach-side car park attendants, beach-goers generally in England, and beach smoking bans.  But all with humour and a humility that comes from not taking oneself too seriously.