1031

In England Now

Fatcat, Bottle, and Pip leaned back after a heavy red-meat mealand swilled their glasses. A smile of broad sardonic satisfactionflexed their rosy cheeks. The solution to the Health Service lay likethe crystalline deposit in the bottom of that cheap little bottle fromthe local supermarket, full of sweetness but with deadly results.

Forget the Health Service; what need was there for it? What waswanted was a network of managers with money to spare. The wardscould be closed and doctors disbanded and nurses given hankies towipe away tears-because diseases would be soothed by a chequefrom the managers, a large one for cancers and a fiver for colds.Bronchitics could have a winter of pleasure on tropical shores paidfor by the Government. Parasuicides deserve trust funds set up withgreat foresight; second attempts would receive diminishing returns.A stroke in the elderly would be worth twenty thousand, in theyoung it’d be thirty and a pat on the back. Epileptics could have afield day with a hundred per fit, while status would hit the jackpotwith a million pounds.The hospitals have closed and the nice men have gone and the

grey suited shadows hand cheques out for pain. The renal and heartfailures are happy with the diagnoses and the ruin of the HealthService squandered for gain.But what of the patients? But what of the patients? But what of the

patients?, the great populace wails. A cold shoulder to cry on and athousand for infarcts. An appendix gets fifty but with anaesthesiajust a crown.And what of the handicapped, the diabetics, and the blind; the

deaf and mutilated, congenital and acquired? What of patients withinfections, the arthritics, and fascinomas; the endocrine neoplastics,thyrotoxics, and depressed? It’s clear they’re not listening. There’smoney to spare but first read the small print: they get more if they’redrowned.

Fatcat has a nasty itch on his comfortable bottom. His personalitch doctor is called in to scratch. He pampers and panders to thewhim of the Fatcat and tickles his rear and manicures his hands. Foran itch to the Fatcat is a serious illness, a deadly disease about whichhe’s afraid. The diagnosis is itching, the treatment is cream, and thefollow-up is endless both in the nights and the days. But there’splenty of time for the Fatcat who’s itching ’cos the ill and thedisabled have taken money, not care. For the future Health Servicewas made for the likes of the Fatcat and the grey suited shadows thathand cheques out for pain.

* * *

"Rufus, you have a funny face! Funny peculiar, I mean."The subject hardly lent itself to further discussion; and, anyway,

who was I to bandy words with a rising neurologist whose teachingrepertoire included a brilliant presentation of Facies in Diseases?Nevertheless, for many years I occasionally recalled John’s dictum.The decades melted away. The day of my retirement was

imminent. I was to be eased out of a regius chair whose ruggedgranite contours leave a permanent impression on the glutealmuscles. The dean was the soul of kindness at our leave-taking."Your colleagues wish to have your portrait painted", he said. Hewas not to know that my alarm was the result of broodingmelancholy incurred at the hands of a brash neurologist aggravatedby long friendship with the director of the city art galleries. Thisremarkable man often complained of lack of space to exhibit more ofhis vast collection. One day he took me on a tour of the cellars. "Agreat many of these are portraits", he said. "There are scores ofprofessors and ex-presidents ... Our medical colleagues inparticular have used up a lot of our space." "And now", I said,rather sententiously, "here amidst Stygian gloom, they’ve turnedtheir faces to the wall. Sic transit gloriam".The director nodded agreement. "But, of course", he resumed,

"most of these portraits will be recycled". "Recycled?" I repeated inastonishment. "Oh, yes, there’s now a method for recovering andmarketing the high-grade paint; the canvases, gently decolorised, go

to students; and the frames sell very well to art dealers—especially inthe USA." "This recycling", I said, still feeling rather shocked, "isit done here-in the art gallery?" "Oh, no!-by experts in a disusedcotton mill in Lancashire." "So ... so, if I had had my portraitpainted in 1970 it might now-re-cycled-be on sale as, say, ’Awindy day at North Berwick’ or ’Storm-clouds over Jura’?" "Notimpossible", he replied complacently, "and a better fate thanusually befalls most of those bronze busts ..." "Meaning?", Iinterrupted. "They make excellent gargoyles-modified, of course,by using a high speed drill. They are much in demand by collegesundergoing renovation. But I send the funny ones to cathedralmasons..." "Funny?" I interjected. "Well, hardly funny-butfunny peculiar", he replied, laughing; but there was no music inthat laugh.

* * *

WE dined al fresco and with coffee enjoyed the fragrant breezethat cooled the summer evening. Over the Alps the first starsappeared.

"Vacation’s over", sighed my wife. "Why can’t we manage morevacation and less work?" Similar thoughts must have occurred to allof us.

Then, from around the comer of the square, a man appeared,dressed in the costume of a more northern country, cradling astrange instrument in his arms. Carefully he took his stance, inhaleddeeply, and began to play. There was swift audience reaction:expressions of joy, astonishment, disbelief, and mortification couldbe detected as the mournful notes pierced the calm night. He playedonly briefly before offering his cap to the audience. In just a fewminutes it was filled to the brim. Some people gave to express theirdelight, but I believe the most generous contributions came fromthose who fervently wished that he would never set wind to thatcursed instrument again.

I did some rapid arithmetic: in five minutes he had earned enoughto enjoy another day in one of Europe’s most charming cities."Would it take long to learn the bagpipes?", I asked my wife as

the solitary figure vanished into the dusk.

* * *

THE news that a determined effort is to be made to reduce waitingtimes has been received with approval in our neck of the woods. Infact our patients do have individual appointments, and all three of usare regularly at our desks before the appointed hour, but only toooften the session ends in chaos and we depart at the double to signletters and so on, leaving the nurses frantically shuttling the next misen scène into place. The problem is, of course, that we deal with themost intractable material ever encountered-human nature.

If I may humbly offer a few suggestions: a new grade of healthworker will have to be created, the Special Officer, Diagnostic(SOD). Two SODS will be needed for each clinic, one to screenpatients on arrival and send all those who have arrived without theirappointment cards, doctor’s letters, hearing aids, spectacles &chome to collect them. Motility will be tested, and those unable torise from their seat and reach the consulting room in under tenseconds will be given wheelchairs or referred for physio as

appropriate. No one will be permitted to go to the toilet or for a cupof tea (frequent causes for patient disappearance) without writtenpermission. In the consulting room patients will be limited to onecomplaint only, and attempts to introduce symptoms that rightlybelong to other disciplines will be strongly discouraged (and ifpersisted with will merit a lecture from the SOD and a black markon the appointment card). No patient shall be permitted to weep: atthe first sign of tears he/she must be removed and a psychiatricappointment made. Finally. No procedures, curettings, or biopsiesmay be done the same day as the first appointment. This rule isinviolable, however old, crippled or frail the patient, or howeverdisabling or potentially dangerous the lesion.

If these simple rules are followed we shall undoubtedly needmore resources (ie money), and some patients may suffer. But weshall be in a position to assure the middle-aged, middle-classattenders-the main complainants about unpunctuality-that theircoffee mornings, hair appointments, and the like are secure.