Month: March 2014

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Jam Tomorrow

Commuting days until retirement: 255

George Osborne

The saintly Mr Osborne

My unlikely hero of the hour – well, of last week, anyway – is the gentleman whose title derives from a medieval tablecloth bearing a chessboard pattern: the Chancellor of the Exchequer, the Right Honourable George Gideon Oliver Osborne M.P. I’m as cynical about politicians as most people, but just occasionally one of them does something that seems so aligned with my own selfsh interests that I develop something that looks fearfully like a soft spot for them.

In this case, of course, it was the recent budget. Before the budget, the number of commuting days you see at the top of this post was in danger of being at least doubled. It works like this: as you might not know if you’re very much younger than me, the money you are putting aside as a pension throughout your working life (or not as the case may be) is not taxed by the government; but the downside of this has always been that you were not allowed to do whatever you liked with it when you retired, however sensible your plans might be. Your only option was to use it to buy an annuity, which would supply you with an income in retirement. You could shop around for the best deal, but once you had signed up for one, that was it; you were in it for life.

With all the recent economic shenanigans, and the record low interest rates, annuity rates have been flatlining. I was increasingly aware that if I had retired in May 2015 at the age of 67,as I had planned, the income I’d be stuck with wouldn’t be what I had once expected. My best option was to hang on grimly for another year or two in the reasonable hope that annuity rates would look up a bit.

But since last week Mr. Osborne has unexpectedly changed all the rules. Now when people retire they will be able to grab it all and run – or perhaps set off in a Lamborghini or on a world cruise, as the media have not been slow to point out. I’m fairly hopeless with money, but not that hopeless; and at least there’s no need to wait around for things to look up before retiring. I can choose whatever investment option looks best for my income, and then update it as often as I want.

It still means halving my income – this is the time if life when you wish you had thought more about boring things like pensions when you were younger. But of course they were only relevant to old people, that curious species that had nothing to do with you. I was only guided into saving what I did by various advisers whose wisdom I belatedly recognise; otherwise I would probably have left it until it was much too late.

But for me, it’s worth it to sacrifice a comfortable income for the incalculable improvement in quality of life that consists in having the time and freedom to develop my own thoughts, rather than being harnessed much of the time in the traces of my employer’s narrow aspirations. (Necessarily so, but narrow nonetheless: you see why this blog is anonymous.) And so the figure at the top of this post is safe for now, and I’m starting to salivate at the prospect of jam tomorrow; maybe not today, but definitely sooner than the day after tomorrow. The jam in question may be rather abstract – not the sort of item to appear on an accountant’s balance sheet – but it’ll taste good to me. Mr. Osborne has obliged me by giving the top of the jar its first vigorous opening twist.

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Sharp Compassion

Commuting days until retirement: 260

The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer’s art
Resolving the enigma of the fever chart.
   (from T.S.Eliot – East Coker)

Do No HarmA book review prompted this post: the book in question is Do No Harm: Stories of Life, Death and Brain Surgery, by Henry Marsh. I’ve read some more reviews since, and heard the author on the radio. I think I shall be devoting some commuting time to his book in the near future. It’s a painfully honest account of his life as brain surgeon, a calling from which he’s about to retire. Painful, in that he is searchingly candid aboout failures as well as successess, and about the self-doubt which he has experienced throughout his career. In fact his first chapter begins – rather alarmingly, after a life in the profession: ‘I often have to cut into the brain and it is something I hate doing.’

Some examples: we hear what it is like to explain what has happened to a woman patient in whom one of the mishaps which is always a risk in brain surgery has left her paralysed down one side. He tells her he knows from experience that there is a good chance it will improve.

‘I trusted you before the operation,’ she said. ‘Why should I trust you now?’
I had no immediate reply to this and stared uncomfortably at my feet.

He describes visiting a Catholic nursing home which cares for patients with serious brain damage. He recognises some of the names on the doors, and realises them to be former patients of his own for whom things didn’t go as well as he would have hoped.

Marsh’s title Do No Harm is of course an ironic reference to the central tenet of the Hippocratic Oath; but we know that in modern medicine things aren’t as simple as that, and that every operation should only be undergone after a weighing up of the risks and likely downside against the benefits. These are never so stark as in neurosurgery, and, not surprisingly, its sheer stressfulness ranks above that of intervention in other parts of the body. Marsh rather disarmingly says, against the popular conception, that it mostly isn’t as technically complex as many other kinds of surgery – it’s just that there is so much more at stake when errors occur. He quotes an orthopaedic surgeon who attends Marsh himself for a broken leg, and hearing what he does, clearly feels much happier being in orthopaedics. “Neurosurgery,” he says, “is all doom and gloom.”

I have often imagine what it must be like to be wielding a scalpel, poised over a patient’s skin, and then to be cutting into a stomach or a leg – never mind a brain. Of course a long training, learning from the experts and eventually taking your own first steps would give you the confidence to be able to cope with this; but it’s to Marsh’s credit that he has retained such a degree of self-doubt. Indeed, he speculates on the personalities of some of the great neurosurgeons of the past, who didn’t have the technical facilities of today. Advances could often only be made by taking enormous risks, and Marsh imagines that it would sometimes have been necessary for them to insulate themselves against concern for the patient to a point that marks them as having not just overweening self-confidence, but poitively psychopathic personalities.

I’m lucky not to have been under the knife myself very often, and never, thankfully, for the brain. But what I have experienced of the medicine has shown me that personalities which, with their unusual degree of arrogance, verge on the psychopathic, are all too common in the higher reaches of the profession. One who sticks in my memory wasn’t actually treating me: he had been commissioned to supply case histories for a medical computer program that I was involved in producing. This was not neurosurgery, but another area of medicine, in which I was aware that he was pre-eminent. We went through these case histories, some of them very complex, which he explained. “I diagnosed that,” he would say, visibly preening himself. On the whole he was perfectly good to work with, provided you showed a decent amount of deference. But at one point he moved beyond the subject matter, to lay down how he thought the program should work. This was my area, and I could see some problems with what he was saying, and explained politely. There was an icy pause. Although never less than polite, he proceeded to make it clear that nobody, least of all a cypher like me, was authorised to challenge an opinion of his, on anything. (Later I went ahead and did it my way in any case.) This was back in the eighties, nearly 30 years ago. Thinking about him before writing this, I googled him, and sure enough, he’s still out there, working at a major hospital and with a Harley Street practice. He must indeed have had enormous ability to have been at the top of his area for so long; but as a practitioner of the healing art he was, like, I suspect, many others, definitely not cuddly.

On the radio programme I heard, Henry Marsh remarked that, if you accept praise for your successes, you must accept blame for the failures, and that there are the medical practitioners who don’t follow that precept. I suspect that my friend described above would have been one of them; I have never encountered a level of self-regard that was so tangibly enormous. Perhaps we should be thankful that there are those who harness supreme technical skill to such overweening confidence – but you shudder a little at the thought of their scalpel in your brain. If this was to befall me, I’d much rather the knife was wielded by someone of Marsh’s cast of mind, rather than an equally skilful surgeon with all the humility of a bulldozer.