Leandro Herrero: “An enlightened top leadership is sometimes a fantastic alibi for a non-enlightened management to do whatever they want”

Auto reblogging is perhaps a little narcissistic but this is something that has relevance far beyond healthcare…. Dr Herrero’s blog is highly highly recommended.

A Medical Education

From Leandro Herrero’s  website, a “Daily Thought” which I am going to take the liberty of quoting in full:

Nothing is more rewarding than having a CEO who says world-changing things in the news, and who produces bold, enlightened and progressive quotes for all admirers to be. That organization is lucky to have one of these. The logic says that all those enlightened statements about trust, empowerment, humanity and purpose, will be percolated down the system, and will inform and shape behaviours in the milfeulle of management layers below.

I take a view, observed many times, that this is wishful thinking. In fact, quite the opposite, I have seen more than once how management below devolves all greatness to the top, happily, whilst ignoring it and playing games in very opposite directions. Having the very good and clever and enlightened people at the top is a relief for…

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First Known When Lost on Spring and mortality, with Herrick, Wallace Stevens, and Epictetus

Original here

Spring beautifully — and gently — counsels us to be mindful of our mortality. This is sound advice. In fact, we are well-advised to consider our mortality on a daily basis, through all the seasons. I am not suggesting that we should brood over “the strumble/Of the hungry river of death” from morn to eventide. But an awareness of the shortness of our stay here provides a sense of perspective, and reminds us that we ought to be continually grateful for what the World bestows upon us, without our asking, each day.

Spring (like all the other seasons) teaches us gratitude, though the gratitude may at times have a wistful and bittersweet cast.

To Blossoms

Fair pledges of a fruitful tree,
Why do ye fall so fast?
Your date is not so past;
But you may stay yet here a while,
To blush and gently smile;
And go at last.

What, were ye born to be
An hour or half’s delight;
And so to bid goodnight?
‘Twas pity Nature brought ye forth
Merely to show your worth,
And lose you quite.

But you are lovely leaves, where we
May read how soon things have
Their end, though ne’r so brave:
And after they have shown their pride,
Like you a while: They glide
Into the grave.

Robert Herrick, Poem 467, Hesperides (1648).

“Death is the mother of beauty.” (Wallace Stevens, “Sunday Morning.”) What do blossoms do? They “stay yet here a while,/To blush and gently smile;/And go at last.” What do “lovely leaves” do? “They glide/Into the grave.” This is how the World works, and there is no reason to brood or to grieve. Our response should be gratitude. Gratitude and acceptance.

“Do not seek to have everything that happens happen as you wish, but wish for everything to happen as it actually does happen, and your life will be serene.”

Epictetus, The Enchiridion, Section VIII (translated by W. A. Oldfather, 1928).

Preferring soiled banknotes to new 

A little snippet from the Institute for Money Technology and Financial Inclusion  blog , taken from an article promisingly titled “Micro Insurance Claim Payments through Pre-paid Cards: Technology and Regulation Driven Financial Inclusion in India” I found this finding on the valued placed on tangibility and how trust is indicated by the evidence of prior use fascinating – and surely reflects a phenomenon seen in other contexts; the reassurance of not being the first.

An interesting finding was that people often preferred soiled banknotes to new banknotes for fear of counterfeit currency. This emphasis on tangibility and trust based on physical signs of repeated use explains in part why mobile money has not taken off as a mode of payment and why some did not take as well to the pre-paid cards. A female respondent from a village near Varanasi said, “I don’t believe in new notes. The MFI agent once refused to accept them because the metallic part [the machine readable security thread and electrotype water mark] were damaged in the new currency note I had as part of my fortnightly deposit. The new notes have not been used before and I don’t know if they are genuine. I think many of my friends share this feeling too.”

Gola: The Life and Last Days of an Island Community


Recently I read this book, published in 1969 by Radio Telifis Eireann, on Gola Island. Gola is a mile from Magheragallon Strand in Gweedore, three miles from Bunbeg harbour.

When the book was written, Gola seemed about to be permanently depopulated. When I was young in the 80s and early 90s, it was supposedly depopulated, and yet in recent years the population has officially risen to 15 at the 2011 census (2016 census result awaited, I guess) and polling opens there, like the other islands, the day before the “mainland.”


This book, now nearly 50 years old, is itself something of a relic. It is very much a book of two parts; the first written by the TCD geographer F.H. Aalen, the second by the sociologist Hugh Brody. Both spent considerable time on the island, joining the various “intellectuals and semi-intellectuals” the boatmen describes as making the bulk of non-local Gola visitors.

Brody’s part gives an outline of the geographical context of the island and of the somewhat atypical rural life of the North West coast of Donegal. As he points out, and this was something I took for granted as a child but appreciate now, there is a paradoxical combination of remote isolation and relatively high population density in the strips of land along the coast of the Rosses and Gweedore (and to a lesser extent Cloghaneely) – a density bordering on urbanity at times.


Aalen’s writing comes acrosss as very dated. Words like primitive, neglected and backward recur regularly, without any contextualising. The words of “improving” landlords such as Lord George Hill are taken at face value. The evil of the “rundale” system, whereby land was subdivided and subdivided among families until unworkable plots remained, is presented as a straightforward matter of benighted local custom getting in the way of the obviously right, progressive thing to do. There is little real context, beyond an emphasis on isolation, as to why this system developed. Indeed, there is no sense that, in what is a harsh environment, that the local people may in fact have been highly adaptive in how they managed and coped.


There is a rather despairing tone to all this, and the sense is that a primitive way of life is, not without some sentimental regret perhaps, gradually fading away. Aalen is of course being  clear-eyed and realistic in many ways. He writes of how the economy of the area is dependent on remittances and seasonal work from Scotland. There is no doubt that, as contact with urban modernity increases, the traditional life of the islands declines. Aalen quotes the original Paddy The Cope testifying to an Oireachtas committee in the 1920s that, without remittances from Scotland, the economy of the Rosses would not last a year.


Things change quite considerably in Brody’s section on the sociology of the island. There is a certain wry humour here and more of a human sympathy with the islander’s point of view. Brody finds that elementary sociological facts, such as the actual population of the island, are hard to estimate. This is because life on the island is, and has always been, seasonal. Traces of this kind of transhumance remain not only in Gola but on the nearby mainland. My own family, to a certain degree, have engaged in it. Indeed, the rundale system of small plots divided by borders marked in memory and perhaps a wisp of wire of a fence also persists.

Brody finds that what would frustrate many investigators is actually one of the strengths and resilient features of the island. Indeed, he has a wonderful passage on how the islander’s stance is perfectly rational from their point of view. I don’t have the book to hand to quote it in full, but it conveys a much more open view than Aalen’s, and one which now, given that after some decades of depopualtion Gola is repopulated again, seems far more perceptive than Aalen’s very positivist view of human activity.

I have blogged before about how the decline of island life marks, not the irresistible march of progress, but a loss of a way of life, and therefore a loss of diversity. The irony of the rather self-congratulatory contemporary celebration of diversity is that all too often the diversity of ways of life and of living is receding; the diversity that is celebrated is a somewhat atomised one of individual or family existence in a more homogenised society overall.

I feel that my comments above on Aalen’s writing may be a little harsh, as the book overall is an enthralling read for anyone familiar with the area, or simply interested in island life and Irish sociology. It is also worth noting that this book, written nearly half a century ago, very much has an overall message that the days of a populated Gola were imminently over- it is after all subtitled “The Life and Last Days of an Island Community”-  and yet here we are in 2017 awaiting the 2016 census population of this island.

Review of “Old Friends”, Tracy Kidder, 2000

This was written in around 2000 and originally appeared in The Magazine, a zine I self produced a few issues of. I ended up posting the review on Amazon  – there’s probably a morality tale there. I wrote this when I was 21 or 22, hence the references to “we young people.” Since this, I have had a lot more experience of nursing homes, and yet I wouldn’t change much about the review, although I might if I re-read the book (which was the subject of a scalding review by Mary Gordon in the New York Times)

Oddly enough I can’t find the cover of the book I read online – which featured a black and white photo of an older man and a younger man in a diner. Perhaps it was the UK edition or somesuch. The internet can blind one….




“For most of those long-lived, ailing people, Linda Manor represented all the permanence that life still had to offer. It was their home for the duration, their last place on earth.”

Thus writes Tracy Kidder in “Old Friends”, an account of life in Linda Manor, a Massachussets old folk’s home. It would be a useful exercise to watch a day’s television and see how many elderly people are featured. The old are increasingly invisible in our society. Once respect for one’s elders was a maxim in most cultures. Now all has changed in the consumer capitalist west; with a prevalent worship of a narrowly-defined sense of “youth” – physically slim, impulsive, impatient; and the traditional virtues of the elderly – experience, deliberation, rumination – are derided in that accurate barometer of the spirit of the times, advertising. In medical training, there is an unspoken but clear bias against the elderly; students are advised to ensure that the stereotypically scatty little old lady sticks to matters of strict clinical relevance.
The notion that we have anything to learn from the elderly has disappeared from most contemporary culture. The elderly are a nuisance, a problem to be medicated and managed and forgotten. Kidder’s book – unsentimental and heartbreaking, a clear-eyed portrait full of dignity and beauty and humour – is a counterblast to the cult of youth and the pathologising of old age. Increasingly we, as young people, live lives surrounded by people of our own age only – the decline of large families mean that we are less likely to have infant siblings or indeed much older siblings, while the large extended family gathering is increasingly dwindling.
The blurb on the back of “Old Friends” begins:”What’s wrong with Tracy Kidder? A robust man, even a youthful one, a father fit and healthy, with years of life ahead of him: why did he voluntarily enter an old people’s home?” One might fear a self-fixated meditation on the authors own concerns; but Kidder is an absent presence in the book; he gives his elderly cast the stage. The focus is mainly on Lou, a serene, wise ninety year old Philadelphian; and his roommate Joe, a tempermental impatient seventy-two year old who chafes at existence in the home after an active life.

Kidder presumably had an extraordinary degree of access; not merely physical but also emotional. We are taken into the rooms of the dying, the deepest fears of those who will shortly join their ranks, the sadness and guilt of relatives. We see the power structure of the nursing home, a relatively enlightened one where nevertheless elderly people with enormous professional and administrative experience are made – with the best intentions – to feel like children.
We learn from the elderly in this book; and the elderly learn from each other. The gruff taciturn Joe is gently coached by Lou into telling his wife he loves her. Joe and Lou coach the staff of Linda Manor in tact and sensitivity- for example the hearty “Did you have a bowel movement today?” is replaced by the less intrusive”Did you or didn’t you?” The full emotional range is here; love, ambition, anger, jealousy, pride; life in its most distilled, pure form – life facing

Nthposition review of Pieces for the Left Hand, J Robert Lennon, 2005

Now this would be classed as flash fiction , I am not sure if the term existed in 2005 but it didn’t flash (ho ho) into my mind. Another piece from Nthposition.com – hopefully not completely gone from the world writ on water that is the internet…


Pieces for the left hand

by Seamus Sweeney

[ bookreviews ]

There’s a form of literary snobbery that holds that the bigger a book, the better. To be worthwhile, a fiction must be Important; and to be Important, a fiction must be large. We are a long way from Telemachus, who held that ‘a big book is a big evil.’ In this age of literary elephantiasis, where biographies of the most modest literary or historical figures regularly weigh in at well over the 1,000-page mark, where a novel is not a novel unless it approaches the dimensions of the phone book, the nice things Polonius and various others have said about brevity have been forgotten.

Of course, to every action there is an equal and opposite reaction, and in suitably Newtonian fashion some writers turn to the brief, the concise. Last year, the poet Don Paterson brought out The Book of Shadows, a well-received attempt to revive the ultimate mini-literary form – the aphorism.

The small story – by ‘small’ I mean a page or two pages, around 200 or 300 words long at most, rather than a short story as such – has had distinguished practitioners in the past. It is a literary form that has ancient roots. The parables of the New Testament echo in those fragments of Kafka, and those laconic miniatures of Borges that haunt the imagination longer than most deskbusting Important New Novels. The readers of the early days of universal education and widely diffused literacy were rich in small, wonderful stories. Johann Peter Hebel, the German educationalist and journalist, wrote in the early 19th Century a series of ‘house friend’ almanacs that featured tiny stories, one of which, ‘Unexpected Reunion’, Kafka described as “the most wonderful story of all time”. Wittgenstein reportedly carried a small volume of Hebel stories with him at all times, and if you feel like emulating him, Penguin Classics have published a collection called The Treasure Chest which I can heartily recommend.

J Robert Lennon’s Pieces For the Left Hand is subtitled ‘100 Anecdotes’. It consists of exactly that – 100 mini-stories, told in an artless, conversational style. In the Preface, which itself reads a little like one of the stories that follow, we are told about “the author of these stories” – a 47-year-old man, living with his college Professor life in upstate New York, “unemployed, and satisfied to be unemployed”. Rather than working – though in the past he worked what, it is hinted, must have been a tedious job to support his family while his wife began her academic career, “he walks for hours, cutting through fields and forests, hiking along the shoulders of roads”. These walks have begun “to shake things loose in the author’s mind”, and memories accumulate until, sifting through them, he tells himself the stories in his mind. “He is happy with them as they are: ephemeral, protean.”

The stories are grouped in seven sections: ‘Town and Country’, ‘Mystery and Confusion’, ‘Lies and Blame’, ‘Work and Money’, ‘Parents and Children’, ‘Artists and Professors’, and ‘Doom and Madness.’ Some of the anecdotes seem inconsequential, or are burdened with a too-pat irony. But the beauty of a book like this is that the next story is not too far away, and it might be funny or moving or wise or just odd.

It is of course invidious to further compress the already small stories that make up the collection. Some samples: two twins (male and female), turn out years later not even to be related and marry, much to the disgust of the townsfolk who still feel they ‘should’ be brother and sister. A nearby small town the author visits seems deadened, glazed over with grief; his initial sympathy on learning that the inhabitants are mourning the deaths of 11 schoolchildren in a fire is tempered when he discovers that this happened 40 years before. The section ‘Artists and Professors’ contains the most artificial stories, rather too steeped in an over-literary preciosity for my taste, but it also one of the most amusing: ‘Mikeworld’, the story of a 10th planet, the invention of a conceptual artist, which becomes part of the official science of a newly independent South Pacific state.

The stories in this book are not vital or arresting in the way Borges or Kafka’s pieces can be. There is something too much of the bucolic contentment of the narrator’s ambles about them. Also, there is a lack of proper names – we read endlessly about “our Mayor” or “a prominent businessman” or “our local paper’s film critic” – all of which may be intended to convey universality, but means that few of the characters gain more than archetypal identity.

Having said that, it is perhaps the perfect book for someone who has to make a succession of short, frequent bus or Tube journeys (full disclosure: for this review, I read the book on a series of such bus trips). It is always stimulating and never boring. It is a wonderful book for dipping into and reading a few stories at a time; indeed, I suspect that the impact would the lost and the faults enumerated above would be more obvious if one read it all in one sitting.

“People who are not expecting to cry will cry.”

“People who are not expecting to cry will cry.”

I would not necessarily expected to have found an article on what will happen when Queen Elizabeth II dies as gripping as I did, but Sam Knight’s piece in the Guardian is a fascinating, and in ways disturbing read.


While Knight reveals some of the hitherto secret details – such as “London Bridge is down” as the code phrase to mark Elizabeth’s death – and discusses the immediate issues of Charles’ succession – the real interest of the piece is the psychological impact that the Queen’s death will have:

More overwhelming than any of this, though, there will be an almighty psychological reckoning for the kingdom that she leaves behind. The Queen is Britain’s last living link with our former greatness – the nation’s id, its problematic self-regard – which is still defined by our victory in the second world war. One leading historian, who like most people I interviewed for this article declined to be named, stressed that the farewell for this country’s longest-serving monarch will be magnificent. “Oh, she will get everything,” he said. “We were all told that the funeral of Churchill was the requiem for Britain as a great power. But actually it will really be over when she goes.”

Knight links this to Brexit, to the possibility (again) of Scottish independence. Elizabeth’s coronation, in ways, marked the beginning of television age in Britain, and her death and burial will no doubt be over-interpreted in ways, but Knight’s piece is compelling in its evocation of an inevitable event that will mark a more than symbolic watershed.

queen coinwarhol_2348861k

The most arresting line is at the end of this paragraph (though I do wonder how Brian Masters could possibly have come up with his estimate):

People will be touchy either way. After the death of George VI, in a society much more Christian and deferential than this one, a Mass Observation survey showed that people objected to the endless maudlin music, the forelock-tugging coverage. “Don’t they think of old folk, sick people, invalids?” one 60-year old woman asked. “It’s been terrible for them, all this gloom.” In a bar in Notting Hill, one drinker said, “He’s only shit and soil now like anyone else,” which started a fight. Social media will be a tinderbox. In 1972, the writer Brian Masters estimated that around a third of us have dreamed about the Queen – she stands for authority and our mothers. People who are not expecting to cry will cry.

No matter what one thinks of monarchy – or The Monarchy – this is one of those instances where I can only urge Read The Whole Thing. Knight writes that the life expectancy for a 91 year old is four and half years – but of course Elizabeth has very good maternal genes for longevity, and London Bridge is likely to have some years yet before falling.