Each year brings further evidence of the changes upon us. Tarnished leaves hang longer upon the trees, delaying till nigh on Halloween the piling into drifts that are so delicious to kick through. The still-growing grass seems to mock the wheezing old mowers that, destined for retirement in a grassless landfill, must keep chugging through until spring before replacements can be bought. And the children have already penned their Christmas letters.
This one will be a bad winter, the energy industry is being warned. Quite how anybody knows, given the inaccuracy of 5-day forecasting, I am not sure. But plans are being made. There has been a surge of natural disasters in the world lately. When will our turn come?
Perhaps this is not just about the weather though. Perhaps global warming itself is an expression of postmodernism. Perhaps? Both entail a loss of certainty. Things that we once took for granted — art means paintings, winter means snow, daffodils mean spring, natural disasters happen in other places but never here — must now be considered contingent. They may be true, may not: no-one can tell.
Global warming is affecting the public sector too. I see it every day. Constant storms and eddies in the health service that surpass the achievements of installation artists in creating patterns and structures that are intrinsically ephemeral. Whole departments appear, dissolve, transform, merge and finally cease to be without ever having contributed to the care of sick people. Whole organisations have sometimes been seen to do the same.
Within these eddies are people, some good, some bad. The most successful seem to be those that simply follow the currents, cropping up in ever less likely positions of authority within ever less likely organisational structures. Always it seems, before anyone has any time to ask what have they been doing, before there has been any time to assess the results of any of their decision making, they have followed the eddies on. Portfolio careers are an especially postmodern idea. It is an abstraction one step further to think that such a career can be had without actually trying, but rather as a direct consequence of working as a health service administrator.
You can see how some people get side-tracked. They get the idea about us all having to accommodate ourselves to the constant possibility of change in our lives. But then they get to believing that it is the change itself that matters, not just the flexibility to accommodate it. I suspect they are the ones that actually add heat to the currents, speeding them up, altering their flow, changing their patterns again, for bad as well — occasionally — as good.
At times it feels like our practice is a ship separated from the fleet. We look after our postmodern patients (multiple complaints, all diffuse and determinedly resistant to the notion of a single diagnosis) in relative, isolated calm. Few currents disturb our voyage. Not that we can rest easy like this. All communications with the rest of the fleet are incomplete, unsatisfactory, like morse with missing dots. Never mind the lack of support, what are the chances that we will get caught up in a coming storm?
What will happen this winter? Or next year? Will we be swept away some day? No-one can tell: perhaps.
Even if we were, that would not necessarily be the end of it though. Good news from the European Union Habitats and Species Directive: member states should consider species killed off by human activities as candidates for reintroduction.
- © British Journal of General Practice, 2005.
