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The penniless exiles of Soho

A farewell to Soho Pam, the local beggar Pamela Jennings.

One time, I listened to a tall, silver-haired man holding court in the smoking area of the New Evaristo Club in Soho, London. Challenged by a fellow drinker to explain why this was the greatest place on earth, he rambled on about the area’s much-mythologised history – it had long been the sinkhole of noble misfits from Francis Bacon to Dylan Thomas, all sozzled enough to get along – and claimed that it even had a patron saint. OK, not a saint but a foreign king, who had died a beggar on the streets above us (we were on the lower-ground floor). This king, he said, was buried somewhere close by.

How this hard-luck story proved Soho’s greatness was beyond me but it was too late in the evening to split hairs. At the time, I assumed it was just another tall tale to add to all the others that clung to this part of the capital. But a quick look at Peter Ackroyd’s London: a Biography later revealed it was true: the king was from Corsica; his remains were interred in the churchyard of St Anne’s in the mid-18th century. “This penniless exile might almost be considered the true monarch of the area,” Ackroyd wrote.

Not so long ago, the sad news spread that another of Soho’s penniless exiles had died: the beggar Pamela Jennings, better known as Soho Pam, a familiar sight to those of us who drink at the Coach and Horses, the French House or any of the other pubs on what was her nightly circuit. Pam was a diminutive, fortysomething woman with closely cropped hair, glasses that framed curious eyes and an uncanny ability to extract a “donation” from even the most hardened Londoner.

Like many, I saw her around and considered her a part of the city – if, indeed, I ever considered her at all. To me she was a stranger, at most an occasional but benign presence in the dimmest corner of my eye. Others I spoke to at the Star and Garter, the Coach and at Trisha’s (as regulars call the New Evaristo, after its proprietor) reported a similarly remote relationship but they were full of local lore about money given to her and then returned; about drinks she had bought for hard-up friends; about the “cuddles” she’d give.

Those who knew her better celebrated her life in the press and online. Bar Italia posted on its blog: “Goodbye to another proper Soho character”; the artist Robert Rubbish called her the “queen of Soho” and wrote: “She was a very sweet lady and refreshing to see.” Alastair Choat, landlord of the Coach, told the West End Extra: “There’s a lot of hardcore regulars or locals in Soho that started to look out for her, that she would always come to for a little bit of moral support.”

With the nearby Crossrail development at Tottenham Court Road Station due to be completed in 2016 and the area’s rental prices ever rising, the Soho of popular imagination is fast being swept away, its characters and all, by TK Maxx, Patisserie Valerie and the like. Ackroyd wrote: “In Soho, every street is a memorial” – but now, it seems, even these memorials are fading from view.

The Chinese-American geographer Yi-Fu Tuan once posited, “If we think of space as that which allows movement, then place is pause.” The strange spaces that surround us are transformed by these pauses, these stillnesses we create whenever we invest a piece of ourselves in our haunts. In some small way, they become our homes. Yet this sense of place is brittle; places change, as do their associations. “There is no there there,” wrote Gertrude Stein, recalling a trip she took as an adult to the city of her childhood, Oakland, California, and finding that what intangible connection had made it her own no longer existed. I thought of this as I sat on one of the benches outside the Coach: Soho Pam’s “there” is no longer there. Rest in peace.

Yo Zushi's most recent album of songs, "Notes for 'Holy Larceny'", was released by Pointy Records (£9.99). His new song "Careless Love" can be downloaded for free here. Follow him on Twitter at @YoZushi81

Yo Zushi is a sub-editor of the New Statesman. His work as a musician is released by Eidola Records.

This article first appeared in the 04 February 2013 issue of the New Statesman, The Intervention Trap

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide