The Goldberg Variations

The world of work, predominantly corporate and office-based, makes up the bulk of many British and American lives. It’s literally what we do most of the day, for most of the days of the year.

But, despite the fact many of us live its weirdly intense emotions, it’s extremely hard to write about. When you put the words down, or even try and tell someone, it disappears, or sounds petty or prissy or boring or confusing. It’s an act of love to listen to it.

Joseph Conrad got around this by making it about mass murder. Gogol made it about an overcoat and the nature of existence. Franz Kafka was really writing about his family. David Graeber and Barbara Ehrenreich broke it down at great length, and rebuilt it in their own voices.

And Yoel Noorali has made it funny, but also about death and insanity. Which seems somehow totally correct. Below is an excerpt of his book, The Kingdom, which is anchored in his experiences inside Britain’s National Health Service — one of the biggest, and most idiotically run, organizations on earth.

He worked in the Liver Wing of a large British hospital, “a unit specialising in the diagnosis, treatment, and management of patients with cancers of the liver and pancreas” as an administrator, accidentally renamed “Yeol Morali” by the weirdnesses of the system.

His job was to click complex medical terms in software known as Liverware, with a small team of other administrators, including The Mother (who spends her time talking about her daughter, or her husband's dashcam installation business), The Moron (whose name is self-explanatory) and several generic others all referred to as Diane. Along the way he runs into an old university friend, Adam, who had a seemingly perfect life.

I think of this chapter, The Goldberg Variations, as the flipside to Juliette Cezzar’s essay from inside McKinsey. (Which, of course, works with the NHS.) It perfectly describes how it feels to be observed and managed like a thing, and the impact it has on both Yoel and his wife Charlotte.

I hope it won't be as gruesomely familiar to you as it was to me. (I suspect it will, though.) RS.

IN MY FIRST SPRING AT THE NHS I DAYDREAMED about death and dying often.

These visions started after The Mother swivelled around to ask us what field we’d specialise in if we were clinicians. She chose surgery. I recalled a previous month’s swivel, when the pair of us had been alone in the office.

‘Yoel, do you think you could ever kill a man?’ she’d asked.

‘...No,’ I’d replied, ‘I’m not very confrontational.’

‘But if you had to,’ she persisted, ‘could you?’

‘No,’ I repeated, trying to click, ‘I’m weak.’

‘What if they raped Charlotte?’

‘Is Liverware working for you?’

‘What if they raped Charlotte?’

I kept clicking, to no effect. ‘No,’ I said. ‘I wouldn’t hunt a rapist down.’

‘That’s not what I meant,’ The Mother said. ‘I meant what if they were raping Charlotte?’

‘Charlotte’s very safety-conscious,’ I said. ‘She gets Ubers everywhere.’

‘Do you know how many rapes happen in Ubers?’

‘No. Do you?’

‘My dad used to be a cabbie.’

‘I think Liverware might be down.’

‘He says they’re all sex freaks.’

‘Whose turn is it to contact IT?’

‘You haven’t answered. Do you think you could ever kill?’

I tried to click Liverware to life, sighing something to the effect that I’d do my best to kill a cabbie in that one example of an attempted rape. The Mother continued staring, waiting to be asked the same question. Her eyes made it apparent she’d only asked the question to be asked it in return. I sighed again.

‘And what about you?’

‘If anyone ever attempted to harm my child,’ she said, ‘I would murder them. I would find the power to kill. That’s what being a mother is all about.’

She didn’t have the composure for surgery, I felt.

I chose autopsies. I’d never thought about it before but I realised that if I could do my entire life over that’s where I’d be: the morgue. I could not picture a more peaceful office.

I tended to drown out my colleagues’ conversations midway through by lowering new noise-cancelling headphones over my ears—lately, to listen to Glenn Gould—but I didn’t when they asked, ‘Why the morgue?’ I answered, ‘Because in the morgue, there are no deadlines, no targets; the deadline has passed.’

I began checking the job boards of the six hospitals nearest to me for admin vacancies in morgues. The morgue appealed to me in some of the ways Glenn Gould did. There was a dig- nity about both. Both were dignifying. If I worked hard in the morgue, maybe I’d be able to get a job at Dignitas. That was the ultimate goal. I was done ‘saving lives with my administrative skills’. My administrative skills would now streamline death. Dignitas. I could greet people at reception, a concierge.

‘This way.’ ‘No, you won’t feel a thing.’ ‘Good luck! I’ll see you soon!’

Glenn Gould scored these reveries with a dignity he also imposed on the mass emails:

I hope this email finds you well! I wanted to give you all a bit of an update around the upcoming Love Admin Week, taking place from 24 April 2023–28 April 2023! We have lots of events and celebrations taking place that week, we will be out and about in the trust, with the Admin Network merchandise, and looking to engage with as many Admin as possible!

I have a number of events taking place that week, that I want to share with you, for a chance to attend! There will be four Face to Face Training Sessions on the topic of ‘Being your Best’. This will be delivered by an external provider and will last approximately 2.5 hours.

Glenn Gould also scored the ant infestation. I watched a column crawl from the neighbouring desk, across the top of my keyboard, and onto the next desk. Some of these ants carried crumbs. They’d travelled four floors. It’s a testament to the cleanliness of the rest of the hospital that across four floors nothing had distracted the ants. The ants had one destination. The filthiest shithole in the building. Nothing would stand in their way.

I admired the ants. In a Teams meeting with a new middle manager, I glanced at a group of un-killed ants and then at myself in the corner of the screen, mid-buffering. Yeol, the ants. Yeol, the ants. I found I identified but couldn’t figure out on what basis since I didn’t have any of their determination.

The answer only came to me later, when I watched one ant break rank, drifting closer to the keys: stupid, mad.

In the meeting, the new middle manager promised us she had ‘read the ant emails’. Afterwards, she asked us to start rais- ing our hands before speaking. Any drops of dignity unwrung during Christmas, in a department with no dignity to spare, she finished wringing. Any decent human would hear The Mother gearing up for another dashcam monologue—‘Tommy was installing a dashcam...’—and reach for their headphones. This middle manager hissed, ‘Shush.’

I was speechless.

It was the kind of noise you’d use to separate cats. All that time spent wishing The Mother would stop speaking and now the silence just sounded sad. This crestfallen emoji, swivelling back to her screen:...click...click... I felt so sad I almost asked, after twelve months, ‘What actually is a dashcam?’

The first law of thermodynamics states that energy can neither be created nor destroyed. It can only flow into new forms, vessels. But when the middle manager drained the dignity from the room it didn’t collect elsewhere. It just died.

Outside of commuting hours few people passed the morgue. A thin, brightly lit corridor led to the entrance, hidden in a wing shared with laboratories and the post room. A young courier with a blonde ponytail, carrying a red cooler containing litres of blood, exchanged a smile of recognition with me each time we waited at the door of the lab. I carried an envelope, or several envelopes, containing pieces of organs. Occasionally, she carried organs too. She wore Skullcandy headphones. Somehow, she added to the cluster of carefree associations orbiting the morgue: a teen humming pop songs while she swung kidneys in a case. To live is to die. To die is to live. She captured that sameness happily.

On the morgue’s heavy wooden door peeled an old piece of paper stating, ‘WE ARE SEVERELY UNDERSTAFFED. PLEASE BEAR WITH US.’ Yet, the morgue never advertised any openings. I passed the door at least twice a day and I hadn’t, in a year of working at the hospital, seen the door open.

The morgue was dead. In the movie Flatliners medical students experiment with stopping their hearts in order to feel dead. I wanted that sensation from a job. If I “died” while I worked—if I was dead to the work—maybe I’d be less depressed. ‘Because,’ I tried to explain to Charlotte, over dinner, ‘dying puts you in touch with the very essence of life—which is to die.’

Charlotte sipped her white wine, serene in a post-yoga glow, and I sipped mine, ashen after another chapter of The Denial of Death by Ernest Becker. I’d been misunderstanding and para- phrasing the book for some time. Charlotte suggested finding healthier ways to get through the day. She said, ‘You should get a job doing work you enjoy.’

I stifled a laugh. She sipped her white wine and tried to continue, her forehead creasing deeper the more I interrupted. It worried her, she said, to hear me speak for so long and in such circles about ‘death’ and ‘Flatliners’, which she hadn’t seen. She heard me out but I realised I didn’t particularly understand what I was saying. I sounded like an undergraduate thinking out loud, drunkenly making it up as I went along, explaining and re-explaining minor plot points of Flatliners that Charlotte had misunderstood, which even I had a foggy memory of (I hadn’t watched the film more than once). Charlotte largely stayed silent and still while I tied myself in these knots, her eyes stern with thought even, for instance, when I heard myself qualifying ‘what I personally mean by death’. Finally, when exhaustion opened a gap, she said, ‘I don’t think these are the right spirits for applying for a new job.’ A pause. ‘A morgue won’t be Flatliners.’

After that, she added that this manner of speaking (‘death’, ‘dignity’, ‘Dignitas’, ‘Flatliners’) might be setting the stage for what we liked to call my Annual Nervous Breakdown, an event that generally occurs in the spring.

My Annual Nervous Breakdown likely began when another middle manager hired and introduced The Shusher. Nobody really knew what all these middle managers did, least of all, I suspected, the middle managers. The number of meetings they arranged with each other suggested they did have something to do just as much as it didn’t; the meetings may have been in aid of clarifying this. Whenever I glimpsed one through the glass panel of a door, and saw all those curious faces around the table, I imagined them asking each other, ‘What are we doing here? Why?’

The middle managers were not so different to The Mother, then—nor to any of the clickers, whose dream of ‘leaving the shithole’ usually ended when they realised they could manage it. Because so many clickers signed themselves off on indefinite stress leave and the middle managers, in Costa, didn’t, the department organised itself into an informal dreidel structure: for every one clicker, two middle managers to oversee that particular clicking. Thus, to maintain balance, the middle managers needed to be very light, register only as the faintest possible presence—as pure thought, no action—which the majority did instinctively. I rose from my seat to meet The Shusher hoping she would too. We shook hands, hers notably cold. She shook a Diane’s hand. Then, addressing everyone, she asked, ‘So how are things?’

‘Great. Fine,’ I said, smiling. ‘Everything’s fine.’

We all smiled for a while. Her eyes drifted across the room, lingering quizzically on the bin, full of The Moron’s fried chicken boxes, some open with bones inside. In the interlude, the other middle manager announced The Shusher’s plan to shadow us for a fortnight.

I sat back down, trying to hold my smile. ‘We know you’re working hard,’ she said, ‘but we don’t want you working so hard you forget to work smart.’ She smiled. ‘Some oversight will help us identify where you’re going wrong.’

‘Not wrong,’ said The Shusher, laughing awkwardly. ‘Nobody’s doing anything wrong. It’s more to see where we’re falling short of certain norms, misaligning with our objectives.’

‘Exactly, any abnormal misaligning that you can correct we can point out.’

‘You do really important work. We want to make your lives easier.’

The Shusher smiled at us as if assessing our throats for any space she could shove more admin into. A Diane wheeled to the kettle, asking her if she wanted a tea, and I resumed clicking, occasionally glancing over my shoulder. The Shusher was short, maybe twenty-eight, with eyes strained wide open, like a nocturnal animal’s. She declined the tea. The Mother had already heard, somehow, that her boyfriend served in the military. She asked us for our names again to make sure she’d remember them and then left the room repeating, ‘Yole, Yole, Yole...’

‘How do you click smarter?’ The Mother asked.

‘She must’ve meant faster,’ I said.

I glanced at the surviving clickers, sitting at their desks.

The compound stress of the exits meant the workload was now out of control. I was clicking thousands of times a day. The days of an hour’s writing at work were burning somewhere back in December. I worked late and through lunch. The errands Charlotte assigned me I was now trying to cram into what we jokingly called my ‘mental health runs’—circular sprints around Peckham, soundtracked by Gould—such that I’d run to buy wine and run back along Rye Lane with the bottle in my fist, as if a manic alcoholic. I’d also done this with a chicken, a panettone, and a drill.

My writing schedule exacerbated the stress. For ten years I’d been waking up at 5am to work on my awful novels before heading off to my day job; I still did this but after finishing at the hospital at 6pm I now returned home to work for an artist whose catalogues I subedited for extra cash. Consequently, each weekday I stared at a computer for sixteen-hour stretches: four hours in front of a novel I couldn’t seem to finish about a novelist unable to finish a novel, eight hours in front of liver cancer, and four more in front of contemporary art.

Whenever The Shusher smiled her eyes thinned. She had unusually sharp canines. It felt unbelievable but she genuinely had the demeanour of a vampire. Once, after she left the room to shadow another team, I swivelled to The Mother. I looked over my shoulder. ‘Does she, um, I don’t know’—a breathy laugh—‘seem like a vampire to you?’

I intended for this to sound like a joke but it came out paranoid. ‘They’re all like that,’ The Mother sighed. I smiled, in a way that I sensed looked fake. We returned to our screens. My fear of the email I suspected The Shusher would send at the end of the shadowing—something full of ‘suggestions’ and ‘thoughts’—kept escalating. In the days preceding its arrival I reacted to the mounting stress in several strange ways. I listened to Gould’s The Goldberg Variations more than ever, determined to block out my colleagues for longer and longer periods. During what passed for breaks the rapid piano continued looping as I checked job boards for morgue vacancies or reread the report from a patient’s scan that an error with the radiologist’s dictation software had rendered curiously poetic:

The study in conjunction with the CT demonstrates a small 7mm hypovascular lesion in close proximity to a haemangioma in Segment V/VI. This could represent a small metastasis. This could be treated with percutaneous ablation if this is correlated on functional imaging. Was a year you were aware of the year if a year and you are a year you. You follow your mother year if a high uric year by year follow her earlier if there are.

I couldn’t get that penultimate line out of my head: Was a year you were aware of the year if a year and you are a year you. To me, it was a bittersweet poem about time passing. And the poem accompanied a concurrent rising—and random—interest in anatomy. I didn’t know why but I found myself reading the referrals with a deepening fixation on the clinical correspond- ence concerning the patients’ bodies: the cellular changes, the metastases, the decay. Walking home from the hospital once I saw a pigeon pecking innocuously at a crumb in the gutter. I heard a voice asking: ‘How would a bird behave if its wings got ripped off? What would the movement look like?’

Finished with the crumb, the pigeon walked away. The light for the crossing turned green and I carried on, up the hill. I wondered where pigeons went to die. Millions lived in the city.

Where were the bodies? The only dead I ever saw were victims of collisions with cars. Where did the natural deaths happen?

I wanted to know how a living thing shuts down. Simultaneously, I had stopped shutting down my computer. By not switching it on each morning I gained ninety seconds. But I feared a deeper meaning to the efficiency, as if I’d conflated my life and the PC’s.

A mild hypochondriac streak plagued conversations with Charlotte, in which I persuaded myself I might’ve been dying, although for no apparent reason. In the living room I looked at her curled up on the sofa reading Nancy Mitford while I, rigid in the IKEA armchair, persisted with The Denial of Death. I put the book down. I asked her, ‘Do you, um, think I might have lung cancer?’

‘Why?’

‘Or liver cancer?’

‘Why?’

I didn’t know. I said I guessed I just couldn’t be certain I didn’t have cancer. I wanted to rule it out.

‘I work in PR,’ Charlotte said, turning back to her book. ‘I don’t know if you have lung cancer.’ Years of similar conjecture had inured her to this. ‘Why are you asking me? Can’t you just get a scan at work?’

The sorts of things you can ask for at the NHS are toner, paper, a mousepad—maybe. People in car crashes can’t get scans. For me to get an MRI I’d have had to leap in front of a train.

‘What happens if I die?’ I asked Charlotte.

‘Nobody knows, do they?’ She kept reading, eyes down.

‘They do, but I don’t mean that. I mean practically.’

Charlotte closed her book. ‘Well, I always thought that with the life insurance paying off the mortgage I could sell the flat, buy a smaller flat outright, and use the profit to get a mortgage on a second property to rent out. And if we had a baby by then, I could use the income from the rent to spend more time with the baby and maybe adjust my hours at work.’

I blinked. She’d planned. And the plan sounded amazing. I almost felt jealous. I’d asked the question expecting her to think out loud for a while, improvise an answer, and received in seconds a strategy that gave me the impression I was in the way.

‘What about you?’ she asked, sipping a green tea. ‘Do you know what you’ll do if I die?’

‘Jump in front of a train?’

Charlotte smiled. ‘That’s sweet.’

‘I haven’t given it much thought,’ I said. ‘You’re so healthy.’

She shrugged. ‘Anything can happen.’

At the office, the notion I might be dying without knowing it growled on: lung metastases, lung metastases, lung metastases. Click click click. With the job in the morgue I wanted to feel dead, not be dead: the good bits without the bad—the freedom, the quiet. I viewed it as my maranasati, a way of meditating I’d read about in a Michel Houellebecq book. It encourages Buddhists to imagine their own corpses—the rotting flesh, the smell of the blood, the worms, the insects—until they grow accustomed to the inevitable. Click click click. But I hadn’t done my maranasati yet; I hadn’t even applied for a job. None were available. I remained afraid of the inevitable. An email from a colleague at another hospital haunted me. I’d asked him for the results of a patient’s surveillance scan. He replied:

Hi,

they died on 03/01/ 2023 thanks

I stared at my screen, spellbound. I couldn’t stop picturing the administrators who’d one day trade these emails about me. Bergman, Mann, Bosch: I’d never seen the insignificance of our passings rendered with such radical clarity. This was all that the endless effort to live amounted to: ‘Hi, they died on 03/01/2023, thanks.’

Despite the emails to The Shusher the ants continued to best the department. Throughout the day we blew new columns back or mashed individuals with our hands. The Mother had bought a spray, using it without warning or skill, with the cloud causing coughing fits. Choking, I suggested somebody throw away their dead fucking cucumber. Nobody understood. I opened the door to our waist-height fridge on my knees and yanked the cucumber out of the vegetable bin, fingers pinching a glob of mush at one end of the plastic sack of foul black liquid. I’d monitored it for months. The ample opportunities to throw the cucumber out myself I’d deliberately resisted because that wasn’t the point. The person who bought the cucumber should’ve thrown the cucumber away. It was the principle of the matter. I looked up from the floor at The Mother, The Moron, and the two Dianes, all watching me with faces suggesting the words: Is he...okay? In reply, I asked, ‘So no one minds if I throw out their cucumber? Because it’s just black liquid now.’

‘Just...throw it out,’ a Diane said.

‘That’s an amazing idea. No one minds?’ I eyed each face in turn.

‘...No.’

‘Great. I’ll do it then.’

I marched to one of the bins in the corridor. I hurled it in, heard the thud. For a second, I felt sad, bereft. Apart from the ants about the only thing I could relate to in the place was the cucumber. You hardly saw the dead alcoholics. Well, fuck it, I thought, the ants could quicken my maranasati alone. We’d make do without.

Around that time, I ran into Adam the animator one evening in the park. I didn’t recognise him at first. He looked thin, standing on the path alone, hands in pockets, dark eyes on his dog rolling with another dog in faraway grass. I reached his feet panting, recovering from another attempt to outrun my depression, probably holding a bottle of Beaujolais. The catch-up went much better this time. Adam said that after giving birth to their second child his wife had decided she wanted a divorce and also custody. I said I’d successfully sought a career in the health sector. What next? Oh I don’t know, a morgue? Dignitas? Yep good to see you too, best of luck.

You’re not dying, I told myself in the shower, brushing my teeth. Nothing dies. Nothing dies permanently. The matter flows into new forms, vessels. The particles regroup. I brushed long and hard: manual, never electric. You get another go. You come back as something better. I spat; blood in the toothpaste. An ant. The ants eat you and you become an ant: happy, industrious, a good pace. I switched the shower off, still brushing. Where’s the dignity going, though? Where’s that regrouping? A last spit in the sink. Is any of this physics?

The running helped. Sometimes I only needed to let some air into my lungs for my eyes to un-sink enough to see everything in its place: birds, cars, children, each knowing where it belongs. Running rearticulated the strangeness of that symphony. Strangeness defanged depression. How, the runner asks, is a green parakeet at home in Peckham?

We received The Shusher’s email at 5pm, following a Teams meeting in which she introduced a few of the headlines. As she spoke, I watched myself in my small square on the screen, holding my smile. The Shusher said she wanted us to conduct something called a ‘time in motion’ exercise. She wanted us to record everything we did over the course of a week. ‘You could even say how long it takes you to make a tea,’ she added, with a laugh. I smiled wider, laughing soundlessly. Next, she wanted to organise ‘some official team-building opportunities’, ‘possibly via Microsoft Teams’. She said she’d spoken to the team in charge of team building and that the team-building team had recommended a ‘team balloon game’. I continued smiling but became breathless, shaky, convinced the indignity would kill me even before it had actually happened: an a priori heart attack, an a priori heart attack I’d actually watch myself—or some pixelated version of myself—enduring quietly in his tiny square of the screen, the nice smile held for so long that surely the strain was warping the skeleton, setting the skull into a grin destined to go on grinning long after the ants had come and gone for the flesh.

Still preoccupied with holding the smile, of the next announcement I only heard the alarming words: ‘standards’, ‘expectations’, ‘improvements’. The subject was ‘policies and procedures’. She explained how we each violated the hospital’s uniform rules. I looked down at my Modest Mouse T-shirt. After that she banned anyone from arriving early in order to leave early for an appointment, and, finally, she announced:

When in the office the personal use of headphones is not permitted.