At the Centre of Things - 5 November 1999

For the first time in, well, too long, I'm back in San Francisco.

And after the jungle of New York with its pushing polyglot crowds, the whining ambulances and the screaming police cars - I admit I live close to four hospitals - it is a kind of therapy, a healing pleasure, just to sit here and look down and out over a small park, see one or two middle-aged Chinese doing their grave exercises - their slow motion stretches and stridings - an old man dosing over a newspaper, three people walking - easily, slowly - three only along four streets that I overlook.

And beyond a couple of high rise buildings - sharp as knives in the sun - are one of the city's seven high hills with its stack of little white houses and beyond them again the far, spreading, blue backdrop of the Bay and a freighter sliding off to Japan, I guess.

And yet the first exhilarating feeling is not the pleasure of familiar sights and people but the great relief at not being in New York City.

I hasten to say that this relief is not peculiar to leaving New York, it's the same after you've lived too long in any great capital city.

The trouble with New Yorkers, Londoners, maybe Parisians more than anybody, is they think they're at the centre of things.

They learn this when they're a child, their history books tell them so and indeed a long stretch of the national history did happen there.

They begin to take it for granted in youth. The papers boast about it. By early middle age at the latest they take a smirky pride in knowing in their bones without ever questioning that anything of importance, everything important in literature, theatre, the arts, architecture, medicine, originated in the greatest city in the world - theirs.

In some languages, notably English, this feeling is so rooted in the past that it long ago went into an idiom, without the natives being remotely aware that other nations find the idiom offensive.

I wonder how long ago Englishmen started saying - "He's gone out to the States."

And in my own time I've watched Americans wince politely when an English woman, usually, enquired intelligently - "When did your family first come out here?"

"Out" means in any language out from centre, hence "eccentric" was first the Greek and then the Roman word for, originally, a provincial - somebody who didn't live in the capital. Only much later did it come to mean someone who behaved in an odd way.

And in a country like this, which is also a continent, by the time enough people had truly settled the east coast and bred several generations here in Boston, Philadelphia, New York - they too came naturally to say - "What happened to Paul?"

"Paul? Oh he went out to California."

Can you imagine the inner writhing of an old Bostonian whose family arrived in the 1650s who hears some newly-arrived, uppity Englishman say - "It's only the second time I've been out here."

Well this all came up when a friend of mine - who's a figure, let's say an entrepreneur, in theatre - had just come back to New York to report on five productions he'd seen - theatre, ballet, opera, art exhibition, drama school - in what he called "the finest theatre complex of auditoriums" - showcases if you like for theatre and the other arts - "the finest that I know of".

And he knows Europe well and Australia and beyond. Where was it? It was way out a mile high in the Rockies in Denver, Colorado.

I find that such discoveries are always a shock to New Yorkers and they usually dismiss them as a rumour they don't believe.

In my experience the long-established New Yorkers are the most totally convinced that they're blessed in having the best theatre, music, restaurants, doctors, authors, scholars anywhere.

An old and nationally famous radio comedian, he summed up this view of the New Yorker better than anybody. He used to specialise in parodying this sceptical, smug, wise guy side of New Yorkers.

"As far as I'm concerned," he said, "everywhere outside New York is Bridgeport, Connecticut."

This is funny but unfortunately all too true. If you won't spread the word I can tell you that my closest New Yorker friends know next to nothing about the United States.

And I think of the Americans down the years I've played golf with. They know the city and state they were born in and the city they settled in. Otherwise they hold all these simple prejudices and preconceptions that Europeans hold about any given region - the Midwest, the South, the Northwest, Florida - you name it.

And it follows, I think, that one 'centrist' - one Londoner, one New Yorker - is almost sure to share the same sort of prejudices as his buddy centrist across the border.

A man in London has a hobby in, let's say, watches, clocks. He's sure to ask the advice of a New Yorker about a clock centre in America, on the assumption that the answer is probably a New York museum or perhaps the Smithsonian or one of the Eastern universities.

In fact this very question did come up. And the answer from the New Yorker was - "You ought to go up to Harvard and look over its collection of historical science instruments."

So the Englishman did go. But the curator there of that collection said - "Sorry, the world's most comprehensive collection of timekeeping devices is the work of one man in a small town, way out from Chicago. It is called Rockford, Illinois."

The crazy hobbyist who collected it was one Seth Atwood, who decided only 30 years ago to put together objects that he'd heard about, read about but had no idea how to get at them - if they still existed.

As the Harvard curator put it - "To the dealers and experts who met him on his visit to London in 1968 he was a man way out of his depth.

"He imagined collecting not just objects but an entire subject. He had a shopping list of 100 pieces representing the most significant and most famous makers in the history of time measurement."

Within seven years he'd collected 1200 pieces of great rarity.

So he set up a time museum in an inn in this Illinois small town. And 20 years after his enquiries in London Atwood had, in his museum, over 3,500 pieces and as the Harvard curator says today - "His museum became a horological Mecca. Experts flocked to him from the five continents."

Including one Londoner I know who knew better than to ask a New Yorker or even go up to Harvard.

Now this is just the most extreme proof I can think of that genius, curiosity, great talent in anything may well be nurtured in a capital city but doesn't necessarily take root and grow there.

One of the deepest, never acknowledged assumptions of New Yorkers is that they have the great good fortune to live in the centre of the best medicine.

Well it may be, as I say, the continental scope of the United States that makes this probably untrue of any one city.

The most renowned heart - cardiology - clinic in America and, some foreigners have told me, in the world, is in Cleveland, Ohio.

The people there pioneer or test out all the new theories and procedures. They it was, who heard about Senor Batista, the Brazilian who, in a primitive village, thought of doing something to a heart that was preposterous and undoable to every expert who heard about it.

Dr Batista thought if a heart was alarmingly, grossly enlarged the thing to do was to carve off a third of it and sew up the rest.

The Cleveland boys went to Brazil, saw him at it, brought him to Cleveland, gave him a squeaky-clean environment, learned and refined his operation.

Today it's being done routinely in several American cities. It is a desperate remedy but the survival rates will get better.

Incidentally a doctor friend of mine who lives in a big, big city got tired of being asked by anxious patients - "Is it true that Dr Sawbones is the best in town, in the East, maybe in the country?"

All big city dwellers want to be sure that their choice of surgeon, especially, is the best in town. They know if he's in New York, of course, he'd be the best in the country.

Well my friend had a patient who wasn't going to go ahead until she knew she had the best.

"Who," she kept demanding, "who is the best heart man in the United States?"

My friend by now in total exasperation said - "I don't know, maybe a guy out in ..." (and he plucked a name out of nowhere) "out in Ames, Iowa."

I told this story to an old lady who looked at me gravely and said - "I know a man who went to that man."

"Which man?"

"The man," she said, "in Ames, Iowa."

Medicine, especially, is a field in which people wanting reassurance about the best are acting not from town pride, so much as from anxiety.

I remember an obstetrician telling me - "Every woman has to believe her obstetrician is the best, otherwise lots of them would never go through with it."

I wind up this little medical excursion by saying that once every two years a celebrated American magazine draws up a list of the "best hospitals in the country" for each defined speciality.

Now this, to begin with, is an impossible scientific aim but there is a national medical panel that sets out its standards, criteria, and it labours exceedingly. One thing the whole panel agrees on - they agree to differ frequently about number one in a single speciality.

But there is one hospital in all the lists comes out number two. Number two in every speciality. So if you're afflicted with any one or a whole clutch of a score of a diseases you couldn't do better than live in Baltimore, Maryland, where finds itself Johns Hopkins Hospital.

So as I was saying it's a great relief to get away for a time from New Yorkers and their conviction that they're at the centre of things.

The only trouble with San Franciscans is, they think they're at the centre of things.

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