Review: Intensive Care by Gavin Francis
I finally finished a book in 2021! And it’s one with undeniable ongoing relevance. The subtitle is “A GP, a Community & COVID-19.” Francis, a physician who is based at an Edinburgh practice and frequently travels to the Orkney Islands for healthcare work, reflects on what he calls “the most intense months I have known in my twenty-year career.” He draws all of his chapter epigraphs from Daniel Defoe’s A Journal of the Plague Year and journeys back through most of 2020, from the day in January when he and his colleagues received a bulletin about a “novel Wuhan coronavirus” to November, when he was finalizing the book and learned of promising vaccine trials but also a rumored third wave and winter lockdown.
In February, no one knew whether precautions would end up being an overreaction, so Francis continued normal life: attending a conference, traveling to New York City, and going to a concert, pub, and restaurant. By March he was seeing more and more suspected cases, but symptoms were variable and the criteria for getting tested and quarantining changed all the time. The UK at least seemed better off than Italy, where his in-laws were isolating. Initially it was like flu outbreaks he’d dealt with before, with the main differences being a shift to telephone consultations and the “Great Faff” of donning full PPE for home visits and trips to care homes. The new “digital first” model left him feeling detached from his patients. He had his own Covid scare in May, but a test was negative and the 48-hour bug passed.
Through his involvement in the community, Francis saw the many ways in which coronavirus was affecting different groups of people. He laments the return of mental health crises that had been under control until lockdown. Edinburgh’s homeless, many in a perilous immigration situation thanks to Brexit, were housed in vacant luxury hotels. He visited several makeshift hostels, where some residents were going through drug withdrawal, and also met longtime patients whose self-harm and suicidal ideation were worsening.
Children and the elderly were also suffering. In June, he co-authored a letter begging the Scottish education secretary to allow children to return to school. Perhaps the image that will stick with me most, though, is of the confused dementia patients he met at care homes: “there was a crushing atmosphere of sadness among the residents … [they were] not able to understand why their families no longer came to visit. How do you explain social distancing to someone who doesn’t remember where they are, sometimes even who they are?”
Francis incorporates brief histories of vaccination and the discovery of herd immunity, and visits a hospital where a vaccine trial is underway. I learned some things about COVID-19 specifically: it can be called a “viral pneumonia”; it has two phases, virological (the virus makes you unwell) and immunological (the immune system misdirects messages and the lungs get worse); and it affects the blood vessels as well as the lungs, with one in five presenting with a rash and some developing chilblains in the summer. Amazingly, as the year waned, Francis only knew three patients who had died of Covid, with many more recovered. But in August, a city that should have been bustling with festival tourists was nearly empty.
Necessarily, the book ends in the middle of things; Francis has clear eyes but a hopeful heart. While this is not the first COVID-19 book I’ve encountered (that was Duty of Care by Dominic Pimenta) and will be far from the last – next up for me will be Rachel Clarke’s Breathtaking, out at the end of this month – it is an absorbing first-hand account of a medical crisis as well as a valuable memorial of a time like no other in recent history. A favorite line was “One of the few consolations of this pandemic is its grim camaraderie, a new fellowship among the fear.” Another consolation for me is reading books by medical professionals who can compassionately bridge the gap between expert opinion and everyday experience.
Intensive Care was published by the Wellcome Collection/Profile Books on January 7th. My thanks to the publisher for the free copy for review.
Gavin Francis’s other work includes:
Previously reviewed: Shapeshifters
Also owned: Adventures in Human Being
I’m keen to read: Empire Antarctica, about being the medical officer at the British research centre in Antarctica – ironically, this was during the first SARS pandemic. (In July 2020, conducting medical examinations on the next batch of scientists to ship out there, he envied them the chance to escape: “By the time they came home it would be 2022. Surely we’d have the virus under control by then?”)
Best of 2020: Nonfiction
Complementing yesterday’s list of my top fiction and poetry reads of 2020, I have chosen my six favorite nonfiction works of the year. Last year’s major themes were bodies, archaeology, and the environmental crisis; this year’s are adjacent: anatomy, nature, deep time, death, and questions of inheritance, both within families and more broadly. What will we leave behind? As usual, these topics reflect my own interests but also, I think, something of the zeitgeist.
Let the countdown begin!
Kay’s Anatomy: A Complete (and Completely Disgusting) Guide to the Human Body by Adam Kay: Think of this as a juvenile, graphic novel version of Bill Bryson’s The Body; that’s exactly how thorough, accessible, and entertaining it is. Kay ditches his usual raunchiness and plumps for innocuous forms of humor: puns, dad jokes, toilet humor, running gags and so on. But where it counts – delivering vital information about not smoking, mental health, puberty, and facing the death of someone you love – Kay is completely serious, and always lets young readers know when it’s essential to tell an adult or ask a doctor. Henry Paker’s silly, grotesque illustrations are the perfect accompaniment.
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Sign Here If You Exist and Other Essays by Jill Sisson Quinn: The naturalist’s second essay collection considers themes of connection and change. Quinn regrets the afterlife prospect she lost along with her childhood Christian faith, while adopting a baby leads her to question notions of belonging and inheritance. Whether she’s studying wasps and reptiles or musing on family and faith, she knits her subjects together with meticulous attention. Putting self and nature under the microscope, she illuminates both. (Reviewed for Foreword.)
Footprints: In Search of Future Fossils by David Farrier: Blending human and planetary history, environmental realism and literary echoes, Farrier, a lecturer in English literature, tells the story of the human impact on the Earth. Each chapter is an intricate blend of fact, experience, and story. We’ll leave behind massive road networks, remnants of coastal megacities, plastics, carbon and methane in the permafrost, the fossilized Great Barrier Reef, nuclear waste, and jellyfish-dominated oceans. An invaluable window onto the deep future.
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Greenery: Journeys in Springtime by Tim Dee: From the Cape of Good Hope to the Arctic Circle, Dee tracks the spring as it travels north. From first glimpse to last gasp, moving between his homes in two hemispheres, he makes the season last nearly half the year. His main harbingers are migrating birds, starting with swallows. The book is steeped in allusions and profound thinking about deep time and what it means to be alive in an era when nature’s rhythms are becoming distorted. A fresh, masterful model of how to write about nature.
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Dear Life: A Doctor’s Story of Love and Loss by Rachel Clarke: I’ve read so many doctors’ memoirs and books about death that it takes a truly special one to stand out. Clarke specializes in palliative medicine and alternates her patients’ stories with her own in a natural way. A major theme is her relationship with her doctor father and his lessons of empathy and dedication. She wrote in the wake of his death from cancer – an experience that forced her to practice what she preaches as a hospice doctor: focus on quality of life rather than number of days. This passionate and practical book encourages readers to be sure they and their relatives have formalized their wishes for end-of-life care and what will happen after their death.
Vesper Flights by Helen Macdonald: Any doubt that Macdonald could write a worthy follow-up to H Is for Hawk evaporates instantly. Though these essays were written for various periodicals and anthologies and range in topic from mushroom-hunting to deer–vehicle collisions and in scope from deeply researched travel pieces to one-page reminiscences, they form a coherent whole. Equally reliant on argument and epiphany, the book has more to say about human–animal interactions in one of its essays than some whole volumes manage. As you might expect, birds are a recurring theme. Her final lines are always breath-taking. I’d rather read her writing on any subject than almost any other author’s.
(Books not pictured were read digitally, or have already gone back to the library.)
What were some of your top nonfiction reads of the year?
Upcoming posts:
28th: Library Checkout
29th: Runners-up from 2020 (all genres)
30th: Best backlist reads
31st: Random superlatives and some statistics
Mrs. Shields & Me: (Re)reading Carol Shields in 2020
It’s pure happenstance that I started reading Carol Shields’s work in 2006.
2005: When I first returned to England for my MA program at Leeds, I met a PhD student who was writing a dissertation on contemporary Canadian women writers. At that point I could literally name only one – Margaret Atwood – and I hadn’t even read anything by her yet.
2006: Back in the States after that second year abroad, living with my parents and killing time until my wedding, I got an evening job behind the circulation desk of the local community college library. A colleague passed on four books to me one day. By tying them up in a ribbon, she made a gift out of hand-me-downs: The Giant’s House, The Secret History, and two by Shields: Happenstance and The Stone Diaries. I’ve gone on to read most or all of the books by these authors, so I’m grateful to this acquaintance I’ve since lost touch with.

The inspiration for my post title.
Starting in June this year, I joined Marcie of Buried in Print in reading or rereading six Shields novels. She’s been rereading Shields for many years, and I benefited from her insight and careful attention to connections between the works’ characters and themes during our buddy reads. I’d treated myself to a secondhand book binge in the first lockdown, including copies of three Shields novels I’d not read before. We started with these.
Small Ceremonies (1976)
Shields’s debut ended up being my surprise favorite. A flawless novella, it brings its many elements to a satisfying conclusion and previews the author’s enduring themes in 180 pages. Judith is working on a third biography, of Susanna Moodie, and remembering the recent sabbatical year that she and her husband, a Milton scholar, spent with their two children in Birmingham. High tea is a compensating ritual she imported from a dismal England. She also brought back an idea for a novel. Meanwhile family friend Furlong Eberhardt, author of a string of twee, triumphantly Canadian novels, is casting around for plots.
What ensues is something of a sly academic comedy à la David Lodge, laced with Shields’s quiet wisdom on marriage, parenting, the writer’s vocation, and the difficulty of ever fully understanding another life. Specific links to her later work include a wonderful dinner party scene with people talking over each other and a craft project.
The Box Garden (1977)
The companion novel to Small Ceremonies is narrated by Judith’s sister Charleen, a poet and single mother who lives in Vancouver and produces the National Botanical Journal. I imagined the sisters representing two facets of Shields, who had previously published poetry and a Moodie biography. Charleen is preparing to travel to Toronto for their 70-year-old mother’s wedding to Louis, an ex-priest. Via flashbacks and excruciating scenes at the family home, we learn how literally and emotionally stingy their mother has always been. If Charleen’s boyfriend Eugene’s motto is to always assume the best of people, her mother’s modus operandi is to assume she’s been hard done by.
The title comes from the time when a faithful Journal correspondent, the mysterious Brother Adam, sent Charleen some grass seed to grow in a window box – a symbol of thriving in spite of restrictive circumstances. I thought the plot went off in a silly direction, but loved the wedding reception. Specific links to Shields’s later work include a botanical hobby, a long train journey, and a final scene delivered entirely in dialogue.
A Celibate Season (1991)
“We’re suffering a communication gap, that’s obvious.”
This epistolary novel was a collaboration: Blanche Howard wrote the letters by Jocelyn (“Jock”), who’s gone to Ottawa to be the legal counsel for a commission looking into women’s poverty, while Shields wrote the replies from her husband Charles (“Chas”), an underemployed architect who’s keeping the home fire burning back in Vancouver. He faces challenges large and small: their daughter’s first period versus meal planning (“Found the lentils. Now what?”). The household starts comically expanding to include a housekeeper, Chas’s mother-in-law, a troubled neighbor, and so on.
Both partners see how the other half lives. The misunderstandings between them become worse during their separation. Howard and Shields started writing in 1983, and the book does feel dated; they later threw in a jokey reference to the unreliability of e-mail to explain why the couple are sending letters and faxes. Two unsent letters reveal secrets Jock and Chas are keeping from each other, which felt like cheating. I remained unconvinced that so much could change in 10 months, and the weird nicknames were an issue for me. Plus, arguing about a solarium building project? Talk about First World problems! All the same, the letters are amusing.
Rereads
Happenstance (1980/1982)
This was the first novel I read by Shields. My Penguin paperback gives the wife’s story first and then you flip it over to read the husband’s story. But the opposite reflects the actual publishing order: Happenstance is Jack’s story; two years later came Brenda’s story in A Fairly Conventional Woman. The obvious inheritor of the pair is A Celibate Season with the dual male/female narratives, and the setups are indeed similar: a man is left at home alone with his teenage kids, having to cope with chores and an unexpected houseguest.
What I remembered beforehand: The wife goes to a quilting conference; an image of a hotel corridor and elevator.
Happenstance
Jack, a museum curator in Chicago, is writing a book about “Indian” trading practices (this isn’t the word we’d use nowadays, but the terminology ends up being important to the plot). He and his best friend Bernie, who’s going through a separation, are obsessed with questions of history: what gets written down, and what it means to have a sense of the past (or not). I loved all the little threads, like Jack’s father’s obsession with self-help books, memories of Brenda’s vivacious single mother, and their neighbor’s failure as Hamlet in a local production. I also enjoyed an epic trek in the snow in a final section potentially modeled on Ulysses.
A Fairly Conventional Woman
“Aside from quiltmaking, pleasantness was her one talent. … She had come to this awkward age, forty, at an awkward time in history – too soon to be one of the new women, whatever that meant, and too late to be an old-style woman.”
Brenda is in Philadelphia for a quilting conference. Quilting, once just a hobby, is now part of a modern art movement and she earns prizes and hundreds of dollars for her pieces. The hotel is overbooked, overlapping with an International Society of Metallurgists gathering, and both she and Barry from Vancouver, an attractive metallurgist in a pinstriped suit whom she meets in the elevator, are driven from their shared rooms by roommates bringing back one-night stands. This doesn’t add anything to the picture of a marriage in Jack’s story and I only skimmed it this time. It’s a wonder I kept reading Shields after this, but I’m so glad I did!
I reviewed these last two earlier this year. They were previously my joint favorites of Shields’s work, linked by a gardening hobby, the role of chance, and the unreliability of history and (auto)biography. They remain in my top three.
The Stone Diaries (1995)
What I remembered beforehand: a long train ride, a friend who by the feeling ‘down there’ thought that someone had had sex with her the night before, and something about the Orkney Islands.
Larry’s Party (1997)
What I remembered beforehand: a food poisoning incident (though I’d thought it was in one of Shields’s short stories), a climactic event involving a garden maze, a chapter entitled “Larry’s Penis,” and the closing dinner party scene.
Looking back: Fortunately, in the last 15 years I’ve done something to redress my ignorance, discovering Canadian women writers whom I admire greatly: Elizabeth Hay, Margaret Laurence, Mary Lawson and especially Margaret Atwood and Carol Shields.
Looking out: “I am watching. My own life will never be enough for me. It is a congenital condition, my only, only disease in an otherwise lucky life. I am a watcher, an outsider whether I like it or not, and I’m stuck with the dangers that go along with it. And the rewards.”
- That’s Judith on the last page of Small Ceremonies. It’s also probably Shields. And, to an extent, it seems like me. A writer, but mostly a reader, absorbing other lives.
Looking forward: I’m interested in rereading Shields’s short stories and Mary Swann (to be reissued by World Editions in 2021). And, though I’ve read 13 of her books now, there are still plenty of unread, lesser-known ones I’ll have to try to find secondhand one day. Her close attention to ordinary lives and relationships and the way we connect to the past makes her work essential.
Three Women and a Boat by Anne Youngson
“Does being grown up mean we are all doomed to be ordinary?”
One of my favorite things about where I live is the opportunity to walk along the Kennet & Avon canal, which runs by the bottom of our garden. Just a 10-minute stroll on the towpath takes us into Newbury’s town center, but someone with more time and motivation could take the canal all the way from London to Bristol. We have a small population of permanent boat dwellers beside one of the bridges, but many more vessels pass through or moor up for a night or a week. Even more so than gazing through a lit house window on a dark, cold night, looking at canal-boats sparks my imagination, making me wonder what life is like for the people (and cats) who live on them. How do they store everything, especially books??
My curiosity about canal living and my love for Meet Me at the Museum (2018), Anne Youngson’s charming, bittersweet debut novel in letters between a farmer’s wife in England and a curator at the Denmark museum that houses the Tollund Man, were two strong motives to request her follow-up; a third was the title’s nod to the delightful Victorian classic Three Men in a Boat (although, for its 2021 U.S. release, it has been renamed The Narrowboat Summer; Jerome K. Jerome must be too niche a reference for the average American reader.)
On a towpath not far from London, two women are drawn to the Number One by the sound of a dog howling. Eve Warburton has just been made redundant after 30 years at a corporate job, and Sally Allsop has just decided to leave her impassive husband. Distressed at the animal’s unearthly cries, they break down the boat door to check on it and it promptly runs away. Luckily, it’s not long until the boat owner, Anastasia, returns, followed by Noah the terrier.
Anastasia is a no-nonsense woman but takes kindly to Eve and Sally. Her situation is thus: she needs to go into hospital soon for cancer treatment, but she has no money for moorings or necessary repairs on the Number One, her only home. She needs someone to pilot her boat to Chester, where she knows someone who will carry out the maintenance for free, and back. Conveniently, Eve and Sally, free of the commitments that once defined them, now have all the time in the world. Anastasia will live in Eve’s flat during her treatment. In a matter of days, Eve and Sally learn the basics about canal-boats and set off on their journey. Along the way they’ll meet drifters, craftspeople and storytellers, and rethink what they want from life.
Youngson perches halfway between Rachel Joyce and Carol Shields in this one. Much like Meet Me at the Museum, it’s about second chances in the second half of life, with relatable situations and an open, hopeful ending. I liked the details of the journey – makeshift meals, Scrabble games, transcripts of blunt phone calls with Anastasia – but Eve and Sally remained a bit blank for me, such that I did not care equally about all the protagonists’ fates. Still, this is a pleasant amble of a novel and one that I expect to be popular with my local book club. (See also: Susan’s review.)
A favorite passage:
Anyone can use the canal, for holidays, for living, for plying a trade. They’ve always been a bit alternative. An alternative to a horse and cart, then an alternative to a railway, then an alternative to a caravan holiday, an alternative to a house. I like that. I like that it’s not fixed. No one owns it. And I like that it is slow, which is exactly what made the search for alternatives essential. The canals were wide enough to cope with a boat moving at the walking pace of a horse. Any faster, and they break apart. That’s the only thing that needs to be preserved: the banks, the locks, the bridges. And what would destroy them is speed.
Three Women and a Boat was published in the UK by Doubleday on November 12th. My thanks to the publisher for the proof copy for review.
It will be published as The Narrowboat Summer in the USA by Flatiron Books on January 26, 2021.
Recent Reviews for Shiny New Books: Poetry, Fiction and Nature Writing
First up was a rundown of my five favorite poetry releases of the year, starting with…
Dearly by Margaret Atwood
Dearly is a treasure trove, twice the length of the average poetry collection and rich with themes of memory, women’s rights, environmental crisis, and bereavement. It is reflective and playful, melancholy and hopeful. I can highly recommend it, even to non-poetry readers, because it is led by its themes; although there are layers to explore, these poems are generally about what they say they’re about, and more material than abstract. Alliteration, repetition, internal and slant rhymes, and neologisms will delight language lovers and make the book one to experience aloud as well as on paper. Atwood’s imagery ranges from the Dutch masters to The Wizard of Oz. Her frame of reference is as wide as the array of fields she’s written in over the course of over half a century.
I’ll let you read the whole article to discover my four runners-up. (They’ll also be appearing in my fiction & poetry best-of post next week.)
Next was one of my most anticipated reads of the second half of 2020. (I was drawn to it by Susan’s review.)
Artifact by Arlene Heyman
Lottie’s story is a case study of the feminist project to reconcile motherhood and career (in this case, scientific research). In the generic more than the scientific meaning of the word, the novel is indeed about artifacts – as in works by Doris Lessing, Penelope Lively and Carol Shields, the goal is to unearth the traces of a woman’s life. The long chapters are almost like discrete short stories. Heyman follows Lottie through years of schooling and menial jobs, through a broken marriage and a period of single parenthood, and into a new relationship. There were aspects of the writing that didn’t work for me and I found the book as a whole more intellectually noteworthy than engaging as a story. A piercing – if not notably subtle – story of women’s choices and limitations in the latter half of the twentieth century. I’d recommend it to fans of Forty Rooms and The Female Persuasion.
Finally, I contributed a dual review of two works of nature writing that would make perfect last-minute Christmas gifts for outdoorsy types and/or would be perfect bedside books for reading along with the English seasons into a new year.
The Stubborn Light of Things by Melissa Harrison
This collects five and a half years’ worth of Harrison’s monthly Nature Notebook columns for The Times. The book falls into two rough halves, “City” and “Country”: initially based in South London, Harrison moved to the Suffolk countryside in late 2017. In the grand tradition of Gilbert White, she records when she sees her firsts of a year. Often, she need look no further than her own home and garden. I appreciated how hands-on and practical she is: She’s always picking up dead animals to clean up and display the skeletons, and she never misses an opportunity to tell readers about ways they can create habitat for wildlife (e.g. bat and bird nest boxes that can be incorporated into buildings) and get involved in citizen science projects like moth recording.
The book’s final two entries were set during the UK’s first COVID-19 lockdown in spring 2020 – a notably fine season. This inspired me to review it alongside…
The Consolation of Nature by Michael McCarthy, Jeremy Mynott and Peter Marren
A tripartite diary of the coronavirus spring kept by three veteran nature writers based in southern England (all of them familiar to me through their involvement with New Networks for Nature and its annual Nature Matters conferences). The entries, of a similar length to Harrison’s, are grouped into chronological chapters from 21 March to 31 May. While the authors focus in these 10 weeks on their wildlife sightings – red kites, kestrels, bluebells, fungal fairy rings and much more – they also log government advice and death tolls. They achieve an ideal balance between current events and the timelessness of nature, enjoyed all the more in 2020’s unprecedented spring because of a dearth of traffic noise.