Being the Expert for #NonficNov / Three on a Theme: “Care”
The Being/Becoming/Asking the Expert week of the month-long Nonfiction November challenge is hosted by Rennie of What’s Nonfiction. This is my second entry for the week after Monday’s post on postpartum depression, as well as the second installment in my new “Three on a Theme” series, where I review three books that have something significant in common and tell you which one to pick up if you want to read into the topic for yourself.
It will be no surprise to regular readers that both of my ‘expert’ posts have been on a health theme: I have an amateur’s love of medical memoirs and works of medical history, and I’ve followed the Wellcome Book Prize closely for a number of years – participating in official blog tours, creating a shadow panel, and running this past year’s Not the Wellcome Prize.
The three books below are linked by the word “Care” in the title or subtitle; all reflect, in the wake of COVID-19, on the ongoing crisis in UK healthcare and the vital role of nurses.
Labours of Love: The Crisis of Care by Madeleine Bunting
Bunting’s previous nonfiction work could hardly be more different: Love of Country was a travel memoir about the Scottish Hebrides. It was the first book I finished reading in 2017, and there could have been no better start to a year’s reading. With a background in history, journalism and politics, the author is well placed to comment on current events. Labours of Love arose from five years of travel to healthcare settings across the UK: care homes for the elderly and disabled, hospitals, local doctors’ surgeries, and palliative care units. Forget the Thursday-night clapping and rainbows in the windows: the NHS is perennially underfunded and its staff undervalued, by conservative governments as well as by people who rely on it.
We first experience bodily care as infants, Bunting notes, and many of the questions that run through her book originated in her early days of motherhood. Despite all the advances of feminism, parental duties follow the female-dominated pattern evident in the caring careers:
By the age of fifty-nine, women will have a fifty-fifty chance of being, or having been, a carer for a sick or elderly person. At the same time, many are still raising their teenage children and almost half of those over fifty-five are providing regular care for grandchildren.
Women dominate caring professions such as nursing (89 per cent), social work (75 per cent) and childcare (98 per cent). They now form the majority of GPs (54 per cent) and three out of four teachers are female. And they provide the vast bulk of the army of healthcare workers in the NHS (80 per cent) and social-care workers (82 per cent) for the long-term sick, disabled and frail elderly.
These are things we know intuitively, but seeing the numbers laid out so plainly is shocking. I most valued the general information in Bunting’s introduction and in between her interviews, while I found that the bulk of the book alternated between dry statistics and page after page of interview transcripts. However, I did love hearing more from Marion Coutts, the author of the 2015 Wellcome Book Prize winner, The Iceberg, about her husband’s death from brain cancer. (Labours of Love was longlisted for the Baillie Gifford Prize for Non-Fiction 2020.)
My thanks to Granta for the free copy for review.
Duty of Care: One NHS Doctor’s Story of Courage and Compassion on the COVID-19 Frontline by Dr Dominic Pimenta
We’re going to see a flood of such books; I’m most looking forward to Dr Rachel Clarke’s Breathtaking (coming in January). Given how long it takes to get a book from manuscript to published product, I was impressed to find this on my library’s Bestsellers shelf in October. Pimenta’s was an early voice warning of the scale of the crisis and the government’s lack of preparation. He focuses on a narrow window of time, from February – when he encountered his first apparent case of coronavirus – to May, when, in protest at a government official flouting lockdown (readers outside the UK might not be familiar with the Cummings affair), he resigned his cardiology job at a London hospital to focus on his new charity, HEROES, which supports healthcare workers via PPE, childcare grants, mental health help and so on.
It felt uncanny to be watching events from earlier in the year unfold again: so clearly on a trajectory to disaster, but still gripping in the telling. Pimenta’s recreated dialogue and scenes are excellent. He gives a real sense of the challenges in his personal and professional lives. But I think I’d like a little more distance before I read this in entirety. Just from my skim, I know that it’s a very fluid book that reads almost like a thriller, and it ends with a sober but sensible statement of the situation we face. (All royalties from the book go to HEROES.)
The Courage to Care: A Call for Compassion by Christie Watson
I worried this would be a dull work of polemic; perhaps the title, though stirring, is inapt, as the book is actually a straightforward sequel to Watson’s 2018 memoir about being a nurse, The Language of Kindness. Although, like Bunting, Watson traveled widely to research the state of care in the country, she mostly relies on her own experience of various nursing settings over two decades: a pediatric intensive care unit, home healthcare for the elderly, a children’s oncology day center, a residential home for those with severe physical and learning disabilities, a community mental-health visiting team, and the emergency room. She also shadows military nurses and prison doctors.
With a novelist’s talent for scene-setting and characterization, Watson weaves each patient and incident into a vibrant story. Another strand is about parenthood: giving birth to her daughter and the process of adopting her son – both are now teenagers she raises as a single mother. She affirms the value of everyday care delivered by parents and nurses alike. I was especially struck by the account of a teenage girl who contracted measles (then pneumonia, meningitis and encephalitis) and was left blind and profoundly disabled, all because her parents were antivaxxers. In general, I’ve wearied of doctors’ memoirs composed of obviously anonymized case studies, but I’ll always make an exception for Clarke and Watson because of their gorgeous writing.
Note: Watson had left nursing to write full-time, but explains in an afterword that she returned to critical care in a London hospital during COVID-19.
What I learned:
Empathy is a key term for all three authors. They emphasize that the skills of compassion and listening are just as important as the ability to perform the required medical procedures.
A chilling specific fact I learned: 43,000 people died in the Blitz* in the UK. Pimenta cited that figure and warned that COVID-19 could be worse. And indeed, as of now, over 63,000 people have died of COVID-19 in the UK. The American death toll is even more alarming.
Here are some passages that stood out for me from each book:
Bunting: “Good care is as much an art as a skill, as much competence as tact. … Care is where we make profound collective decisions about the worth of an individual life. … There is no tradition of ageing wisely in the West, unlike in many Asian and African cultures where age has prestige, status and is associated with wisdom … We need to speak about care in a different language, instead of the relentless macho repetition of words such as ‘efficiency’, ‘quality’, ‘driving’, ‘choice’, ‘delivery’ and productivity.’”
Pimenta: “this will be akin to the Blitz*, and … we need to start thinking of it like that. A marathon, not a sprint. … The challenges to come – a second or even third wave, a global recession, climate change, mass misinformation … and political and societal upheaval … – will all require more from all of us if we hope to meet them. The challenge of our generation is not behind us, it is only just beginning. I plan to continue doing something about it, and perhaps now you do as well. So stay informed, stay safe and be kind.”
Watson: “So much of nursing, I think to myself, seems obvious, and yet seeing that need in the first place is difficult and takes experience, training and something extra. … The mundanity of human existence is where I find the most beauty … It takes my breath away: how fragile, extraordinary and vulnerable, how full of hatred and love and obsession and complexity we all are – every single one of us.”
*I highly recommend all of folk artist Kris Drever’s latest album, Where the World Is Thin, but especially the song “Hunker Down / That Old Blitz Spirit,” which has become my lockdown anthem.
If you read just one, though… Make it The Courage to Care by Christie Watson.
Can you see yourself reading any of these books?
Review: Extinctions by Josephine Wilson
I don’t often get a chance to read the wonderful-sounding Australian books I see on prize shortlists or on Kate’s blog, so I was delighted when Extinctions, which won the 2017 Miles Franklin Literary Award, was published in the UK last year. It may just be my mind making easy associations, but Josephine Wilson’s second novel indeed reminded me of other Australian fiction I’ve enjoyed, including The Life and Loves of Lena Gaunt by Tracy Farr, Salt Creek by Lucy Treloar, and The Singing Ship by Rebecca Winterer. I can’t quite put my finger on what these novels have in common despite their disparate time settings. A hot and forbidding landscape? An enduring sense of pioneer spirit, of survival against the odds? All four, to an extent, pit an explorer’s impetus against family trauma and/or racial difference.
The antihero of Extinctions is widower Frederick Lothian, who at age 69 is a reluctant resident of St Sylvan’s Estate retirement village. It’s January 2006, the middle of a blistering Australian summer, and amid his usual morbid activities of reading the newspaper obituaries and watching his elderly co-residents fall over outside his air-conditioned unit, he has plenty of time to drift back over his life. A retired engineer, he’s an expert on concrete construction as well as a noted collector of modernist furniture. But he’s been much less successful in his personal life. His son is in a care home after a devastating accident, and his adopted daughter Caroline, who is part Aborigine, blames and avoids Fred. A run-in with a nosy neighbor, Jan, forces him to face the world – and his past – again.
Meanwhile, Caroline is traveling in the UK to secure specimens for a museum exhibit on extinct species, and the idea of feeling utterly lonesome, like the last of one’s kind, recurs: Frederick sits stubbornly on his own at St Sylvan’s, pondering the inevitability of death; Caroline and Jan, both adopted, don’t have the comfort of a family lineage; and the museum specimens whose photographs are dotted through the novel (including the last passenger pigeon, Martha, which also – not coincidentally, I’m sure – was Fred’s wife’s name) represent the end of the line.

A famous modernist chair features in the book. This is just my office chair.
I loved pretty much everything about this book: the thematic connections, the gentle sense of humor (especially during Fred and Jan’s expensive restaurant dégustation), the chance for a curmudgeonly protagonist to redeem himself, and the spot-on writing. Highly recommended.
My rating:
A favorite passage:
“Like many educated people, Frederick had his opinions, most of which were set in concrete so as to render them more akin to truths, but in reality politics and modern history were his weak points – along with poetry. Where poetry and politics were concerned he feared a lack of foundation, which left him vulnerable to challenge. Deep down he knew that opinion – like concrete – was most resilient when well founded and reinforced.”
Other readalikes: Darke by Rick Gekoski & Ok, Mr Field by Katharine Kilalea
With thanks to Serpent’s Tail for the free copy for review.
Blog Tour Review: Little Fires Everywhere by Celeste Ng
I’m delighted to be helping to close out the UK blog tour for Little Fires Everywhere. Celeste Ng has set an intriguing precedent with her first two novels, 2014’s Everything I Never Told You and this new book, the UK release of which was brought forward by two months after its blockbuster success in the USA. The former opens “Lydia is dead. But they don’t know this yet.” The latter starts “Everyone in Shaker Heights was talking about it that summer: how Isabelle, the last of the Richardson children, had finally gone around the bend and burned the house down.” From the first lines of each novel, then, we know the basics of what happens: Ng doesn’t write mysteries in the generic sense. She doesn’t want us puzzling over whodunit; instead, we need to ask why, examining motivations and the context of family secrets.
Little Fires Everywhere opens in the summer of 1997 in the seemingly idyllic planned community of Shaker Heights, Ohio: “in their beautiful, perfectly ordered city, […] everyone got along and everyone followed the rules and everything had to be beautiful and perfect on the outside, no matter what mess lay within.” That strict atmosphere will take some getting used to for single mother Mia Warren, a bohemian artist who has just moved into town with her fifteen-year-old daughter, Pearl. They’ve been nomads for Pearl’s whole life, but Mia promises that they’ll settle down in Shaker Heights for a while.
Mia and Pearl rent a duplex owned by Elena Richardson, a third-generation Shaker resident, local reporter and do-gooder, and mother of four stair-step teens. Pearl is fascinated by the Richardson kids, quickly developing an admiration of confident Lexie, a crush on handsome Trip, and a jokey friendship with Moody. Izzy, the youngest, is a wild card, but in her turn becomes enraptured with Mia and offers to be her photography assistant. Mia can’t make a living just from her art, so takes the occasional shift in a Chinese restaurant and also starts cleaning the Richardsons’ palatial home in exchange for the monthly rent.
The novel’s central conflict involves a thorny custody case: Mia’s colleague at the restaurant, Bebe Chow, was in desperate straits and abandoned her infant daughter, May Ling, at a fire station in the dead of winter. The baby was placed with the Richardsons’ dear friends and neighbors, the McCulloughs, who yearn for a child and have suffered multiple miscarriages. Now Bebe has gotten her life together and wants her daughter back. Who wouldn’t want a child to grow up in the comfort of Shaker Heights? But who would take a child away from its mother and ethnic identity? The whole community takes sides, and the ideological division is particularly clear between Mia and Mrs. Richardson (as she’s generally known here).
For all that Shaker Heights claims to be colorblind, race and class issues have been hiding under the surface and quickly come to the forefront. Mrs. Richardson’s journalistic snooping and Mia’s warm words – she seems to have a real knack for seeing into people’s hearts – are the two driving forces behind the plot, as various characters decide to take matters into their own hands and make their own vision of right and wrong a reality. Fire is a potent, recurring symbol of passion and protest: “Did you have to burn down the old to make way for the new?” Whether they follow the rules or rebel, every character in this novel is well-rounded and believable: Ng presents no clear villains and no easy answers.

The U.S. cover
There are perhaps a few too many coincidences, and a few metaphors I didn’t love, but I was impressed at how multi-layered this story is; it’s not the simple ethical fable it might at first appear. There are so many different shards in its mosaic of motherhood: infertility, adoption, surrogacy, pregnancy, abortion; estrangement, irritation, longing, pride. “It came, over and over, down to this: What made someone a mother? Was it biology alone, or was it love?” Ng asks. I also loved the late-1990s setting. It’s a time period you don’t often encounter in contemporary fiction, and Ng brings to life the ambiance of my high school years in a way I found convincing: the Clinton controversy, Titanic, the radio hits playing at parties, and so on.
Each and every character earns our sympathy here – a real triumph of characterization, housed in a tightly plotted and beautifully written novel you’ll race through. This may particularly appeal to readers of Curtis Sittenfeld, Pamela Erens and Lauren Groff, but I’d recommend it to any literary fiction reader. One of the best novels of the year.
My rating:
Little Fires Everywhere was published by Little, Brown UK on November 9th. My thanks to Grace Vincent for the review copy.
Blog Tour: Two Voices, One Story
“[B]eing an adoptive parent is like parenting in Technicolor: everything is just a little more intense. This means the highs can be really high, but it also means that the lows are going to be really low. You have to prepare yourself.”
~Sharon Roszia, quoted in A Book about Love, by Jonah Lehrer
Two Voices, One Story is a mother–daughter memoir that splits narration duties between Elaine Rizzo and Amy Masters, the now-teenage daughter she adopted from China in 1999. Elaine’s sections provide the main thread of their story, while Amy’s passages, generally shorter and printed in italics, chime in to give her perspective on various events and relationships that have been important in her life.
Elaine is forthright about her infertility and the miscarriage that led to her decision to adopt. In the late 1990s, China’s one-child policy was still in place, but it was the severe flooding of the Yangtze River that led directly to Amy’s adoption. Thousands died and millions more were displaced. Given the context, it’s not so surprising that baby Amy was left outside a welfare center. She was given the Chinese name Tong Fang – “Copper Child.”
For me the highlight of the book was Elaine and Lee’s trip to China to pick up Amy. Although they were nervous and disoriented, they experienced the kindness of strangers and responded with compassion of their own, taking along extra toiletries and clothes of different sizes and leaving the surplus with the care center. Amy had bronchitis, one more worry on top of all the paperwork and red tape they had to go through to finalize the adoption.
Back in England, Amy had some behavioral problems that were likely vestiges of her time at the orphanage. She hated noise, especially thunderstorms; she hit herself and others; and she often woke up screaming. Private schooling ensured she wouldn’t get left behind, and there were many happy times with extended family and holidays to Australia and the west coast of Wales, where Elaine and Amy would later settle with Elaine’s second husband.
But life wasn’t always rosy: Amy was strong-willed and uncooperative – perhaps nothing out of the ordinary for a teenager, but still a challenge for her parents. Elaine recalls a social worker telling them “that very often adoptive parents don’t feel like they have the right to tell their child off, or that they think they shouldn’t say or do anything which might upset the child, because they are trying to compensate for what has happened prior to the adoption.”
Lengthy commuting to her job back in England and years-long house renovations demanded much of Elaine’s attention, yet she remained alert to what was going on with Amy. Unfortunately, in her teen years Amy experienced racism from a few schoolmates, including abusive Facebook messages that drove the family to contact the police. Amy herself, though, always comes across as easygoing about being different: “Every Christmas we used to do a Nativity show and I remember being an angel first and then one of the kings, which I suppose was the right role for me because I really do come from the East.”
Even though this is a very quick read, my interest waxed and waned. The telling can be clichéd and sentimental, and I felt too much space was given to banal details that added little to an understanding of the central mother–daughter relationship. This self-published book has a very appealing cover but needs another look from an experienced editor who could fix the fairly frequent typos and punctuation issues and cut out the bullet points (nine pages’ worth) and speech tics like “I will also say…” and “I have to comment…”
I would certainly recommend this book to those who have a personal experience of or interest in adoption, particularly from overseas (for a fictional take on adoption from China, you might also try The Fortunes by Peter Ho Davies, The Red Thread by Ann Hood, and This Must Be the Place by Maggie O’Farrell), as well as to anyone wondering how to parent or educate a child who is in some way different.
I’ll end with some lovely words from Amy:
when my Chinese mum left me outside the gates of the welfare center almost eighteen years ago now, because there was nothing left for me in Tongling, she must have had the desperate hope that I would find a happy life with people who loved me. I can only say that her wish did come true.
My rating:
Two Voices, One Story will be published by Clink Street Publishing on March 21st. Thanks to Rachel Gilbey of Authoright Marketing & Publicity for arranging my free copy for review.
I was pleased to participate in the blog tour for Two Voices, One Story.