“For fans of Adam Kay’s This Is Going to Hurt and Christie Watson’s The Language of Kindness,” the blurb on my press release for Leah Hazard’s memoir opens. The publisher’s comparisons couldn’t be more perfect: Hard Pushed has the gynecological detail and edgy sense of humor of Kay’s book (“Another night, another vagina” is its first line, and the author has been known to introduce herself with “Midwife Hazard, at your cervix!”), and matches Watson’s with its empathetic picture of patients’ plights and medical professionals’ burnout.
Hazard alternates between anonymized case studies of patients she has treated and general thoughts on her chosen career (e.g. “Notes on Triage” and “Notes on Being from Somewhere Else”). Although all of the patients in her book are fictional composites, their circumstances are rendered so vividly that you quickly forget these particular characters never existed. Visceral details of sights, smells and feelings put you right there in the delivery room with Eleanor, one-half of a lesbian couple welcoming a child thanks to the now-everyday wonder of IVF; Hawa, a Somali woman whose pregnancy is complicated by the genital mutilation she underwent as a child; and Pei Hsuan, a Chinese teenager who was trafficked into sex work in Britain.
Sometimes we don’t learn the endings to these stories. Will 15-year-old Crystal have a healthy baby after she starts leaking fluid at 23 weeks? What will happen next for Pei Hsuan after her case is passed on to refugee services? Hazard deliberately leaves things uncertain to reflect the partial knowledge a hospital midwife often has of her patients: they’re taken off to surgery or discharged, and when they eventually come back to deliver someone else may be on duty. All she can do is to help each woman the best she can in the moment.
A number of these cases allow the author to comment on the range of modern opinions about pregnancy and childrearing, including some controversies. A pushy new grandmother tries to pressure her daughter into breastfeeding; a woman struggles with her mental health while on maternity leave; a rape victim is too far along to have a termination. At the other end of the spectrum, we meet a hippie couple in a birthing pool who prefer to speak of “surges” rather than contractions. Hazard rightly contends that it’s not her place to cast judgment on any of her patients’ decisions; her job is simply to deal with the situation at hand.
I especially liked reading about the habits that keep the author going through long overnight shifts, such as breaking the time up into 15-minute increments, each with its own assigned task. The excerpts from her official notes – in italics and full of shorthand and jargon – are a neat window into the science and reality of a midwife’s work, with a glossary at the end of the book ensuring that nothing is too technical for laypeople.
Hazard, an American, lives in Scotland and has a Glaswegian husband and two daughters. Her experience of being an NHS midwife has not always been ideal; there were even moments when she was ready to quit. Like Kay and Watson, she has found that the medical field can be unforgiving what with low pay, little recognition and hardly any time to wolf down your dinner during a break, let alone reflect on the life-and-death situations you’ve been a part of. Yet its rewards outweigh the downsides.
Hard Pushed has none of the sentimentality of Call the Midwife – a relief since I’m not one to gush over babies. Still, it’s a heartfelt read as well as a vivid and pacey one, and it’s alternately funny and sobering. If you like books that follow doctors and nurses down hospital hallways, you’ll love it. This was one of my most anticipated books of the first half of the year, and it lived up to my expectations. It’s also one of my top contenders for the 2020 Wellcome Book Prize so far.
A few favorite passages:
“So many things in midwifery are ‘wee’ [in Scotland, at least!] – a wee cut, a wee tear, a wee bleed, the latter used to describe anything from a trickle to a torrent. Euphemisms are one of our many small mercies: we learn early on to downplay and dissemble. The brutality of birth is often self-evident; there is little need to elaborate.”
“Whenever I dress a wound in this way, I remember that this is an act of loving validation; every wound tells a story, and every dressing is an acknowledgement of that story – the midwife’s way of saying, I hear you, and I believe you.”
“midwives do so much more than catch babies. We devise and implement plans of care; we connect, console, empathise and cheerlead; we prescribe; we do minor surgery. … We may never have met you until the day we ride into battle for you and your baby; … you may not even recognise the cavalry that’s been at your back until the drapes are down and the blood has dried beneath your feet.”
Hard Pushed was published in the UK on May 2nd (just a few days before International Midwives’ Day) by Hutchinson. My thanks to the publisher for the free proof copy for review.
On Tuesday the longlist for the 2019 Wellcome Book Prize will be announced. For the third year in a row I’m running a shadow panel, and it’s composed of the same four wonderful book bloggers who joined me last year: Paul Cheney of Halfman, Halfbook, Annabel Gaskell of Annabookbel, Clare Rowland of A Little Blog of Books, and Dr. Laura Tisdall.
This year we’re going to do things slightly differently: we plan to split up the longlist, taking two to three titles each, so that between us we will have read them all and can announce our own preferred shortlist before the official shortlist is announced in March. At that point we’ll catch up by (re)reading the six shortlisted books, each reviewing the ones we haven’t already. Essentially, I’m adding an extra stage of shadow panel judging, simply because I can. I hope it will be fun – and also less onerous, in that we should get a leg-up on the shortlist and not have to read all six books in March‒April, which has proved to be a challenge in the past.
My Wellcome Prize hopefuls are all the fiction or nonfiction titles I’ve read on a medical theme that were published in the UK in calendar year 2018. I have put asterisks beside the 12 books in this post that I predict for the longlist. (The combination of wishful thinking and likelihood means that these are not exclusively my personal favorites.)
Below is a list of the books I’ve already featured on the blog in some way, with links to my coverage and a few-word summary of their relevance.
Gross Anatomy by Mara Altman: Female body woes
*Beneath the Skin: Great Writers on the Body: Essays on organs
*All that Remains by Sue Black: Forensic anthropology
Everything Happens for a Reason by Kate Bowler: Living with advanced cancer
Heal Me by Julia Buckley: Tackling chronic pain
*The Unmapped Mind by Christian Donlan: Adjusting to life with MS
From Here to Eternity by Caitlin Doughty: Funerary rites around the world
This Really Isn’t About You by Jean Hannah Edelstein: A genetic disease in the family
Natural Causes by Barbara Ehrenreich: Questioning the wellness culture
On Smaller Dogs and Larger Life Questions by Kate Figes: Pondering breast cancer
Shapeshifters by Gavin Francis: Instances of bodily change
The Reading Cure by Laura Freeman: Healing from an eating disorder
Nine Pints by Rose George: The story of blood
Waiting for the Last Bus by Richard Holloway: Ageing and death
*Heart: A History by Sandeep Jauhar: Heart disease and treatments
Sick by Porochista Khakpour: Chronic Lyme disease
Human Errors by Nathan Lents: Flawed bodies; evolutionary adaptations
Skybound by Rebecca Loncraine: Breast cancer; flying lessons
Amateur by Thomas Page McBee: Memoir of F2M transformation
*Face to Face by Jim McCaul: Tales of facial surgery
*Somebody I Used to Know by Wendy Mitchell: A firsthand account of early Alzheimer’s
*That Was When People Started to Worry by Nancy Tucker: Mental illness from the inside
*The Language of Kindness by Christie Watson: Nursing as a vocation
Little by Edward Carey: Anatomical models in wax (thanks to Clare for the reminder!)
Orchid & the Wasp by Caoilinn Hughes: Non-epileptic seizures
*The Winter Soldier by Daniel Mason: Neurology, surgery during WWI
The Way of All Flesh by Ambrose Parry: Medicine in 1840s Edinburgh
Other eligible books that I have read but not happened to mention on the blog:
In Shock by Rana Awdish: The doctor became the patient when Awdish, seven months pregnant, was rushed into emergency surgery with excruciating pain due to severe hemorrhaging into the space around her liver, later explained by a ruptured tumor. Having experienced brusque, cursory treatment, even from colleagues at her Detroit-area hospital, she was convinced that doctors needed to do better. This memoir is a gripping story of her own medical journey and a fervent plea for compassion from medical professionals.
Doctor by Andrew Bomback: Part of the Bloomsbury Object Lessons series, this is a wide-ranging look at what it’s like to be a doctor. Bomback is a kidney specialist; his wife is also a doctor, and his father, fast approaching retirement, is the kind of old-fashioned, reassuring pediatrician who knows everything. Even the author’s young daughter likes playing with a stethoscope and deciding what’s wrong with her dolls. In a sense, then, Bomback uses fragments of family memoir to compare the past, present and likely future of medicine.
A Moment of Grace by Patrick Dillon [skimmed]: A touching short memoir of the last year of his wife Nicola Thorold’s life, in which she battled acute myeloid leukemia. Dillon doesn’t shy away from the pain and difficulties, but is also able to summon up some gratitude.
Get Well Soon: Adventures in Alternative Healthcare by Nick Duerden: British journalist Nick Duerden had severe post-viral fatigue after a run-in with possible avian flu in 2009 and was falsely diagnosed with ME / CFS. He spent a year wholeheartedly investigating alternative therapies, including yoga, massage, mindfulness and meditation, visualization, talk therapy and more. He never comes across as bitter or sorry for himself. Instead, he considered fatigue a fact of his new life and asked what he could do about it. So this ends up being quite a pleasant amble through the options, some of them more bizarre than others.
*Sight by Jessie Greengrass [skimmed]: I wanted to enjoy this, but ended up frustrated. As a set of themes (losing a parent, choosing motherhood, the ways in which medical science has learned to look into human bodies and minds), it’s appealing; as a novel, it’s off-putting. Had this been presented as a set of autobiographical essays, perhaps I would have loved it. But instead it’s in the coy autofiction mold where you know the author has pulled some observations straight from life, gussied up others, and then, in this case, thrown in a bunch of irrelevant medical material dredged up during research at the Wellcome Library.
*Brainstorm: Detective Stories From the World of Neurology by Suzanne O’Sullivan: Epilepsy affects 600,000 people in the UK and 50 million worldwide, so it’s an important condition to know about. It is fascinating to see the range of behaviors seizures can be associated with. The guesswork is in determining precisely what is going wrong in the brain, and where, as well as how medicines or surgery could address the fault. “There are still far more unknowns than knowns where the brain is concerned,” O’Sullivan writes; “The brain has a mind of its own,” she wryly adds later on. (O’Sullivan won the Prize in 2016 for It’s All in Your Head.)
I’m also currently reading and enjoying two witty medical books, The Mystery of the Exploding Teeth and Other Curiosities from the History of Medicine by Thomas Morris, and Chicken Unga Fever by Phil Whitaker, his collected New Statesman columns on being a GP.
Four additional books I have not read but think might have a chance of making the longlist:
Primate Change: How the World We Made Is Remaking Us by Vybarr Cregan-Reid
The Beautiful Cure: Harnessing Your Body’s Natural Defences by Daniel M. Davis
Because I Come from a Crazy Family: The Making of a Psychiatrist by Edward M. Hallowell
*She Has Her Mother’s Laugh: The Powers, Perversions, and Potential of Heredity by Carl Zimmer
Look out for the announcement of the longlist on Tuesday afternoon! I’ll report back, perhaps on Wednesday, with some reactions and the shadow panel’s reviewing strategy.
Have you read, or are you interested in, any of these books?
Can you think of other 2018 releases that might be eligible for the Wellcome Book Prize?
Across my four best-of posts (Nonfiction was on Wednesday and Fiction on Thursday; Backlist reads are coming up tomorrow), I will have spotlighted roughly the top 20% of my year’s reading. The 15 runners-up below – 5 fiction and 10 nonfiction – are in alphabetical order by author. The ones marked with an asterisk are my Best 2018 Books You Probably Never Heard Of (Unless You Heard about Them from Me!).
*Frieda by Annabel Abbs: If you rely only on the words of D.H. Lawrence, you’d think Frieda was lucky to shed a dull family life and embark on an exciting set of bohemian travels with him as he built his name as a writer; Abbs adds nuance to that picture by revealing just how much Frieda was giving up, and the sorrow she left behind her. Frieda’s determination to live according to her own rules makes her a captivating character.
A Ladder to the Sky by John Boyne: A delicious piece of literary suspense with a Tom Ripley-like hero you’ll love to hate: Maurice Swift, who wants nothing more than to be a writer but doesn’t have any ideas of his own, so steals them from other people. I loved how we see this character from several outside points of view before getting Maurice’s own perspective; by this point we know enough to understand just how unreliable a narrator he is.
The Overstory by Richard Powers: A sprawling novel about regular people who through various unpredictable routes become so devoted to trees that they turn to acts, large and small, of civil disobedience to protest the clear-cutting of everything from suburban gardens to redwood forests. I admired pretty much every sentence, whether it’s expository or prophetic.
You Think It, I’ll Say It by Curtis Sittenfeld: Sittenfeld describes families and romantic relationships expertly, in prose so deliciously smooth it slides right down. These 11 stories are about marriage, parenting, authenticity, celebrity and social media in Trump’s America. Overall, this is a whip-smart, current and relatable book, ideal for readers who don’t think they like short stories.
*Meet Me at the Museum by Anne Youngson: A charming, bittersweet novel composed entirely of the letters that pass between Tina Hopgood, a 60-year-old farmer’s wife in East Anglia, and Anders Larsen, a curator at the Silkeborg Museum in Denmark. It’s a novel about second chances in the second half of life, and has an open but hopeful ending. I found it very touching and wish it hadn’t been given the women’s fiction treatment.
Rough Beauty: Forty Seasons of Mountain Living by Karen Auvinen: An excellent memoir that will have broad appeal with its themes of domestic violence, illness, grief, travel, wilderness, solitude, pets, wildlife, and relationships. A great example of how unchronological autobiographical essays can together build a picture of a life.
*Heal Me: In Search of a Cure by Julia Buckley: Buckley takes readers along on a rollercoaster ride of new treatment ideas and periodically dashed hopes during four years of chronic pain. I was morbidly fascinated with this story, which is so bizarre and eventful that it reads like a great novel.
*This Really Isn’t About You by Jean Hannah Edelstein: A wry, bittersweet look at the unpredictability of life as an idealistic young woman in the world’s major cities. Another great example of life writing that’s not comprehensive or strictly chronological yet gives a clear sense of the self in the context of a family and in the face of an uncertain future.
*The Pull of the River: Tales of Escape and Adventure on Britain’s Waterways by Matt Gaw: This jolly yet reflective book traces canoe trips down Britain’s rivers, a quest to (re)discover the country by sensing the currents of history and escaping to the edge of danger. Gaw’s expressive writing renders even rubbish- and sewage-strewn landscapes beautiful.
The Feather Thief: Beauty, Obsession, and the Natural History Heist of the Century by Kirk Wallace Johnson: A delightful read that successfully combines many genres – biography, true crime, ornithology, history, travel and memoir – to tell the story of an audacious heist of rare bird skins from the Natural History Museum at Tring in 2009. This is the very best sort of nonfiction: wide-ranging, intelligent and gripping.
*No One Tells You This by Glynnis MacNicol: There was a lot of appeal for me in how MacNicol sets out her 40th year as an adventure into the unknown. She is daring and candid in examining her preconceptions and asking what she really wants from her life. And she tells a darn good story: I read this much faster than I generally do with a memoir.
The Library Book by Susan Orlean: This is really two books in one. The first is a record of the devastating fire at the Los Angeles Central Library on April 29, 1986 and how the city and library service recovered. The second is a paean to libraries in general: what they offer to society, and how they work, in a digital age. Sure to appeal to any book-lover.
Help Me!: One Woman’s Quest to Find Out if Self-Help Really Can Change Her Life by Marianne Power: I have a particular weakness for year-challenge books, and Power’s is written in an easy, chatty style, as if Bridget Jones had given over her diary to testing self-help books for 16 months. Help Me! is self-deprecating and relatable, with some sweary Irish swagger thrown in. I can recommend it to self-help junkies and skeptics alike.
Mrs Gaskell & Me: Two Women, Two Love Stories, Two Centuries Apart by Nell Stevens: Stevens has a light touch, and flits between Gaskell’s story and her own in alternating chapters. This is a whimsical, sentimental, wry book that will ring true for anyone who’s ever been fixated on an idea or put too much stock in a relationship that failed to thrive.
The Language of Kindness: A Nurse’s Story by Christie Watson: Watson presents her book as a roughly chronological tour through the stages of nursing – from pediatrics through to elderly care and the tending to dead bodies – but also through her own career. With its message of empathy for suffering and vulnerable humanity, it’s a book that anyone and everyone should read.
Coming tomorrow: My best backlist reads of the year.
After all that Wellcome Book Prize reading, I’ve given myself a break from the medical reads, right? No way! I’m already eagerly looking out for hopefuls for next year’s prize – I’ve amassed quite a nice little pile – and this is a particularly strong candidate, based on the 20 years that Watson spent as a nurse in England’s health system before leaving to write full-time. (Her debut, Tiny Sunbirds Far Away, won the Costa First Novel Award in 2011; she followed it up with Where Women Are Kings in 2013.) It taps into the widespread feeling that medicine is in desperate need of a good dose of compassion, and will ring true for anyone who spends time in hospitals, whether as a patient or a carer.
Watson presents her book as a roughly chronological tour through the stages of nursing – from pediatrics through to elderly care and the tending to dead bodies – but also through her own career, as she grows from a seventeen-year-old trainee who’s squeamish about blood to a broadly experienced nurse who can hardly be fazed by anything. The first chapter is set up like a tour of the hospital, describing everything she sees and hears as she makes her way up to her office, and the final chapter takes place on her very last day as a nurse, when, faced with a laboring mother in a taxi, she has to deliver the baby right there in the carpark.
In between we hear a series of vivid stories that veer between heartwarming and desperately sad. Watson sees children given a second shot at life. Aaron gets a heart–lung transplant to treat his cystic fibrosis and two-year-old Charlotte bounces back from sepsis – though with prosthetic limbs. But she also sees the ones who won’t get better: Tia, a little girl with a brain tumor; Mahesh, who has muscular dystrophy and relies on a breathing tube; and Jasmin, who is brought to the hospital after a house fire but doesn’t survive for long. She dies in the nurses’ arms as they’re washing the smoke smell out of her hair.
Although Watson specialized in children’s intensive care nursing, she trained in all branches of nursing, so we follow her into the delivery room, mental health ward, and operating theatre. As in Maggie O’Farrell’s I Am, I Am, I Am, we learn about her links to hospitals over the years, starting with her memories of being nursed as a child. She met her former partner, a consultant, at the hospital; they had a child together and adopted another before splitting 12 years later. And as her father was dying of lung cancer, she developed a new appreciation for what nurses do as she observed the dedicated care he received from his hospice nurse. She characterizes nursing as a career that requires great energy, skill and emotional intelligence, “that demands a chunk of your soul on a daily basis,” yet is all too often undervalued.
For me the weakest sections of Watson’s book are the snippets of history about hospitals and the development of the theory and philosophy of nursing. These insertions feel a little awkward and break up the flow of personal disclosure. The same applies to the occasional parenthetical phrase that seems to talk down to the reader, such as “women now receive medical help (IVF) to have their babies” and “obstetricians (doctors) run the show.” Footnotes or endnotes connected to a short glossary might have been a less obtrusive way of adding such explanatory information.
I would particularly recommend this memoir to readers of Kathryn Mannix’s With the End in Mind and Henry Marsh’s Admissions. But with its message of empathy for suffering and vulnerable humanity, it’s a book that anyone and everyone should read. I have it on good authority that there has recently been a copy on the desk of Jeremy Hunt, Health Secretary of the UK, which seems like an awfully good start.
A few favorite passages:
“I wanted to live many lives, to experience different ways of living. I didn’t know then that I would find exactly what I searched for: that both nursing and writing are about stepping into other shoes all the time.”
“What I thought nursing involved when I started: chemistry, biology, physics, pharmacology and anatomy. And what I now know to be the truth of nursing: philosophy, psychology, art, ethics and politics.”
“You get used to all sorts of smells, as a nurse. [An amazingly graphic passage!] But for all that I’ve seen and touched and smelled, and as difficult as it is at the time, there is a patient at the centre of it, afraid and embarrassed. … The horror of our bodies – our humanity, our flesh and blood – is something nurses must bear, lest the patient think too deeply, remember the lack of dignity that makes us all vulnerable. It is our vulnerability that unites us. Promoting dignity in the face of illness is one of the best gifts a nurse can give.”
The Language of Kindness was published in the UK on May 3rd by Chatto & Windus. My thanks to the publisher for the free review copy. It is released today, May 8th, by Doubleday Canada and Tim Duggan Books in the States.