Nonfiction about doctors’ memorable patients and a life of chronic pain and disability; novels set in 1970s Canada and contemporary (but magically outside-of-time) Paris.
That One Patient: Doctors’ and nurses’ stories of the patients who changed their lives forever by Ellen de Visser
[Translated from the Dutch by Brent Annable]
Ellen de Visser is a science writer for the most popular newspaper in the Netherlands, De Volkskrant. Her “That One Patient” column, which began in the summer of 2017, turns interviews with medical professionals into punchy first-person narratives. A collection of them was published in Dutch in 2019. This English translation tacks on 10 additional pieces based on conversations with English and American practitioners (including Dr. Anthony Fauci, immunologist and presidential medical advisor), four of them explicitly reflecting on COVID-19.
Many of the cases are decades old yet stuck with the doctor or nurse in question because of a vital lesson learned. Overtreatment is regretted just as much as an omission of care. Again and again, these medical professionals conclude that it’s impossible to judge someone else’s decisions or quality of life. For instance, a surgeon admits he had a hard time empathizing with his obese patients undergoing stomach reduction until he followed up with a young woman who told him about how invisible she’d felt before her surgery. Premature and disabled children bring grief or joy, not always in the expected doses. A doctor resents the work his team puts into repairing a woman who jumped from an eighth-floor window – why the heroic measures for someone who wanted to die? – until he learns she was pushed. A cancer surgeon develops breast cancer and now knows exactly what her patients go through.
Some of these stories are disturbing: being stalked by a patient with a personality disorder, a man poisoning his girlfriend, a farmer predicting the very day and time of his death. A gynaecologist changes his mind about abortion after he meets a 15-year-old who gave birth at home and left her baby outside in a plastic bag to die of exposure. Other pieces are heart-warming: A paramedic delivers a premature, breech baby right in the ambulance. Staff throw a wedding at the hospital for a dying teen (as in Dear Life by Rachel Clarke). A woman diagnosed with cancer while pregnant has chemotherapy and a healthy baby – now a teenager. There’s even a tale from a vet who crowdfunded prostheses for a lively terrier.
One unique thing about the Netherlands is that euthanasia is legal and provided by doctors upon the express request of a patient suffering from a terminal illness. It is taken for granted in these essays, yet some interviewees express their discomfort with it as an option for young patients. De Visser is careful to note that, even with the situation as it is, only 4% of deaths in the Netherlands are by euthanasia, and the majority of these are end-stage cancer cases.
As with any collection of this nature, some stories are more enticing than others, but overall I found it a surprising and moving set of reflections that is alive to ethical complexities and grapples with tough issues like disability, doctor error, loneliness, pain, and sense of purpose.
Two quotes, in particular, stood out to me, one from a nurse – “We are only ever guests in other people’s lives, and that’s how we ought to behave” – and the other from Dr. Fauci’s piece. In 2014 he treated a doctor who had been volunteering in Sierra Leone after an Ebola outbreak but became ill with the virus and had to be evacuated. “He cited Hippocrates: ‘It is far more important to know what sort of person has the disease, rather than what sort of disease the person has.’ You treated me like a person, not a disease, he said. And that’s what medicine is all about.”
With thanks to 4th Estate for the proof copy for review.
A Still Life: A Memoir by Josie George
Over a year of lockdowns, many of us have become accustomed to spending most of the time at home. But for Josie George, social isolation is nothing new. Chronic illness long ago reduced her territory to her home and garden. The magic of A Still Life is in how she finds joy and purpose despite extreme limitations. Opening on New Year’s Day and travelling from one winter to the next, the book is a window onto George’s quiet existence as well as the turning of the seasons. (My full review will appear in a forthcoming issue of the Times Literary Supplement. See also Eleanor’s thorough review.) This is top of my wish list for next year’s Barbellion Prize shortlist.
With thanks to Bloomsbury for the proof copy for review.
A Town Called Solace by Mary Lawson
I discovered Mary Lawson in 2015 with Road Ends and caught up with Crow Lake in the summer of 2019. All four of her books are set in fictional locations inspired by the villages and rural areas of Northern Ontario, where the author grew up before moving to England in 1968. So Solace, while not a real town, is true to her memory and, despite the sometimes gruff or know-it-all locals, an emotional landmark for the three central characters, all of whom are processing trauma and looking for places of comfort where they can start over.
1972. First we meet Clara, a plucky seven-year-old sitting vigil. She’s waiting for the return of two people: her sixteen-year-old sister, Rose, who ran away from home; and their next-door neighbour, Mrs. Orchard, whose cat, Moses, she’s feeding until the old lady gets back from the hospital. As days turn into weeks, though, it seems less likely that either will come home, and one day Clara sees a strange man moving boxes around in Mrs. Orchard’s house. This is Liam Kane, who’s inherited the house from a family friend. In his thirties and recently divorced, he’s taking a break in this tiny town, never imagining that he might find a new life. The third protagonist, and only first-person narrator, is Elizabeth, who lies in a hospital bed with heart trouble and voices her memories as a monologue to her late husband.
As we cycle through these three characters’ perspectives in alternating chapters, we gradually come to understand the connections between them. There are satisfying parallels in that, on multiple occasions but in slightly different ways, a child attaches to an older person or an adult stands in as a guardian for a neglected child. All of Lawson’s creations, even the secondary figures, are dealing with distressing memories or a loss of some kind, the details of which might only emerge much later on. Solace offers myriad opportunities for recovery, whether kitty playtime at Mrs. Orchard’s or diner food and homemade ice cream.
Like Lawson’s other works, this is a slow burner featuring troubled families. Her characters, often full of regret and sorrow, take a shadowy past as a prompt to reset their lives. They’re charming in spite of their flaws. I recalled that Crow Lake also looks back to the climactic happenings experienced by a seven-year-old girl. And like Road Ends, A Town Called Solace makes a convincing case for present decisions being influenced by historical trauma. It’s a tender and inviting story I’d recommend to readers of Wendy McGrath and Anne Tyler, with Clever Girl by Tessa Hadley and Olive, Again by Elizabeth Strout as specific readalikes. (My dilemma now is whether to read my only remaining Lawson novel, The Other Side of the Bridge, right away or save it: she’s not the most prolific author, with four books in 19 years.)
A favorite passage:
[Liam’s] life prior to coming north seemed to be taking on the quality of an old movie, one in which he’d been deeply engrossed while watching it but which now seemed trivial, unconvincing and profoundly lacking in either colour or plot. Solace had colour and plot in spades, maybe too much. In every way it was coming to seem more real than Toronto, with its endless malls and traffic jams and high-powered jobs. Though maybe, if he went back to Toronto, the same would be true in reverse. Maybe when he’d been back for a couple of months he’d find that it was Solace that seemed unreal, its unremarkable streets and stores like something from a dream, its dramatic landscape fading to nothing, like a holiday photo left in the sun.
With thanks to Chatto & Windus for the free copy for review.
The Strays of Paris by Jane Smiley
(Published in the USA in December 2020 under the title Perestroika in Paris. It’s been given a The Boy, the Mole, the Fox and the Horse treatment for its UK release.)
My summary for Bookmarks magazine: “A racehorse, Perestroika—nicknamed Paras—strays from her unlocked suburban stable one day, carrying her groom’s purse in her mouth, and ends up in Paris’s Place du Trocadéro. Here she meets Frida the dog, Sid and Nancy the mallards, and Raoul the raven. Frida, whose homeless owner died, knows about money. She takes euros from the purse to buy food from a local market, while Paras gets treats from a baker on predawn walks. Etienne, an eight-year-old orphan who lives with his ancient great-grandmother, visits the snowy park to feed the wary animals (who can talk to each other), and offers Paras a home. A sweet fable for animal lovers.”
Yes, this is a talking animal book, but the animals only talk to each other; they communicate with humans through their gestures and soulful eyes. Kindly shopkeepers work out what Frida wants to buy based on what she stares at or points to with a paw; the baker whose window Paras passes on her early morning walks intuits that the horse is hungry; Etienne, who gives a couple of the stray animals a home during a chill winter, learns to understand when Paras needs to go out to relieve herself, after piles of dung build up in the sitting room.
I liked how patiently and convincingly Smiley builds the portrait of each character – human or animal – and the overall situation of kindness and good fortune. Raoul is particularly amusing for his birdsplaining: “It is a feature of age. I have learned so many things in my life that they just force their way out of my beak,” he says. However, a crow would be much more realistic for Paris (or any city) than a raven, and, overall, this was a little twee and farfetched for my tastes. It was nice to read something a bit different from Smiley, who I haven’t tried since her Last Hundred Years Trilogy. She has a sideline in YA horse novels; this should probably have been lumped with those. (Annabel liked it a bit more.)
I was sent an unsolicited review copy by Picador/Mantle.
What recent releases can you recommend?
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?”)
It’s my stop on the “Not the Wellcome Prize” blog tour. With two dozen reviews of health-themed 2019 books to choose from, I decided to nominate these two for the longlist because they’re under the radar compared to some other medical releases, plus they showcase the breadth of the books that the Prize recognizes: from a heartfelt memoir of a mother welcoming premature babies to a laugh-out-loud graphic novel about a doctor practicing in a small town in Wales. (The Prize website says “picture-led books are not eligible,” so in fact it is likely that graphic novels have never been considered, but we’ve been flexible with the rules for this unofficial blog tour.)
Mother Ship by Francesca Segal
This first work of nonfiction from the author of the exquisite The Innocents is a visceral diary of the first eight weeks in the lives of her twin daughters, who were born by Caesarean section at 29 weeks in October 2015 and spent the next two months in the NICU, “an extremely well-funded prison or perhaps more accurately a high-tech zoo.” In Mother Ship, she strives to come to terms with this unnatural start to motherhood. “Taking my unready daughters from within me felt not like a birth but an evisceration,” she writes. “My children do not appear to require mothering. Instead they need sophisticated medical intervention.”
Segal describes with tender precision the feeling of being torn: between the second novel she’d been in the middle of writing and the all-consuming nature of early parenthood; and between her two girls (known for much of the book as “A-lette” and “B-lette”), who are at one point separated in different hospitals. Her attitude towards the NHS is pure gratitude.
As well as portraying her own state of mind, she crafts twinkly pen portraits of the others she encountered in the NICU, including the staff but especially her fellow preemie mums, who met in a “milking shed” where they pumped breast milk for the babies they were so afraid of losing that they resisted naming. (Though it was touch and go for a while, A-lette and B-lette finally earned the names Raffaella and Celeste and came home safely.) Female friendship is thus a subsidiary theme in this exploration of desperate love and helplessness.
The Lady Doctor by Ian Williams
This sequel to 2014’s The Bad Doctor returns to a medical practice in small-town Wales. This time, though, the focus is on Iwan James’s colleague, Dr. Lois Pritchard, who also puts in two days a week treating embarrassing ailments at the local hospital’s genitourinary medicine clinic. At nearly 40, Lois is a divorcee with no children; just a dog. She enjoys her nights out drinking with her best friend, Geeta, but her carefree life is soon beset by various complications: she has to decide whether she wants to join the health centre as a full partner, a tryst with her new fella goes horribly wrong, and her estranged mother suddenly reappears in her life, hoping that Lois will give her a liver transplant. And that’s not to mention all the drug addicts and VD-ridden lotharios hanging about.
Williams was a GP in North Wales for 20 years, and no doubt his experiences have inspired his comics. His tone is wonderfully balanced: there are plenty of hilarious, somewhat raunchy scenes, but also touching moments where Lois learns that a doctor is never completely off duty and has no idea what medical or personal challenge will crop up next. The drawing style reminded me most of Alison Bechdel’s or Posy Simmonds’, with single shades from rose to olive alternating as the background. I especially loved the pages where each panel depicts a different patient to show the range of people and complaints a doctor might see in a day. Myriad Editions have a whole “Graphic Medicine” series that I’m keen to explore.
See below for details of the blogs where other reviews have appeared or will be appearing soon.
The shadow panel will choose a shortlist of six titles to be announced on 4 May. We will then vote to choose a winner, with the results of a Twitter poll serving as one additional vote. The Not the Wellcome Prize winner will be announced on 11 May.