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?
A calmer month for new releases after September’s bumper crop. I read a sophisticated mystery set at a theological college, a subtle novel about empathy and being a good friend, and a memoir of raising one of Britain’s first llamas.
The Gospel of Eve by Rachel Mann
Last year I dipped into Mann’s poetry (A Kingdom of Love) and literary criticism/devotional writing (In the Bleak Midwinter); this year I was delighted to be offered an early copy of her debut novel. The press materials are full of comparisons to Donna Tartt’s The Secret History; it’s certainly an apt point of reference for this mystery focusing on clever, Medieval-obsessed students training for the priesthood at a theological college outside Oxford.
It’s 1997 and Catherine Bolton is part of the first female intake at Littlemore College. She has striven to rid herself of a working-class accent and recently completed her PhD on Chaucer, but feels daunted by her new friends’ intelligence and old-money backgrounds: Ivo went to Eton, Charlie is an heiress, and so on. But Kitty’s most fascinated with Evie, who is bright, privileged and quick with a comeback – everything Kitty wishes she could be.
If you think of ordinands as pious and prudish, you’ll be scandalized by these six. They drink, smoke, curse and make crude jokes. In seminars with Professor Albertus Loewe, they make provocative mention of feminist theory and are tempted by his collection of rare books. Soon sex, death and literature get all mixed up as Kitty realizes that her friends’ devotion to the Medieval period goes as far as replicating dangerous rituals. We know from the first line that one of them ends up dead. But what might it have to do with the apocryphal text of the title?
I didn’t always feel the psychological groundwork was there to understand characters’ motivations, but I still found this to be a beguiling story, well plotted and drenched in elitism and lust. Mann explores a theology that is more about practice, about the body, than belief. Kitty’s retrospective blends regret and nostalgia: “We were the special ones, the shining ones,” and despite how wrong everything went, part of her wouldn’t change it for the world.
My thanks to publicist Hannah Hargrave for the proof copy for review. Published today by Darton, Longman & Todd Ltd.
What Are You Going Through by Sigrid Nunez
A perfect follow-up to The Friend and very similar in some ways: again we have the disparate first-person musings of an unnamed narrator compelled to help a friend. In Nunez’s previous novel, the protagonist has to care for the dog of a man who recently killed himself; here she is called upon to help a terminally ill friend commit suicide. The novel opens in September 2017 in the unfamiliar town she’s come to for her friend’s cancer treatments. While there she goes to a talk by an older male author who believes human civilization is finished and people shouldn’t have children anymore. This prophet of doom is her ex.
His pessimism is echoed by the dying friend when she relapses. The narrator agrees to accompany her to a rental house where she will take a drug to die at a time of her choosing. “Lucy and Ethel Do Euthanasia,” the ex jokes. And there is a sort of slapstick joy early in this morbid adventure, with mishaps like forgetting the pills and flooding the bathroom.
As in Rachel Cusk’s Outline trilogy, the voice is not solely or even primarily the narrator’s but Other: her friend speaking about her happy childhood and her estrangement from her daughter; a woman met at the gym; a paranoid neighbor; a recent short story; a documentary film. I felt there was too much recounting of a thriller plot, but in general this approach, paired with the absence of speech marks, reflects how the art we consume and the people we encounter become part of our own story. Curiosity about other lives fuels empathy.
With the wry energy of Jenny Offill’s Weather, this is a quiet novel that sneaks up to seize you by the heartstrings. “Women’s stories are often sad stories,” Nunez writes, but “no matter how sad, a beautifully told story lifts you up.” Like The Friend, which also ends just before The End, this presents love and literature as ways to bear “witness to the human condition.”
With thanks to Virago for the proof copy for review.
Along Came a Llama: Tales from a Welsh Hill Farm by Ruth Janette Ruck
Originally published in 1978 (now reissued with a foreword by John Lewis-Stempel), this is an enjoyably animal-stuffed memoir reminiscent of Gerald Durrell and especially Doreen Tovey. Ruck (d. 2006) and her family – which at times included her ill sister, her elderly mother and/or her sister-in-law – lived on a remote farm in the hills of North Wales. On a visit to Knaresborough Zoo, Ruck was taken with the llamas and fancied buying one to add to their menagerie of farm animals. It was as simple as asking the zoo director and then taking the young female back to Wales in a pony box. At that time, hardly anyone in the UK knew anything about llamas or the other camelids. No insurance company would cover their llama in transit; no one had specialist knowledge on feeding or breeding. Ruck had to do things the old-fashioned way, finding books and specialist scientific papers.
But they mostly learned about Ñusta (the Quechua word for princess) by spending time with her. At holidays they discovered her love of chocolate Easter eggs and cherry brandy. The cud-chewing creature sometimes gave clues to what else she’d been eating, as when she regurgitated plum stones. She didn’t particularly like being touched or trailed by an orphaned lamb, but followed Ruck around dutifully and would sit sociably in the living room. Life with animals often involves mild disasters: Ñusta jumps in a pool and locks Ruck’s husband in the loo, and the truck breaks down on the way to mate her with the male at Chester Zoo.
From spitting to shearing, there was a lot to get used to, but this account of the first three years of llama ownership emphasizes the delights of animal companionship. There were hardships in Ruck’s life, including multiple sclerosis and her sister’s death, but into the “austere but soul-rewarding life of a hill firm … like a catalyst or a touch of magic, the llama came along.” I was into llamas and alpacas well before the rest of the world – in high school I often visited a local llama farm, and I led a llama in a parade and an alpaca in a nativity play – so that was my primary reason for requesting this, but it’s just right for any animal lover.
With thanks to Faber & Faber for the free copy for review.