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?”)
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.