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?
Thinking about Dead Bodies with John Troyer (Hay Festival)
My second of three digital Hay Festival talks this year was by John Troyer, director of the interdisciplinary Centre for Death and Society at the University of Bath. Troyer is from Wisconsin (where he was speaking from, having been trapped there during a visit to his parents) and grew up with a father who owned a funeral home. This meant that he was aware of death from a young age: One of his earliest memories is of touching the hand of a dead woman when he went to visit his father at work.
That’s not the only personal experience that went into his new book, Technologies of the Human Corpse, which I’m now keen to read. In 2018 his younger sister, Julie, died of brain cancer at age 43, so her illness and death became a late addition to the preface and also fed into a series of prose poems interspersed between the narrative chapters. She lived in Italy and her doctors failed to tell her that she was dying – that job fell to Troyer. (Unfortunately, this seems to be a persistent problem in Italy. In Dottoressa, her memoir of being an American doctor in Rome, which I read for a TLS review, Susan Levenstein writes of a paternalistic attitude among medical professionals: they treat their patients as children and might not even tell them about a cancer diagnosis; they just inform their family.)
Troyer discussed key moments that changed how we treat corpses. For instance, during the American Civil War there was a huge market for the new embalming technology; it was a way of preserving the bodies of soldiers so they could be returned home for funerals. Frauds also arose, however, and those taken in might find their loved one’s body arrived in a state of advanced decay. At around the same time, early photography captured corpses looking serene and sleeping. We might still take such photos, but we don’t tend to display them any more.
In the 1970s the “happy death” movement advocated for things like “natural death” and “death with dignity.” This piggybacked on the environmental and women’s movements and envisioned death as a taboo that had to be overcome. In recent decades a “necro-economy” based on the global trafficking of body parts (not organs for regulated transplant, Troyer clarified, but other tissue types) has appeared. While whole bodies may be worth just £2,000, “disarticulated” ones divided into their parts can net more like £100,000. Donating one’s body to science is, of course, a noble decision. Many people are also happy to donate their organs, though there remains a particular wariness about donating the eyes.
Troyer and Florence on my screen.
One section of Troyer’s book has become “uncannily resonant” in recent days, he noted. This is Chapter 3, on the AIDS corpse, an object of stigma. The biggest changes to death in the time of COVID-19 have been that family members are not able to be with a dying person in the ICU and that funerals cannot proceed as normal. In a viral pandemic, countries are producing a huge number of corpses that they aren’t prepared to deal with. (Indeed, the Washington, D.C. area is so overwhelmed with dead bodies that ice skating rinks have been requisitioned as makeshift morgues. The suburban Maryland rink I visited as a child is one such. Grim.)
Troyer spoke of the need for an everyday-ness to the discussion of death: talking with one’s next of kin, and encountering death in the course of a traditional education – he finds that even his final-year university students, studying in a related field, are very new to talking about death. A good way in that he recommends is simply to ask your loved ones what music they want played at their funerals, and the conversation can go from there.
We may not be able to commemorate the dead as we would like to at this time, but Troyer reminded the audience that funerals are for the living, whereas “the dead are okay with it – they know we’re doing our best.” The event was sensitively chaired by Peter Florence, the co-founder and director of Hay Festival (also responsible for last year’s controversial Booker Prize tie); the fact that Troyer got emotional talking about his sister only gave it more relevance and impact.
I’ve read an abnormally large number of books about death, especially in the five years since my brother-in-law died of brain cancer (one reason why Troyer’s talk was so meaningful for me). Most recently, I read Bodies in Motion and at Rest (2000) by Thomas Lynch, a set of essays by the Irish-American undertaker and poet from Michigan. I saw him speak at Greenbelt Festival in 2012 and have read four of his books since then. His unusual dual career lends lyrical beauty to his writing about death. However, this collection was not memorable for me in comparison to his 1997 book The Undertaking, and I’d already encountered a shortened version of “Wombs” in the Wellcome Collection anthology Beneath the Skin. But this passage from “The Way We Are” stood out:
After years and years of directing funerals, I’ve come to the conclusion that seeing [the dead body] is the hardest and most helpful part. The truth, even when it hurts, has a healing in it, better than fiction or fantasy. When someone dies it is not them we fear seeing, it is them dead. It is the death. We fear that seeing will be believing. We fear not seeing too. We search the wreckage and the ruins, the battlefields and ocean floors. We must find our dead to let the loss be real.
Just for a bit of morbid fun, I decided to draw up my top 10 nonfiction books about death, dying and the dead. Many of these are personal accounts of facing death or losing a loved one. In contrast to the bereavement and cancer memoirs, the books by Doughty and Gawande are more like cultural studies, and Montross’s is about working with corpses. If you need a laugh, the Bechdel (a graphic memoir) and Doughty are best for black comedy.
The Light of the World by Elizabeth Alexander- Fun Home: A Family Tragicomic by Alison Bechdel (her father, too, was a funeral home director)
- Dear Life: A Doctor’s Story of Love and Loss by Rachel Clarke
- The Iceberg by Marion Coutts
- From Here to Eternity: Traveling the World to Find the Good Death by Caitlin Doughty
Being Mortal: Medicine and What Matters in the End by Atul Gawande- When Breath Becomes Air by Paul Kalanithi
- Body of Work: Meditations on Mortality from the Human Anatomy Lab by Christine Montross
- The Bright Hour: A Memoir of Living and Dying by Nina Riggs
- To Travel Hopefully: Journal of a Death Not Foretold by Christopher Rush
In Praise of Literary Prizes
I like a spot of competition. Whether watching Olympic figure skating, playing board games like Scrabble and Boggle, entering a low-key Oscars pool, or rooting for my favorites in American Idol seasons and Miss America pageants, I’ve always loved trying to pick the best. This means that literary prizes are hugely exciting for me, and I follow the races closely.
I’m particularly devoted to the Man Booker Prize. I was delighted to see Hanya Yanagihara’s A Little Life on the recent longlist (catch up on it here), a truly interesting set of books, diverse in terms of their genres and authors’ nationalities and nicely balanced between male and female writers (6:7). I’ve read four of the longlisted titles so far:
The Fishermen, Chigozie Obioma (full review in May 2015 issue of Third Way): From a young Nigerian debut novelist comes a haunting tale of sibling rivalry and revenge. With sectarian riots afoot, the four oldest Agwu boys decide to make money by skipping school and fishing in the Omi-Ala River. Things get more complicated when Abulu, the local madman, issues a prophecy that seems bound to divide the brothers. The first quarter of the novel, especially, is drenched in foreshadowing (not always subtle, nor do the plot turns often rise above the predictable). Rich with prophecy and allusions, this owes much to biblical narratives and tragedies from Shakespeare to Chinua Achebe.- Lila, Marilynne Robinson – reviewed at For Books’ Sake
- A Spool of Blue Thread, Anne Tyler – also reviewed at For Books’ Sake
- A Little Life, Hanya Yanagihara – reviewed at Shiny New Books
Next up: I’m reviewing The Green Road by Anne Enright for the November 2015 issue of Third Way. The Booker Prize shortlist will be announced on September 15th and the winner on October 13th.
Beyond the Booker, here are some of the other prizes I follow throughout the year, listed in vague chronological order:
The Not the Booker Prize run by the Guardian. On this year’s shortlist is Shame by Melanie Finn, a book I loved when I reviewed it for Third Way’s April 2015 issue. It’s a powerful story of regret and the search for redemption. Though it has elements of a straightforward psychological thriller, the daring structure and moral complexities are more akin to Graham Greene. In alternating chapters, Pilgrim Jones contrasts flashbacks to her car accident and the subsequent investigation back in Switzerland with her present-tense African odyssey. This is Conrad’s Africa, a continent characterized by darkness and suffering. The question of culpability remains murky, yet the possibility of salvation shines through. [Voting will take place in October.]
- The Guardian First Book Award (open to both fiction and nonfiction): the shortlist will be announced this Friday, August 14th. One entry, Spill Simmer Falter Wither by Sara Baume, has already been chosen by readers, and the other nine are selected from publishers’ submissions. [Winner announced in late November.]
The Dylan Thomas Prize for young writers (under 39) went to Joshua Ferris for To Rise Again at a Decent Hour last year. [Longlist in September, shortlist in October and winner announced in November.]
- The Costa Book Awards give separate prizes for fiction, debut fiction, biography, poetry, and children’s books, and also choose one overall winner. [Category shortlists in late November, category winners in early January and overall winner on January 26, 2016.]
- The Folio Prize, only two years old, considers any work of fiction published in English; before the Booker expanded to include American entries last year, it was the most Catholic of the fiction prizes. Now it risks being considered redundant; especially since it lost its Folio Society sponsorship, it’s unclear whether it will continue. [Shortlist in February and winner announced in March.]
The Wellcome Book Prize is for medical-themed literature, fiction or nonfiction. Last year’s winner, The Iceberg by Marion Coutts, meant a lot to me for personal reasons but was also one of the most unusual and impressive memoirs I’ve ever read. I reviewed it for The Bookbag here. [Shortlist in March and winner announced in April.]
- The Pulitzer Prize is America’s premier literary award. I confess I often feel a little out of touch with the winners and don’t necessarily make a conscious effort to seek out the nominated books. I’d like to be more familiar with Pulitzer winners. Next year marks the prize’s centennial, so there’s no better time! [Winners announced in April.]
- The Independent Foreign Fiction Prize is for any book that has been translated into English and published in the UK in the previous year. I’ve found some great offbeat reads by browsing through previous longlists. As of next year, the prize is merging with the Man Booker International award, which previously recognized the life work of a foreign author every other year. [Longlist in March, shortlist in April and winner announced in May.]
The Bollinger Everyman Wodehouse Prize, the UK’s prize for comic literature, has run since 2000. Among the past winners are Paul Torday, Howard Jacobson, Terry Pratchett, Geoff Dyer, Gary Shteyngart, and (surprise!) Ian McEwan. I’ve read five of the winners, including Lost for Words by Edward St. Aubyn. [Shortlist in March and winner announced in May.]
- The Baileys Women’s Prize for Fiction (formerly known as the Orange Prize). Ali Smith won the 2015 award for How to Be Both. [Longlist in March; shortlist and winner announced in June.]
Do you follow literary prize races? Do you make a point of reading the winner and/or the shortlisted books? All comments welcome!
Bookish Beck = Rebecca Foster. American transplant to England. Freelance proofreader and book reviewer.
Bookish Beck 