Review: Intensive Care by Gavin Francis
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?”)
Signs of Life: To the Ends of the Earth with a Doctor by Stephen Fabes
Stephen Fabes is an emergency room doctor at St Thomas’s Hospital, London. Not exciting enough for you? Well, he also spent six years of the past decade cycling six continents (so, all bar Antarctica). His statistics are beyond impressive: 53,568 miles, 102 international borders, 1000+ nights of free camping, 26 bicycle tires, and 23 journals filled with his experiences. A warm-up was cycling the length of Chile with his brother at age 19. After medical school in Liverpool and starting his career in London, he found himself restless and again longing for adventure. The round-the-world cycle he planned fell into four sections: London to Cape Town, the West Coast of the Americas, Melbourne to Mumbai, and Hong Kong to home.
Signs of Life is a warm-hearted and laugh-out-loud funny account of Fabes’ travels, achieving a spot-on balance between major world events, the everyday discomforts of long-distance cycling and rough camping, and his humanitarian volunteering. He is a witness to the Occupy movement in Hong Kong, the aftermath of drought and tribal conflict in Africa, and the refugee crisis via the “Jungle” migrant camp in Calais. The desperate situations he saw while putting his medical expertise to good use in short bursts – e.g., at a floating clinic on a Cambodian lake, a malaria research center in Thailand, a leper hospital in Nepal, and a mental health rehabilitation clinic in Mumbai – put into perspective more minor annoyances like fire ants in El Salvador, Indonesian traffic, extreme cold in Mongolia, and camel spiders.
Wherever he went, Fabes met with kindness from strangers, even those who started off seeming hostile – having pitched his tent by a derelict cabin in Peru, he was alarmed to awake to a man pointing a gun at him, but the illicit gold miner soon determined he was harmless and offered him some soup. (Police officers and border guards were perhaps a bit less hospitable.) He also had occasional companions along the route, including a former housemate and a one-time girlfriend. Even limited shared language was enough to form common ground with a stranger-turned-fellow cyclist for a week or so. We get surprising glimpses of how Anglo-American culture permeates the developing world: For some reason, in the ‒Stans everyone’s point of reference when he introduced himself was Steven Seagal.
At nearly 400 pages, the memoir is on the long side, though I can see that it must have felt impossible to condense six years of adventures any further. I was less interested in the potted histories of other famous cyclists’ travels and would have appreciated a clearer sense to the passing of time, perhaps in the form of a date stamp at the head of each chapter. One of my favorite aspects of the book, though, was the use of medical metaphors to link geography to his experiences. Most chapters are titled after health vocabulary; for instance, in “Membranes” he ponders whether country borders are more like scars or cell membranes.
Fabes emphasizes, in a final chapter on the state of the West upon his return in early 2016, that, in all the most important ways, people are the same the world over. Whether in the UK or Southeast Asia, he sees poverty as the major factor in illness, perpetuating the inequality of access to adequate healthcare. Curiosity and empathy are his guides as he approaches each patient’s health as a story. Reflecting on the pandemic, which hit just as he was finalizing the manuscript, he prescribes global cooperation and innovation for this time of uncertainty.
We’re all armchair travelers this year, but this book is especially for you if you enjoy Bill Bryson’s sense of humor, think Dervla Murphy was a badass in Full Tilt, and enjoyed War Doctor by David Nott and/or The Crossway by Guy Stagg. It’s one of my top few predictions for next year’s Wellcome Book Prize – fingers crossed it will go ahead after the 2020 hiatus.
My rating:
With thanks to Dr Fabes and Profile Books for the free copy for review.
October Recommendations: Ashworth, Donoghue, Kay & McWatt
Intricate essays about writing in the wake of trauma, a feel-good novel about an odd couple on a trip to France, hilarious festive outtakes from a career in medicine, and a race-themed family memoir: I have four very different books to recommend to you this month. All:
Notes Made while Falling by Jenn Ashworth
(Coming from Goldsmiths Press [UK] on the 15th; already out from MIT Press [USA])
Like Anne Boyer’s The Undying and Sinéad Gleeson’s Constellations, this is an incisive memoir-in-essays about the effects of trauma on a woman’s body. Specifically, Ashworth’s story starts with her son’s birth in 2010, a disaster she keeps returning to over the course of seven sinuous personal essays. A routine C-section was followed by haemorrhaging, blood transfusions and anaphylaxis. The effects lasted for years afterwards: haunted by the sound of her blood dripping and the feeling that her organs could fall out of her abdomen at any time, she suffered from vomiting, insomnia and alcoholism, drinking late into the night as she watched gruesome true crime films.
Ashworth toggles between experience, memory, and the transformation of experience into a written record. She admits she has lost faith in fiction, either reading or writing it (she is a lecturer at Lancaster University and the author of four novels). Her Mormon upbringing in Preston is a major part of her backstory, and along with her childhood indoctrination she remembers brief stays in a children’s home and in the hospital with chicken pox.
The essays experiment with structure and content. For instance, “Ground Zero” counts down from #8, with incomplete final lines in each section, then back up to #8, with each piece from the second set picking up where the first left off. Slashes and cross-outs represent rethinking or alternate interpretations. “Off Topic: On Derailment” encompasses so many topics, from excommunication to Agatha Christie to rollercoasters to Charles Dickens, that you have to read it to believe she can make it all fit together (elsewhere she muses on Chernobyl, magic tricks and hating King Lear).
“How to Begin: The Cut” started as a talk given at Greenbelt 2013, when I was in the audience. I especially loved “A Lecture on Influence,” a coy self-examination through creative writing lessons, and “How to Fall without Landing: Celestial City,” a meditation on the precariousness of the human condition. Her frame of literary reference is wide and surprising. This also reminded me of Sight by Jessie Greengrass, The Empathy Exams by Leslie Jamison, I Am, I Am, I Am by Maggie O’Farrell, and In the Days of Rain by Rebecca Stott; I would recommend it to readers of any of the above.
Some favorite lines:
“My God-hurt head has a hole in it or needs one; to let the world in, or out – I can’t ever decide.”
“how to write about everything? How to take in the things that don’t belong to you without being poisoned by them? How to make use of the things that live inside, those seedlings you never asked for? How to breathe in? How to breathe out? How to keep on doing that?”
“Some days it feels like writing truthfully about her own life is the most subversive thing a woman can do.”
My thanks to the publisher for the free copy for review.
Akin by Emma Donoghue
(Coming from Picador [UK] on the 3rd; already out from Little, Brown and Co. [USA])
I’ve read Donoghue’s six most recent works of fiction. Her books are all so different from each other in setting – a one-room prison in contemporary America, bawdy 1870s San Francisco, rural Ireland in the 1850s – that it’s hard to pin her down to one time period or roster of topics. She never writes the same book twice, and that’s got to be a good thing.
Akin gets off to a slightly slow start but soon had me hooked. Noah Selvaggio, a childless widower and retired chemist in New York City, is looking forward to an imminent trip to Nice, where he was born, to celebrate his 80th birthday. He never guessed that he’d have company on his trip, much less a surly 11-year-old. This is Michael Young, his nephew Victor’s son. Victor died of a drug overdose a year and a half ago; the boy’s mother is in prison; his maternal grandmother has just died. There’s no one else to look after Michael, so with a rush passport he’s added to the itinerary.
In some ways Michael reminded me of my nephews, ages 11 and 14: the monosyllabic replies, the addiction to devices and online gaming, the finicky eating, and the occasional flashes of childlike exuberance. Having never raised a child, Noah has no idea how strict to be with his great-nephew about screen time, unhealthy food and bad language. He has to learn to pick his battles, or every moment of this long-awaited homecoming trip would be a misery. And he soon realizes that Michael’s broken home and troubled area of NYC make him simultaneously tougher and more vulnerable than your average kid.
The odd-couple dynamic works perfectly here and makes for many amusing culture clashes, not so much France vs. the USA as between these Americans of different generations. The dialogue, especially, made me laugh. Donoghue nails it:
[Noah:] “The genre, the style. Is rap the right word for it? Or hip-hop?”
[Michael:] “Don’t even try.” Michael turned his music back on.
(At the cathedral)
[Michael:] “This is some seriously frilly shit.”
[Noah:] “It’s called Baroque style.”
[Michael:] “I call it fugly.”
But there’s another dimension to the novel that keeps it from being pleasant but forgettable. Noah’s grandfather was a famous (fictional) photographer, Père Sonne, and he has recently found a peculiar set of photographs left behind by his late mother, Margot. One is of the hotel where they’re staying in Nice, known to be a holding tank for Jews before they were sent off to concentration camps. The more Noah looks into it, the more he is convinced that his mother was involved in some way – but which side was she on?
This is feel-good fiction in the best possible sense: sharp, true-to-life and never sappy. With its spot-on dialogue and vivid scenes, I can easily see it being made into a movie, too. It’s one of my favorite novels of the year so far.
My thanks to the publisher for the proof copy for review.
Twas the Nightshift before Christmas by Adam Kay
(Coming from Picador on the 17th)
If you’ve read This Is Going to Hurt, the UK’s bestselling nonfiction title of 2018, you’ll know just what to expect from the comedian’s holiday-themed follow-up. It’s raunchy, morbid and laugh-out-loud funny. In the seven years that Kay was a medical doctor, he had to work on Christmas Day six times. He takes us through the holiday seasons of 2004 to 2009, from the sickeningly festive run-up to the letdown of Christmas day and its aftermath. With his Rudolph tie on and his Scrooge spirit intact, he attends to genital oddities, childbirth crises and infertility clients, and feebly tries to keep up his relationships with his family and his partner despite them having about given up on him after so many holiday absences.
This will be a stocking-stuffer for many this year, and I can see myself returning to it year after year and flicking through for a laugh. However, there’s one story here that Kay regrets omitting from This Is Going to Hurt as being too upsetting, and he also ends on a serious note, urging readers to spare a thought for those who give up their holidays to keep our hospitals staffed.
A favorite passage:
“A lot of the reward for this job comes in the form of a warm glow. It doesn’t make you look any less tired, you can’t pay the rent with it, and it’s worth a lot less than the social life you’ve traded it for, but this comforting aura of goodness and purpose definitely throws light into some dark corners and helps you withstand a lot of the shit.”
My thanks to the publisher for the proof copy for review.
Shame on Me: An Anatomy of Race and Belonging by Tessa McWatt
(Coming from Scribe UK on the 10th)
“What are you?” This question has followed McWatt since she was eight years old. When her third-grade teacher asked the class if they knew what “Negro” meant, one boy pointed to her. “Oh, no, not Tessa,” the teacher replied, following up with a question: “What are you, Tessa?” But it has always been hard to put her mixed-race background into one word. Her family moved from Guyana to Canada and she has since settled in England, where she is a professor of creative writing; her ancestry is somewhat uncertain but may include Chinese, Indian, indigenous South American, Portuguese, French/Jewish, African, and Scottish.
The book opens with the startling scene of her grandmother, a young Chinese woman brought over to work the sugarcane fields of British Guiana, being raped by her own uncle. “To strangers, even friends—on some days also to myself—I am images of violence and oppression. I am the language of shame and destitution, of slavery and indenture, of rape and murder. I am images of power and privilege, of denial and shades of skin, shapes of faces,” McWatt writes.
Her investigation of the meaning of race takes the form of an academic paper, Hypothesis–Experiment–Analysis–Findings, and within the long third section she goes part by part through the bodily features that have most often been used as markers of racial identity, including the nose, eyes, hair and buttocks. She dives into family history but also into wider historical movements, literature and science to understand her hybrid self. It’s an inventive and sensitive work reminiscent of The Color of Water by James McBride. I would recommend it to anyone who enjoys reading (or feels they should try) interrogations of race.
A favorite line:
“as I try to square my politics with my privilege, it seems that my only true inheritance is that I am always running somewhere else.”
I won a signed proof copy in a Twitter giveaway.
Have you read any October releases that you would recommend? Do any of these tempt you?
My Most Anticipated Releases of the Second Half of 2019
Although over 90 books from the second half of the year are already on my radar, I’ve managed to narrow it down to the 15 July to November releases that I’m most excited about. I have access to a few of these already, and most of the rest I will try requesting as soon as I’m back from Milan. (These are given in release date order within thematic sections; the quoted descriptions are from the publisher blurbs on Goodreads.)
[By the way, here’s how I did with my most anticipated releases of the first half of the year:
- 16 out of 30 read; of those 9 were somewhat disappointing (i.e., 3 stars or below) – This is such a poor showing! Is it a matter of my expectations being too high?
- 10 I still haven’t managed to find
- 1 print review copy arrived recently
- 1 I have on my Kindle to read
- 1 I skimmed
- 1 I lost interest in]
Fiction
The Lager Queen of Minnesota by J. Ryan Stradal [July 23, Pamela Dorman Books] Stradal’s Kitchens of the Great Midwest (2015) is one of my recent favorites. This one has a foodie theme again, and sounds a lot like Louise Miller’s latest – two sisters: a baker of pies and a founder of a small brewery. “Here we meet a cast of lovable, funny, quintessentially American characters eager to make their mark in a world that’s often stacked against them.”
Hollow Kingdom by Kira Jane Buxton [August 6, Grand Central Publishing / Headline Review] As soon as I heard that this was narrated by a crow, I knew I was going to have to read it. (And the Seattle setting also ties in with Lyanda Lynn Haupt’s book.) “Humanity’s extinction has seemingly arrived, and the only one determined to save it is a foul-mouthed crow whose knowledge of the world around him comes from his TV-watching education.”
Inland by Téa Obreht [August 13, Random House / Weidenfeld & Nicolson] However has it been eight years since her terrific debut novel?! “In the lawless, drought-ridden lands of the Arizona Territory in 1893, two extraordinary lives collide. … [L]yrical, and sweeping in scope, Inland subverts and reimagines the myths of the American West.” The synopsis reminds me of Eowyn Ivey’s latest.
A Door in the Earth by Amy Waldman [August 27, Little, Brown and Company] I loved The Submission, Waldman’s 2011 novel about a controversial (imagined) 9/11 memorial. “Parveen Shamsa, a college senior in search of a calling, feels pulled between her charismatic and mercurial anthropology professor and the comfortable but predictable Afghan-American community in her Northern California hometown [and] travels to a remote village in the land of her birth to join the work of his charitable foundation.” (NetGalley download)
Bloomland by John Englehardt [September 10, Dzanc Books] “Bloomland opens during finals week at a fictional southern university, when a student walks into the library with his roommate’s semi-automatic rifle and opens fire. In this richly textured debut, Englehardt explores how the origin and aftermath of the shooting impacts the lives of three characters.” (print review copy from publisher)
The Dutch House by Ann Patchett [September 25, Harper / Bloomsbury UK] I’m more a fan of Patchett’s nonfiction, but will keep reading her novels thanks to Commonwealth. “At the end of the Second World War, Cyril Conroy combines luck and a single canny investment to begin an enormous [Philadelphia] real estate empire … Set over … five decades, The Dutch House is a dark fairy tale about two smart people who cannot overcome their past.”
Medical themes
Will My Cat Eat My Eyeballs?: Big Questions from Tiny Mortals about Death by Caitlin Doughty [September 10, W.W. Norton / September 19, Weidenfeld & Nicolson] I’ve read Doughty’s previous books about our modern attitude towards mortality and death customs around the world. She’s wonderfully funny and iconoclastic. Plus, how can you resist this title?! Although it sounds like it’s geared towards children, I’ll still read the book. “Doughty blends her mortician’s knowledge of the body and the intriguing history behind common misconceptions … to offer factual, hilarious, and candid answers to thirty-five … questions.”
The Undying: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care by Anne Boyer [September 17, Farrar, Straus and Giroux] “A week after her forty-first birthday, the acclaimed poet Anne Boyer was diagnosed with highly aggressive triple-negative breast cancer. … A genre-bending memoir in the tradition of The Argonauts, The Undying will … show you contemporary America as a thing both desperately ill and occasionally, perversely glorious.” (print review copy from publisher)

From the author’s Twitter page.
Breaking and Mending: A doctor’s story of burnout and recovery by Joanna Cannon [September 26, Wellcome Collection] I haven’t gotten on with Cannon’s fiction, but a memoir should hit the spot. “A frank account of mental health from both sides of the doctor-patient divide, from the bestselling author of The Trouble with Goats and Sheep and Three Things About Elsie, based on her own experience as a doctor working on a psychiatric ward.”
The Body: A Guide for Occupants by Bill Bryson [October 3, Doubleday / Transworld] His last few books have been somewhat underwhelming, but I’d read Bryson on any topic. He’s earned a reputation for making history, science and medicine understandable to laymen. “Full of extraordinary facts and astonishing stories, The Body: A Guide for Occupants is a brilliant, often very funny attempt to understand the miracle of our physical and neurological makeup.”
The Depositions: New and Selected Essays on Being and Ceasing to Be by Thomas Lynch [November 26, W.W. Norton] Lynch is such an underrated writer. A Michigan undertaker, he crafts essays and short stories about small-town life, the Irish-American experience and working with the dead. I discovered him through Greenbelt Festival some years back and have read three of his books. Some of what I’ve already read will likely be repeated here, but will be worth a second look anyway.
Other Nonfiction
Confessions of a Bookseller by Shaun Bythell [August 29, Profile Books] The Diary of a Bookseller was a treat in 2017. I’ve read the first two-thirds of this already while in Milan, and I wish I was in Wigtown instead! This sequel picks up in 2015 and is very much more of the same – the daily routines of buying and selling books and being out and about in a small town – so it’s up to you whether that sounds boring or comforting. I’m finding it strangely addictive. (NetGalley download)
We Are the Weather: Saving the Planet Begins at Breakfast by Jonathan Safran Foer [September 17, Farrar, Straus and Giroux / October 10, Hamish Hamilton] Foer’s Eating Animals (2009) was a hard-hitting argument against eating meat. In this follow-up he posits that meat-eating is the single greatest contributor to climate change. “With his distinctive wit, insight and humanity, Jonathan Safran Foer presents this essential debate as no one else could, bringing it to vivid and urgent life, and offering us all a much-needed way out.”
Surfacing by Kathleen Jamie [September 19, Sort of Books] Jamie is a Scottish poet who writes exquisite essays about the natural world. I’ve read her two previous essay collections, Findings and Sightlines, as well as a couple of volumes of her poetry. “From the thawing tundra linking a Yup’ik village in Alaska to its hunter-gatherer past to the shifting sand dunes revealing the impressively preserved homes of neolithic farmers in Scotland, Jamie explores how the changing natural world can alter our sense of time.”
Unfollow by Megan Phelps-Roper [October 8, Farrar, Straus and Giroux / riverrun] Ties in with my special interest in women’s religious memoirs. “In November 2012, at the age of twenty-six, [Phelps-Roper] left [Westboro Baptist Church], her family, and her life behind. Unfollow is a story about the rarest thing of all: a person changing their mind. It is a fascinating insight into a closed world of extreme belief, a biography of a complex family, and a hope-inspiring memoir of a young woman finding the courage to find compassion.”
Which of these do you want to read, too?
What other upcoming 2019 titles are you looking forward to?
This Really Isn’t About You by Jean Hannah Edelstein
This was the book I wanted Places I Stopped on the Way Home to be: a wry, bittersweet look at the unpredictability of life as an idealistic young woman in the world’s major cities. Edelstein’s memoir also fits into several of my favorite subgenres: it’s a family memoir, a medical memoir and a bereavement memoir all at once. The story opens in Brooklyn in February 2014 as Edelstein, age 32, is trying to build an adult life back in America after 14 years in London and Berlin. Two years earlier her father had told her via Skype from Baltimore that he had lung cancer, and she returned to the States to be closer to help. But when the moment came, she was still unprepared: “if someone had said to me: What would you like to be doing when your father dies? I would not have said, I would like to be looking for love on OKCupid. But I did not have the luxury to make that decision. Who does?”
Her father never smoked yet died of lung cancer; his mother had colon cancer and died at 42. Both had Lynch syndrome, a genetic disease that predisposes people to various cancers. Six months after her father’s death, Edelstein took a genetic test, as he had wanted her to, and learned that she was positive for the Lynch syndrome mutation. The book’s structure (“Between” – “Before” – “After”) plunges readers right into the middle of the family mess, then pulls back to survey her earlier life, everything from childhood holidays in her mother’s native Scotland to being a secretary to a London literary agent who hated her, before returning to the turning point of that diagnosis. How is she going to live with this knowledge hanging over her? Doctors want her to have a prophylactic hysterectomy, but how can she rule out children when she doesn’t yet have a partner in her life?
So many aspects of this book resonated for me, especially moving between countries and having a genetic disease in the family. Beyond those major themes, there were tiny moments that felt uncannily familiar to me, like when she’s helping her mother prepare for an online auction of the contents of the family home in Maryland, or comparing the average cleanliness and comfort of rental properties in England and the States. There are so many little memorable scenes in this memoir: having an allergic reaction to shellfish two days after her arrival in the States, getting locked out of her sublet and having to call an Uzbek/Israeli locksmith at 3 a.m., and subsisting on oatmeal three times a day in London versus going on all-expenses-paid trips to Estonia and Mauritius for a conference travel magazine.
This is a clear-eyed look at life in all its irony (such as the fact that she’s claustrophobic and dreads getting MRI tests when it was her own father, a nuclear physicist, who built the world’s first full-body MRI scanner at Aberdeen) and disappointment. I’m prizing this as a prime 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.
My rating:
Readalikes:
The Family Gene by Joselin Linder
My Salinger Year by Joanna Rakoff
Mrs Gaskell & Me by Nell Stevens
Favorite lines:
“when I was in London, … I wondered if the problem of having my whole life ahead of me, free and clear and open for anything, was that having an unlimited number of options made the chance of choosing the wrong thing so high.”
“I was not yet old enough to realize that I’d never really know, that there would never be a time when I could think: I am here. This is me, without becoming uncertain again a moment later.”
“When I lived in England I drank a lot of tea, many cups a day, even though I didn’t like it. I learned quite fast after I arrived in London that drinking tea was an important way to connect with people: when I went over to their homes, or if we worked together in an office. Being offered a cup of tea meant that you were being offered an entry to something, and accepting it was important.”
This Really Isn’t About You was published by Picador on August 23rd. My thanks to the publisher for the free copy for review.
A Journey through Chronic Pain: Heal Me by Julia Buckley
Julia Buckley can pinpoint the very moment when her battle with chronic pain began: it was a Tuesday morning in May 2012, and she was reaching across her desk for a cold cup of coffee. Although she had some underlying health issues, the “fire ants” down her arm and “carving knife” in her armpit? These were new. From there it just got worse: neck and back pain, swollen legs, and agonizing periods. Heal Me is a record of four years of chronic pain and the search for something, anything to take the pain away. “I couldn’t say no – that was a forbidden word on my journey. You never know who’s going to be your saviour.”
Having exhausted the conventional therapies available privately and via the NHS, most of which focus on cognitive behavioral therapy and coping strategies, Buckley quit work and registered as disabled. Ultimately she had to acknowledge that forces beyond the physiological might be at work. Despite her skepticism, she began to seek out alternative practitioners in her worldwide quest for a cure. Potential saviors included a guru in Vienna, traditional healers in Bali and South Africa, a witch doctor in Haiti, an herbalist in China, and a miracle worker in Brazil. She went everywhere from Colorado Springs (for medical marijuana) to Lourdes (to be baptized in the famous grotto). You know she was truly desperate when you read about her bathing in the blood and viscera of a sacrificial chicken.
Now the travel editor of the Independent and Evening Standard, Buckley captures all these destinations and encounters in vivid detail, taking readers along on her rollercoaster ride of new treatment ideas and periodically dashed hopes. She is especially incisive in her accounting of doctors’ interactions with her. All too often she felt like a statistic or a diagnosis instead of a person, and sensed that her (usually male) doctors dismissed her as a stereotypically hysterical woman. Fat shaming came into the equation, too. Brief bursts of compassion, wherever they came from, made all the difference.
I was morbidly fascinated with this story, which is so bizarre and eventful that it reads like a great novel. I’ll be cheering it on in next year’s Wellcome Book Prize race.
My rating:
Heal Me: In Search of a Cure is published today, January 25th, by Weidenfeld & Nicolson. My thanks to the publisher for a free copy for review.
Julia graciously agreed to take part in a Q&A over e-mail. We talked about invisible disabilities, the gendered treatment of pain, and whether she believes in miracles.
“I spent a day at the Paralympic stadium with tens of thousands cheering on equality, but when it was time to go home, nobody wanted to give me a seat on the Central Line. I was, I swiftly realised, the wrong kind of disabled.”
Yours was largely an invisible disability. How can the general public be made more aware of these?
I feel like things are very, very gradually moving forward – speaking as a journalist, I know that stories about invisible disabilities do very well, and I think as we all try to be more “on” things and “woke” awareness is growing. But people are still cynical – Heathrow and Gatwick now have invisible disability lanyards for travellers and someone I was interviewing about it said “How do I know the person isn’t inventing it?” I think the media has a huge part to play in raising awareness, as do things like books (cough cough). And when trains have signs saying things like “be aware that not all disabilities are visible” on their priority seats, I think that’s a step forward. Openness helps, too, if people are comfortable about it – I’m a huge believer in oversharing.
“I wondered whether it was a peculiarly female trait to blame oneself when a treatment fails.”
You make a strong case for the treatment of chronic pain being gendered, and your chapter epigraphs, many from women writers who were chronic pain or mental health patients, back this up. There’s even a name for this phenomenon: Yentl Syndrome. Can you tell us a little more about that? What did you do to push back against it?
Yentl Syndrome is the studied phenomenon that male doctors are un/consciously sexist in their dealings with female patients – with regards to pain, they’re twice as likely to ascribe female pain to psychological reasons and half as likely to give them adequate painkillers. In the US, women have to cycle through 12 doctors, on average, before they find the one to treat their pain adequately. There are equally shocking stats if you look at race and class, too.
I did absolutely nothing to push back against it when I was being treated, to be honest, because I didn’t recognise what was going on, had never heard of Yentl Syndrome and thought it was my problem, not theirs. It was really only when I met Thabiso, my sangoma in South Africa, that I felt the scales lift from my eyes about what had been going on. I make up for it now, though – I recently explained to a GP what it was, and suggested he be tested for it (long story, but we were on the phone and he was being incredibly patronising and not letting me speak). He hung up on me.
“In my head I added, I don’t care what they do to me, as long as it helps the pain.”
Meatloaf sang, “I would do anything for love, but I won’t do that.” Can you think of anything you wouldn’t have done in the search for a cure?
Well, I refused a spiritual surgery from John of God – I would have had the medical clamp up my nose or happily been cut into, but I was phobic about having my eyeball scraped – I had visions of Un Chien Andalou. So I had said repeatedly I was up for the other stuff but wouldn’t do the eye-scraping, and was told that probably meant I’d get the eye-scraping so I should go for the “invisible” surgery instead. But I can’t think of anything else I wouldn’t have done. The whole point, for me, was that if I didn’t throw myself into something completely, if I didn’t get better I’d never know if that was the treatment not working or my fault. Equally, my life was worthless to me – I knew I would probably be dead if I didn’t find an answer, so I didn’t have anything to lose.
Having said that, I know I would have had major difficulties slaughtering a goat if I’d gone back to Thabiso – I’m not sure if I could even have asked anyone else to do that for me.
Looking back, do you see your life in terms of a clear before and after? Are you the same person as you were before you went through this chronic pain experience?
There’s definitely a clear before and after in terms of how I think of my life – before the accident and after it. The date is in my head and I measure everything in my life around that, whether that’s a work event, a holiday, anything else – it’s always XX months/years before or after the accident. I don’t have the same thing with the day I got better because I try not to think about what happened and why, so I still calculate everything around the accident even though I should probably try and move my life to revolve around that happier day.
Largely I’m the same person. I still have the same interests and the same job, so I haven’t changed in that way. But I’d say I’m more focused – I lost so much of my life that I’m trying to make up for it now. So I don’t watch TV, I don’t go out to anything I’m not really interested in, I didn’t go to the work Christmas party because I could think of better things to do than stand around sober shouting over music … so I’m more ruthless about how I spend my time.
I also think invisible illness – or people’s reaction to it – hardens you. You have to grow a shell, otherwise you wouldn’t get through it. So I’m probably more brusque. I’m also really fucking angry about how I was treated and how I see other people – especially other women – being treated and I know that low-level anger shows through a lot. But as I said to a friend (male, obviously) recently, when he read my book and was upset at my anger: once you start noticing what’s going on, when you see people’s lives ruined because of pain, when in extreme cases you see women dying because of their gender, how can you not be angry? I think we should all be more angry. Maybe we could get more done.
You got a book contract before you’d completed all the travel. At that point you didn’t know what the conclusion of your quest would be: a cure, or acceptance of chronic pain as your new normal. Given that uncertainty, how did you go about shaping this narrative?
For the proposal for the book I did a country-by-country, treatment-by-treatment chapter plan (it was wildly ambitious, but pain and finances put the dampeners on it) and suggested the last chapter would be at a meditation retreat in Dorset, learning acceptance. I put in some waggish comment like “assuming I don’t get cured first hahaha”, but secretly I knew there was no way I could write the book if I wasn’t cured, partly on a very literal level – I physically wouldn’t be able to do it – but more because I didn’t see how I would ever be able to accept it. I actually postponed the deadline twice for the same reasons, and when I realised deadline 3 was looming and I wasn’t better and I was going to have to suck it up and write it I was distraught. I genuinely thought that putting all that I had been through onto the page and having to admit that I had failed – and failed my fellow pain people I was doing it for – would kill me. So I don’t know what I would have done if it had come to the crunch; luckily I got my pot of white chrysanthemums and didn’t have to see what happened.
You are leery of words like “miracle” and “cure,” so what terms might you use to describe what ended your pain after four years?
Something happened, and it happened in Brazil. But I would never tell anyone to hop on a plane to Brazil. What happened to me happened after four years of soul-searching and introspection as well as all those treatments. If I’d gone to Brazil first, I don’t know what would have happened.
Who do you see being among the audience for your book?
I’d love people who need it to read it and take what they need from it, but I’d also love doctors to read it – as an insight into patient psychology if nothing else – and I’d love it to be seen as a continuation of the whole #MeToo debate. That sounds holier than thou, and obviously it’d be great for people to read it as a Jon-Ronson-meets-Elizabeth-Gilbert-style romp because I’d feel like I’d succeeded from a writing point of view, but to be honest the only reason I wanted to write it in the first place was to show what’s happening to people in pain, and once I got better, the only thing that mattered to me was getting it into the hands of people who need it. I know how much I needed something like this.
Brain vs. Heart Surgery: Admissions and Fragile Lives
It’s never too early to start thinking about which books might make it onto next year’s Wellcome Book Prize nominees list, open to any medical-themed books published in the UK in calendar year 2017. I’ve already read some cracking contenders, including these two memoirs from British surgeons.
Brain surgeon Henry Marsh’s first book, Do No Harm, was one of my favorite reads of 2015. In short, enthrallingly detailed chapters named after conditions he had treated or observed, he reflected on life as a surgeon, expressing sorrow over botched operations and marveling at the God-like power he wields over people’s quality of life. That first memoir saw him approaching retirement age and nearing the end of his tether with NHS bureaucracy.
Admissions: A Life in Brain Surgery serves as a sort of sequel, recording Marsh’s last few weeks at his London hospital and the projects that have driven him during his first years of retirement: woodworking, renovating a derelict lock-keeper’s cottage by the canal in Oxford, and yet more neurosurgery on medical missions to Nepal and the Ukraine. But he also ranges widely over his past, recalling cases from his early years in medicine as well as from recent memory, and describing his schooling and his parents. If I were being unkind, I might say that this feels like a collection of leftover incidents from the previous book project.
However, the life of a brain surgeon is so undeniably exciting that, even if these stories are the scraps, they are delicious ones. The title has a double meaning, of course, referring not only to the patients who are admitted to the hospital but also to a surgeon’s confessions. And there are certainly many cases Marsh regrets, including operating on the wrong side in a trapped nerve patient, failing to spot that a patient was on the verge of a diabetic coma before surgery, and a young woman going blind after an operation in the Ukraine. Often there is no clear right decision, though; operating or not operating could lead to equal damage.
Once again I was struck by Marsh’s trenchant humor: he recognizes the absurdities as well as the injustices of life. In Houston he taught on a neurosurgery workshop in which students created and then treated aneurysms in live pigs. When asked “Professor, can you give us some surgical pearls?” he “thought a little apologetically of the swine in the nearby bay undergoing surgery.” A year or so later, discussing the case of a twenty-two-year-old with a fractured spine, he bitterly says, “Christopher Reeve was a millionaire and lived in America and he eventually died from complications, so what chance a poor peasant in Nepal?”
Although some slightly odd structural decisions have gone into this book – the narrative keeps jumping back to Nepal and the Ukraine, and a late chapter called “Memory” is particularly scattered in focus – I still thoroughly enjoyed reading more of Marsh’s anecdotes. The final chapter is suitably melancholy, with its sense of winding down capturing not just the somewhat slower pace of his retired life but also his awareness of the inevitable approach of death. Recalling two particularly hideous deaths he observed in his first years as a doctor, he lends theoretical approval for euthanasia as a way of maintaining dignity until the end.
What I most admire about Marsh’s writing is how he blends realism and wonder. “When my brain dies, ‘I’ will die. ‘I’ am a transient electrochemical dance, made of myriad bits of information,” he recognizes. But that doesn’t deter him from producing lyrical passages like this one: “The white corpus callosum came into view at the floor of the chasm, like a white beach between two cliffs. Running along it, like two rivers, were the anterior cerebral arteries, one on other side, bright red, pulsing gently with the heartbeat.” I highly recommend his work to readers of Atul Gawande and Paul Kalanithi.
My rating:
Admissions: A Life in Brain Surgery was published in the UK by Weidenfeld & Nicolson on May 4th. My thanks to the publisher for sending a free copy for review. It will be published in the USA by Thomas Dunne Books on October 3rd.
What Marsh does for brain surgery in his pair of memoirs, Professor Stephen Westaby does for heart surgery in Fragile Lives, a vivid, compassionate set of stories culled from his long career. A working class lad from Scunthorpe who watched his grandfather die of heart failure, he made his way up from hospital porter to world-leading surgeon after training at Charing Cross Hospital Medical School.
Each of these case studies, from a young African mother and her sick child whom he met while working in Saudi Arabia in the 1980s to a university student who collapses not far from his hospital in Oxford, is told in impressive depth. Although the surgery details are not for the squeamish, I found them riveting. Westaby conveys a keen sense of the adrenaline rush a surgeon gets while operating with the Grim Reaper looking on. I am not a little envious of all that he has achieved: not just saving the occasional life despite his high-mortality field – as if that weren’t enough – but also pioneering various artificial heart solutions and a tracheal bypass tube that’s named after him.
Like Marsh, he tries not to get emotionally attached to his patients, but often fails in this respect. “Surgeons are meant to be objective, not human,” he shrugs. But, also like Marsh, at his retirement he feels that NHS bureaucracy has tied his hands, denying necessary funds and equipment. Both authors come across as mavericks who don’t play by the rules, but save lives anyway. This is a fascinating read for anyone who enjoys books on a medical theme.
A few favorite lines:
“We stop life and start it again, making things better, taking calculated risks.”
“We were adrenaline junkies living on a continuous high, craving action. From bleeding patients to cardiac arrests. From theatre to intensive care. From pub to party.”
My rating:
Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table was published in the UK by HarperCollins on February 9th. I read a public library copy. It will be published in the USA, by Basic Books, under the title Open Heart on June 20th.