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?
The Not the Wellcome Prize Blog Tour: Francesca Segal and Ian Williams
It’s my stop on the “Not the Wellcome Prize” blog tour. With two dozen reviews of health-themed 2019 books to choose from, I decided to nominate these two for the longlist because they’re under the radar compared to some other medical releases, plus they showcase the breadth of the books that the Prize recognizes: from a heartfelt memoir of a mother welcoming premature babies to a laugh-out-loud graphic novel about a doctor practicing in a small town in Wales. (The Prize website says “picture-led books are not eligible,” so in fact it is likely that graphic novels have never been considered, but we’ve been flexible with the rules for this unofficial blog tour.)
Mother Ship by Francesca Segal
This first work of nonfiction from the author of the exquisite The Innocents is a visceral diary of the first eight weeks in the lives of her twin daughters, who were born by Caesarean section at 29 weeks in October 2015 and spent the next two months in the NICU, “an extremely well-funded prison or perhaps more accurately a high-tech zoo.” In Mother Ship, she strives to come to terms with this unnatural start to motherhood. “Taking my unready daughters from within me felt not like a birth but an evisceration,” she writes. “My children do not appear to require mothering. Instead they need sophisticated medical intervention.”
Segal describes with tender precision the feeling of being torn: between the second novel she’d been in the middle of writing and the all-consuming nature of early parenthood; and between her two girls (known for much of the book as “A-lette” and “B-lette”), who are at one point separated in different hospitals. Her attitude towards the NHS is pure gratitude.
As well as portraying her own state of mind, she crafts twinkly pen portraits of the others she encountered in the NICU, including the staff but especially her fellow preemie mums, who met in a “milking shed” where they pumped breast milk for the babies they were so afraid of losing that they resisted naming. (Though it was touch and go for a while, A-lette and B-lette finally earned the names Raffaella and Celeste and came home safely.) Female friendship is thus a subsidiary theme in this exploration of desperate love and helplessness.
The Lady Doctor by Ian Williams
This sequel to 2014’s The Bad Doctor returns to a medical practice in small-town Wales. This time, though, the focus is on Iwan James’s colleague, Dr. Lois Pritchard, who also puts in two days a week treating embarrassing ailments at the local hospital’s genitourinary medicine clinic. At nearly 40, Lois is a divorcee with no children; just a dog. She enjoys her nights out drinking with her best friend, Geeta, but her carefree life is soon beset by various complications: she has to decide whether she wants to join the health centre as a full partner, a tryst with her new fella goes horribly wrong, and her estranged mother suddenly reappears in her life, hoping that Lois will give her a liver transplant. And that’s not to mention all the drug addicts and VD-ridden lotharios hanging about.
Williams was a GP in North Wales for 20 years, and no doubt his experiences have inspired his comics. His tone is wonderfully balanced: there are plenty of hilarious, somewhat raunchy scenes, but also touching moments where Lois learns that a doctor is never completely off duty and has no idea what medical or personal challenge will crop up next. The drawing style reminded me most of Alison Bechdel’s or Posy Simmonds’, with single shades from rose to olive alternating as the background. I especially loved the pages where each panel depicts a different patient to show the range of people and complaints a doctor might see in a day. Myriad Editions have a whole “Graphic Medicine” series that I’m keen to explore.
See below for details of the blogs where other reviews have appeared or will be appearing soon.
The shadow panel will choose a shortlist of six titles to be announced on 4 May. We will then vote to choose a winner, with the results of a Twitter poll serving as one additional vote. The Not the Wellcome Prize winner will be announced on 11 May.
Review Books Roundup: Blackburn, Bryson, Pocock, Setterwall, Wilson
I’m attempting to get through all my 2019 review books before the end of the year, so expect another couple of these roundups. Today I’m featuring a work of poetry about one of Picasso’s mistresses, a thorough yet accessible introduction to how the human body works, a memoir of personal and environmental change in the American West, Scandinavian autofiction about the sudden loss of a partner, and a novel about kids who catch on fire. You can’t say I don’t read a variety! See if one or more of these tempts you.
The Woman Who Always Loved Picasso by Julia Blackburn
Something different from Blackburn: biographical snippets in verse about Marie-Thérèse Walter, one of Pablo Picasso’s many mistress-muses. When they met she was 17 and he was 46. She gave birth to a daughter, Maya – to his wife Olga’s fury. Marie-Thérèse’s existence was an open secret: he rented a Paris apartment for her to live in, and left his home in the South of France to her (where she committed suicide three years after his death), but unless their visits happened to overlap she was never introduced to his friends. “I lived in the time I was born into / and I kept silent, / acquiescing / to everything.”
In Marie-Thérèse’s voice, Blackburn depicts Picasso as a fragile demagogue: in one of the poems that was a highlight for me, “Bird,” she describes how others would replace his caged birds when they died, hoping he wouldn’t notice – so great was his horror of death. I liked getting glimpses into a forgotten female’s life, and appreciated the whimsical illustrations by Jeffrey Fisher, but as poems these pieces don’t particularly stand out. (Plus, there are no page numbers! which doesn’t seem like it should make a big difference but ends up being annoying when you want to refer back to something. Instead, the poems are numbered.)
My rating:
With thanks to Carcanet Press for the free copy for review. Published today.
The Body: A Guide for Occupants by Bill Bryson
Shelve this next to Being Mortal by Atul Gawande in a collection of books everyone should read – even if you don’t normally choose nonfiction. Bryson is back on form here, indulging his layman’s curiosity. As you know, I read a LOT of medical memoirs and popular science. I’ve read entire books on organ transplantation, sleep, dementia, the blood, the heart, evolutionary defects, surgery and so on, but in many cases these go into more detail than I need and I can find my interest waning. That never happens here. Without ever being superficial or patronizing, the author gives a comprehensive introduction to every organ and body system, moving briskly between engaging anecdotes from medical history and encapsulated research on everything from gut microbes to cancer treatment.
Bryson delights in our physical oddities, and his sense of wonder is infectious. He loves a good statistic, and while this book is full of numbers and percentages, they are accessible rather than obfuscating, and will make you shake your head in amazement. It’s a persistently cheerful book, even when discussing illness, scientists whose work was overlooked, and the inevitability of death. Yet what I found most sobering was the observation that, having conquered many diseases and extended our life expectancy, we are now overwhelmingly killed by lifestyle, mostly a poor diet of processed and sugary foods and lack of exercise.
My rating:
With thanks to Doubleday for the free copy for review.
Surrender: Mid-Life in the American West by Joanna Pocock
Prompted by two years spent in Missoula, Montana and the disorientation felt upon a return to London, this memoir-in-essays varies in scale from the big skies of the American West to the smallness of one human life and the experience of loss and change. Then in her late forties, Pocock had started menopause and recently been through the final illnesses and deaths of her parents, but was also mother to a fairly young daughter. She explores personal endings and contradictions as a kind of microcosm of the paradoxes of the Western USA.
It’s a place of fierce independence and conservatism, but also mystical back-to-the-land sentiment. For an outsider, so much of the lifestyle is bewildering. The author attends a wolf-trapping course, observes a Native American buffalo hunt, meets a transsexual rewilding activist, attends an ecosexuality conference, and goes foraging. All are attempts to reassess our connection with nature and ask what role humans can play in a diminished planet.
This is an elegantly introspective work that should engage anyone interested in women’s life writing and the environmental crisis. There are also dozens of black-and-white photographs interspersed in the text. In 2018 Pocock won the Fitzcarraldo Editions Essay Prize for this work-in-progress. It came to me as an unsolicited review copy and hung around on my shelves for six months before I picked it up; I’m glad I finally did.
My rating:
With thanks to Fitzcarraldo Editions for the free copy for review.
Let’s Hope for the Best by Carolina Setterwall
[Trans. from the Swedish by Elizabeth Clark Wessel]
Although this is fiction, it very closely resembles the author’s own life. She wrote this debut novel to reflect on the sudden loss of her partner and how she started to rebuild her life in the years that followed. It quickly splits into two parallel story lines: one begins in April 2009, when Carolina first met Aksel at a friend’s big summer bash; the other picks up in October 2014, after Aksel’s death from cardiac arrest. The latter proceeds slowly, painstakingly, to portray the aftermath of bereavement. In the alternating timeline, we see Carolina and Aksel making their life together, with her always being the one to push the relationship forward.
Setterwall addresses the whole book in the second person to Aksel. When the two story lines meet at about the two-thirds point, it carries on into 2016 as she moves house, returns to work and resumes a tentative social life, even falling in love. This is a wrenching story reminiscent of In Every Moment We Are Still Alive by Tom Malmquist, and much of it resonated with my sister’s experience of widowhood. There are many painful moments that stick in the memory. Overall, though, I think it was too long by 100+ pages; in aiming for comprehensiveness, it lost some of its power. Page 273, for instance (the first anniversary of Aksel’s death, rather than the second, where the book actually ends), would have made a fine ending.
My rating:
With thanks to Bloomsbury UK for the proof copy for review.
Nothing to See Here by Kevin Wilson
I’d read a lot about this novel while writing a synopsis and summary of critical opinion for Bookmarks magazine – perhaps too much, as it felt familiar and offered no surprises. Lillian, a drifting twentysomething, is offered a job as a governess for her boarding school roommate Madison’s stepchildren. Madison’s husband is a Tennessee senator in the running for the Secretary of State position, so it’s imperative that they keep a lid on the situation with his 10-year-old twins, Bessie and Roland.
You see, when they’re upset these children catch on fire; flames destroy their clothes and damage nearby soft furnishings, but leave the kids themselves unharmed. Temporary, generally innocuous spontaneous combustion? Okay. That’s the setup. Wilson writes so well that it’s easy to suspend your disbelief about this, but harder to see a larger point, except perhaps creating a general allegory for the challenges of parenting. This was entertaining enough, mostly thanks to Lillian’s no-nonsense narration, but for me it didn’t soar.
My rating:
With thanks to Text Publishing UK for the PDF for review. This came out in the States in October and will be released in the UK on January 30th.
Would you be interested in reading one or more of these?
How Not to Decide: Motherhood by Sheila Heti
Should one have children? No matter who’s asking the question or in what context, you’re going to get the whole gamut of replies, as proven by this recent Literary Hub survey of authors. Should I have children? Turn the question personal and, even if it’s actually rhetorical, you’ll still get an opinion from every quarter. As The Decision looms over her, the narrator of Sheila Heti’s new novel, a 37-year-old writer from Toronto, isn’t sure who to listen to. Her neurotic inner voice makes her second-guess her life. “The question of a child is a bug in the brain—it’s a bug that crawls across everything, every memory, and every sense of my own future.” Meanwhile, acquaintances and strangers alike all have their two cents to chip in. Everywhere she goes on her book tour, for instance, she hears other people’s stories and has to sift through them. She’s something like the protagonist of Rachel Cusk’s Outline trilogy, though with a stronger personality and internal commentary.
Having a child is an act of creation, and Heti’s narrator worries that she only has sufficient creative energy for one or the other: writing or breeding. Her identity as an artist is so precious to her that she is terrified of giving it up, or watering it down, to risk being a (not very good?) mother. Yet she has the sense that to remain childless she had better come up with a really good excuse. People will want to know what she is going to do with her life instead, and they’re unlikely to be satisfied by the notion that her books are like her babies.
The novel is in short, aphoristic paragraphs and is dominated by cogitation rather than scenes, though there are some concrete events and secondary characters, such as the narrator’s mother; her friend Libby, a new mother; and her partner, Miles, who has a 12-year-old daughter from a previous relationship. The sections are given headings like “PMS,” “Bleeding,” “Follicular,” and “Ovulating,” which suggest the cyclical nature of life: whether she likes it or not, this character is part of a physical process geared towards reproduction.
The cyclical workings of the female body mirror the circularity of her thoughts: she keeps revolving around the same questions, never seeming to get any closer to a decision – though by the end she does decide. The temptation is always to offload the choice onto an external, fate-like force. The narrator wants the oracular voice of the universe to answer everything for her via coin tosses. (Heti writes in a prefatory note that these were based on actual coin tosses.) She asks series of yes/no questions and reports what the coins have to say. It’s a way of avoiding responsibility for her own decision, and produces some truly hilarious passages. Oh, the absurdity of having a dialogue with an impersonal force!
Our heroine does ultimately realize how random and meaningless the coins’ yes/no answers are, but she continues to look outside herself for wisdom: to a fortune teller, psychics, dreams, and even a crazy woman in New York City who hits her up for money. Anything to bypass the wringer of her own mind. She also latches onto the biblical story of Jacob wrestling with the angel, and contrasts this with the symbol of a kitchen knife, which represents a demon that robs her of hope.
Every woman is a daughter as well as a potential mother, and a particularly moving strand of Motherhood is the narrator’s relationship with her female ancestors. Her Hungarian grandmother, Magda, survived Auschwitz only to die of cancer at 53; her mother, a doctor, devoted herself to her career and left the traditional household and childrearing tasks to her husband. This dual legacy of suffering and professional pride helps explain the narrator’s feelings. Deep down, she believes her family line was meant to end in a concentration camp; how dare she continue it now? She also emulates her mother’s commitment to a cerebral vocation – “So I also wanted to be the brains: to be nothing but words on a page.”
Chance, inheritance, and choice vie for pride of place in this relentless, audacious inquiry into the purpose of a woman’s life. I marked out dozens of quotes that could have been downloaded directly from my head or copied from my e-mails and journal pages. The book encapsulates nearly every thought that has gone through my mind over the last decade as I’ve faced the intractable question of whether to have children. I suspect it will mean the most to people who are still unsure or have already decided against children; parents may interpret Heti’s arguments as personal barbs, even though the narrator insists her own decision is not an inherent comment on anyone else’s. It’s a book I could have written, but now don’t have to; Heti has captured brilliantly what it’s like to be in this situation in this moment in time.
Here are a few of my favorite passages. They should give you an idea of whether this book might resonate with you, or at least interest you academically:
“On the one hand, the joy of children. On the other hand, the misery of them. On the one hand, the freedom of not having children. On the other hand, the loss of never having had them—but what is there to lose?”
“for a woman of curiosity, no decision will ever feel like the right one. In both, too much is missing. What can I say, except: I forgive myself for every time I neglected to take a risk, for all the narrowings and winnowings of my life. I understand that fear beckons to a person as much as possibility does, and even more strongly.”
“I don’t have to live every possible life, or to experience that particular love. I know I cannot hide from life; that life will give me experiences no matter what I choose. Not having a child is no escape from life, for life will always put me in situations, and show me new things, and take me to darknesses I wouldn’t choose to see, and all sorts of treasures of knowledge I cannot comprehend.”
My rating:
Motherhood was published in the UK by Harvill Secker on May 24th. My thanks to the publisher for the free copy for review. It came out in North America on May 1st (Knopf Canada / Henry Holt and Co.).