This historical novel set in Edinburgh in 1847 has one of the best opening paragraphs I’ve come across in a while:
That immediately sets the tone: realistic, sly, and somewhat seedy. If the title sounds familiar, it’s because it’s borrowed from Samuel Butler’s gloomy 1903 meditation on sin and salvation in several generations of a Victorian family. I remember trudging through it on a weekend break to Strasbourg during my year abroad.
Parry (a pseudonym for husband–wife duo Chris Brookmyre and Marisa Haetzman) uses the allusion to highlight the hidden sins of the Victorian period and hint at the fleshy concerns of their book, which contains somewhat gruesome scenes of childbirth and surgery. Ether and chloroform were recent introductions and many were still apprehensive about them or even opposed to their use on religious grounds, as Haetzman, a consultant anesthetist, learned while researching for her Master’s degree in the History of Medicine.
Into this milieu enters Will Raven, the new apprentice to Dr. Simpson, a professor of midwifery. Will is troubled by the recent loss of his friend Evie Lawson, the dead prostitute of the first paragraph, and wonders if she could have been poisoned by some bad moonshine. Only as he hears rumors about a local abortionist – no better than a serial killer – who’s been giving women quack pills and potions, followed by rudimentary operations that leave them to die of peritonitis, does he begin to wonder if Evie could have been pregnant when she died.
The novel peppers in lots of period slang and details about homeopathy, phrenology and early photography. Best of all, it has a surprise heroine: the Simpsons’ maid, Sarah Fisher, who keeps shaming Will with her practical medical know-how and ends up being something of a sidekick in his investigations. She wants to work as a druggist’s assistant, but the druggist insists that only a man can do the job. Dr. Simpson recognizes that the housemaid’s role is rather a waste of Sarah’s talents and expresses his hope that she’ll seek to be part of a widespread change for women.
The Way of All Flesh is sure to appeal to readers of Michel Faber’s The Crimson Petal and the White and Steven Price’s By Gaslight. It’s not quite as rewarding as the former, but the length and style make it significantly more engaging than the latter. It also serves as a good fictional companion to Lindsey Fitzharris’s The Butchering Art; for that reason, I wouldn’t be surprised to see it appear on next year’s Wellcome Book Prize longlist.
“That was Edinburgh for you: public decorum and private sin, city of a thousand secret selves.”
“‘Simpson likes to think of medicine as more than pure science,’ [Raven] countered. ‘There must also be empathy, concern, a human connection.’ ‘I suggest that both elements are required,’ offered Henry. ‘Scientific principles married to creativity. Science and art.’ If it is an art, it is at times a dark one, Raven thought, though he chose to keep this observation to himself.”
The Way of All Flesh comes out today, August 30th, in the UK. It was published in the States by HarperCollins on the 28th. My thanks to Canongatefor sending a free copy for review.
I know that a number of you have long-term, faithful book clubs. Boy, am I envious! You might find it surprising that I’ve only ever been in one traditional book club, and it wasn’t a resounding success. Partway through my time working for King’s College, London, an acquaintance from another library branch started the club. A group of five to eight of us from Library Services aimed to meet after work one evening a month at a Southbank venue or a staff room to discuss our latest pick. By poring over old e-mails and my Goodreads library, I’ve managed to remember 10 of the books we read between November 2011 and June 2013:
Do Androids Dream of Electric Sheep?, Philip K. Dick [classic science fiction]
The Little Shadows, Marina Endicott [Canadian historical fiction]
A Spot of Bother, Mark Haddon [contemporary fiction]
The Talented Mr. Ripley, Patricia Highsmith [classic suspense]
The Vintner’s Luck, Elizabeth Knox [bizarre historical fiction/magic realism]
What Was Lost, Catherine O’Flynn [contemporary fiction]
Franny and Zooey, J.D. Salinger [classic short fiction]
The Rabbi’s Cat, Joann Sfar [graphic novel in translation]
Girl Meets Boy, Ali Smith [an update of Greek myth]
Angel, Elizabeth Taylor [an obscure English classic
That may well be the complete list. Although I was a member for 20 months until I quit to go freelance, we often only managed to meet every other month because we couldn’t find a mutually convenient free evening or no one had read the book in time. I was consistently frustrated that – even when our selections were only about 200 pages long – I was often one of the only people to have read the whole book.
Overall, the quality of books we chose struck me as mediocre: I rated half of these books 2 stars, and the rest 3 stars. (I think I was a harsher rater then, but it’s not a good sign, is it?) Perhaps this is part of the inevitable compromising that goes with book clubs, though: You humor other people in their choices and hope they’ll be kind about yours? My suggestion, for the record, was the pretty dismal Little Shadows, for which I got a free set of book club copies to review for Booktime magazine. But I also voted in favor of most of the above list.
Looking back, I am at least impressed by how varied our selections were. People were interested in trying out different genres, so we ranged from historical fiction to sci-fi, and even managed a graphic novel. But when we did get together for discussion there was far too much gossipy chat about work, and when we finally got around to the book itself the examination rarely went deeper than “I liked it” or “I hated all the characters.”
If it was profound analysis I was after, I got that during the years I volunteered at Greenbelt, an annual summer arts festival with a progressive Christian slant. I eagerly read the eclectic set of three books the literature coordinator chose for book club meetings in 2010 – Star of the Morning: The Extraordinary Life of Lady Hester Stanhope by Kirsten Ellis, The First Person and Other Stories by Ali Smith, and The Bridge of San Luis Rey by Thornton Wilder – and then as a literature volunteer for the next three years I read and prepared copious notes and questions about our festival “Big Read.” We did Exile by Richard North Patterson in 2011, Dark Eden by Chris Beckett in 2012 and So Many Ways to Begin by Chris Beckett in 2013, and each time I offered to chair the book club meetings.
Unfortunately, due at least in part to logistical considerations, these were run in the way many festival events are: a panel of two to five talking heads with microphones was at the front of the tent, sometimes on a raised dais, while the audience of whatever size sat towards the back. This created a disconnect between the “experts” and the participants, and with the exception of the McGregor meeting I don’t recall much audience input. I’ve mostly blanked out the events – as I tend to for anything that entails public speaking and nervous preparation for something you can’t control – but I was pleased to be involved and I should probably make more of this on my CV. It wasn’t your average book club setting, that’s for sure.
In recent years the closest thing I’ve had to a book club has been online buddy reading. The shadow panels for the Wellcome Book Prize and Sunday Times Young Writer of the Year Award fall into this category, as do online readalongs I’ve done for several Iris Murdoch novels and for C.S. Lewis’s Mere Christianity with various female family members. A few of us book bloggers chatted about Andrea Levy’s Small Island in an online document earlier this year, and my mom and I e-mailed back and forth while reading W. Somerset Maugham’s The Painted Veil in May. I’m also doing my last three of the #20BooksofSummer as online buddy reads, checking in occasionally on Twitter.
Of course, there are some inherent limitations to this kind of discussion – people read at different paces and don’t want to spoil the plot for others, and at some point the back-and-forth fizzles out – but it’s always been easier for me to organize my thoughts in writing, so I likely feel more comfortable contributing than I might in an in-person meeting.
This is all context for my decision to join my neighborhood book club next month. The club arose some months back out of our community’s Facebook group, a helpful resource run by a go-getting lady a few doors down from us. So far it’s turning out to be a small group of thirty- and fortysomething women who alternate meetings at each other’s houses, and the name they’ve chosen gives an idea of the tone: “Books, Booze and Banter.”
I made the mistake of not getting involved right at the start; I wanted to hang back and see what kind of books they’d choose. This means I wasn’t part of the early process of putting titles in a hat, so I’ve looked on snobbishly for several months as they lurched between crime and women’s fiction, genres I generally avoid. (Still, there were actually a couple books I might have joined them for had I not been in America and had they been readily available at the public library.) For many people a book club selection will be the only book they get through that month, so I can understand how they’d want it to be something ‘readable’ that they’d be happy to pick up anyway. Even though statistically I read 27 books a month, I’m still jealously protective of my reading time; I want everything I read to be worthwhile.
So for September I managed to steer the group away from a poorly received historical novel of over 400 pages and the new Joël Dicker and onto Ladder of Years by Anne Tyler, which the bookstore chain Waterstones has been promoting heavily as one of their books of the month. I already had a charity shop copy in hand and the others liked the sound of it, so we’re all set for September 12th! Future months’ literary fiction choices look promising, too, so provided I enjoy the discussion and the camaraderie I plan to stick with it: a backlist Pat Barker novel I’ve not read, and Kirsty Logan and Jonathan Coe novels I’ve read before and won’t reread but will remind myself about briefly before the meetings.
I’m out of practice with this book club thing. My mother tells me that I have a lot to contribute but that I must also be open to what I’ll learn from other people – even if I don’t expect to. So I don’t want to set myself up as some kind of expert. In fact, I probably won’t even mention that I’m a freelance book reviewer and book blogger. Mostly I’m hoping to find some friendly faces around the neighborhood, because even though we’ve lived here just over two years I still only know a handful of names and keep myself to myself as I work from home. Even if I have to read books I wouldn’t normally, it’ll be worth it to meet more people.
What has your experience with book clubs (in person and online) been?
Amateur: A True Story about What Makes a Man, Thomas Page McBee
Thomas Page McBee was the first transgender man to box at Madison Square Garden. In his second memoir, which arose from a Quartz article entitled “Why Men Fight,” he recounts the training leading up to his charity match and ponders whether aggression is a natural male trait. McBee grew up in a small town outside Pittsburgh with a stepfather who sexually abused him from age four. In 2011 he started the testosterone injections that would begin his gender transformation. During the years that followed, other men seemed to pick fights with him fairly often, and he was unsure what to do about it. Finally, in 2015, the Manhattan editor decided to confront the belligerent male stereotype by starting boxing training.
What I most appreciated were the author’s observations of how others have related to him since his transition. He notices that he’s taken more seriously at work as a man, and that he can be an object of fear – when jogging behind a woman at night, for instance. One of the most eye-opening moments of the book is when he realizes that he’s been talking over his own sister. Thankfully, McBee is sensitive enough to stop and change, recognizing that kindness and vulnerability are not faults but attributes any person should be proud of.
I have a feeling I would have preferred his previous memoir, Man Alive, which sounds like it has more about the transition itself. Jonathan Eig’s biography of Muhammad Ali is one of the best books I’ve read this year, and in comparison I didn’t find the boxing writing here very interesting. Likewise, this pales beside two similar but more perceptive books I’ve read that have been hugely influential on my own understanding of gender identity: Conundrum by Jan Morris and The Argonauts by Maggie Nelson.
Amateur was published in the UK by Canongate on August 2nd. My thanks to the publisher for the free copy for review.
Shapeshifters: On Medicine and Human Change by Gavin Francis
Gavin Francis is a physician with a practice near Edinburgh. His latest book is like a taster course in medical topics. The overarching theme is the modifications the body undergoes, so there are chapters on, for example, body-building, tattoos, puberty, prosthetic limbs, dementia and menopause. Over his years in general practice Francis has gotten to know his patients’ stories and seen them change, for better or worse. These anecdotes of transformation are one source for his book, but he also applies insight from history, mythology, literature, etymology and more. So in a chapter on conception he discusses the Virgin Mary myth, Leonardo da Vinci’s fetal diagrams, the physiological changes pregnant women experience, and the case of a patient, Hannah, who had three difficult, surprise pregnancies in quick succession.
We are all in the process of various transformations, Francis argues, whether by choice or involuntarily. (I decided on the link with McBee because of a chapter on sex changes.) I was less convinced by the author’s inclusion of temporary, reversible changes such as sleep, hallucinations, jet lag and laughter. And while each chapter is finely wrought, I felt some sort of chronological or anatomical order was necessary to give the book more focus. All the same, I suspect this will be a strong contender for next year’s Wellcome Book Prize because of its broad relevance to human health and its compassionate picture of bodies in flux.
Shapeshifters was published by the Wellcome Collection/Profile Books on May 2nd. My thanks to the publisher for the proof copy for review.
Here are 30 books that are on my radar for the months of July through November (I haven’t heard about any December titles yet), plus one bonus book that I’ve already read. This is by no means a full inventory of what’s coming out, or even of what I have available through NetGalley and Edelweiss; instead, think of it as a preview of the books I actually intend to read, in release date order. The quoted descriptions are from the publisher blurbs on Goodreads. If I already have access to the book in some way, I’ve noted that.
The first half of the year seemed to be all about plants. This time around I have plenty of memoirs, some medical and some bookish; birds and watery imagery; and some religious and philosophical themes.
17 out of 30 read; of those 8 were at least somewhat disappointing (d’oh!)
1 currently reading
1 lost interest in
1 I still intend to read
5 I didn’t manage to find]
No One Tells You This: A Memoir by Glynnis MacNicol [July 10, Simon & Schuster]: “If the story doesn’t end with marriage or a child, what then? This question plagued Glynnis MacNicol on the eve of her 40th birthday. … Over the course of her fortieth year, which this memoir chronicles, Glynnis embarks on a revealing journey of self-discovery that continually contradicts everything she’d been led to expect.” (NetGalley download)
The Lost Chapters: Finding Recovery and Renewal One Book at a Time by Leslie Schwartz [July 10, Blue Rider Press]: “Leslie Schwartz’s powerful, skillfully woven memoir of redemption and reading, as told through the list of books she read as she served a 90-day jail sentence. … Incarceration might have ruined her, if not for the stories that comforted her while she was locked up.”
The Bumblebee Flies Anyway: Gardening and Surviving Against the Odds by Kate Bradbury [July 17, Bloomsbury Wildlife]: “Finding herself in a new home in Brighton, Kate Bradbury sets about transforming her decked, barren backyard into a beautiful wildlife garden. She documents the unbuttoning of the earth and the rebirth of the garden, the rewilding of a tiny urban space.”
Crux: A Cross-Border Memoir by Jean Guerrero [July 17, One World]: “A daughter’s quest to find, understand, and save her charismatic, troubled, and elusive father, a self-mythologizing Mexican immigrant who travels across continents—and across the borders between imagination and reality; and spirituality and insanity—fleeing real and invented persecutors.”
The Incendiaries by R.O. Kwon [July 31, Riverhead]: “A shocking novel of violence, love, faith, and loss, as a young woman at an elite American university is drawn into acts of domestic terrorism by a cult tied to North Korea. … The Incendiaries is a fractured love story and a brilliant examination of the minds of extremist terrorists, and of what can happen to people who lose what they love most.” (Print ARC for blog review at UK release on Sept. 6 [Virago])
Bitter Orange by Claire Fuller [Aug. 2, Penguin Fig Tree]: I’ve loved Fuller’s two previous novels. This one is described as “a suspenseful story about deception, sexual obsession and atonement” set in 1969 in a run-down English country house. I don’t need to know any more than that; I have no doubt it’ll be brilliant in an Iris Murdoch/Gothic way. (Print ARC for blog review on release date)
If You Leave Me by Crystal Hana Kim [Aug. 7, William Morrow]: “An emotionally riveting debut novel about war, family, and forbidden love—the unforgettable saga of two ill-fated lovers in Korea and the heartbreaking choices they’re forced to make in the years surrounding the civil war that continues to haunt us today.” This year’s answer to Pachinko? And another botanical cover to boot! (Edelweiss download)
A River of Stars by Vanessa Hua [Aug. 14, Ballantine Books]: “In a powerful debut novel about motherhood, immigration, and identity, a pregnant Chinese woman makes her way to California and stakes a claim to the American dream. … an entertaining, wildly unpredictable adventure, told with empathy and wit” Sounds like The Leavers, which is a Very Good Thing.
The Shakespeare Requirement by Julie Schumacher [Aug. 14, Doubleday]: A sequel to the very funny epistolary novel Dear Committee Members! “Now is the fall of his discontent, as Jason Fitger, newly appointed chair of the English Department of Payne University, takes aim against a sea of troubles, personal and institutional.” (Edelweiss download)
Gross Anatomy: Dispatches from the Front (and Back) by Mara Altman [Aug. 21, G.P. Putnam’s Sons]: “By using a combination of personal anecdotes and fascinating research, Gross Anatomy holds up a magnifying glass to our beliefs, practices, biases, and body parts and shows us the naked truth—that there is greatness in our grossness.” (PDF from publisher; to review for GLAMOUR online)
Meg, Jo, Beth, Amy: The Story of Little Women and Why It Still Matters by Anne Boyd Rioux [Aug. 21, W. W. Norton Company]: This is the bonus one I’ve already read, as part of my research for my Literary Hub article on rereading Little Women at its 150th anniversary. (That’s also the occasion for this charming book.) Rioux unearths Little Women’s origins in Alcott family history, but also traces its influence through to the present day. She also makes a strong feminist case for it. My short Goodreads review is here. (Edelweiss download)
Lake Success by Gary Shteyngart [Sept. 4, Random House]: I read his memoir but am yet to try his fiction. “When his dream of the perfect marriage, the perfect son, and the perfect life implodes, a Wall Street millionaire takes a cross-country bus trip in search of his college sweetheart and ideals of youth. … [a] biting, brilliant, emotionally resonant novel very much of our times.” (Edelweiss download; for Pittsburgh Post-Gazette review)
In My Mind’s Eye: A Thought Diary by Jan Morris [Sept. 6, Faber & Faber]: One of my most admired writers. “A collection of diary pieces that Jan Morris wrote for the Financial Times over the course of 2017.” I have never before in my life kept a diary of my thoughts, and here at the start of my ninth decade, having for the moment nothing much else to write, I am having a go at it. Good luck to me.
Help Me!: One Woman’s Quest to Find Out if Self-Help Really Can Change Her Life by Marianne Power [Sept. 6, Picador]: “[F]or a year she vowed to test a book a month, following its advice to the letter, taking the surest road she knew to a perfect Marianne. As her year-long plan turned into a demented roller coaster where everything she knew was turned upside down, she found herself confronted with a different question: Self-help can change your life, but is it for the better?” (Print ARC)
Normal People by Sally Rooney [Sept. 6, Faber & Faber]: Much anticipated follow-up to Conversations with Friends. “Connell and Marianne both grow up in the same town in rural Ireland. The similarities end there; they are from very different worlds. But they both get places to study at university in Dublin, and a connection that has grown between them despite the social tangle of school lasts long into the following years.”
Mrs. Gaskell & Me by Nell Stevens [Sept. 6, Picador]: “In 2013, Nell Stevens is embarking on her PhD … and falling drastically in love with a man who lives in another city. As Nell chases her heart around the world, and as Mrs. Gaskell forms the greatest connection of her life, these two women, though centuries apart, are drawn together.” I was lukewarm on her previous book, Bleaker House, but I couldn’t resist the Victorian theme of this one! (Print ARC to review for Shiny New Books)
Heart: A History by Sandeep Jauhar [Sept. 18, Farrar, Straus and Giroux]: “Deftly alternating between key historical episodes and his own work, Jauhar tells the colorful and little-known story of the doctors who risked their careers and the patients who risked their lives to know and heal our most vital organ. … Affecting, engaging, and beautifully written.” (Edelweiss download)
To the Moon and Back: A Childhood under the Influence by Lisa Kohn [Sept. 18, Heliotrope Books]: “Lisa was raised as a ‘Moonie’—a member of the Unification Church, founded by self-appointed Messiah, Reverend Sun Myung Moon. … Told with spirited candor, [this] reveals how one can leave behind such absurdity and horror and create a life of intention and joy.”
Ghost Wall by Sarah Moss [Sept. 20, Granta]: I’ve read Moss’s complete (non-academic) oeuvre; I’d read her on any topic. This novella sounds rather similar to her first book, Cold Earth, which I read recently. “Teenage Silvie is living in a remote Northumberland camp as an exercise in experimental archaeology. … Behind and ahead of Silvie’s narrative is the story of a bog girl, a sacrifice, a woman killed by those closest to her, and as the hot summer builds to a terrifying climax, Silvie and the Bog girl are in ever more terrifying proximity.” (NetGalley download)
Time’s Convert (All Souls Universe #1) by Deborah Harkness [Sept. 25, Viking]: I was a sucker for Harkness’s A Discovery of Witches and its sequels, much to my surprise. (The thinking girl’s Twilight, you see. I don’t otherwise read fantasy.) Set between the American Revolution and contemporary London, this fills in the backstory for some of the vampire characters.
All You Can Ever Know: A Memoir by Nicole Chung [Oct. 2, Catapult]: “Nicole Chung was born severely premature, placed for adoption by her Korean parents, and raised by a white family in a sheltered Oregon town. … With warmth, candor, and startling insight, Chung tells of her search for the people who gave her up, which coincided with the birth of her own child.” (Edelweiss download)
Melmoth by Sarah Perry [Oct. 2, Serpent’s Tail]: Gothic fantasy / historical thriller? Not entirely sure. I just know that it’s the follow-up by the author of The Essex Serpent. (I choose to forget that her first novel exists.) Comes recommended by Eleanor Franzen and Simon Savidge, among others. (Edelweiss download)
The Ravenmaster: Life with the Ravens at the Tower of London by Christopher Skaife [Oct. 2, 4th Estate]: More suitably Gothic pre-Halloween fare! “Legend has it that if the Tower of London’s ravens should perish or be lost, the Crown and kingdom will fall. … [A]fter decades of serving the Queen, Yeoman Warder Christopher Skaife took on the added responsibility of caring for these infamous birds.” I briefly met the author when he accompanied Lindsey Fitzharris to the Wellcome Book Prize ceremony.
I Am Dynamite!: A Life of Friedrich Nietzsche by Sue Prideaux [Oct. 4, Faber & Faber]: “Friedrich Nietzsche’s work forms the bedrock of our contemporary thought, and yet a shroud of misunderstanding surrounds the philosopher behind these proclamations. The time is right for a new take on Nietzsche’s extraordinary life, whose importance as a thinker rivals that of Freud or Marx.” (For a possible TLS review?)
Almost Everything: Notes on Hope by Anne Lamott [Oct. 16, Riverhead]: I haven’t been too impressed with Lamott’s recent stuff, but I’ll still read anything she publishes. “In this profound and funny book, Lamott calls for each of us to rediscover the nuggets of hope and wisdom that are buried within us that can make life sweeter than we ever imagined. … Almost Everything pinpoints these moments of insight as it shines an encouraging light forward.”
The Library Book by Susan Orlean [Oct. 16, Simon & Schuster]: The story of a devastating fire at Los Angeles Public Library in April 1986. “Investigators descended on the scene, but over 30 years later, the mystery remains: Did someone purposefully set fire to the library—and if so, who? Weaving her life-long love of books and reading with the fascinating history of libraries and the sometimes-eccentric characters who run them, … Orlean presents a mesmerizing and uniquely compelling story as only she can.” (Edelweiss download)
Unsheltered by Barbara Kingsolver [Oct. 18, Faber & Faber]: Kingsolver is another author I’d read anything by. “[T]he story of two families, in two centuries, who live at the corner of Sixth and Plum, as they navigate the challenges of surviving a world in the throes of major cultural shifts.” 1880s vs. today, with themes of science and utopianism – I’m excited! (Edelweiss download)
Nine Pints: A Journey through the Money, Medicine, and Mysteries of Blood by Rose George [Oct. 23, Metropolitan Books]: “Rose George, author of The Big Necessity [on human waste], is renowned for her intrepid work on topics that are invisible but vitally important. In Nine Pints, she takes us from ancient practices of bloodletting to modern ‘hemovigilance’ teams that track blood-borne diseases.”
The End of the End of the Earth: Essays by Jonathan Franzen [Nov. 13, Farrar, Straus and Giroux]: “[G]athers essays and speeches written mostly in the past five years … Whether exploring his complex relationship with his uncle, recounting his young adulthood in New York, or offering an illuminating look at the global seabird crisis, these pieces contain all the wit and disabused realism that we’ve come to expect from Franzen.”
A River Could Be a Tree by Angela Himsel [Nov. 13, Fig Tree Books]: “How does a woman who grew up in rural Indiana as a fundamentalist Christian end up a practicing Jew in New York? … Ultimately, the connection to God she so relentlessly pursued was found in the most unexpected place: a mikvah on Manhattan’s Upper West Side. This devout Christian Midwesterner found her own form of salvation—as a practicing Jewish woman.”
Becoming by Michelle Obama [Nov. 13, Crown]: “In her memoir, a work of deep reflection and mesmerizing storytelling, Michelle Obama invites readers into her world, chronicling the experiences that have shaped her—from her childhood on the South Side of Chicago to her years as an executive balancing the demands of motherhood and work, to her time spent at the world’s most famous address.”
Which of these do you want to read, too? What other upcoming 2018 titles are you looking forward to?
Two recent books about our flawed bodies and the ultimate pointlessness of trying to control them…
Natural Causes: Life, Death and the Illusion of Control by Barbara Ehrenreich
A decade ago, Barbara Ehrenreich discovered a startling paradox through a Scientific American article: the immune system assists the growth and spread of tumors, including in breast cancer, which she had in 2000. It was an epiphany for her, confirming that no matter how hard we try with diet, exercise and early diagnosis, there’s only so much we can do to preserve our health; “not everything is potentially within our control, not even our own bodies and minds.” I love Ehrenreich’s Smile or Die (alternate title: Bright-Sided), which is what I call an anti-self-help book refuting the supposed health benefits of positive thinking. In that book I felt like her skeptical approach was fully warranted, and I could sympathize with her frustration – nay, outrage – when people tried to suggest she’d attracted her cancer and limited her chances of survival through her pessimism.
However, Natural Causes is so relentlessly negative and so selective in the evidence it provides that, even though it’s sure to be considered for next year’s Wellcome Book Prize longlist, I would be unlikely to recommend it. In the first chapter, “Midlife Revolt,” which has been excerpted at Literary Hub and is worth reading, Ehrenreich writes of her decision to give up routine medical screening after a false positive mammogram caused undue stress. She decided once she passed 70 she was old enough to die without accepting a “medicalized life.” Moreover, she believes there’s an epidemic of “overdiagnosis,” especially in the USA, where there can be a profit motive behind testing. (This is certainly not the case in the UK, where the NHS doesn’t pester me about getting cervical smear tests to line any pockets; no, it’s about saving taxpayers money by catching cancer early and thus minimizing treatment costs.)
Ehrenreich goes on to argue that many medical procedures are simply rituals to establish patient trust, that cancer screening is invasive and ineffective, that there is little evidence that meditation does any good, and that fitness has become a collective obsession that probably doesn’t help us live any longer. It’s uncomfortable to hear her dismiss early detection techniques as worthless; no one whose doctor found cancer in the early stages would agree. The author also seems unwilling to confront her own personal prejudices (e.g. against yoga).
Although she uses plenty of statistics to back up her points, these usually come from newspapers and websites rather than peer-reviewed journals; only in two chapters about how macrophages ‘betray’ the body by abetting cancer does she consult the scientific literature, in keeping with her PhD in cellular immunology. Her most bizarre example of how our bodies aren’t evolutionarily fit for purpose is copious menstruation. Overall, the book is a strange mixture of hard science, social science, and, in later chapters, philosophy, as Ehrenreich asks about the nature of the self and the soul and what survives of us after death. As usual, her work is very readable, but this doesn’t match up to many other mind/body books I’ve read.
“The only cure for bad science is more science, which has to include both statistical analysis and some recognition that the patient is not ‘just a statistic,’ but a conscious, intelligent agent, just as the doctor is.”
“The objection raised over and over to any proposed expansion of health insurance was, in so many words: Why should I contribute to the care of those degenerates who choose to smoke and eat cheeseburgers? … we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?”
Natural Causes was published in the UK by Granta on April 12th. My thanks to the publisher for the free copy for review.
Human Errors: A Panorama of Our Glitches, from Pointless Bones to Broken Genes by Nathan H. Lents
Lents is a biology professor at John Jay College, City University of New York, and in this, his second book, he explores the ways in which the human body is flawed. These errors come in three categories: adaptations to the way the world was for early humans (to take advantage of once-scarce nutrients, we gain weight quickly – but lose it only with difficulty); incomplete adaptations (our knees are still not fit for upright walking); and the basic limitations of our evolution (inefficient systems such as the throat handling both breath and food, and the recurrent laryngeal nerve being three times longer than necessary because it loops around the aorta). Consider that myopia rates are 30% or higher, the retina faces backward, sinuses drain upwards, there are 100+ autoimmune diseases, we have redundant bones in our wrist and ankle, and we can’t produce most of the vitamins we need. Put simply, we’re not a designer’s ideal. And yet this all makes a lot of sense for an evolved species.
My favorite chapter was on the inefficiencies of human reproduction compared to that of other mammals. Infertility and miscarriage rates are notably high, and gestation is shorter than it really needs to be: because otherwise their heads would get too big to pass through the birth canal, all babies are effectively born premature, so are helpless for much longer than other newborn mammals. I also especially liked the short section on cancer, which would eventually get us all if we only lived long enough. As it is, “evolution has struck an uneasy balance with cancer. Mutations cause cancer, which kills individuals, but it also brings diversity and innovation, which is good for the population.”
Lents writes in a good conversational style and usually avoids oversimplifying the science. In places his book reminded me of Kathryn Schulz’s Being Wrong and Mark O’Connell’s To Be a Machine. It’s a wry and gentle treatment of human weakness; the content never turns depressing or bitter. Recommended for all curious readers of popular science.
“While lithopedions [“stone babies”] and abdominal pregnancies are quite rare, they are also 100 percent the result of poor design. Any reasonable plumber would have attached the fallopian tube to the ovary, thereby preventing tragic and often fatal mishaps like these.”
“to call our immune system perfectly designed would be equally inaccurate. There are millions of people who once happily walked this planet only to meet their demise because their bodies simply self-sabotaged. When bodies fight themselves, there can be no winner.”
Human Errors was published in the UK by Weidenfeld & Nicolson on May 3rd. My thanks to the publisher for the free copy for review.
After all that Wellcome Book Prize reading, I’ve given myself a break from the medical reads, right? No way! I’m already eagerly looking out for hopefuls for next year’s prize – I’ve amassed quite a nice little pile – and this is a particularly strong candidate, based on the 20 years that Watson spent as a nurse in England’s health system before leaving to write full-time. (Her debut, Tiny Sunbirds Far Away, won the Costa First Novel Award in 2011; she followed it up with Where Women Are Kings in 2013.) It taps into the widespread feeling that medicine is in desperate need of a good dose of compassion, and will ring true for anyone who spends time in hospitals, whether as a patient or a carer.
Watson presents her book as a roughly chronological tour through the stages of nursing – from pediatrics through to elderly care and the tending to dead bodies – but also through her own career, as she grows from a seventeen-year-old trainee who’s squeamish about blood to a broadly experienced nurse who can hardly be fazed by anything. The first chapter is set up like a tour of the hospital, describing everything she sees and hears as she makes her way up to her office, and the final chapter takes place on her very last day as a nurse, when, faced with a laboring mother in a taxi, she has to deliver the baby right there in the carpark.
In between we hear a series of vivid stories that veer between heartwarming and desperately sad. Watson sees children given a second shot at life. Aaron gets a heart–lung transplant to treat his cystic fibrosis and two-year-old Charlotte bounces back from sepsis – though with prosthetic limbs. But she also sees the ones who won’t get better: Tia, a little girl with a brain tumor; Mahesh, who has muscular dystrophy and relies on a breathing tube; and Jasmin, who is brought to the hospital after a house fire but doesn’t survive for long. She dies in the nurses’ arms as they’re washing the smoke smell out of her hair.
Although Watson specialized in children’s intensive care nursing, she trained in all branches of nursing, so we follow her into the delivery room, mental health ward, and operating theatre. As in Maggie O’Farrell’s I Am, I Am, I Am, we learn about her links to hospitals over the years, starting with her memories of being nursed as a child. She met her former partner, a consultant, at the hospital; they had a child together and adopted another before splitting 12 years later. And as her father was dying of lung cancer, she developed a new appreciation for what nurses do as she observed the dedicated care he received from his hospice nurse. She characterizes nursing as a career that requires great energy, skill and emotional intelligence, “that demands a chunk of your soul on a daily basis,” yet is all too often undervalued.
For me the weakest sections of Watson’s book are the snippets of history about hospitals and the development of the theory and philosophy of nursing. These insertions feel a little awkward and break up the flow of personal disclosure. The same applies to the occasional parenthetical phrase that seems to talk down to the reader, such as “women now receive medical help (IVF) to have their babies” and “obstetricians (doctors) run the show.” Footnotes or endnotes connected to a short glossary might have been a less obtrusive way of adding such explanatory information.
I would particularly recommend this memoir to readers of Kathryn Mannix’s With the End in Mind and Henry Marsh’s Admissions. But with its message of empathy for suffering and vulnerable humanity, it’s a book that anyone and everyone should read. I have it on good authority that there has recently been a copy on the desk of Jeremy Hunt, Health Secretary of the UK, which seems like an awfully good start.
A few favorite passages:
“I wanted to live many lives, to experience different ways of living. I didn’t know then that I would find exactly what I searched for: that both nursing and writing are about stepping into other shoes all the time.”
“What I thought nursing involved when I started: chemistry, biology, physics, pharmacology and anatomy. And what I now know to be the truth of nursing: philosophy, psychology, art, ethics and politics.”
“You get used to all sorts of smells, as a nurse. [An amazingly graphic passage!] But for all that I’ve seen and touched and smelled, and as difficult as it is at the time, there is a patient at the centre of it, afraid and embarrassed. … The horror of our bodies – our humanity, our flesh and blood – is something nurses must bear, lest the patient think too deeply, remember the lack of dignity that makes us all vulnerable. It is our vulnerability that unites us. Promoting dignity in the face of illness is one of the best gifts a nurse can give.”
The Language of Kindness was published in the UK on May 3rd by Chatto & Windus. My thanks to the publisher for the free review copy. It is released today, May 8th, by Doubleday Canada and Tim Duggan Books in the States.
Hey, we got it right! Mark O’Connell’s To Be a Machine, our shadow panel’s pick, won the Wellcome Book Prize 2018 last night. Of the three shadow panels I’ve participated in and the many others I’ve observed, this is the only time I remember the shadow winner matching the official one. Clare, Paul and I were there in person for the announcement at the Wellcome Collection in London. When we briefly spoke to the judges’ chair, Edmund de Waal, later in the evening, he said he was “relieved” that their decision matched ours – but I think it was definitely the other way around!
Simon Chaplin, Director of Culture & Society at the Wellcome Trust, said that each year more and more books are being considered for the prize. De Waal revealed that the judges read 169 books over nine months in what was for him his most frightening book club ever. “To bring the worlds of medicine and health into urgent conversation” requires a “lyrical and disciplined choreography,” he said, and “how we shape stories of science … is crucial.” He characterized the judges’ discussions as both “personal and passionate.” The Wellcome-shortlisted books make a space for public debate, he insisted.
The judges brought each of the five authors present onto the stage one at a time for recognition. De Waal praised Ayobami Adebayo’s “narrative of hope and fear and anxiety” and Meredith Wadman’s “beautifully researched and paced thriller.” Dr Hannah Critchlow of Magdalene College, Cambridge called Lindsey Fitzharris’s The Butchering Art “gruesome yet fascinating.” Oxford English professor Sophie Ratcliffe applauded Kathryn Mannix’s book and its mission. New Scientist editor-in-chief Sumit Paul-Choudhury said Mark O’Connell’s book is about the future “just as much as what it means to be human in the twenty-first century.” Journalist and mental health campaigner Bryony Gordon thanked Sigrid Rausing for her “great honesty and stunning prose.”
But there can only be one winner, and it was Mark O’Connell, who couldn’t be there as his wife is/was giving birth to their second child imminently. The general feeling in the room was that he’d made the right call by deciding to stay with his family. He must be feeling like the luckiest man on earth right now, to have a baby plus £30,000! Max Porter, O’Connell’s editor at Granta and the author of Grief Is the Thing with Feathers, received the award on his behalf and read out the extremely witty speech he’d written in advance.
Afterwards we spoke to three of the shortlisted authors. Kathryn Mannix said she’d so enjoyed following our shadow panel reviews and that it was for the best that O’Connell won, as any other outcome might have spoiled the lovely girls’ club the others had going on during the weekend’s events. I got two signatures and we nabbed a quick photo with Lindsey Fitzharris. It was also great to meet Simon Savidge, the king of U.K. book blogging, and author and vlogger Jen Campbell. Other ‘celebrities’ spotted: Sarah Bakewell and Ben Goldacre.
This time I stayed long enough for pudding canapés to come around – raspberry cake pops and mini meringues with strawberries. What a great idea! On the way out I again acquired a Wellcome goody bag: this year’s tote with a copy of The Butchering Art, which I only had on Kindle before. I’d also treated myself to this brainy necklace from the Wellcome shop and wore it to the ceremony. An all-round great evening. I’m looking forward to next year’s prize season already!