Hazel McHaffie

Shape-shifters

What do you feel about an author who adopts a completely different genre from the one you’re familiar with? Like, say, JK Rowling changing from wizardry for children (Harry Potter) to adult fiction (The Casual Vacancy) and then to the Cormoran Strike crime stories (The Cuckoo’s Calling)? (I vividly remember my own reaction when I read The Casual Vacancy … did this indeed come from the same pen, the same imagination?) Or Kazuo Ishiguro (winner of this year’s Nobel Prize) who displays a remarkable ability to create a completely different book each time, and for each to read as if written by a different person – Remains of the Day (gently historical and romantic); Never Let me Go (science fiction); When we were Orphans (detective novel). Does it bother you?

There’s a reason for my question. My latest manuscript has been deemed much more like a regular commercial novel than my previous ones. It deals with a specific medical ethical dilemma as they all do, but the structure is that of a mainstream psychological thriller. Will that be an issue for those people who associate me with my former style?

Of course, I’ve already made a giant leap from non-fiction* to novels, years ago. And I know there are plenty of readers who would only go for one or the other, not both. However, I believe my professional credentials to some extent give me some credibility in my latest incarnation. Added to that there is no set McHaffie-style: each of my novels has been written in a way to reflect the subject matter – romance, family saga, diary, etc – so perhaps there is no issue to worry about.

But it’s certainly been a totally different experience writing this current novel, from my point of view. Much more of a challenge. (I do like a good challenge!) I spent far longer preparing the ground for this one, before I ever started writing the story; researching the key elements of a thriller, mapping out the sections, balancing the surprises, to create tension and all the other things that keep a reader turning the pages. And I’m not done yet. Feedback from my first-round critics suggests I need to work on creating still more conflict and toughening up some of my characters. Apparently I do too much ‘niceness’!! Snag is, when everything is carefully calibrated and distributed first time round, as soon as you start altering things that equilibrium is disturbed. Arggggghhhh ….

I may be gone some time! – to half-quote a very famous last word.

*It’s Baby Loss Awareness Week which has reminded me forcefully of the years I spent studying the impact of loss on families in my academic life.

 

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Nothing new under the sun

Big sigh!

Publishing anything – a letter/article in a newspaper, a research paper, a novel – is always subject to time. Will someone else pip me to the post? Will I appear to be a plagiarist rather than an original thinker? Two incidents have stirred that old anxiety for me recently.

It’s a while since I read a novel which explores an ethical issue in my own sphere of interest, so I was intrigued by Susan Lewis’ 2017 book, Hiding in Plain Sight, especially when I kept reading and found her story overlaps with no less than three of my own novels.

* One of her principal characters is Penny Lawrence who led a disturbed childhood before running away aged 14. In Over my Dead Body (2013), I tried to get inside the mind of a child who struggles to relate to her family, and a mother who agonises over her own response to her child.
* Penny Lawrence gets involved in the world of selling babies to infertile couples. I asked a lot of what-if questions about surrogate pregnancy in Double Trouble (2005).
* When Penny Lawrence meets up with her mother and sister almost thirty years later, all three are forced to face the fractures in their family lives foursquare. In my current novel, Killing me Gently, I’m delving into the effect parents’ and children’s behaviour and emotions can have on family cohesion and integrity.

And curiously one of the titles I considered for my book was Killing in Plain Sight.

But there the similarities end. Susan Lewis’ take on these issues, her writing style, her whole approach, are completely different from mine. Character and plot tend to be far darker, the psyche more tortured, the secret lives more sinister. She’s quick to reassure us that her books are not intended to leave us feeling frightened or miserable but they do dabble in disturbing and sensitive subjects – in this case family tragedy and mental illness. I too deal with sensitive and troubling issues, I have even been known to end on a sad note, but I do aim to have redeeming features in my characters, and to leave lots of breathing space for the reader to form his/her own opinion on the rights and wrongs of what happens.

There’s ample room for both of us to be writing on these issues, I think.

So hopefully this same maxim will apply in the case of the new Sunday evening drama, The Cry, which started this week on BBC1. I couldn’t believe my eyes when the trailers started just after I finished my latest edit of Killing me Gently. Difficult to predict the degree of overlap at the moment but there are uncanny similarities.

I’ve never seen so many flash-backs and flash-forwards before, but we know this is about a young mum (played by Jenna Coleman aka Queen Victoria!) struggling with a fractious baby who vanishes mysteriously, and now the mum’s on trial for something baby-related. The series will be finished before my book comes out, so if push comes to shove I can always tweak my own plot if necessary, but of course, I devoutly hope it won’t be. Months, if not years, of blood, sweat and tears have gone into creating and realising this psychological thriller, getting it balanced, making the point.

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A lifelong apprenticeship

Wow! I’ve had quite a jolt.

Picture if you will …

… the Canary Islands: brilliant sunshine, millions of years of volcanic activity, vibrant flora, a whistling language, an excellent health service but serious economic struggles …

Fascinating and a real get-away-from-it-all break. But, in the back of my mind, lurks the thought that I have an author appearance shortly after I get back to the UK. Hmm. Best tactic? Jot down a few ideas in idle moments, on the train/plane/ferry, let the topic (‘Well-being’) simmer on the old back burner, but concentrate on the Canarian experience.

Overall strategy? Take the audience up to the bedside of some of my characters, let them listen to the conversations, enter into the minds, of people who are facing challenging, even tragic, choices. Give them a chance to consider the different options themselves. Maybe ruffle their sense of well-being a tiny tad …?

Saving SebastianHow would you feel having a four-year-old dying in front of you, I wonder? Would you agree to create another baby specifically to try to save his life, knowing that many perfectly healthy embryos will probably be destroyed in the process, that this new child might have the same fatal blood disorder too, that it might all be in vain?

How would you react to being told you have a terrible degenerative disease which will certainly destroy your body inch by inch, killing you before you reach your 42nd birthday, your brain fully aware of every ghastly step?

You get the idea.

It’s a long time since I wrote – or indeed read – my earliest books, so I quickly realise I need a crash course on McHaffie’s medical ethical novels. Happily I have several on my Kindle, so I immediately start to update myself. And that’s when I make a sobering discovery. I want to edit them! Hey, why did I write this that way?! But of course, I can’t change it; not now they’re published. Any more than I could change the experience I had of Tenerife, or La Palma, or La Gomera, once the ferry drew away from each in turn.

Why should that surprise me?  It shouldn’t. I’ve moved on, honed certain skills, developed my craft, progressed – hopefully! As Ian Rankin once said; the reason we keep writing is, we’re always trying to improve, to write the perfect story. It’s a lifetime’s apprenticeship.

And each time I embark on a new book, the older ones recede in my mind, much as the islands become hazy and less defined as the ferry powers off across the Atlantic.

New horizons beckon. I’m already scanning the ocean for new excitement, noticing the changes in colour and swell, watching the other passengers, wondering about their lives … scavenging new ideas, creating new connections, forging a new pathway in this fathomless deep that is our world/imagination.

So, it’s been a salutary experience, re-visiting my own earlier novels. I’ve had to forgive myself for the failures and infelicities of the past, cling on to the better aspects, and extract useful messages that might provoke discussion and pique interest when I’m in that other life, in that Scottish library, talking to an audience about ‘Well-being’ and the writing life.

OK, next step? Inject some humour! Don’t want them leaving in tears, never wanting to go to a library again, do we?! And there’s planty to amuse in my books … a fabulous train conductor on the Aberdeen-Penzance Cross-Country run; a minister with holey/holy socks and an all-embracing love; a lab technician who quotes Oscar Wilde to excellent effect … I’m sure they’ll come to my aid. But first, let’s savour every experience these amazing islands have to offer. No need for regret on that score.

 

 

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Riches indeed

What do you think of when you hear ‘riches’, I wonder? Opulent collections of jewellery and antiques, maybe? Billionaires? Bank vaults? Material wealth, in other words.

But, of course, riches can mean abundant or valuable resources, as well. As in health or oil or friendship. And it was this meaning that hit me foursquare when I visited the Canary Islands recently (a Spanish archipelago in the Atlantic Ocean). Situated as it is, off the coast of Morocco/Western Sahara, it gets more than its fair share of wall-to-wall sunshine, and the exuberance of plant life that owes its colour and abundance to that valuable resource, offers a real sense of luxuriance.

And once you start thinking along these lines, abundance and extravagance are everywhere.

And particularly in these tropical islands, the precious commodity of fresh water – in such short supply in some areas, husbanded with such care and pride in others – with its concomitant luscious green vegetation, represents riches indeed.

But the thing that really struck me was a comment made by a native Canarian guide. His English was good – honed by a spell in Bath! – but he not infrequently searched for a word. English, he said, was such a rich language, there was always another word, another expression, to capture what you wanted to convey. It stopped me in my tracks.

But it’s true. And we take it so much for granted, don’t we? I know I do, immersed in words in my day-to-day work. Just as the Canary Islanders take sunshine for granted all year round.

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Words words words

Cartoonists, journalists, feminists, politicians, the world and his wife, are pitching in to the incident on the tennis courts this week, where Serena Williams took exception to her treatment by the umpire in the women’s final of the US Open Tennis tournament. She smashed an expensive racket in public in her frustration, and accused the umpire of being a thief. She was heavily penalised. The rights and wrongs of her tirade, the whole issue of gender equality, are not the topics I want to home in on here; what has got me thinking in all the fallout from this, though, is the power of words and the baggage that comes with them. Serena clearly read much more about discrimination into what happened than I saw.

Also this week the media spotlight has also been on death by one’s own hand: National Suicide Prevention Week 2018. The importance of taking care with the words used has been highlighted – not saying ‘commit’ suicide, for example; not ignoring subtle cries for help. Such deaths are a tragedy whichever way you look at them, but understood with much more sympathy today than they were in the past. When I was growing up, we were told to ignore taunts and bullying. ‘Sticks and stones will break my bones but names will never hurt me‘ was the response to childish angst. But of course, we now know this is patently not true. Words DO hurt. Far more deeply that a swift slap or punch. They can seriously, sometimes irrevocably, damage your health. Mental stress can be every bit as debilitating as physical ailments, perhaps even more so. Certainly my own scars from psychological onslaught are much deeper and recurrently painful than those from any bodily trauma.

So words are powerful beasts. As the Biblical writer James says in a poetic description on control and careful speech: ‘… no man can tame the tongue. It is a restless evil, full of deadly poison,’ and he concedes, no one has completely mastered his own tongue. And that adage IS still true. Who hasn’t regretted something they’ve said; and felt the burden of not being able to recall or erase those words? Salutary lessons all.

Which brings me to the written word. Authors do at least know the importance of the right word in the right place. I have a row of lexicons on my desk, as well as everything the internet has to offer, to help me choose wisely. Like Oscar Wilde and his famous busy day taking out and putting back a comma, I can sometimes agonise for ages about a word or phrase, take it out, put it back, tweak it, change it, before I can move on. But who can factor in the inferences and prejudices of the reader for whom those very same words can be laden with meanings and accusations and slurs and judgements unseen by me? To minimise the danger of being inadvertently (sometimes it’s deliberate, of course!) misunderstood or causing offence, I draft in a range of experts and readers to examine the text for inaccuracies or infelicities which have escaped me. Invaluable allies.

But hey, I must get back to my serious editing – I’m working to a tight deadline this week. Third draft and a further 13,000 words to lose, so a way to go yet. I find a specific target helps to concentrate the mind, making me focus on every word to see if it’s pulling its weight; actually hunting for as many as possible that are just coming along for the ride. Which again highlights the issue I started with. Words count.

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Reflections on a golden summer

It certainly was quite a summer, wasn’t it? Wall to wall sunshine for weeks on end – no craving a Mediterranean break this year! And it seemed to fly by, often leaving little time for reflection. But September has brought a brief lull in my diary and inevitably I’m looking back and wondering what I’ve learned from the experiences; after all it’s the job of a writer ‘to see what everyone else sees and think what no one else thinks’ – or so they tell me!

Our beautiful city is currently in the process of dismantling the trappings of the biggest arts festival in the world; it looks rather forlorn, much as packing away Christmas feels. But the memories of a feast for the senses are bright and lasting. I’d like to share two reflections which are relevant to the blog and impinge on my decisions as a novelist.

When I first decided to fictionalise medical ethical dilemmas it was because I was increasingly aware of how story-telling can bring an issue to life and touch us more deeply than any textbook or lecture or internet search. This reality was reinforced during the Festival. I understand the life and times and motivation of Martin Luther the Protestant reformer,

and of Dr Josef Mengele the German SS officer and medical experimenter,

far better than I knew before, having watched superb dramatisations from their perspective.

I have greater empathy with the children of Dresden (another beautiful city) since seeing it through the eyes of a young Eleanor (performed by her real-life granddaughter) hiding from the bombs unleashed by ‘our’ side, picking her way through the rubble of flattened streets, cobbling together a life from the ruins of war.

And the second reflection? There’s a huge wealth of talent out there! I witnessed only a miniscule fraction of it. In total there were some 317 venues across the city; 3,548 different shows were staged; 2,838,839 tickets were issued. Mind blowing, isn’t it? And the standard was high. Only two of the many shows I saw disappointed in any way, and even they were professionally executed (the content was simply not to my taste). And most had a serious message behind them.

So I’ve returned to my own novel with renewed energy. I too can contribute, albeit in a small way, to this wonderful resource. And autumn seems like the perfect time to knuckle down to it. The crops are almost ready for harvesting. The nights are lengthening. The weeds are slowing their pace. Visitors have returned home. I have space to prioritise work; poring over every word, every comma; ruthless in my editing. I already have two pages of questions to take to the experts to ensure every aspect is authenticated. Ahhhh, yes, authentication. I’m struck by how often truth is stranger than fiction; if I’d written such-and-such real-life story reviewers would have condemned it as ‘far-fetched’, ‘not credible’, ‘hyperbolic’.

A case in point: this weekend I read a summary of a serious case review published by Wigan Safeguarding Children Board, which featured a 10-week old baby who died after being strapped in a car seat in a hotel room for 15 hours. Tragic in itself. But, more alarming still, 3 of the parents’ children have died in the space of two years. Indeed, of the 7 children the mother has given birth to since June 2015, only 4 have survived longer than 16 months.The authorities were aware of the history: alcohol abuse, neglect, domestic violence, frequent referrals to child social care, mental health challenges. The review reported ‘The commitment of the services that supported the child and family in the years preceding the child’s death was unquestionable, and the reviewers have identified many examples of good practice by professionals in providing information and support.
What’s more, all 4 surviving children remain with their parents. Would you have believed this in a work of fiction? ‘Far-fetched’, ‘not credible’, ‘hyperbolic’, come to mind!

Notwithstanding, I’m making every effort to make my own tale, Killing me Gently, ring true. And much as I love the buzz of summer, it feels like coming home myself to be back in the study, lost in my writing. And who knows, maybe one day this story will be dramatised! Screenwriters, film directors, out there, if you’re listening ….

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To act or not to act

Remember last week I mentioned the cases of child abuse or mistreatment that go to court? That got me thinking.

I’ve been creeping uncomfortably close to this area in my current novel, Killing me Gently – the delicate relationship being built up in the early weeks and months following the birth of a new baby and mysterious things happening which perplex the professionals responsible for ensuring everyone’s safety. We know that some children can be very difficult to love; some appear to reject overtures of maternal affection; some parents struggle to bond with their child for assorted reasons; some parents actually harm and even kill their children. Cruelty and rejection can come in many guises (as I’ve had brought home to me recently in the experiences foster carer Cathy Glass recounts), but so sensitive and nuanced is this whole topic that primary care teams and social services can be unsure of how best to support such families, when to intervene, when indeed to remove the child from the biological family.

Perhaps it was this preoccupation in my writing life that reminded me of a recent news report that I filed away for reference purposes. At the beginning of August a serious case review found that professionals had missed a series of opportunities to save the life of a little girl, Elsie Scully-Hicks, in Cardiff. Pause for a moment and just look at that gorgeous little smiling face … And then take in the fact that this precious life was snuffed out before she even saw her second birthday.

Elsie had been placed with fitness instructor, Matthew Scully-Hicks, and his husband, Craig, at the age of 10 months, and following due process, formally adopted by them just two weeks before her death aged 18 months. The couple were described as well educated and articulate, and highly regarded by each of the involved agencies as good positive parents. They’d already successfully adopted an older child. Indeed, such was their standing that a catalogue of significant bruises and fractures were dismissed as normal childhood accidents (as Elsie’s adopted father alleged). There was indeed a conspicuous lack of professional curiosity about each of her many injuries.

In reality the stay-at-home dad was struggling with her care – he described her as ‘Satan in a babygro’. And when she was just 18 months old, he shook her so violently before throwing her to the floor, that he killed her. Last year he was jailed for life after being convicted of murder at Cardiff Crown Court.

The agencies concerned have promised to learn lessons from this review, but of course, nothing can bring little Elsie back. No one involved in this case will ever forget her. I rather suspect some professionals will never forgive themselves. I shudder to think what it’s like to live with these weighty responsibilities; just getting inside the skin of health visitors and social workers grappling with such judgements in my fictional world is more than enough for me – and I know the outcome! Pause for a moment and think of all those courageous people engaged in making these momentous decisions every day. And living with the consequences. I salute them.

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The Children Act

Mrs Justice Maye, Royal Courts of Justice, The Strand, aka My Lady, is 59, childless, a much respected High Court judge and concert-level pianist. Her days are dominated by a relentless workload and the endless responsibility of forming judgements in the Family courts. Humdrum divorces and decisions relating to child protection run cheek by jowl alongside seriously challenging high-profile cases fraught with moral challenges.

A strict Chareidi marriage is broken when the wife seeks to educate herself and base family life on reality not religious tradition. Thirteen years together, the arranged marriage, cultures, identities, aspirations, family relationships, loyalties, all are called into question. Fiona’s heart goes out to the two little Jewish girls caught in the crossfire.

Conjoined twins, infant sons of Jamaican and Scottish parents, one potentially viable, abnormally thin from the effort of sustaining two bodies, the other a fattening shell leeching off his brother, become the focus of a battle that has the world on tiptoes watching. On one side, the hospital, masked surgeons at the ready poised to save the life of one of the boys. On the other, religious conviction refusing to sanction murder, preferring to let both boys die rather than risk reinterpreting their rigid code. Fiona’s decision will become the purview of newspaper columnists, taxi drivers, the nation at large, all clamouring for justice and right, vociferous, all certain of their own angle on what that right is. But what is the solution?

A seventeen-year-old boy, with leukaemia, urgently needs a blood transfusion, without which he will die within days or, worse, survive with grossly disabling impairments. But the patient himself, Adam, and his parents, are devout Jehovah’s Witnesses; they will not compromise their beliefs even if it means he will lose his life. Fiona knows the world is watching and will judge her decision. She takes the unorthodox step of going to visit the lad in hospital, a meeting that will have a profound effect on both of them. I won’t spoil the book for you by spelling out the consequences.

As if this wasn’t all a burden big enough for anyone to carry, Fiona is dealing with a major domestic crisis at home. How can she keep the professional and the personal from encroaching on each other? Which takes precedence?

This story, The Children Act, nudges against my own field of interest, the philosophical and moral points interweaving with the legal decisions. Exactly the kind of issues I’ve debated long and hard. Replicas of the kind of cases I’ve followed closely in real life. But Fiona herself is steeped in precedent and the finer points of legal argument, well trained, very experienced. She’s quick to make the distinction: This court is a court of law, not of morals, and our task has been to find, and our duty is then to apply, the relevant principles of law for the situation before us – a situation which is unique.

This is author Ian McEwan at his best. Giving us a fascinating insight into a legal mind toying with the niceties of various options, arguments and counter-arguments, balancing emotional responses against professional duty. A mind that must cut through the various moral claims and determine the one course of action that will remain defensible under minute scrutiny, robust enough to become, at least in part, legal precedent in the future. And sometimes, where every choice has a downside, be bold enough to choose the least undesirable outcome, the lesser evil. Even, in extremis, be courageous enough to find argument in ‘the doctrine of necessity’ – an idea established in common law that in certain limited circumstances, which no parliament would ever care to define, it was permissible to break the criminal law to prevent a greater evil.

Small wonder that some of these cases haunt Fiona, leave her agonising internally, shrunken to a geometrical point of anxious purpose. She’s famed for her elegant summations, her cool detachment, her wise decisions, but even so, on occasion, she agonises retrospectively about her exact phrasing, her final judgement. And never more so than when she becomes involved with young Adam, only weeks from his eighteenth birthday, who is determined to hold fast to his religious heritage – even unto death. These cases leave scar tissue in the memory. They also attract opprobrium in the shape of a postbag of critical mail … there began to arrive in small pastel-coloured envelopes the venomous thoughts of the devout … some deployed abusive language, some said they longed to do her physical harm. A few of those claimed to know where she lived.

Sobering, too, to realise that there are other cases which fall outside the jurisdiction of judges like Fiona Maye, which would perhaps be even harder to bear. Cases reserved for the criminal rather than the family courts: children tortured, starved or beaten to death, evil spirits thrashed out of them in animist rites, gruesome young stepfathers breaking toddlers’ bones while dim compliant mothers looked on, and drugs, drink, extreme household squalor, indifferent neighbours selectively deaf to the screaming, and careless or hard-pressed social workers failing to intervene.

A slim volume, The Children Act, which came out in 2014, deals with a massive issue, and I highly recommend it. Last week supermarket Tesco was giving it away free of charge – presumably publicity for the film, starring Emma Thompson as My Lady, which comes out tomorrow. I plan to be there!

PS
Friday:
We duly went to the very first showing this morning and had the unnerving but rather special experience of being the only people in the whole cinema! The film’s superb and well worth seeing.

 

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Reflections on Mortality

The 2018 Festival is proving to be as spectacular as ever – so much talent, such variety. You’d need to be a complete Philistine not to find something to your taste and I’m having a ball. And there’s so much to soak up around and about the city besides the featured events. During a visit to Blackwell’s book shop for their Writers at the Fringe event, for example, I noticed a book display dedicated to the 70th anniversary of the NHS, several of the exhibits talking about the art as well as the science of caring, and as I sat waiting for the five authors to begin their presentations, it got me thinking.

Wouldn’t we all love to be cared for by a truly empathetic compassionate doctor in our last months, weeks, days? I found one recently – one moreover who recognises that ‘Doctors – like writers, artists, and spies – are professional people-watchers‘. Sounds like my kind of person, huh?

I’ve been intimately acquainted with death since the age of 18. To some extent health care professionals have to learn to maintain a safe distance in order to keep on giving, but it’s a difficult balance to achieve. I once worked with a lovely young doctor (who has been my friend for over forty years) who was so nervous when he had to convey bad news that he giggled. As his colleague I understood it was because he cared too much for his own comfort; the relatives couldn’t know that and were probably appalled by his seeming insensitivity.

Asian American doctor Pauline Chen learned through bitter experience too, and she’s taken the brave step of writing about the difficulties and pain of contemplating death and walking alongside people facing its reality in Final Exam: A Surgeon’s Reflections on Mortality. Like most naive youngsters she entered medicine with a rosy view of saving countless lives; she had no idea of the extent to which death would become such a haunting constant in her career. But in a society where more than 90% of patients will die from a prolonged illness, she joined the ranks of those whose task it is to shepherd the terminally ill and their families through the intricacies and pitfalls of the end, those who are expected to know how to provide comfort and support.

Initially Chen discovered from her mentors and teachers how to suspend or suppress shared human feelings, to adopt the twin coping mechanisms of denial and de-personalisation. At first, too raw to be let loose on patients, she learned to detach from the elderly lady cadaver in the dissection lab where the formaldehyde, used to preserve dead bodies pervaded her clothes and hands and hair – the olfactory version of a high-pitched shriek. Once out in the clinical arena, she had far more disturbing senses to deal with and she learned to avoid, obfuscate, reinvent, disguise, deny.

‘Even medical students chosen for their humanitarian qualities and selected from a huge pool of applicants may have their generous impulses profoundly suppressed by their medical education.’

But gradually, painfully, she came to realise, through a multiplicity of small inconsistencies and troubling paradoxes, that these techniques were in fact incapacitating her. She began to extricate herself from those same learned responses and to open herself up to something far more rewarding than curing someone. She came to see that when terminally ill patients were ‘Pushed to view their own mortality directly, they too would live the remainder of their own lives that much more fully than the rest of us.’ New dimensions, wider horizons, opened up to her: that, in fact, ‘… dealing with the dying allows us to nurture our best humanistic tendencies.’ And she came to appreciate the advice of a much respected colleague who was both oncologist and cancer patient: ‘You’ll be a better doctor if you can stand in your patients’ shoes.’ That the ‘honor of worrying – of caring, of easing suffering, of being present – may be our most important task, not only as friends but as physicians, too. And when we are finally capable of that, we will have become true healers.‘ I love the idea of it being an honour to worry and care.

Final Exam is a beautifully crafted book, from the simple but evocative cover and the so-apposite title page, through the quality paper, to the single tribute on the back from one of my favourite medical authors, Atul Gawande:
‘..a revealing and heartfelt book. Pauline Chen takes us where few do – inside the feeling of practicing surgery, with its doubts, failures, and triumphs. Her tales are also uncommonly moving, most especially when contemplating death and our difficulties as doctors and patients in coming to grips with it.’

In telling the stories of many of her patients alongside her own, Pauline Chen has generously shared what it means to have the grace and humility to examine our own imperfections and misconceptions, to learn from the honesty, pain and sorrow of others, to become a more empathetic and warm human being. We don’t need to be practising health care professions to learn from her example.

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Challenges and choices

The International Arts Festival is currently in full swing in our fair city, and it’s easy to get caught up in the exciting momentum of events and performances. Guilty as charged.

But of course, for many, far far more serious questions beset them than which actors, writers, musicians or artistes to support. I currently have six special people on my worry/prayer list all facing major challenges in relation to their health, life and death.

It’s not appropriate to be specific about them, but perhaps they are behind my extra sensitivity to the difficult choices so many face. For this post I’m thinking of those people who’re involved in the consequences of legal change, medical advances or financial restrictions associated with healthcare – my kind of workaday world. I’ll enumerate but a few (with links) reported in the national press in just 36 hours by way of illustration. All raise a number of thorny issues and I leave you to ponder those for yourself.

Relatives and health care workers caring for patients trapped in unresponsive bodies with minimal or no consciousness no longer need to go to court to resolve the question of withdrawing/withholding life sustaining measures. Decisions about dignified death can be made quietly and privately in a timeous way.

In figures released last month, the first trial of a pioneering immunology vaccine called DCVax has shown some real promise. DCVax essentially uses the patient’s own immune system to fight the tumour, tailoring treatment to their specific needs. This trial has already been running for 11 years and came to public attention when MP Dame Tessa Jowell was not eligible to receive DCVax for her glioblastoma. Sadly she died in May, but not before she had successfully campaigned for increased funding for brain cancer research. To date patients have needed to stump up £200,000 for this treatment.

New National Guidelines, known as Saving Babies’ Lives Care Bundle, have been issued in response to the alarming statistic that 600 babies could be saved from stillbirth annually if the mothers were adequately monitored.  SBLCB focuses in on the incidence of smoking, signs of failure to grow, reduced fetal movement, inadequate monitoring in labour – risk factors that were all known about decades ago when I was in clinical practice. Given that 3000 babies are stillborn every year in England alone this seems like an important area to concentrate on.

ASDA has apologised for selling a pregnancy test that issued false results leading a young woman in Devon to believe she was pregnant when she wasn’t. However the store has not recalled this product and insist it has been quality tested.

One in five people who have eating disorders have their lives cut short, but a considerable number are turned away from help because they are not skinny enough. And this in spite of National Institute of Health and Care Excellence guidance to disregard body mass index. (I found this to be true when I was researching Inside of Me.) A campaign is now underway to ensure the NICE guidelines are being adhered to.

News at the end of July was that more than half of Scotland’s population have pledged to donate their organs and/or tissues after death. That’s the highest rate in the UK and comes after a high profile awareness campaign. It’s good news for the 550 or so waiting for transplants and a significant factor in the discussion about whether we should change to an opt-out system, currently under review. Interestingly 90% of the population support organ donation, so one wonders about the mismatch.

I could go on but I promised just a brief snapshot. But I’m doing my best to keep perspective during my annual summer sortie into the world of drama and art.

 

 

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