OK, I know everybody’s heard about this book – it’s been in the top 10 works of fiction; the film version’s had a fair old hype too. And indeed, I read it some time ago but events overtook me and I’ve only just got around to posting my blog about it.
On the face of it a love story about two terminally ill teenagers, written for teenagers, sounds as if it’ll be either mawkish or depressing. And this is no glossy utopian take on death; the narrative doesn’t shy away from the horrors of serious illness, the mundane distasteful physiological consequences as well as the more slippery psychological ones. But somehow The Fault in our Stars, in John Green‘s hands, manages to achieve a curious appeal all its own. If you go to his website and watch his video clips, you’ll see he speaks much as he writes – in a breathless rush.
Green is an established writer for young adults and he’s well able to capture the language (‘middle-school vernacular’), the thinking and priorities of teenagers, the uncertainties, the emotions, and he does so with precision and poignancy … most of the time anyway. I realise youngsters with cancer have a wisdom and maturity beyond their years, but I confess, some of the characters’ thoughts and exchanges stretched my credulity a tad at times. And yet that’s part of what the book’s about, a level of sophistication and erudition and insight that’s both profound and disturbing. I liked the combination of pathos and laugh-out-loud humour, the sensitivity balanced by mockery and wry wit – about serious issues like life, death, love, loss and grief. My kind of subjects.
The story line is simple. Sixteen-year old Hazel Grace is on borrowed time. We know from the outset she’s terminally ill with secondary deposits in her lungs after thyroid cancer. There’s no hiding her condition – she drags an oxygen cylinder behind her wherever she goes. Enter beautiful heart-throb Augustus/Gus, aged seventeen, who’s already lost a limb to osteosarcoma. Add to the mix heart-broken jilted Isaac who’s about to have his second cancerous eye surgically removed, and boy, you’re already wondering, can I take much more of this? But these teenagers aren’t sitting around feeling maudlin, no siree; indeed they have a refreshingly robust take on illness. The dialogue sparkles with raw in-house acceptance, mutual understanding and gallows humour. Their take on everything from a hand on a false knee and dubious jokes about blindness, to the ‘incessant mechanized haranguing of intensive care’, and the unnatural parting of a dead boy’s hair, is coloured by their up-close and personal experience of teetering on the edge of oblivion.
The story line might indeed be simple, but the messages beneath it are anything but. At the end of the text the author himself appends a note: This book is a work of fiction. I made it up. Neither novels nor their readers benefit from attempts to divine whether any facts hide inside a story. Such efforts attack the very idea that made-up stories can matter …
And that is certainly the point of this book: the made-up story matters. I wasn’t reduced to tears, not even nearly, but I did feel vaguely disturbed and challenged. The Fault in our Stars won’t be in my top one hundred favourites, but it was well worth reading. Next question: Should I watch the film? I’m usually loathe to see a dramatisation of a book I’ve read; the mismatch is too uncomfortable and disillusioning. I might just make an exception here.
Oh, and I bought a copy of the book for my teenage granddaughter for Christmas. That’s how much I recommend it.
Isn’t it weird how things you read so often resonate with real life? They seem to jump off the pages. Some of it’s serendipity, some of it presumably just because we’re preoccupied at some level with a particular facet of life, making us super-sensitive to any mention of it anywhere it crops up.
That’s how it was with Lisa Genova‘s Left Neglected for me. (Clever title, by the way.) After a set back with my own ongoing health problems this past week, my upbeat facade slipped a bit; despondency crept round the edges of my guard. Sigh. Would I ever get back to full capacity and pick up the strands of my previous working life?
OK, distraction required urgently. Tidy desk … light a scented candle … reach for the next book on my tbr pile.
And there it was: Left Neglected.
The protagonist Sarah, a young mum of three, brain damaged in a car accident, is struggling with a crisis of confidence. Will she ever get back into her high powered, multi-tasking, crowded, demanding life again? And boy, this woman has far, far bigger mountains to climb than I; much, much further to fall. Already my own task assumes less daunting dimensions.
But so much of what Sarah experiences resonates with me. There’s …
‘the everyday, no-big-deal but assured voice’ she and I reserve for visitors …
the resentment we feel towards those who would protect us from work-related tasks lest they stress us out: ‘Focus on you, don’t worry about work’ …
awareness of our own powerlessness: ‘The therapy might work and it might not. I can work as hard as I’ve always worked at everything I’ve ever done, and it might not be any more effective that just lying here and praying’.
Then there’s the lurking sense of day-to-day failure: ‘This is not the confident image of health and competency I was hoping to project’ …
not to mention the unspoken dread for the future: ‘What if I don’t recover 100 percent?’ …
in spite of the oft-repeated rallying cry: ‘I’m a fighter, I can do this.’
Lisa Genova is a neuroscientist by background which probably accounts for her choice of topics and the authenticity and insightful awareness of her writing. I loved her first book about dementia, Still Alice (now a major film). This time she has totally captured the real feelings of someone facing the ongoing issues of serious debilitating illness. The bonus is that her writing is also a delight to my soul. Listen to the way she introduces Sarah’s little girl Lucy who’s 5:
‘Lucy comes out of her bedroom dressed like a lunatic.
“How do you like my fashion, Mom?”
She’s wearing a pink and white polka-dot vest layered over an orange long-sleeve shirt, velvet leopard print leggings under a sheer pink ballerina tutu, Ugg boots, and six clips secured randomly in her hair, all different colors.
“You look fabulous, honey.”‘
Or the baby, Linus’ habit of crying relentlessly till a parent goes to him:
‘Plan aborted. Baby wins. Score: Harvard MBA-trained parents, both highly skilled in negotiation and leadership: 0. Nine-month-old child with no formal education or experience on the planet: too many times for my weary brain to count.’
If you’d told me Genova would take over 75 pages to even get to the accident I’d have gulped. Will there be enough hooks to keep me engrossed? No danger. She builds up a powerful picture of a beleaguered super-mom in her thirties juggling many competing demands. A nagging list is playing in Sarah’s head as she drives:
‘You need to call Harvard before noon, you need to start year-end performance reviews, you need to finalize the B-school training program for science associates, you need to call the landscaper; you need to email the London office, you need to return the overdue library books, you need to return the pants that don’t fit Charlie to the Gap, you need to pick up formula for Linus, you need to pick up the dry cleaning, you need to pick up the dinner; you need to make a dentist appointment for Lucy about her tooth, you need to make a dermatological appointment for you about that mole, you need to go to the bank, you need to pay the bills, don’t forget to call Harvard before noon, email the London office …’
By the time we get to page 75 we’re not surprised that she’s searching for her phone while she drives from A to B and momentarily takes her eye off the road. We might even secretly sympathise. How else will she stay on top?
And after all that happens to her, perhaps we aren’t surprised either to find that incapacity, space and time give her a different sense of priorities:
‘For the first time in almost a decade, I stop barreling a thousand miles an hour down that road. Everything stopped. And although much of the stillness of the past four months has been a painful and terrifying experience, it has given me a chance to lift my head up and have a look around … Maybe success can be something else, and maybe there’s another way to get there. Maybe there’s a different road for me with a more reasonable speed limit.’
Ahhh. Speed limits. I too have been evaluating mine. Must I also accept that ‘life can be fully lived with less’?
In her acknowledgements Lisa Genova thanks all the people actually coping with Left Neglect who shared their experiences with her, giving her ‘the real and human insight into the condition that simply can’t be found in textbooks’. And this human warmth is what makes the novel so much more than the anatomy of an illness.
So I salute you, Lisa Genova. And I thank you for putting my own problems into a healthier perspective.
I’ve since patrolled the Infirmary corridors in a torn and skimpy hospital gown (guaranteed to rob you of any sense of power or control you might be clinging to!) waiting for a medical verdict. My turn comes. I learn that a doctrine of doctors with yards of erudite letters after their names and aeons of experience with hearts of all descriptions, have put their mighty heads together to devise a plan to set me back on the road to recovery. It will take some months but I may not … may not … after all have to give up what I love doing. Thank you thank you thank you. The NHS at its amazing best. I may be dizzy and nauseated and fuzzy-headed and more tired than I’ve even been in my life, but I’m back on top of the world!
I’m intrigued. The name Val McDermid doesn’t conjure up pictures of muslin dresses and mincing men and gentle romance, does it? Far from it. But here she is re-writing Jane Austen – well, not the whole bang shoot; Northanger Abbey to be precise.
It’s part of the Austen project: six contemporary authors were asked to rework these famous classics in whatever way they choose. Not surprisingly there have been a fair few swift intakes of breath at the sheer audacity of such an exercise. I mean, Jane Austen? THE Jane Austen? Come on! Quite understandably some reviewers have been prejudiced against it from the outset.
I confess I’m a convinced Austenite myself, and I personally didn’t want anyone to ruin her work for me either. That’s possibly why I turned to Northanger Abbey revisited first – my least favourite, and the least well-known, of her novels – well, that and because I was given it for Christmas.
The modern story is cleverly set in Edinburgh at the time of the Book Festival – I’m instantly totally at home! It moves to the abbeys in the Borders – familiar territory again. Both chosen by McDermid to reflect the essential characteristics of the original settings and thereby sustain the plot.
In brief … Cat Morland is a naive, home-schooled 17 year old from a sheltered background who lives life through fiction. So much so indeed that she believes novels to be source books for real life. When she meets the rich, handsome, well educated Henry Tilney she is captivated. By the time she arrives at his ancestral pile, she has woven deep dark secrets into the mysterious Northanger Abbey, convinced that it will reveal unimaginable horrors. And indeed the magnificent abbey becomes the personification of all her fantasies rolled into one. Secret compartments, forbidden corridors, locked rooms, bullet holes in a family Bible, a beautiful but deceased mother who mustn’t be mentioned, a Jekyll-and-Hyde patriarch, sudden departures … all fuel her imagination.
Reading Val’s own explanation for her choices – voice, setting, characters, plot – gives me additional respect for her skill, her versatility, and the seriousness with which she approached this commission. She has indeed been sensitive to the original. Perhaps the biggest difference between the two versions is the way the authors handle the suspense. We know from hindsight that boy gets girl – no cliff hanger there then. Austen also gave away the mystery early on, choosing to let the will-they/won’t-they element in the romance alone carry the reader through. McDermid – as befits a crack crimewriter – keeps the reader wondering ‘why’ right to the end … although the denouement when it came seemed ridiculously tame to me compared with the build up. But that really wasn’t the point of the exercise. The point is that Austen knew what makes people tick; her books are a reflection of real life. And McDermid has echoed the emotional intimacies of teenage girls, the obsessions of rank and heritage, the arrogance of handsome buccaneers, the blindness and ambitions of parenthood, the hypocrisy and humour of polite society. She has simply brought them up to the present day. In my back yard!
Even I am not mad enough to post a blog on Christmas Day! But I can’t resist the temptation to give you a little Christmas present on 24th: a wonderful auditory experience.
The Reith lectures are prestigious radio talks given each year by eminent figures of the day. The 2014 ones were given by a man for whom I already have huge respect: Dr Atul Gawande. He’s a surgeon but also an accomplished writer, and someone who admits he’s in the business of disturbing people’s complacency.
I’ve read and reviewed several of his books so I had high hopes, and his verbal presentations didn’t disappoint; indeed he made them remarkably conversational and free from humbug and jargon. The gift – to me – was that each one hinged around a compelling story, reflecting my conviction that stories capture an audience but can at the same time convey deep truths. I was instantly gripped; I was receptive to his messages. I hope they captivate you too.
In Boston the first talk began with a moving account of Dr Gawande’s son who, aged 11 days, was found to have a serious heart defect – diagnosed thanks to the wisdom and understanding of a paediatrician who noted that his oxygen saturation monitor was attached to the wrong finger, giving a false reading. Dr Gawande talked of his 37 nieces and nephews in rural India for whom such skill would not have been available, and led into the substance of his message, reasons why doctors fail: ignorance, ineptitude and necessary fallibility.
In the second lecture (in London) he gave a graphic account of a little girl who fell through the ice of a pond in Austria and drowned, but, thanks to extraordinary team work and slow but methodical application of science, was brought back to life and a productive future. From this he developed the idea of how systems built upon the knowledge and discoveries of the centuries can allow doctors to deliver incredible care. Discipline, every member of the team doing what they do best, makes daring possible.
Edinburgh was the setting for the third lecture and this time we heard about Dr Gawande’s daughter’s piano teacher. Peg had cancer and it was thanks to the compassion and sensitivity of those around her that she got to live out her last weeks and months doing what she loved best – teaching music; giving her pupils treasures they would never forget. From this moving narrative he unpacked the question of what to do when you can’t fix the unfixable and how important it is to really listen to the patient’s own priorities. Mere length of life isn’t the only goal; it’s how you live that shortened life.
For the last lecture in the series the speaker returned to his family’s roots in New Delhi. It was knowing that the requisite knowledge to save life existed elsewhere in the world but not in India, that drove Atul’s father to study medicine himself. He wanted that knowledge for his people. From here the speaker moved into the cultural differences that make the elderly a revered part of families, and that allow an elderly widow of 82, newly treated for heart failure, to regain her self respect by becoming a cook in her own huge care facility, whereas in the Western world she would be stripped of her value to society. We segued smoothly into the importance of sustaining the reasons a person wishes to stay alive.
Beautifully done. And it’s those graphic stories that will remain with me. I shall hang onto that thought as we move into a new year and I try to pick up the reins of novel writing again after my enforced sabbatical. I wish you all the joys of discovery through reading.
And all blessings of the season whatever it means to you. If you are sad or lonely or troubled, may you share something of the peace it symbolises and the warmth of kindness, and find the courage to hope.
Imagine you are sitting in court … a stern faced judge is condemning the young man in the dock to life imprisonment, to serve a minimum of 30 years. He’s only in his 30s. He’ll be almost 70 when – if – he is ever released. Horrendous. And that young man is … your son. Already the hate mail is arriving, your own private life is becoming public, you are personally reviled and shunned … for giving birth to a monster.
Now imagine that you are totally, utterly convinced that your boy is innocent of the alleged crime. You know him, his nature, his attitudes. He’s chosen nursing as his career; he’s spent his life caring for people; he’s incapable of hurting anyone. And yet … the evidence is spelled out by the lawyers and police: what he said; what he did; the links between him and so many deaths in mysterious circumstances. The prosecution describe him as a ‘thoroughly evil and dangerous man … arrogant and manipulative’ – a fiend who deliberately and maliciously injected insulin into elderly patients in his care. The press liken him to Harold Shipman, but in this case he’s been stopped in his tracks after just four murders, possibly five. The jury with no vested interest either way, listen carefully, objectively, to the evidence, and they conclude that he is guilty beyond reasonable doubt.
You watch your boy being taken away to serve this terrible sentence, your precious son locked away with criminals, his life and future in tatters.
Small wonder that you don’t accept this verdict … that you seek an alternative explanation. There must be one. Years pass. Eventually there’s a new investigation. The enquiry reveals that there is no direct forensic evidence connecting your son to any of those deaths; that there was no trace of insulin in any of the patients allegedly murdered; that tests used in evidence were invalid; that mathematical calculations reveal it is unfeasible and unrealistic that the level of insulin needed to effect these deaths could have been injected; that naturally-occurring hypoglycaemia happens more often than was thought in the frail elderly non-diabetic sick patient; that eminent experts do not believe there were any murders committed at all. Indeed, new data suggest that these four women died from a condition called insulin auto immune syndrome.
It looks as if your boy has spent six years waiting for his case to come to court, a further six years in prison, for a crime he did not commit. That he has lost his career, his good name, his freedom, and yet he has done nothing wrong. That he only came to attention because he predicted the death of an old lady (something nurses often do), and he just happened to be on duty when these four people died.
A novel I’ve dreamed up? No – although I’d have been jolly pleased with the plotting if I had made it up! No, it was a case discussed on BBC 1 on Monday evening: The Innocent Serial Killer? At once fascinating, frightening and disturbing. Scottish nurse Colin Norris was arrested in 2002. His case came to court in 2008. He is still in prison. His mother has actually lived through this nightmare scenario I’ve just described. She’s living it still.
The results of the BBC investigation were mesmerizing. I found myself identifying with everyone concerned – as a patient, as a grieving relative, as a nurse, as a mother, as a juror, as a writer. And I was appalled. I wanted to march into Durham prison and demand his instant release at least until his case is reheard. OK, I don’t know him; I can’t vouch for him personally; and this programme was presenting a certain line in evidence; but there does seem to be more than enough doubt over this conviction to suggest a possible – maybe even probable – miscarriage of justice, and don’t we Brits pride ourselves on our scrupulously fair innocent-until-proven-guilty system? Besides, there but for the grace of God go I. I’ve predicted deaths. I’ve been on duty when a spate of deaths has occurred. I’ve joked about jinxing the ward. It’s what nurses do. It’s how they survive in a workplace where the grim reaper stalks the corridors.
Stranger than fiction indeed and much much more tense and terrifying.
You’ve probably all read about the young video fashion blogger, Zoella, whose book, Girls Online, was a runaway best seller last month. And the subsequent furore over the revelation that she used a ghost-writer. Hmmm. Well, I want to assure you that this blog post has actually been my own unaided work in spite of the traumas of the week. Apologies for the absence of illustration but I’ve been rather otherwise occupied.
Three days ago I was admitted to hospital as an emergency and kept in; I’ve just been discharged this afternoon. With a lot of time on my hands and being on the receiving, not giving, end I had plenty of leisure to analyse what makes for the kind of caring that I would rate as good.
Things it is not: steaming through tasks to meet targets without a care for the person in the bed; a patronising or condescending attitude; crashing metal bin lids all night long; omitting smiles and random acts of kindness from the care plan; leaving the patient feeling they are an unwelcome intrusion; loud conversations between staff at all hours of the night.
Things it is: human kindness in word and demeanour; showing the utmost respect for even the most trying of patients; adding a smile to the mix; according the patient the benefit of some understanding of their condition; a word of true sympathy for those in pain or unable to sleep. How I wish I’d appreciated these things so clearly when I was on the vertical, clothed end of the partnership!
From the horizontal position I saw evidence of the excellent and the not so shining. I loved the consultant who sat at eye level with her patients and exuded warmth and bonhomie wherever she went. I admired the skill of the expert who could cut away the humbug of weeks and get to the kernel of the problem. I was amazed by the lightning speed one care assistant could get through showers and bed-making and serving meals. But I’d like to single out three people for special mention.
Two were medical students who were dispatched to take my history on the first day. They not only took great care to elucidate accurate facts, they were totally sympathetic and respectful, treating me as an equal, a partner in the business of making me well again. And they even popped back several times to see how I was faring, to check if I needed any further information. They showed inherent human kindness and empathy. Our future is safe in their hands.
The third was a student nurse who was especially sensitive to the feelings of all she came into contact with. Intuitively she seemed to know just how to make everyone feel valued and supported – even the most irritating and difficult patients. She took the time to sit with the frail and frightened; she followed up requests; she thanked the patient for their part in exchanges.
So what was the key to the excellence of these three young professionals? Warmth, grace, humility and true empathy with people – worth so much when you’re feeling ill and vulnerable. Almost everyone else in the teams had more knowledge and experience and technical know-how (and of course, we need our healers to possess these skills), but these ‘learners’ stood out for me. Because they took the time to see and indeed value the real person in the bed. I devoutly hope our medical systems don’t evolve to train or force this natural people-skill out of our doctors and nurses of the future. It could be said of one very experienced and senior person I met: ‘He doesn’t do emotion’. I could respect his wisdom but I felt intimidated and somehow guilty in his presence. By contrast, in the hands of those two medical students, at the other end of the food chain, I felt understood and valued.
But enough of this … it’s been a long and taxing day. I’m delighted to report that after two months of incapacitating problems I’ve now been given the correct diagnosis; I’m on the right treatment; I am hoping not to need to report health issues ever again. I might even get back to writing my novel once more ere long! What’s not to celebrate?
My enforced inactivity continues as doctors try to find out why my heart is doing crazy things. Those who know me best recognise the potential frustration for someone used to living life at a hundred miles an hour, and they’ve been kindly plying me with distractions of various kinds, helping to keep me sane and functioning at some level.
So, for example, a complete boxed set of the drama West Wing has kept me sitting down for countless hours. Plus it’s given me a new perspective on life at the top of politics in a country the size and structure of the USA. But it also includes fascinating glimpses into the world of … medical ethics no less! Everything from: should a president reveal that he has Multiple Sclerosis and is experiencing lapses in concentration? and should his doctor wife be allowed to treat him secretly? … to: what use could be made of evidence that praying for patients’ recovery influences outcomes? Issues of infant mortality, postcode lottery in medicine, autonomy and Alzheimer’s, confidentiality, jumping the queue for organ donation, medical capacity, assisted dying, mind control experimentation … they all become useful material in the hands of a skilled scriptwriter. This particular programme doesn’t follow through any of these issues as I would, (it makes no claim to do so) but that in itself is thought provoking.
When the dizzyness prevents me sitting up and watching a film, listening to something interesting beats lying idle feeling every erratic heartbeat. Radio 4’s Book of the Week last week was Val McDermid‘s Forensics: the Anatomy of Crime about which I wrote a couple of blog posts ago. Val herself reads this abridged version of her book and gives a fascinating glimpse into the way that the dead and the scenes of crimes speak. She takes the listener into houses devastated by fire or a shooting; she peers at the insects and poisons which tell their own story; she traces the life of history’s most prolific female serial killer, and the Sausage King of Chicago who tried to dispose of his wife’s body in the processing plant, as well as appalling miscarriages of justice. Snippets that really whet the appetite for more. And all told in her distinctive Scots voice. Once again I’m hugely impressed by the depths to which this bestselling crime writer goes in order to authenticate her plots and the sheer scope of her knowledge. (Hurry if you want to hear these 15 minute excerpts – they’ll soon be unavailable.)
So this month of illness might well have wiped my diary free of appointments and activities but I’ve been learning valuable lessons: the art of simply being still, to value thinking, to make the best of my limited abilities. And hardest of all: patience. Maybe I should simply reconstruct the events of the last four weeks as a sabbatical as advocated in these tips for creative thinking.