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.
It’s all very well to theorise about how we would act in certain circumstances from a safe distance, but real life in all its chaos can feel very different from the calm scenarios of our speculations. And in that context I’ve experienced some very sobering realisations this past few weeks in relation to medical ethics. Don’t get me wrong, I’m not feeling maudlin or morbid; rather I have an unusual amount of quiet time on my hands to reflect at the moment. So I thought I’d share some of my reflections with you to illustrate my initial statement.
There’s a lot to be said for simply accepting whatever life throws at you and dealing with it as it happens. It also saves a lot of angst if you just go along with whatever doctors say, take whatever treatment they advise, leave all the thinking to other people. But I’ve spent decades pondering ethical questions and challenging received wisdom, and my brain is now hard-wired to do so. So, let me illustrate where I’ve been going with this.
My own mortality has been brought into sharp relief since my heart started doing crazy things and I’ve been in and out of hospitals and GP surgeries. Lying on the floor waiting for the next heartbeat, watching a monitor recording 200 beats a minute, feeling the world receding, concentrates the mind wonderfully.
I’ve been working in the field of medical ethics for decades so not surprisingly I’ve given due attention to my end-of-life wishes. My ideal? To die with dignity, free from suffering, in full possession of my mental faculties. Nothing unique there, then. If things go pear-shaped, I’d rather not prolong a life of disability, lack of cognitive function, or suffering. Fair enough. Given that I’m entirely reliant on medicine to stay alive, I even have the wherewithal at my disposal to effect my own death should I wish to, without breaking any laws or implicating anyone else, or indeed doing anything other than refusing treatment.
I’ve duly prepared myself and others: I’ve thought (ad nauseam) about my own tolerances and limits. I’ve written an advanced directive – and even acquired a medical signature for it. I’ve had the conversation (many) with my nearest and dearest. All textbook stuff so far.
But real life is full of fine lines and unknowns which make actually carrying out those clear wishes problematic. I won’t bore you with a comprehensive treatise on how far short of the textbook reality falls in my own case; merely give a couple of examples by way of illustration.
I have options. I could simply ignore all my current symptoms of dizziness, nausea, blackouts, arrhythmia, get into the car and drive. I could keep doing strenuous things until my heart just gives up. Either, in my judgement, would be totally irresponsible. And my family and friends and doctors and lawyers would certainly have plenty to say – legitimately – about such a reaction. No, I have little choice at this moment but to listen to my body and accept that all is not well, and I believe I have a moral duty to take certain actions in recognition of that.
My heart is not maintaining a steady rhythm. One of the consequences of this is that I’m currently at greatly increased risk of a stroke. But nobody knows how bad such a stroke might/will be. If I suddenly had one, would I want to be resuscitated or treated? Well, it would depend on how severe the consequences of the stroke would be, and nobody could predict that at the time of the stroke. By the time anyone does know, the decision to treat has already been made … hmmmm. And it could be that by then I’m no longer mentally competent to make a decision for myself … ahhhh. How quickly and easily events spiral out of control.
At the moment we don’t know what’s causing the problems; I’m scheduled for more tests. Once we have a better idea of the underlying diagnosis, other questions will surface. They’re contingent on the facts: cause, statistics, outcomes, possible treatments, side-effects, risks-benefits ratios, etc etc. My medical team can supply the information, but I’m the one who must assess what I want. No one can force me to have treatment against my wishes. But my tolerances, my wishes, might not square with those of my medical advisers who have their own professional and personal standards and ethics, although it has to be noted, the consequences of what they do to me will not be borne by them. My assessments might not match those of my family who could be left to cope with my disability or death or worse. For their sakes I might feel an obligation to choose something different from what I might wish for myself alone.
See what I mean? We might think we have it all buttoned up, but life is unpredictable and no man is an island.
I’ve seen up close and personal the effect of heart problems like mine – both instant death from a heart attack (my father), and the slow decline of repeated strokes, vascular dementia, prolonged total dependency (my mother) – so I’m not naive. I know what I would choose for myself; my family do too, but it’s not at all clear to me at the moment that I shall actually be able to put my wishes into effect. I rehearsed these dilemmas with Adam O’Neill when I walked alongside him as he died from Motor Neurone Disease six or seven years ago. I’m rehearsing them again now in real life for myself. It’s an interesting occupation.
Sometimes fiction allows one to tell a truth that couldn’t be so readily conveyed factually because of all the complexities of real life: so said best-selling crime writer, Val McDermid, at a Blackwell’s Bookshop event on Thursday evening last week. How true.
She was appearing with her great friend Professor Sue Black, a renowned forensic anthropologist. I’ve heard them doing a double act before at the Edinburgh International Book Festival so I knew we were in for a real treat.
The flip side of the first aphorism is: fact can sometimes be so much stranger than fiction that a novelist can’t use it because no one would believe it. How far would your credulity stretch, I wonder? Would you believe that a pile of pupae on a kitchen table in Liverpool could be found to have cocaine in its DNA, which in turn would lead to the discovery of the murder of a drug dealer no one knew had been killed? It really happened! Were you aware that only certain species of insects can lay eggs through the zip of a suitcase? Val has met the scientists who’ve investigated this phenomenon in person and seen the actual suitcases they utilised. Did you know that the ink used in tattoos migrates to the lymph nodes, so that if a corpse has had the limbs severed, the lymph nodes in each quadrant can indicate where and what colour their tattoos were? Or if indeed they were added after death. Fascinating true facts.
The evening was full of such wisdom and knowledge. All delivered with great verve and wit. Both women are excellent orators with a lively sense of humour, and a tremendous breadth and depth of knowledge. They also have massive respect for each other and for their readers’ discernment, illustrating perfectly the enormous value for a writer in working alongside experts. Their own relationship goes back twenty years and one can readily understand that in their time they’ve emptied more than one hotel foyer and coffee shop with their ghoulish conversation and macabre sense of the ridiculous! Even at this event, in full view of a large audience, they chortled gleefully about subjects not normally broadcast before the watershed! But hey, did you know that a pubic scalp looks like a tuna steak with hair? (Val said it took her a good year before she could face a tuna steak after Sue shared this fact with her.) Or that PhDs are gained on the study of the backs of men’s hands and the configurations of the male genitalia in various stages of arousal? Such essential statistics are vital for forensic scientists tracking down paedophiles and murderers apparently; and equally valuable to a crime writer weaving an authentic and challenging plot.
Perhaps the clearest message that came across though, was that the best scientists are the ones who can make their subject readily understandable to other people. Sue Black does exactly that. And if anyone could sell a book on forensics, it’s these two. When Val was recently approached by the Wellcome Trust to write a non-fiction book on the history of crime for their forthcoming exhibition, she initially declined. All she did was ‘make it all up’, she protested. But of course, in truth she’s a mine of information, and has an impressive contact list of experts to boot. With the inquiring mind of a journalist, and the lateral and devious thinking of a crime writer, she tracked the changes in techniques and detection over the years and produced Forensics: The Anatomy of Crime, which was published last month. In her lively description she allowed us to share her fascination with the topic that grabbed her interest most: scavenging bugs and beetles, flies and maggots, and what they can teach about a crime.
All in all a most entertaining evening that reinforced for me the importance of meticulous research and true engagement with one’s readers/listeners.
(Footnote for those who are anxious about my current health problems: I was closely guarded by my son and daughter from door to door. I’m happy to report that in spite of the excitement and laughter my heart rose nobly to the occasion and I lived to write this report.)
I’ve just returned from Dublin’s fair city, ‘where the girls are so pretty’ – home of everything from the tragic heroine Molly Malone herself, to the famous Book Of Kells and the amazing library of Trinity College – greatly encouraged. Because writing and storytelling are very much at the heart of things.
Whether you follow a City Tour, or visit the Writers Museum in Parnell Square, or chat to the Irish in their natural habitats, you’ll hear tales of homegrown literary giants; tales moreover told in wonderfully lyrical Irish accents which are poetry in themselves. Some of the detail may be embellished (as one guide said, ‘Why let the truth get in the way of a good story?’), but the essence is the same: Dubliners are proud of their literary heritage. Even ordinary people tell of at least trying to get to grips with Ulysses – the story of the experiences which beset a Dubliner, Lionel Bloom, on 16 June 1904 when his voluptuous wife Molly commits adultery – which is more than can be said of most Joe Bloggs elsewhere, isn’t it?
I suspect the majority of us could get no further than the occasional famous quote from this particular classic: ‘history … is a nightmare from which I am trying to awake’, maybe, or ‘God is a shout in the street’, or ‘Shakespeare is the happy hunting ground of all minds that have lost their balance’, or possibly, ‘To learn one must be humble. But life is the great teacher.’ And indeed, even if we’re familiar with the sayings, how many of us knew they’re from the hand of James Joyce?
If ever I decide to seriously tackle this epic with all its density and complexity and impenetrable prose, I think I stand the best chance of persevering if I’m in Dublin itself, surrounded by people who admire and revere its author. People who don’t closet their acclaimed writers away in an esoteric museum. No. Rather they erect statues of them; they call buildings, bridges, roads after them; they speak of them on the buses, in the pubs and cafés. A nation that is proud of her men of letters. Brilliant.
I’m shocked, frankly.
Babies are precious and special, aren’t they? And couples who can have them naturally are well blessed. Yes? Ask any infertile couple going through expensive and emotionally draining treatment. So what do you think of the latest recruitment incentive?
Apple and Facebook are offering a perk for female employees: the company will pay to freeze their eggs (and you’re talking about c£13,000 a pop here). Why? To help them ‘avoid having to choose between motherhood and professional progression.’ To ‘empower them’. Hello?
Apparently there’s a dearth of top women in Silicon Valley and this offer is designed to encourage them to defer motherhood until they are well up the promotional ladder. The frozen eggs bit is part of a package already in existence in Facebook in the States and due to roll out with Apple in the new year (although there are currently no plans to bring it to the UK). Facebook is also offering adoption and surrogacy assistance and other fertility services for both male and female employees. The mind boggles. Serious serious issues all; the kind of topics I grapple with on a regular basis.
When I think of the heartbreak and tragedy of couples who turn to fertility treatment or surrogacy or adoption as a desperate last measure for medical or other devastating situations, I want to weep at this news. To offer these things as a job-inducement seems to me bordering on sacriligious. I bet the small print doesn’t tell them there are no guarantees for women who voluntarily mess about with their biological clocks.
That’s my personal rant, but what do YOU think? Would you allow your employer to pressure you into something this private and personal? How does this square with your values and personal lifestyle and choices? I’m quite sure there are plenty of people out there who disagree with me or the offer would not be on the table.
In March of this year, Tania Clarence was 42. She lived in a smart five-bedroom house in an affluent area in south-west London. Her husband was an investment banker. She employed a nanny. The trappings of wealth and privilege, you might think.
But on 22nd April, while her husband was abroad, Mrs Clarence ended the lives of three of her children: 3-year-old twin sons, Ben and Max, and daughter Olivia, aged 4, all of whom suffered from type 2 spinal muscular atrophy, a degenerative wasting disease. She suffocated them and then tried to kill herself with an overdose. She was adamant that she didn’t want to be saved; she couldn’t live with the horror of what she’d done. How often must she have regretted that her suicide attempt failed.
Six months later, this week in fact, her defending QC said, ‘caring for three children with this condition was exhausting, distressing, debilitating and turned out to be overwhelming.’ Indeed. She pleaded guilty to manslaughter on the grounds of diminished responsibility. Medical reports described how she was suffering from major depressive illness. The courts have decreed she will not be charged with murder, but she will in all probability be treated in a psychiatric hospital.
Unless we’re drowning in her problems, it’s impossible for any of us to really empathise with the depths which drove her to this point, but I’m sure we can all understand her despair and depression. There was never going to be an escape from this intolerable burden, not just the relentless workload, but watching all three beloved children getting steadily more disabled.
I feel huge sympathy for her. And I say this with some feeling, because when my own firstborn collapsed aged 3 weeks and his doctors predicted a lifetime of disability, pain and suffering for him, I distinctly remember feeling that death would be preferable for him: better that I should be the one bearing the pain of losing him, than that he should suffer. So I for one am devoutly glad that the courts have decided Tania Clarence should not have to face murder charges. She is already serving a life sentence, poor woman.
Amongst the files on my desk for future novels is this one, labelled ‘Mothers Convicted of Child Death or Damage’. I’m not sure I will ever have the courage to write it, but Mrs Clarence’s story goes into it for now.
PS. For those who don’t know, my firstborn defied medical prognoses, and is a totally healthy young man today; he has always been hugely loved. So please don’t waste any sympathy on me. Or castigate me for my callous approach to motherhood! Not for a second did I ever contemplate actually killing him, but then I was never driven beyond endurance.