Hazel McHaffie

Hamnet

Having just been to Stratford upon Avon, this seemed like the perfect time to read Maggie O’Farrell‘s award-winning novel, Hamnet, based on the lives and tragedies of the Shakespeare family. Though I’ve heard the author talk about it at various events, and read reviews, the book was not at all what I was expecting.

Knowing the names of the real-life family members, I was discombobulated by the  pseudonyms they’re given in this story. Hamnet is synonymous with Hamlet – OK, I can cope with that. But Anne Hathaway, renamed Agnes? Though I understand the logic behind it, I’m still not entirely convinced by this strategy. And given that the chapters dot between time-frames, it took a while to be confident of which generation we were dealing with.

Will Shakespeare himself is never named; he’s variously the Latin tutor, son, husband, father. He’s an educated grammar school/oratory boy, well used to brutality, subject to dark moods, who only finds his real inner self and fulfilment in play-writing and acting in London.

The central figure is his wife – unschooled but with a wisdom beyond formal education. She’s portrayed as an other-wordly soul with special powers, strange inexplicable insights and foreknowledge, an affinity with nature, a frail veil between her and the world of the dead. A sorceress, a forest sprite, of another world, not quite belonging in this one.

When Shakespeare first catches sight of her with a falcon on her arm, he mistakes her for a boy, and instantly we see shadows of the famous strategies the real playwright wove into his plots. Seen again in their twins, Judith and Hamnet, who have a unique bond – changing places and clothes, hoodwinking people into thinking each is the other, even in death.

The depiction of the plague is shiveringly realistic. The terror striking into the hearts of families with the gruesome beak-masked physicians, the telltale buboes, the death toll, the unknown elements echoing in our own pandemic five centuries later. But back then with recourse to nothing better than herbal remedies or dried toads!

However, for me, the greatest strength is in O’Farrell’s poignant depiction of a mother’s grief. The unfathomable despair and guilt. The impossibility of folding the sheet over Hamnet’s lifeless body, closing him off for ever from her sight. The isolation that separates parents, alienates relatives, preys on the lives of siblings, changes irrevocably what is important in life. Brilliantly written.

Indeed the whole book is a delight to read, but hauntingly sad, bringing to life a hitherto-unknown young lad whose early death was the inspiration for one of the most well known plays in English Literature.

PS. Just so I don’t leave you on a downbeat, how about this fun description:
… the headless pheasant on the table, scaled legs fastidiously drawn up, as if the bird is worried about getting its feet muddy, even though it happens to be decapitated and very much dead.

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Better still …!

Last week I shared the tribute to Sir Walter Scott in Edinburgh. I wonder how many of you instantly thought of Stratford upon Avon – a whole town devoted to the memory of William Shakespeare. I’ve recently had the delight of visiting it and wandering around in the March sunshine savouring the memorials to his life and work. Fascinating!

There are the buildings where he was born (sadly closed to visitors that day because of an imminent week-long event) …

the cottage where his-wife-to-be,  Anne Hathaway, lived (they married when he was 18, she 26) …

the family home …

the church where he’s buried …

the theatre where his plays are still put on all these years later.

His fictional characters are depicted in enduring form.

Indeed, he is remembered here, there, and everywhere …

even in games etched into the pathways!

It’s a special feeling just wandering in his footsteps.

And seeing his work still enduring. Imagine seeing one of his classics performed here! Perchance to dream …

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A tribute to writers everywhere

Much of what we writers do is unseen and unsung. However, some people do manage to eke out a living from their scribbling. Occasionally a particular book or name becomes a sensation. Very occasionally an author gets applause or awards. Very very occasionally one becomes a household name.

But if you‘re a writer and feeling overlooked and unappreciated, just think for a moment of Sir Walter Scott – 19th century Scottish historical novelist, poet, playwright and historian. How cool is it for an auithor to have a massive Victorian Gothic monument built to commemorate him? It’s a landmark in Edinburgh, slap bang in the capital’s most famous street, Princes Street; the second biggest monument to an author anywhere in the world.

I stood and stared at it this week, and thought of all those people whose words I’ve loved, whose productivity I’ve admired, who I would pop into that arched edifice alongside Scott. It already has sixteen Scottish poets and writers appearing at the top of the lower pilasters, alongside many many other famous figures. But today I want to pay tribute to countless others who have influenced and affected and charmed and impressed me, and even changed the world because of their skill with words.  I salute them all … and the gifted photographers who allowed me to share their superb images.

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No reading wasted

After the heavy duty reading of the past few weeks, not to mention the economic crisis in this country, and the ongoing war in Ukraine, I sorely needed something light and undemanding to restore my functional equilibrium right now.

Some time ago I picked up The Edinburgh Bride by Anne Douglas, on a charity bookcase up north, simply because its strapline said: A heartwarming Scottish saga. ‘Heart-warming’ is exactly what I needed.

Hmm. Well. They do say, no experience is wasted on a writer, and I certainly found this little story illustrated some useful pointers as to what I don’t want to include in my own writing – no disrespect to Anne Douglas. Different objectives. Different style. Different genre. Different readers.

So as well as offering a diversion, it was instructive. Therapeutic.

 

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The price of fanaticism

Following on from Educated (which I reviewed three weeks ago), I was recommended to read Unfollow which tracks the life of Megan Phelps-Roper, the third of eleven children, brought up in the infamous  Westboro Baptist Church, raised to uphold extreme religious views, and take part in public condemnation of everyone outside their community. Though they’re a family of well-educated lawyers, they become ‘the most hated family in America’, but the more vilified and persecuted by the world they are, the better pleased they become: it just demonstrates that they’re indeed chosen by God as his beloved. They and they alone are right; other churches are misguided ‘social clubs’ destined for perdition.

Reading it was not a good experience! I had to force myself to persevere.

The echoes of Tara’s experience in Educated soon began to ring ominously. Saturated in the doctrines of exclusivity and condemnation … terror that the evil within would bar them from God and his people for ever … re-writing history to suit the family’s image … a public show of piety and extreme zeal for God; a different story behind the scenes … an obsessive concern to show a united front within the fold; ready to cast to the dogs anyone who dared to leave it … accountable to no one outside their fences … Uncomfortable reading indeed. And I think, the more so because this family are educated intelligent men and women.

This text, they believe, was made for them and them alone:
But he that is spiritual judgeth all things, yet he himself is judged on no man. For who hath known the mind of the Lord, that he may instruct him? But we have the mind of Christ.

Watching this young girl, fortified by direct Biblical quotes, glorying in condemning all homosexuals, Jews, Mother Theresa, Princess Diana, the Swedish royal family, and her own deserting brother; revelling in the collapse of the Twin Towers and the loss of hundreds of thousands of lives in the 2004 tsunami; organising picketing at the funerals of young soldiers; chilled me to the bone. But she’s implacably set for the defence of the gospel, believing utterly in her myopic picture of a murderous and cruel and wrathful God, who’s bent on humiliation and punishment.

Clearly, the whole world was deceived – but we weren’t. How lucky we were to have the favor of God.

But the brutal elements of their way of life tell a different story, and Megan starts to connect the violence of her mother and grandfather with the church’s attitude to the suffering of outsiders. They actually rejoice at the demise of those people, their total destruction. And violence was how you taught obedience.

Then a lawsuit is filed against them for defamation, invasion of privacy, and intentional infliction of emotional distress, arising from one of many funerals they picketed (a Marine in Maryland). Their response? To pray for the Lord to kill the father of that dead Marine and the lawyers filing the complaint! You couldn’t make it up, could you? Megan herself has her first serious wobble, questioning the behaviour she’s called to support. She’s twenty years old. But the multimillion-dollar judgement against them is eventually overturned at appeal, and they head in a ‘spirit of triumphalism and invulnerability’, for the United States Supreme Court – the highest in the land. It’s now 2010.

The level of insensitivity and obscene ridicule of others’ finer feelings, beggars belief, and yet Megan says she loved it, so confident was she that she was doing the Lord’s work. She travelled far and wide propagating the church’s message against gays, Jews, schools, Muslims, the Grammys, the Oscars … the list goes on and on.

But gradually, gradually she begins to feel sadness in response to the very tragedies her family celebrates. Her alienation is accelerated when self-appointed arrogant elders take over control of the church, making implacable demands for unquestioning obedience, showing a pernicious need for superiority and control, imposing draconian rules, punishing viciously former stalwarts and linchpins. And when her own relatives become the hapless victims, feeling their pain, she at last recognises, with horrifying clarity, that they had all been behaving in this way to outsiders. In humility and shame she realises their church, far from hand selected by God, are completely deluded and fallible people.

Doubts multiply, troublesome questions besiege her. She faces a terrible choice. But, after a lifetime in the protective embrace of family and church, how could she wrench herself away and face the hostile world she has consistently vilified? Whether she leaves or stays her prospects are bleak.

But increasingly she sees the arrogance and incomprehensibility of her former position:
the Bible was written thousands of years ago in languages no one speaks anymore … and somehow, Westboro alone has figured out its one true meaning?… Coming face-to-face with my arrogance, aggressive in its misplaced certainty, was a special sort of shame.

When she issues a public statement decrying her former life and affiliation to Westboro, and later, when she actually meets those she decried, she’s staggered by the generosity of spirit that forgives her and reaches out in friendship and compassion.

It wasn’t the desire for an easy life that led me to leave (my family). Losing them was the price of honesty. A shredded heart for a quiet conscience.

A searingly honest account of the price of fanaticism. And a sobering reflection given what such obsessive arrogance is wreaking in the world today. The redeeming feature is that Megan has made it her mission since to do all she can to be a vocal and empathic advocate for the very people she was taught to despise.

 

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Survivlng the War

The current situation in Ukraine, with the graphic images we’re seeing on our screens, is reminding us so much of the horrors perpetrated during the Second World War, isn’t it? And the thought of so many families running from, or hiding from the Russian onslaught, taking refuge in neighbouring countries like Poland, takes me to a book I read some months ago – events in the 1940s resonating strongly with what’s happening in 2022.

Though I’ve read many many accounts of the persecution of the Jews, Surviving the War is the first about that faction in Poland who sought refuge in the vast forests and swamplands where the organised army would have trouble reaching them. It may not be as familiar as stories of the concentration camps, but it makes sobering reading, with its tales of betrayal and persecution by fellow countrymen as well as the Nazis.

WARNING: This post contains spoilers

Basing her material on a composite of real-life stories, Adiva Geffen, paints an idyllic picture of simple rural life in Poland before the war, with Jews and Gentiles living in harmony in a small village, joining in each other’s religious festivals, caring, sharing and supporting each other. As Avraham says in the book: ... we are one people, their language is our language and their culture is our culture … [and] we have God … the Poles are our brothers – we are united in this.

In her youth, Shurka Shidlovsky grows up both fascinated by, and fearful of, the dark and dangerous Parczew Forest, shrouded in myth and legend. But she lives in a happy family, joyfully observing all the Jewish festivals and holidays, completely oblivious to the horrors to come.

By the age of 15, Shurka is already beautiful and ready to leave school. She and her mother hold out for her to train in a profession/trade and she leaves home for one year to study sewing. City life is a revelation, but she keeps an anchor in the familiar by travelling home for the weekends. It’s during her wedding to the son of a prosperous merchant family, Avraham Orlitzky, that the first hint of trouble casts its long shadow: a young refugee couple appear who have escaped from Berlin as Hitler begins his terrible regime. The year is 1937.

But the innocents in Eastern Poland refuse to believe the stories; it’s nothing more than a ‘passing posturing’. Until, that is, the Germans invade Poland. This time the danger is impossible to ignore. Avraham has no choice but to wear the yellow star, but still he’s reluctant to move his pregnant wife, naively confident that their Polish friends will look after them. And even world leaders choose to ignore the signs of terror that have begun to form a crack in the world – the looting, confiscations, expulsions, eliminations. The year is 1939.

It’s only when, in 1941, Avraham is sent to a labour camp, that he begins to lose hope, and the realisation spurs him into action. The family begin a nomadic life, fleeing from one place of refuge to another, with two children in tow: Irena, and a frail little boy, Yitzhak.

As they move from her parents’ house, to an abandoned pavilion, to a vastly overcrowded Jewish ghetto, experience teaches them that, far from all being brothers, nobody is to be trusted. Brutality and lawlessness are rife. It’s the end of all security, all connections with their past. It’s the beginning of 1942.

And then the Final solution swings into action. News of the crematoria and death showers reaches the Orlitzky family: Horrors not even the devil could have imagined, and they realise that the ghettos have become not just ‘natural death’ chambers through starvation, but now also transfer stations to the concentration camps, extermination camps and forced labour camps. The Parczew Forest is the only place of safety left to them, and they must flee while the ghetto gates remain open. It is August 1942 – just one month before all the Jews left in the ghetto are sent to Treblinka and certain death.

Life in the vast forest is precarious in a different way. And indeed, more people perished there than survived. Shurka and her family camp alongside resistance fighters, Jewish partisans. They are forced to dig their own underground bunkers, camouflage them with branches, scavenge for food, be ready to move immediately if the Germans gain intelligence of their whereabouts, leaving no trace of their presence, only to start again from scratch.

Life even inside the bunkers is fraught with peril. The Jews are huddled together, forbidden to utter a sound, not even to cough. The Germans periodically approach with their weapons and dogs. On one occasion, baby Yitzhak starts crying, refusing any comfort, endangering the whole camp. What is Shurka to do? The account is too tragic and poignant to recount; you have to read it through her eyes.

As winter clenches its frozen fists on the forest, they are again on the move, this time to an old granary, courtesy of a sympathetic peasant, where they live in complete silence for nine weeks and five days. Suspicious neighbours eventually drive them back into the forest. Though Avraham is the king of plenty, obtaining basic provisions under cover of darkness, nevertheless disease, death, constant deprivation, unremitting fear, take their toll. It is 1943.

The threat grows ever closer. The Germans set fire to the forest to drive the hidden Jews out. Then with more precise information from informants, they throw grenades directly  into the bunkers. Shurka and her daughter survive because they have crawled onto a high shelf; but almost all her family are killed in that terrible raid. Alone now, they must once again flee, this time to a series of old granaries or barns during the harsh winter months, imperilling the farmers who grant them shelter, using silverware and jewellery to pay for their silence, capitalising on friendships and allegiances from Avraham’s successful business days. But with spring comes a return to the forest. It is March 1943.

By that September, the Third Reich begins to crumble, but the forest families are by no means safe. They spend another frozen winter hidden in a spacious barn belonging to an avaricious couple of Poles, in a remote village surrounded by swamps. Always silent, constantly vigilant. Irena by now is six years old. It’s while they are there, as the war draws to a close, that tragically, Avraham is killed while out on one of his night-time scavenges. Shurka decides she must return to the forest to seek out those she knows, unaware that the Germans have retreated, the battle over.

Just twenty-two days later, on Sunday 23 July 1944, the people of the Parczew Forest are liberated, marched away, leaving behind the graves of their loved ones. They are free to return to look for the Poland they had lost, but carrying a terrible burden of pain for the rest of their days. And it would take time to fully trust these Russian men who had come with the offer of release. Was it all a trap? After all, their compatriots in the concentration camps in the west are still being sent to their deaths.

Sadly, the reception that awaits them in Poland is one of outright hostility, revealing a hidden anti-Semitism that hurts deeply from supposed brothers. New persecutions follow. And once again the Jews are in hiding, as murderous men rampage through the streets and houses. After losing so much, however, the few forest survivors crave connection, love and intimacy. Suddenly men are in hot pursuit of Shurka. She soon finds new love with a man who lost his own wife and children in Treblinka, and together they resolve to set their sights on the future, not to look back. They marry in November and a son Yaakov is born in August 1945. They eventually begin the slow process of leaving Poland behind, to seek a new life with their fellow Jews in the new State of Israel. The year is 1948.

Shurka’s story challenges me as so many levels:
Would I have the courage to endure such hardship?
Would I endanger my family to protect strangers?
Would I sacrifice my son to save the wider community?
Would I retain faith in God in the face of such horror?

Unanswerable. Uncomfortable. Unimaginable.

 

 

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Catherine Cookson therapy

Catherine Cookson: a name that dominated the library charts for years, famous for her survival tales of plucky women, rooted in the industrial north of England, where she grew up herself. Author of some 103 titles. Now rather dated and overshadowed by more robust and explicit fast-paced writing, but still retaining a place in the lists of the famous, and the hearts of countless fans.

Cookson’s own life story is as tragic and rags-to-riches as that of many of her heroines.

Born in 1906, she was the illegitimate child of an alcoholic mother and a bigamist gambling father, raised by her grandparents. She left school at 14, went into domestic service, then into a laundry, before becoming a landlady. She was in her thirties when she married, and she went on to endure four miscarriages late in pregnancy. It took her a decade to recover from the resultant depression. As a form of therapy, she took up writing, publishing her first novel in 1950, and going on to enjoy phenomenal success. What a triumph over adversity!

She died sixteen days before her 92nd birthday, at her home in Newcastle, her novels, many written from her sickbed, continuing to be published posthumously until 2002.

Aware of her struggles and history, I felt a desire to honour her memory, so slipped in The Rag Maid by way of light relief, between bouts of preparation for more serious presentations. And curiously, on the very day Russia invaded Ukraine last week – 24 Feb 2022 – there was I reading about the war and the Russians in the 19th century in this Cookson novel … the Crimean war, as we know it today.

So, The Rag Maid
The year is 1854. Well brought up, stunningly lovely, Millie Forester, aged 7, finds herself abandoned by her young mother and in the care of a very fat and malodorous rag woman, alongside a teenage boy with achondroplasia, in a hovel surrounded by stinking rags and junk. Her father is in prison (she’s been told he’s dead), her Mama has been picked up for prostitution and herself sent to prison, but commits suicide rather than face further degradation.

Under Millie’s gentle influence, Mrs Aggi cleans up her house and yard, invests in a pony to pull the cart, upgrades her marketing patch, and insists Millie gets an education. But wherever she goes, Millie Forester becomes the object of male adoration and lust, which takes her into desperate situations. Who will save her from a fate like her mother’s?

It’s a simple plot, without artifice, poverty and injustice and class distinction rife. But it has that feel-good factor, that credibility, that Cookson captured, knowing first hand what a life of struggle and dreams felt like. As warmly confirming as the gin Mrs Aggie swears by for everything from anaesthetic to shock.

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The transformational power of education

How many of us really appreciate the education we received? We mostly take it for granted, don’t we? – only stopping in our tracks when we hear children in less advantaged countries expressing their amazement or gratitude for opportunities (often limited) that come their way.

Educated is a searing account of one woman’s extraordinary childhood and the transformative power of education in her life. It’s a compelling and sobering read, beautifully written, and unflinching in its honesty.

Gene Westover doesn’t believe in the state, so his daughter Tara has no birth certificate, no schooling, no medical records. The government doesn’t follow up her absence from school because, according to the state of Idaho and the federal government, she does not exist. Instead she spends her early formative years preparing for the ‘Days of Abomination’, or roaming the mountain, or bottling fruit ready for the End of Days, or delivering herbs and babies with her untrained unlicensed midwife mother.

The extremities of her dysfunctional family emerge only gradually in Tara’s memoir, which somehow makes the revelations the more harrowing.

Tara Westover is the youngest of seven children. Her father is a religious zealot, a paranoid and fundamentalist Mormon, an eccentric, who believes drinking milk is forbidden in the Scriptures; that public school is a ploy by the Government to lead children away from God; college education the work of the devil.

There’s two kinds of them college professors. Those who know they’re lying, and those who think they’re telling the truth. Don’t know which is worse, come to think of it, a bona fide agent of the Illuminati, who at least knows he’s on the devil’s payroll, or a high-minded professor who thinks his wisdom is greater than God’s.

To Tara’s father the theatre is a den of adulterers and fornicators; doctors are sons of perdition, and the Medical Establishment to be avoided at all costs; a teenage girl showing an inch of bare shoulder is a gentile exhibiting rank provocation; accepting a Government grant is to indebt oneself to the Illuminati; safety at work is a matter of faith in God. As Tara says:

We had been bruised and gashed and concussed, had our legs set on fire and our heads cut open. We had lived in a state of alert, a kind of constant terror, our brains flooding with cortisol because we knew that any of those things might happen at any moment. Because Dad always put faith above safety. Because he believed himself right – after the first car crash, after the second, after the bin, the fire, the pallet. And it was us who paid.

It’s only years later that she suspects he suffered from bipolar disorder – unacknowledged, undiagnosed. At the time she believed his rantings: … the whole world was wrong; only Dad was right.

The Westover family live in a state of permanent chaos and squalor, and expectation of the imminent end of life as we know it. They keep themselves distant from anyone who believes differently, and even scorn members of their own church. Their family are the only true Mormons they know.

The house was pure confusion: piles of unwashed laundry, oily and black from the junkyard, littered the bedroom floors; in the kitchen, murky jars of tincture lined every table and cabinet, and these were only cleared away to make space for even messier projects, perhaps to skin a deer carcass or strip Cosmoline off a rifle. But in the heart of this chaos,Tyler [my third brother] had half a decade’s pencil shavings, [stored in matchboxes in his closet] catalogued by year.

It’s a wonder Tara survived childhood given the accidents and horrors and violence that befell her. Her father might believe angels were protecting them; her brothers might say they were protecting her; but to a dispassionate reader Tara relied largely on her own quick wits and instincts to survive. And in self defence she sometimes re-wrote history. It was the only way she could handle the manipulative controlling behaviour that characterised family life.

She finds redemption in study. Initially she uses dense church texts to learn.

In retrospect, I see that this was my education, the one that would matter: the hours I spent sitting at a borrowed desk, struggling to parse a narrow strands of Mormon doctrine in mimicry of a brother who’d deserted me. The skill I was learning was a crucial one, the patience to read things I could not yet understand.

Then she applies herself to mastering the abstraction of algebra and trigonometry, of prepositions and gerunds, and of science, for the entrance exam to college, and that, in spite of her father’s constant refrain that her desire is flying in the face of God’s laws.

The Lord has called  me to testify. He is so displeased. You have cast aside His blessings to whore after man’s knowledge. His wrath is stirred against you. It will not be long in coming.

University life is a shock to the system for Tara, even though it’s Brigham Young. Not only is the whole programme of work completely alien to her, but her fellow students repeatedly shock her. They think nothing of breaking the strict Mormon code of behaviour she has lived by: they shop and watch movies on Sundays, they wear skimpy clothes, they use soap regularly, they drink Coke. She’s surrounded by gentiles disguised as saints. She desperately clings to every truth, every doctrine, her father has taught her, finding a new devotion to an old creed. It’s only when she learns about slavery and apartheid at university that she starts to see her upbringing for what it was.

I had started on a path of awareness, had perceived something elemental about my brother, my father, and myself. I had discerned the ways in which we had been sculpted by a tradition given to us by others, a tradition of which we were either wilfully or accidentally ignorant. I had begun to understand that we had lent our voices to a discourse whose sole purpose was to dehumanize and brutalize others ...

Course-wise Tara is at a grave disadvantage. I wanted to weep at her accounts of ritual humiliation because of her deprived upbringing; her complete unpreparedness for life; her determination to remain true to her father’s philosophy. It’s clear from her writing that this girl is highly intelligent and discerning; and yet her loyalty overrides her instinct. But gradually, incrementally, enlightenment comes, and she receives sympathetic help. So much so that she wins entry to a study abroad programme at Cambridge in England!

I believed myself invincible. It was an elegant deception, a mental pirouette.

But the refinement, the encouragement, the praise, at Cambridge, compared with her former life of violence and manipulative control on the mountain, is initially overwhelming. She could never belong here …

… being here threw into great relief every violent and degrading moment of my life …
I could tolerate any form of cruelty better than kindness. Praise was a poison to me; I choked on it … The ugliness of me had to be given expression.

However, her brilliance as a scholar shines through her social gaucheness. She is nurtured by her academic mentors, winning a Gates scholarship to Cambridge on merit and with their powerful endorsement. Her father still takes the credit, because they home schooled her … but he is also bereft – she is putting herself beyond the reach of his protection.

If you’re in America we can come for you. Wherever you are. I’ve got a thousand gallons of fuel buried in the field. I can fetch you when The End comes, bring you home, make you safe. But if you cross the ocean …

But it’s there, as a full time postgrad, and subsequently a PhD student, in this famous seat of learning, that she finds the courage to live in the real world. It is to cost her dear. One by one her family betray and disown her, creating a fantasy history exonerating themselves, blaming her for the evil influences that have led her astray. In the face of this agony, even a visiting fellowship to Harvard is robbed of any allure. This was what education had cost her. For a time she believes herself to be insane, delusional, crippled by psychological injuries, and begins to unravel. It takes years, and independent corroboration, for her to regain belief in herself. Some rifts are never healed, but eventually she finds a measure of peace – both within herself and with some of her family – without renouncing her own hard won belief.

A superb memoir by an inspirational writer and courageous woman.

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Exemplary service

We all know about the devastating effect of the pandemic on NHS waiting lists, and doctors’ appointments, and cancer diagnoses and treatment. We’ve all been aware of the changed rules of engagement for going into hospitals; some of us even fell foul of the policies that kept us from visiting our loved ones in hospitals and homes, denied us opportunities to say those last goodbyes.

So I’ve been staggered by the ongoing care I’ve received as an outpatient myself. Four and a half years ago I was diagnosed with cancer and had two surgeries to treat it. Because it was one of the more virulent and life-threatening forms of malignancy, I was told I would be monitored closely for five years, and given contact details for specialists whom I could ring if I was worried about anything between appointments. Initially I was seen every three months, and then gradually the time periods extended. Then the pandemic struck and so many routine appointments were cancelled. But mine were continued. When complete lockdown was in place I was given a consultation by phone, but once restrictions lifted sufficiently, the team felt I should be seen in person, and real appointments resumed. Last week I had my penultimate consultation.

To be honest I should have been perfectly satisfied if they’d said, just contact us if you’re worried. Indeed, I’ve felt guilty about taking up a valuable slot in a beleaguered health service, and told them so. But they’ve been adamant; each check is important, my welfare is important. I am both impressed and grateful. They have done all the worrying for me.

So it was perhaps serendipitous that, this latest visit, I took with me to the clinic waiting room a slim volume about a woman who worries about everything! It’s The Purveyor of Enchantment by Marika Cobbold – an undemanding read, requiring little concentration.

Clementine Hope, thirty-six, large and newly divorced, is a piano teacher and pathological worrier. She inherits a house, a stack of unfinished fairy tales, and an inferiority complex from her Aunt Elvira. Her half-sister Ophelia is younger, smaller, calmer and saner, and she despairs of Clementine’s fears and negativity.

When Clementine, after a failed relationship, determines to take herself in hand, she goes overboard in the risks she takes. Why does she have to be so extreme? a friend asks. Her reply: ‘I think you have to be to arrive in the middle. It’s a question of adjustment. I’ve been living a life confined by petty fears. Now I’m trying to be magnificently bold in order to finally arrive somewhere in the region of normal and sensible.’ Magnificently bold or magnificently stupid it may be, but her homespun version of aversion therapy does the trick: her fears recede and she reaches for a different future where she is in control … in spite of Ophelia.

Needless to say, I didn’t read the whole book waiting for my appointment!  Conscious of the importance of limited time and space in the socially distanced chairs, appointments are now super-efficient. Hats off to an excellent department and its team of committed staff. And the book? Well, it’s on its way to the charity shop. Not one for my shelves, I’m afraid.

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Everyday ethics

Wow! We’re only five plus weeks into 2022, and already the papers seem to have been full of stories centred around ethical questions. Time to share a few by way of illustrating their prevalence in our everyday lives.

A survey of almost 300 members by the Association of Palliative Medicine, published on 26 January, has shown that doctors are concerned over the focus on negative and traumatic deaths, while ignoring good palliative care leading to gentle easeful deaths. They believe the public are being scared into supporting assisted dying. The timing of this is significant, given that the Government’s Health and Care Bill to legalise assisted dying within a year of the Act coming into force, is currently being processed in the House of Lords.

Current guidance for the forthcoming Scottish census is that transgender people can select their preferred sex/gender identity even in the absence of a gender recognition certificate. A feminist group, Fair Play for Women, have brought a case against this to a top civil court, calling on the judges to strike down this advice. Under present rules, a person must have a medical diagnosis of gender dysphoria, live in their acquired gender for two years, and have their application approved by an expert panel to officially claim a new gender identity; under the SNP plans, self declaration would suffice.

A call has been made for compensation for the approximately 40,000 care workers who lost their jobs because of the mandatory vaccination against Covid policy, now that the measure has been deemed no longer proportionate.

The Medicine and Healthcare Regulatory Agency is proposing to reclassify a vaginal oestrogen tablet – Gina 10; a form of HRT costing as little as £2.50 per week – so that women over the age of 50 can purchase it over the counter. A consultation, seeking the views of GPs, pharmacists and members of the public, is scheduled to take place. Until now such medication has required consultation with a doctor. The proposed new arrangement might still require the input of a pharmacist.

The ongoing debate about inequality where female transgender athletes compete in women’s sport has been revisited in the case of a University of Pennsylvania swimmer who has broken records in women’s races after transitioning from male to female.

The Health and Social Care Secretary has set out a vision to make Britain a world leader in cancer care. It includes the introduction of new technologies, including vaccines, designed to boost survival rates, as well as new ways to boost early diagnosis. Even before the pandemic Britain’s survival rates lagged behind many other Western nations; since the pandemic the figures for missed diagnoses and delayed treatment have plummeted still further.

The world’s most expensive drug, Libmeldy – a gene therapy that costs £2.8 million per treatment – is to be offered on the NHS to young people suffering from a rare genetic condition called metachromatic leukodystrophy, following a landmark deal. The condition causes severe damage to the nervous system and organs, and carries a life expectancy of 5-8 years.

Recently, No10, the Treasury, the Department of Health and the NHS have been discussing a multi-million pound National Recovery Plan to tackle the NHS backlog exacerbated by the pandemic. Now the Treasury has put on ice an announcement about it, which was due to be made on Monday this week. This comes at a time of mounting unrest in Government following a series of revelations about broken Covid rules in Downing Street and unfortunate statements by the Prime Minister.  Speculations abound.

The Children’s Commissioner has revealed that more than 100,000 children (1 in 4) referred with mental health issues were discharged before receiving treatment. This was the finding in a survey of more than half a million children. The Department of Health and Social Care have now committed an additional £79 million this year for children’s mental health services.

The Human Fertilisation and Embryology Authority have advised doctors to stop providing wholly inappropriate treatment to infertile couples who request unproven add-on therapies in a bid to improve their chances of having a baby. Increasing numbers of couples are asking for them after misleading claims made in marketing or internet forums.

There is certainly no shortage of topics for exercising the brain when it comes to medicine today, is there? Every one of these issues raises so many fascinating and challenging questions. Were I to continue writing novels in the area of medical ethics (still under review incidentally) there would be plenty to keep me occupied for the next twenty years!

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