Covid-19
A Matter of Life and Death
It’s curious how, right now, so many books are taking me back to my own recent experience in hospital fighting for my sister’s best interests to be respected. 
One such is A Matter of Life and Death, written by a palliative care nurse, Kelly Critcher, who elected to take a turn working in a High Dependency Unit during the Covid-19 pandemic. But it’s been a useful exercise. Listening to the perspective of the staff dealing with the fallout, gives a more rounded picture, which helps to keep our own personal frustrations in proportion.
Nursing is in Kelly Critcher’s blood; both her mother and grandmother were nurses, but she initially took a different route, first gaining a degree in Business Management, and then going into office life. However, she found no fulfilment in any of the avenues she tried – they were just a job to be done. Her heart lay elsewhere.
From the outset, nursing suited her perfectly, and she loved the energy and drive of a busy general hospital in Greater London, Northwick Park. However, increasingly she found herself drawn to a less high-powered speciality, one that provided holistic care with the patient’s needs centre-stage: palliative care, an area where she could make a real difference to the lived experience of dying.
… to look death in the eye – to save a patient while the fight can still be won, and confront life’s end with grace and kindness when it can’t.
Her book is divided into two parts, the first of which deals with her professional life up to early 2020, and includes so many incidences that resonate with me. On one level it’s confirming; on another it’s disturbing. I so want to defend those patients whose care fell below the standard they had a right to expect, and I commend this brave nurse who has shined a light on the deficiencies, and championed the cause of the terminally ill. There should be no room for entrenched attitudes, arrogant consultants, dictatorial regimes, old-school ways, that ride rough shod over gentle dignified management.
… there are no second chances when someone is dying. No going back to do it differently next time …
When Covid-19 hit the hospitals, the London Borough of Brent, which has some of the most deprived and diverse communities in the UK, became the epicentre of the pandemic. Northwick Park had the worst death rate of any local authority in England and Wales, and was the first hospital to declare a critical incident, when they ran out of bed space and were about to be overwhelmed. Stringent restrictions had to be implemented, including banning visitors. These measures were particularly hard for staff like Kelly, trained in enabling patients and their families to experience good deaths.
All nurses see the value of a friendly visit to a patient, and in palliative care we recognise family involvement and support as integral to what we do. Covid robbed patients of this basic right ...
It’s hard, knowing what we now know, to be reminded vividly about the failures that characterised the early days of the crisis, when the priority was to clear hospital beds to make way for the tidal wave of patients suffering from this new killer coronavirus about which so little was known. Protection was minimal; risks high.
As we know, staff at the coalface were much more aware of what was unravelling than the Government appeared to be. How vulnerable and badly protected they were. How much they suffered having to implement draconian measures, denying families access to their loved ones, even to say a final goodbye.
People were dying alone, and to us that was an abomination.
This book is no literary masterpiece, and in some places the detail is rather too gruesome for a lay readership (IMO), but it does give some useful insights into life on the NHS frontline. It’s sobering to read …
For years we’ve battled against underfunding, working in old, decrepit hospitals with constant bed and equipment shortages. We have faced complaints from patients, families, managers, politicians, the press and the public on a daily basis. Yet, we still pull ourselves out of bed each day and go to work, knowing that at least some of what we are doing was helping to save lives. Then, in those first few weeks (of the pandemic) that seemed like an eternity, we were national heroes, every one of us.
Were we really so ungrateful?
But alongside the negative experiences, it’s heart-warming to be reminded of the courage and kindness and self-sacrifice the crisis brought out in people. I salute them all. And I thank all those NHS staff who have gone to print and shared their side of the story. Time to move on, methinks!
Edinburgh International Book Festival 2021
Well, who’d have thought it?… the Edinburgh International Book Festival is being transmitted in a hybrid form – virtual alongside real appearances – because of the ongoing Covid-19 pandemic and its attendant restrictions, yet again this year.
This time for the first time it’s based in the Edinburgh College of Art as part of a liaison with the University of Edinburgh. So odd to hear the familiar sounds from a solid building instead of under canvas! But I welcomed the chance to watch it live from the comfort and safety of my own study.
My first session was on Day 1, and so so different from anything I’ve attended before. The speaker was Hoda Barakat, a Lebanese author, speaking from Paris where she now lives. Both she and the chair, David Codling, British Council Co-Director Literature communicated in Arabic, French and English! Leaves one feeling wholly inadequate, doesn’t it? But happily for us lesser mortals, a young Irish translator rendered Barakat’s answers in English too. It made for a cumbersome hour but some salutary messages emerged.
The book under review was Voices of the Lost, a novel which tells the hidden story of immigration and the Arab Spring. Barakat herself feels despairing about her country and feels it must die before new life can emerge. Millions of people have been, and still are, on the move, going to extraordinary lengths to escape from the country they love, and the book explores the complexity of human nature, and the mechanism of violence. She tries to zoom in on the violence and ask: Where does it come from? Even the most monstrous of characters, the torturers and murderers, have their soft spots, she says.
Surely a most timely book in a week that has seen the Taliban take over control of Afghanistan and yet another wave of desperate people seek to flee from their homeland. Who can fail to be moved by the horror faced by those living under brutal regimes, and the perils they face attempting to find asylum in foreign lands?
Another challenging session on a similar theme had three writers – Leah Cowan, Julian Fuks and Abbas Nazari – talking about hostile environments and refugees and exile and immigration, exploring the themes of inter-connectednes and the senselessness of borders. Nazari was a 7 year old Afghan refugee twenty years ago, who has made a name and life for himself in New Zealand, and he too very much brought alive the impact of what’s happening in his country today.
Heart-wrenching topics explored through writers who are prepared to dig deep into trauma and tragedy.
Our NHS – what’s it worth?
Well, I don’t know how you feel about the proposed pay rises for NHS workers announced last week, but for me there’s an uncomfortable mismatch between the plaudits and superlatives and clapping during lockdown, and the value of the suggested tangible ‘rewards’ now. These people who save the lives of strangers, and treat our sick neighbours, and care for our children and our grannies, and keep vigil with our dying, are demoralised, exhausted, burnt-out, and now feeling undervalued.
I’ve recently shared on this blog several new publications about life on the frontline written during the pandemic, but I wanted to remind myself of the commitment and dedication health care practitioners always show, day after day, year after year, so often unseen and unsung. 
So, I turned to an old book on my shelves written long before anyone had ever heard of Covid-19 – A Paramedic’s Diary: Life and Death on the Streets by Stuart Gray (2007). Gray – who hails from Glasgow originally – came to the health service relatively late, having been a professional musician, dabbled in business and computers, and completed a three-year stint in the Royal Army Medical Corps, and he brings an interesting perspective to the experiences he relates.
You couldn’t get much busier than the streets of London, and I’ve often wondered how on earth service vehicles ever get to the emergencies there. London is Gray’s stamping ground, but far from lamenting traffic issues, he concentrates on the human obstacles to delivering the care he’s trained to administer: ‘ignorant time-wasters’ he calls them, who stop him from saving other lives.
People who dial 999 …
for a broken fingernail,
or for help to wrap Christmas presents,
or to move furniture because the feng shui isn’t right,
or to be helped to their bed (because they’re vastly overweight).
You couldn’t make it up!
Then there are the hoax callers who attack or abuse the crews when they turn up, the drunks who have to be removed from buses or out of the gutter, the drug users and any of their cronies who might be lurking in the shadows with malicious intent.
Not many of us joined this profession desperate to wade through as much drink, vomit and stupidity as we could. Most of us are here to care for people who really need it, not selfish self-harmers who go out of their way to blitz the system with their lifestyle problems.
My colleagues and I stand in the wasteland of other people’s lives and watch as they destroy themselves in a bottle.
At the other end of the scale he cares nothing for the inconvenience or danger if the call is legitimate. His commitment shines through as he describes the awesome responsibility of attending a birth, of comforting a mother with a dead baby, or dealing with someone traumatised by a miscarriage. He’s even been known to weep himself once he’s back at home re-living the emotion.
He’s moved by the poignancy of scenes of normal everyday activities like shaving or getting dressed or going shopping – activities which will now never be undertaken because the person who intended to do these things has suddenly left this world. He grieves, not only for the lives cut short by sudden medical catastrophes or accidents, but also for the relatives whose lives have been irrevocably changed in an instant.
Experience has taught him that much can go wrong with attempted suicides. He’s seen at first hand the mess of a botched job, or an incomplete death under a train or a bridge or at the end of a rope. He’s sat alongside people who’ve witnessed suicides, traumatised beyond coherent speech. And he’s all too aware of the risks to paramedics of electrocution, or crushing, or being trapped. To this day he refuses to stand near the edge of a station platform, all too aware of the possibility of being accidentally pushed (I thought I was alone in this obsession). There are enough dangers already in his job.
The hours are long, meal breaks often missed, the pay not commensurate with the tasks undertaken.
EARLIES. Shifts which start at 6.30am, or 7am. They usually present a slower start because people are not yet up and around so they aren’t trying to kill themselves by falling, crashing, running into brick walls, arguing with their drunk neighbours or mainlining speed. You get to see daylight and it’s safer than working late at night. You might even get breakfast.
These are the everyday incidents that make up the working lives of paramedics. Highs and lows, successes and failures. Sights and smells – ‘outrageous’, ‘hellish’ – that few of us could tolerate. But Gray has had his moments of high drama too. He was part of the massive emergency response to the 7 July 2005 (7/7) terrorist attack when three bombs exploded on three separate tube trains, and a bus was blown up in Tavistock Square (medical colleagues of mine were yards away from this one so it’s vivid in my memory). As fast as they could ferry critically ill patients to hospital, the paramedics were sent back out again and again to carry more casualties. ‘It felt like a war zone.’ Some were risking their own lives, alongside the police and firefighters, to get to the injured and dying deep underground.
In spite of it all, the good, the bad and the ugly, Stuart Gray loves his job. It’s ‘almost addictive. It gets under your skin.’ It’s ‘exciting … varied … allows me the honour of walking across a stranger’s threshold and into their private lives.’
What kind of pay rise do YOU think such professionals deserve? And the nurses and doctors who continue where the paramedics leave off – dealing with the vomit, the faeces, the blood, the brain matter, the human emotion, the abuse, the violence, the massive responsibility, the guilt, the dread? What are these amazing people worth?
Decision making on the Covid frontline
Jim Down is an anaesthetist and intensivist in University College London Hospitals. He was working as a consultant there when the Covid pandemic hit this country, and in his book, Life Support, he has captured the slowly emerging horror. We all know so much more about it now, but back in March 2020, not even those at the front line were fully up to speed with what was required. Reports were patchy and conflicting; provision was far from satisfactory; knowledge rudimentary.
By his own admission, Jim Down is a worrier, so what should he do in the face of this emerging crisis? Should he go home to his young family? Should he visit his elderly parents? How close should he get to people? Should he wear a mask? In many ways he felt safest at work protected by layers of suffocating PPE.
I confess, the work of an anaesthetist is much more far-reaching than I was aware of. (Apparently 50% of the country still believe they aren’t doctors!) But in reality, as Dr Down says himself, there are few departments anaesthetists don’t support in one way or another. And throughout the pandemic, it’s been the tribe of c11,000 anaesthetists around the UK who have been vital to the Covid response, converting all available space into fully-functioning Intensive Care Units in record time, delivering care to eye-watering numbers of patients, and designing protocols for some of the most dangerous procedures.
Amongst his other responsibilities Dr Down was given ethics to oversee. Forgive me if I home in on this aspect of his roles – it’s part of my personal raison d’etre, as you know. He set up a ‘three wise people system’ for all major and controversial decisions, and established an Ethics Group for the Trust. But questions and dilemmas presented at every level.
The cost of a day on ICU is approx £1700; what benefit does that need to accrue to be cost-effective? What constitutes a meaningful quality of life? When does a therapy become futile? What risk/chance of disability or suffering makes life not worth living? What constitutes meaningful life? Who decides? When resources are stretched beyond capacity in a pandemic how do we compare relative benefits between patients? All questions that haunt medical practice, but with Covid there were three new crucial differences from the normal balancing acts: the sheer number of patients, the flimsy knowledge of this new disease, and the unusual speed with which decisions might need to be made.
Ethical dilemmas presented too around how far to go, when to stop, when to call family in, in situations where so much was unknown. Then there was the matter of how to effectively deploy limited resources – equipment, drugs, people. The staff themselves were suffering from emotional and physical exhaustion, giving them a diminished capacity to empathise with others, poor concentration, irritability, feelings of helplessness, frustration. Not a good foundation for making sound judgements – thereby increasing stress still further.
Dr Down himself adopted a benchmark: What would I do if it was my brother, sister, mother, father, wife, child? It felt like as good a test of a decision’s rigour as he could muster.
But the personal toll was colossal; the work loads unprecedented. One trained ICU nurse to up to six patients instead of the usual one! One consultant to 42 patients. Teams of medical students and surgeons roaming the units twice a day just to turn people from supine to prone or back again. So much was unknown and unknowable. The patients were extremely sick, for a long time, very fragile and unpredictable, and denied family support. With no simple solutions, very few fixed protocols, the staff constantly questioned themselves, worrying about the repercussions of what they were doing.
We are all acutely aware that something could go wrong for any of us at any time. When it happens to a friend we are reminded of our vulnerability.
They were caring for
the biggest cohort of the sickest patients we’d ever seen, and we were desperately trying to work out how to manage them.
And at times they were treating their own frontline colleagues. Sobering indeed.
This book captures the everyday reality, the swing from the sheer mundanity of meetings and conversations at one end, through the anxieties that proved to be damp squibs, to the overwhelming responsibility of far too many competing demands, the crises at all hours, the inability to support everyone all the time. The frustration of insufficient staff or equipment to carry out the fundamental tasks. The constant questioning.
It underlines the enormous debt the whole country owes to the key workers who bore the heaviest burdens for us all.
Sobering realities from the Covid-19 frontline
I love the idea of a story about a detective hunting lost triangles! A man whose imagination conjures up that plot for his children has my ear!
A doctor who lets his small daughter paint his toenails lurid colours during a pandemic and leaves it on – It’s a little piece of home to take to work, a talisman to protect me and a token to remind me – gets my attention.
One who’s fearless enough to spell out unpalatable facts about our health service in the face of repeated political assurances of world-beating everything, gets my vote.
And when that medic is so incensed by the government’s spineless response to Special Advisor Dominic Cummings’ blatant disregard for instructions to the nation during lockdown, that he tweets a photo of himself in full PPE, stating that if Cummings doesn’t resign, he will, and then does so, has my heartfelt respect.
That man is Dr Dominic Pimenta, Specialist Registrar in cardiology. His story in Duty of Care begins in London in January 2020, when he becomes increasingly aware of a tsunami of disaster heading this way. It’s the stuff of his nightmares.
The book is certainly not comfortable reading. It exposes a stark picture of our country woefully lagging in health care provision:
The simple numbers are so bad they speak for themselves; at present, we have the worst A&E waiting times on record, the worst operating waiting times and the worst record on hitting targets. Even life expectancy is on the decline. We are short-staffed by a figure of around 100,000 staff, including 40,000 nurses. We also have one of the lowest number of critical care beds, general hospital beds and doctors per head of all the 37 countries in the Organisation for Economic Co-operation and Development (OECD). If we were an army, we would be a band of bedraggled, starved and exhausted soldiers. And that was all the case before any sign of coronavirus.
Now, I must confess that I personally have a lot of sympathy for our leaders trying to steer a course between many competing demands, balancing livelihoods against lives, damned if they do, damned if they don’t. It’s all too easy to criticise from the sidelines, or with hindsight. I cringe watching opposition MPs constantly carping about the decisions of government, knowing full well they aren’t going to be held accountable themselves. But this man, Dominic Pimenta, is a medical practitioner, and he had his eyes wide open from the outset. He isn’t scoring political points. So when he catalogues a litany of failings – incompetence, mendacity, lack of transparency, disregard of WHO advice – which have led to thousands of people losing their lives, thousands losing loved ones, thousands developing serious health problems, thousands having vital treatments postponed, thousands suffering serious mental ill health, then we ought to sit up and take note. These are desperately serious consequences indeed.
We could see the pandemic unfold, in high definition, live, 24/7, before our very eyes. And yet, for too long, we did nothing at all.
But in spite of his acute awareness of the true picture, shining through is his pride in the NHS: they responded magnificently to an overwhelming situation. He outlines convincing detail of their titanic struggle, their frustrations, their failures, as well as their triumphs and heroics.
With the right mindset, we are capable of incredible things.
Amen to that.
His own personal energy and determination to make a difference are exhausting to contemplate:
– writing articles spelling out the coming danger
– tweeting analysis and warnings
– publishing in the national press
– appearing on live TV shows
– campaigning for change
– garnering signatories for public appeals
– establishing a charity, HEROES, (now rebranded as Healthcare Workers’ Foundation) for the protection and support of healthcare workers
– attracting celebrity support
– designing prototypes for PPE (personal protection equipment)
– setting up a second organisation, SHIELD, to bring industry leaders and experts together in the creation of innovative solutions to meet the demand for PPE, including cutting edge ‘printing hubs’ …
all while working as a clinician way outside his own comfort zone – at the frontline in ICU – and trying to be a husband, father, brother, son, uncle, friend, in unprecedented times. His manic activity leaves one fearful for both his mental and physical health, but as he says himself, the problem was so vast, it would never feel as if any level of effort was enough.
In Duty of Care he leaves the story at the end of the first lockdown, knowing a second and possible third tsunami are coming. Since he published it, we have all entered that predicted second wave and are dealing with its consequences right now. This week the death toll in the UK passed 62,000. I feel fairly confident we’ve not heard the last from this extraordinary ma, but I leave you with his own parting shot:
So stay informed, stay safe and be kind.
Ethical challenges – did anyone press the pause button?
Well, the world may have been on pause this year, but ethical issues have still raised their heads above the parapet periodically. However, I suspect most of them were lost in the cacophony of sound relating to the pandemic, so to illustrate, I’ll share a selection from the past three months up till yesterday.
December
Sweden’s gymnastic federation has now ruled that young athletes under the age of 18 will be able to train and compete as whichever gender they choose to identify as. They will not need to provide a doctor’s endorsement or any evidence of gender dysphoria.
Following a landmark High Court ruling, in the UK, new guidelines have been introduced by the NHS that make it necessary for children with gender dysphoria to obtain a court order before they are legally allowed to take puberty blockers. It is felt that under 16-year-olds are highly unlikely to fully understand the long-term risks and consequences. However the Tavistock and Portman NHS Trust which runs the UK’s only gender identity development service has said it will appeal against this ruling.
`November
New euthanasia rules are being introduced in the Netherlands – a country already known for its liberal social attitudes. Doctors will now be permitted to spike patients’ drinks before lethal injections are administered, in cases where it’s impossible to obtain informed consent from a person with an advanced directive who has already expressed a wish for help to die when the time is right, but who might resist the final act. The change comes in the wake of a court case where a doctor in a nursing home secretly slipped sedation into coffee for a lady at an advanced stage of dementia. Opponents of euthanasia are understandably alarmed by this widening of the limits in the medical code.
The English Health and Social Care Secretary, Matt Hancock, spelled out confirmation that travelling abroad for assisted dying constituted a legitimate reason to break lockdown restrictions.
It was an accidental error that led to the Oxford/Astro-Zeneca vaccine against Covid-19 reaching 90% efficacy. About 3000 of the more than 20,000 volunteer trial participants had been given just half the dose they should have received according to the research protocol. The ‘correct’ dose achieved just 62% efficacy. A serendipitous result. And a lucky break for whoever was responsible for the mistake!
October
The Dutch government approved plans to allow euthanasia for terminally ill children under the age of 12 who are suffering hopelessly and unbearably. Objectors see the thin end of the wedge visibly widening.
Legislation to allow medically assisted death was passed by the New Zealand parliament last year, but lawmakers delayed implementing it until the public had had their say in a referendum. Under this law, the End of Life Choice Act, a mentally sound adult who has a terminal illness with a life expectancy of less than six months, and who is experiencing unbearable suffering, can request a fatal dose of medication. New Zealanders have voted overwhelmingly to legalise this, which means the measure will now pass.
An angry backlash developed when the Women’s Prize for Fiction opened up its eligibility criteria to include transgender women.
Six consecutive days of protest followed a near-total ban on abortions in Poland by the constitutional court. A country of 38 million people, Poland already has some of the most restrictive abortion laws in Europe, and an estimated 80,000 – 120,000 Polish women travel abroad for terminations or seek illegal abortions each year.
The English government has been keen to make the process of applying for a Gender Recognition Certificate kinder, cheaper and less complicated. As part of a drive for greater equality, the Women and Equalities committee are in the process of examining whether the currently mandatory diagnosis of gender dysphoria should be dropped from the legal process of transitioning, whether transgender people should be required to live in their preferred gender for at least two years before formally transitioning, and how their rights can be better supported.
As it stands, parents in this country are allowed to terminate a pregnancy where the fetus has Down’s syndrome, at any point up to full term. Three adults with Down’s Syndrome are now launching a landmark legal challenge to the Government’s abortion legislation on the grounds that it makes them feel they shouldn’t exist and would be better off dead.
A former Public Health England medical director, Professor Paul Cosford, had never wanted to be a supporter of assisted dying, but after developing incurable lung cancer himself, changed his view and bravely declared his hand in the BMJ.
A poll of 29,000 BMA members found – for the first time – that a majority were in favour of medical professionals being able to prescribe life-ending drugs. The BMA’s position currently is that they are opposed to assisted dying.
A Dutch fertility doctor has been found to have fathered 17 children during the 1980s and 90s, with women who thought they were receiving sperm from anonymous donors.
September
After President Macron turned down his personal appeal for euthanasia, a Frenchman in his fifties, Alain Cocq, suffering from an incurable condition where the walls of his arteries stick together, announced he would refuse drink, food and medicine, and live stream his death. However Facebook said it would block this being broadcast on its forum. M Cocq subsequently said he had lost capacity for the fight, it was too difficult, and he accepted palliative care.
Last year staff at the Gender Identity Development Service raised serious concerns about safeguarding issues relating to the use of inhibitors and the speed or referral for treatment for young people. It transpired that England’s only NHS gender clinic for children knew about recommendations for puberty blockers from an internal review carried out 15 years previously, but failed to implement them. An independent review into these services is underway now to improve access to and delivery of support for these young people.
Who knew there were so many, huh? I shall never be short of material for my novels!
Stress busting!
I’ve been reminded all over again this week of the importance of books in the nation’s health; never, I suspect, has that need been greater than now when a pandemic is threatening our very foundations and security.
It’s been an uncharacteristically stressful week in my own little world, most of it stemming from the vagaries of technology. Frightening how much we depend on the internet and all things electronic in our everyday lives, isn’t it? Being without connections feels like working with one and a half broken arms.
But I know that my personal stresses are as nothing compared with those of countless others during this time of Covid. The BBC wheeled out some big guns in the world of psychiatry during the past few days, who all tell us about the abnormally high incidence of worrying symptoms for mental illness, symptoms sufficiently serious to warrant medical intervention under normal circumstances.
Well, I’ve always been acutely aware of the fine dividing line between normal and abnormal when it comes to mental health. I rapidly but determinedly side-stepped psychiatry in my training, even though the way the mind works and its link with physical health fascinate me. And I’ve never forgotten the patient who first alerted his family to pathological disease when he started cutting his sausages lengthwise … but that’s another story. This week, when things started unravelling for me, it was time to segue into active stress-management mode.
Aromatherapy, mental puzzles and games, exercise, relaxation techniques, helping others less fortunate … the whole gamut came into play. And breathe … And relax …
But of course, books remain one of my main go-to resources. There’s nothing to beat losing yourself in another world. And in this context all I need is something unexacting but gripping. Time to turn to a tried and tested author: Harlan Coben.
I have a stack of his books on my shelves for exactly this kind of situation; these are just a selection, collected over many years. First off the shelf was Run Away.
First page, opening paragraph …
Simon sat on a bench in Central Park – in Strawberry Fields to be more precise – and felt his heart shatter … he stared straight ahead, blinking, devastated …
and I’m already asking who, what, why, when?
His once lovely daughter Paige – who ran away from her comfortable, professional, stable, ordered family life, to shack up with a criminal and wallow in addiction, has been seen busking in that very park where Simon sits with his heart splintering into fragments. Watching her. He’s appalled by what he sees: a malodorous, strung out bag of bones with matted hair and yellow teeth and a cracked voice. Trickster, manipulator, thief. And that encounter leads him deep into the dark and dangerous underworld that swallowed her up – guns, violence, murder, drugs …
because if someone hurts your daughter, a father has an obligation to stop him, no matter what.
But when the man who took her to this hellish place is murdered, Paige vanishes. He’s lost her again.
A second plot line shows a series of young men being targeted and killed. Why? What’s the connection? I twigged the ‘what’ by P167, and the ‘who’ by P194, but not the ultimate ‘why’… P319. Kept me turning the pages. Better still, it crept close to my own field of interest – genetic inheritance, infertility, adoption, ethics … now you’re talking my language!
And all the threads don’t fully come together until the epilogue. The work of a devilishly clever mind. And balm to my troubled one.
Sweets or brussels sprouts?
We … read fiction to learn about what we don’t know and to recognise what we do.
To feel less alone. And we share fiction, in online and physical book clubs, sometimes to find a way to discuss those issues we are struggling with in our everyday lives – and at other times to get as far away from them as possible.
Discuss!
No, this wasn’t really on an exam paper, but in the official journal of the Society of Authors: The Author.
It’s a complete joy to read these productions, every article beautifully written and relevant and helpful, but this particular quote made me pause and reflect on the hundreds and hundreds of books on my shelves and why I a) chose them and b) read/will read them. I’ve given away more of my personal library this year than ever before, partly because the pandemic has meant more time for folk to read books so I’ve shared mine, and partly because many found their way onto the bookcase we put out during lockdown.
It’s terrific news that the nation has turned so wholeheartedly to reading. Apparently online sales of books surged fourfold with an estimated 41% of the population in the UK – both more in number and almost doubling time spent devouring them. Wahey!! And the notes we received from users of our bookcase showed how vitally important books are to mental health.
I loved the observation made by Waterstone’s Children’s Laureate Cressida Cowell: every single primary school needs a well-stocked library, where the stories are ‘modern and exciting and relevant to children’s lives, like sweets, not brussels sprouts‘!
For adults, of course, we need a very mixed diet. Sometimes it does us good to have a sour taste left in our mouths; sometimes our teeth need to be set on edge; sometimes we need to persevere to educate our palate. Writing about difficult issues – mental illness or suicide or sexual abuse or body dysphoria or death or whatever – can hardly be described as sugar candy, and I’m all too conscious that many of my own novels are not mugs of decadent hot chocolate for bedtime. Indeed, I select with great care when I send any of them to people with vulnerabilities. But opening up healthy dialogue about subjects currently shrouded in myth and taboo and isolation and misunderstanding, is wholly desirable. And sometimes fiction can reach the parts and the consumers better than more formal texts … provided care is taken. I was much impressed to hear that the Society of Authors has been working in close collaboration with the Samaritans and recently issued a set of guidelines for authors writing about suicide or self harm. Brilliant. It would be so so easy to get it wrong.
So, let’s hope the habit of reading acquired in this difficult year of Covid-19, becomes a bonus that continues way beyond the pandemic.
Girl, Woman, Other
Did you know that last Thursday was ‘Super Thursday‘? – that day in the literary calendar when there’s a bonanza release of new books in time for Christmas. And this year, because of Covid-19 significantly delaying publication for authors across the board, as many as 600 new titles were released in 24 hours. 600! In one day!! SIX HUNDRED!! What hope is there for mid-or-below-mid-listers to be even noticed, huh? About as much as for a youngster with three C-grades-on-the-basis-of-teacher-assessment getting into Oxbridge, I’d say.
Seemed like a good week to home in on one title that has made the grade, big time: Girl, Woman, Other by Bernardine Evaristo which I mentioned in my post two weeks ago – co-winning the Booker Prize with Margaret Attwood‘s The Testaments. Evaristo is the first black woman ever to achieve this distinction, and she comes across at interview as a bundle of energy and zeal and determination. Positively effervescing! Given the high profile racial issues have been receiving of late, it could be argued that this book – its subject matter and its author – must surely be falling into fertile soil.
Girl, Woman, Other is Evaristo’s eighth work of fiction, which took her six years to complete. It’s written in a hybrid form that falls somewhere between prose and poetry, without capital letters or full stops for sentences, or proper paragraphs, line breaks being used to control rhythm and beat. Sound confusing? I know, and yet … it’s very readable (says this Booker Philistine with wonder in her voice). Here’s a wee peek inside …
The novel follows twelve characters, most of them black British women, moving through the world in different decades, from different backgrounds, having different experiences, making different choices. Each character has her own chapter, but their lives overlap and they are all interconnected in some way. Some of them are close – friends, relatives, lovers – others simply visit the same theatre on the same night. But common threads pervade their stories: oppression, prejudice, discrimination, racism, injustice, sisterhood. Which come in all shapes and sizes. Typically of literary books, there’s no real plot, but the characters challenge the reader to consider British attitudes and practices towards black women through the ages, and more importantly, one’s own prejudices and preconceived ideas.
The primary character and lynch-pin is probably Amma, a black lesbian playwright, now in her 50s, whose new play is being produced at the National Theatre in London. Her vignette starts the book; her after-play party almost concludes it. This part of the story is semi-autobiographical: Evaristo was co-founder, with two other women, of the Theatre of Black Women in the early 1980s. In between, we meet eleven other characters who range through frustrated teacher, abused partner, sassy teenager, nonagenarian farmer, non-binary person, adopted waif, and so much more besides.
Did it work for me? On one level, yes. I found the unusual writing style surprisingly fit for purpose. The characters come alive through their patois/pidgin, their disjointed paragraphs, their learned experiences over time. I especially enjoyed Carole, a Nigerian girl who rises above her circumstances – poverty, gang rape at 13, schooling in an establishment that specialises in producing teenage mothers and early career criminals – to acquire a degree at Oxford amongst future prime ministers and Nobel Laureates, and goes on to set the world of finance alight. And yet still finds herself overlooked and suspected. Then there’s her indomitable mother Bummi, determined to make a success of life against the odds, setting up her own very professional and superior cleaning services company, gradually accepting her daughter’s steps away from her African heritage, but herself accepted by the young English high society man Carole marries. I couldn’t help but take to the sassy teenage LaTisha, the queen of backchat, spouting her unique brand of philosophical wisdom and researched facts, all the while emoting pure insolence – a special skill of hers according to her teachers. And I really took to Hattie, 93 years old, a great great grandmother, still living alone and running the family’s 800 acre farm, outspoken about modern hifalutin ideas like mobile phones and non binary identity and central heating.
But for me, their brief biographies lacked a certain overall depth, and I’d have liked more development of their individual and collective stories. That in itself is a remarkable reflection. Booker Prize winners usually leave me shrugging my shoulders and saying, So what? This one left me wanting more. I’d call that a success.
Viral overload
A surprising number of people have asked me when I’m going to write a book about a pandemic – however, word on the writerly circuit is that this would be ill-advised… for a long time. And it’s certainly not on my radar. But OK, the current pandemic has been uppermost in our thoughts for months, so I thought I’d look at a couple of modern novels written way before this present real-life Covid-19 crisis reared its ugly head, and see what a lively imagination can come up with.
Peter May‘s 2003 novel, The Runner, features endogenous retroviruses. What viruses, do I hear you cry? Viral remnants found in every cell, an integral part of the human genome, normally dormant, but occasionally activated by external viruses and capable of causing catastrophic damage and the emergence of very dangerous diseases … sounding familiar?! In this case, though, it’s the musculature of the heart in young, fit, elite athletes, causing thickening of the walls of arteries, and heart attacks, which the pathologists are finding.
Section Chief Li Yan smells trouble when he sees a succession of such deaths among top athletes in China. Initially they appear to have been involved in accidents or suicide, but something sinister lies beneath the facade. They all reveal strange pathologies at autopsy, and all except one have completely shaven heads. Li has been protecting his pregnant American fiancée, Margaret Campbell, for her own sake and the well-being of their unborn child, but such is his disquiet, that only she will do for post mortem examinations on these young sportsmen. In the event, infection is the least of their worries, as they become embroiled in a far more deadly and macabre race against the evil genius behind these deaths.
And once again I’m hugely impressed by May’s careful research and ability to convey complex science – this time in the world of medical genetics – convincingly and understandably.
The other book just had to be Lockdown, again by the same author, and released this year. He actually started researching for it way back in 2005 – fifteen years before this current real-life pandemic. At the time he was finding it impossible to find a publisher for The Blackhouse (hard to believe, huh?) and his first Enzo book.
But May’s vivid imagination had conjured up a chilling scenario that arose out of his fascination with viral epidemics. He wrote furiously during six weeks, burning the midnight oil – only to find no one would touch it; it was too unrealistic and improbable. But when the current virus we’re familiar with hit this year, the novel was picked up by Riverrun and came out while the author was himself hunkered down in his home in France, forbidden from leaving his home except in exceptional circumstances – because of Covid-19.
London is at the epicentre of a global pandemic. It’s in lockdown. A deadly virus – with a mortality rate of nearly 80% – has already claimed the lives of hundreds of thousands, and the health and emergency services are overwhelmed. Familiar jargon, huh? Family funerals and religious services are banned, grief is on hold, bodies are burned within twenty-four hours. The prime minister and two of his children are among the dead. An emergency measure has been brought into force banning the printing and distribution of newspapers. Civil disorder is simmering, ‘the debris and detritus of a once civilised society scattered across the ruined streets‘, and martial law has been imposed. Soldiers are prepared to shoot on sight anyone who breaks the curfew.
A temporary overspill facility is being rapidly built, until, that is, the construction workers discover the body of a murdered 10-year-old child in the pit they’re excavating. Because of a dire shortage of policemen, DI Jack MacNeil is called out of hiding in a refuge for down-and-outs to solve the case as fast as possible so that building work can resume. This is no ancient crime scene: the bones of the child – who is Chinese and has an unrepaired hare lip and cleft palate – are still fresh, and what’s more, they’ve been recently stripped of flesh by a knife. Enter the experts – except some of them are sick with the virus. And on top of all this, MacNeil learns that his own young son has died of the flu. He throws all his energies into finding the killer of this little girl, a last hurrah before he leaves the Met for good.
In both books there are elements that raise an eyebrow when it comes to believability, but my mind raced off along different possible scenarios for future novels. However, more than that, May’s experience illustrates two salutary things for me. There is a time to publish and a time to refrain from publishing. And even the top names can hit fallow times.
PS. I was amused by one throw-away line in Lockdown: ‘no self-respecting looter was going to be seen dead breaking into a bookshop‘ …!!!