Hazel McHaffie

domestic abuse

Everything that Makes us Human

I rather think the book I’m going to talk about today will always have a special significance to me. I began reading it on the last morning of my sister’s life. For the previous two days and nights my whole concentration had been on her needs, being there for her, but on that last morning she was perfectly at peace, breathing shallowly but evenly. I could finally relax and just be alongside her – so relaxed about her indeed that I reached for something to do. This book was in my bag. I didn’t get far, but it will always have that association. And it turned out to be entirely the right book for the moment.

The book? Everything that Makes us Human: Case Notes of a Children’s Brain Surgeon by Jay Jayamohan, a paediatric neurosurgeon.
He operates on children who have strokes (amongst other things, of course); my sister’s stroke was not amenable to treatment.
He has a huge respect for that which makes a person human; she had true humanity in spades.
He is a remarkable person; so was she.

Operating on brains and spinal cords is as scary as it comes, but doing so on babies and children is beyond my imagination. The stakes couldn’t be higher.
With each clean strike I inwardly breathe a sigh of relief. But if anything it only piles on the pressure. Each next movement seems to carry more danger, the greater likelihood of an accident.

Simply reading about some of the cases Dr Jay describes, produces tension in my jaw and shoulders! Navigating a way through bone to the centre of a child’s being, risking paralysis, loss of cognition, death, for a ‘tiny mite’ so small her total blood volume equates to a small glass of wine, he’s afraid to even move his head to look at a scan … how do you ever dare to try? Talking to his child-patients, informing their parents, coping with disappointment and guilt … it takes a level of courage and confidence way beyond most of us mere mortals. Some children need multiple operations over years and years, and each must be meticulously planned so as not to screw up the prospect for later procedures. Hugely impressive stuff. But this frank and honest book underlines the human frailty of every surgeon: as he says, every ‘failure’ keeps you grounded.

He is hugely sensitive to the pain of the whole family.
Left to my own devices, I could wallow in the hell that is explaining [the tragic options available] … But I need to remember that whatever anguish I’m feeling is nothing – nada – zero – zilch – compared to the turmoil I’m about to inflict on two unsuspecting people.

I won’t lie to them, I won’t sugar-coat the truth. I will, however, go out of my way to deliver it with the softest of velvet gloves at precisely the optimal time.

He’s ‘a little bit broken himself with each telling of bad news. And when he was forced to override a father’s determination to keep his ten-year-old son alive at all costs, he felt it keenly:
… this poor man was in probably the worst place anyone could be. About to lose a child. I see it all the time, but it never gets easier. It never stops piercing my attempts to protect myself from my work, like tiny little stab wounds that will no doubt eventually do me in. I am laid bare every time I have the conversation. In fact, I’m not ashamed to say that I have wept while correcting this chapter, just remembering this man.
What humanity!

He’s acutely aware of the finely nuanced choices that must sometimes be made. Especially when it comes to deciding when enough is enough.
There’s no point in saving a child’s life if she has no life worth living afterwards.
(Precisely what I protested on behalf of my sister.)

Would the patient prefer five years of a quality, ‘normal’ life, knowing there’s a clock counting down somewhere, or would you rather have decades longer but with severe impairment?

Would the parents prefer me to try to remedy this situation with all the risks and uncertainty that entails, or would they prefer to have precious time with their child as he is, knowing that time will be short?
Questions very much in my territory.

What’s more, this skilled surgeon cares not only for medical success, but aesthetic results. He wants the patient ‘to be able to walk around a supermarket and hold her head up’ – the so-called ‘Tesco test’. He wants them all to be well-adjusted happy people irrespective of the time they have left.

As if this weren’t enough to bear, this remarkable man has taken a keen interest in another phenomenon that few of us would choose to tackle: domestic abuse. When a child presents with serious head trauma and the history simply doesn’t add up, his antennae quiver. He isn’t always right, and he acknowledges that. Over time he’s learned both patience and caution; it’s a massive responsibility to remove a child from their parents. Some neurological disorders can mimic abuse. It’s so easy for us amateur armchair critics to malign the social services for neglecting to heed warning signs, but everyone can be more certain with hindsight. As Dr Jay’s mentor told him: It’s not a world to enter lightly’.

Perhaps unsurprisingly Dr Jay does medico-legal work too. He’s called in as a medical expert witness – a neurosurgical one, and there aren’t many of them about! But he’s exactly the kind of expert I’d want on my side, fighting for my cause. Indeed I’d have liked a Dr Jay-look-alike around when I was fighting for my sister’s best interests, just as he fought for some of the babies in his care. (There’s a particularly moving case in Chapter 16 where devoutly religious parents challenged him deeply.) Simply knowing other families have had that reassurance was a comfort to me.

It’s an inspirational story, and there’s a compelling immediacy in the reporting of cases. I loved the clever way each chapter segues neatly into the next. And I felt deeply grateful for people like this who put themselves on the line for others; who truly understand what’s important in life.

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Volunteering … or not

Heroism, self sacrifice, commitment … 2020 highlighted the best in people, didn’t it? Inspirational stories of ordinary folk doing extraordinary things for love of their fellow man. Making a difference. Altruism was very much alive and well.

So why, oh why, were so many generous offers greeted with lukewarm responses and endless obstacles from officialdom? I’ve lost count of the stories of frustration on the part of those who wanted to give their time and expertise in the cause. No response, excessive bureaucracy, endless form-filling, wasted talent. My own experience was no different, so I totally sympathise. And we’re seeing it again, even now, when the situation here in the UK is worse than it’s ever been, the real-life statistics like those of some horror story … thousands of highly-motivated experienced medical professionals, newly retired, wanting to help with the vaccination campaign, but being required to complete umpteen forms, undertake irrelevant courses, submit to multiple layers of scrutiny, put off by absurd caveats. Ordinary, completely unskilled relatives are given crash courses in wielding medical syringes when the need arises, you know!!  They aren’t sent off to do five on-line courses!

Is it fear of litigation, suspicion of intent, lack of knowledge, or sheer administrative incompetence? I know not. But it’s certainly no way to foster goodwill and community spirit, that’s for sure. Nor is it helping to deliver the promised way out of this ghastly pandemic. And I know for certain some volunteers have given up the unequal struggle and sunk back into retirement, disillusioned and unfulfilled. OK, rant over.

Of course, in the total scheme of things it’s a small gripe. You only need to see pictures of starving women holding newborn babies in war-torn Yemen, or exhausted health care workers in tears in our overstretched Intensive Care Units, or the battered and bleeding face of an abused woman running down the street clutching her terrified children, to see there are bigger battles to be fought. But in my enforced isolation, faced with yet another unnecessary form to fill in online, this one is currently raising my blood pressure and focusing my reaction to so much that’s been badly handled in this public health crisis.

And please don’t point me in the direction of the bunch of folk (note restraint!) who deny the very existence of COVID19. My answer to them is:
We have just the job for you at least! Ideal. Tailor made. Transporting patients, attending to their personal toileting, disposing of their waste, cleaning their surfaces, carrying out the dead. In a COVID ward.
You’ll save the NHS a fortune in PPE because you won’t need it; you don’t believe it’s necessary. You won’t need any counselling or stress management or time off isolating. You’d be perfect for purpose.

Thank you, yes. How soon can you start?



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Behind Closed Doors

‘Behind closed doors’ … a familiar slogan, isn’t it? Instantly conjures up the horrors of domestic violence, abuse, and pathological relationships. And too often it’s women who are caught behind those doors, unable or unwilling to seek help, putting on a brave front for the outside world. So it seems like a fitting subject for a week that began with International Women’s Day on March 8th. The flags have already been raised: the Duchess of Cornwall calling for the topic of domestic violence and coercive control to be openly discussed, warning of the corrosive effect of silence; then the Duchess of Sussex using her last solo public platform before she retires from royal life to urge people to respect and value women. So let’s capitalise on that foundation.

Put the same term – ‘behind closed doors – into an Amazon book search, and instantly six titles of novels come up. Hmmm. Odd. My first check when I create a new title for my own books is to make sure it’s unique. But maybe ‘behind closed doors’ is irresistible. It’s so instantly evocative, speaking so powerfully, it can bear repetition without losing impact.

Hey ho. I’ve been sucked in, anyway. I already have two of those six ‘behind closed doors’ books on my shelves. The first one chosen because I’ve enjoyed Susan Lewis‘ writing before, and the second because I was – and still am – devouring anything claiming to be a psychological thriller.

Behind Closed Doors by Susan Lewis isn’t, I have to confess, as compelling as others she’s written. Fourteen-year-old Sophie Monroe has vanished along with her computer, mobile phone and a bag of clothes. The Detective Sergeant who’s investigating the disappearance is painfully reminded of a tragedy that tore her own family apart twenty years ago: her teenage sister vanished and has never been found. She struggles to separate the two stories and maintain perspective and judgement, as a tale of jealousy and fear and secrecy unravels. This one, to my mind, is overly generous with adjectives in places; all the characters seem to have secrets or tragedy in their past; and an improbable number of them have lost children or young parents. So I don’t plan to dwell on that one in this post.

Behind Closed Doors by B A Paris on the other hand, promised a lot. A debut novel billed as ‘makes your blood run cold … fast and frantic …heart-pounding … utterly compelling …’ it fits the basic requirements for a psychological thriller which I can analyse without previous baggage.

‘Grace Angel, wife of brilliant lawyer Jack Angel, is a perfect example of a woman who has it all – the perfect house, the perfect husband, the perfect life.’ So why are there steel shutters on their windows, high walls round their perfect garden, and one window barred? Yep, we’re wary already, aren’t we?

In his professional life, handsome, debonair Jack is the champion of battered wives. Grace has given up her career to be a stay-at-home wife so he doesn’t have to come home to an empty house or an exhausted partner. Losing is not a word in his vocabulary. And ‘everything he does and everything he says is calculated down to the last full stop. He prides himself on uttering only the truth … He is so clever, so very clever.’

Enter new neighbours, Esther and Rufus. Esther is a woman who’s suspicious of perfection. What is it with this completely joined-at-the-hip couple? Why doesn’t Grace have a mobile phone, or have her own email address, or go out to lunch without him, or honour arrangements …?

What really is going on does indeed make the blood run cold. Here is a dark mind, an amoral compass, depravity wrapped up in immaculate manners and a charming devotion. As the past and present inch closer together we are rivetted to the page, willing good to triumph over evil, dreading the psychopath out-manoeuvring the victim. The ending is very cleverly crafted and maintains the suspense to the very last page. Scary stuff but an excellent example of tense and fast-moving plotting.

But behind the fiction, lies the real-life problem. Let’s not forget hidden women everywhere for whom oppression or abuse or injustice in any form is their lived experience.

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Psychological control

I’ve been spending a fair amount of time on train stations of late, and browsing in the book sections on platforms while I wait … and wait … and wait. This week I was struck by the proportion of books in the top 60 which deal with psychology and crime – not just through fiction (there were several of those), but factual books.
Confessions of a Psychopath by ME Thomas
Stalkers by Rachel Cassidy
Talking with Psychopaths and Savages by Christopher Berry-Dee
Talking with Serial Killers by Christopher Berry-Dee
Unnatural Causes by Dr Richard Shepherd

Hmmm. Is this the current trend, d’you suppose/know?

Weirdly enough, I had a book for the journey on Thursday that takes psychological thriller writing to a whole new level. “A wonderful portrayal of psychological obsession at its creepy best’ as one reviewer puts it. The Girl Before by JP Delaney. Creepy serendipity? or just my mind atuned to the subject?

The setting for The Girl Before is an ultra-minimalist house in South Hendon in London: One Folgate Street. Austere, sterile, disciplined. Serene, calm, beautiful emptiness. A mausoleum of a place. Its award-winning architect and owner, Edward Monkford, insists on a huge number of rules – over 200! – for anyone leasing the property: no flatpack furniture, no cushions or rugs, nothing to be left on the floor at any time, no animals, no handrails, no books! …These rules constitute a restrictive covenant, a legal condition imposed on the property in perpetuity. Potential inhabitants must sign documents, fill in questionnaires, submit to being interviewed, before being selected to move in, and undergo repeated ongoing psychometric measurements grappling with intense ethical dilemmas – we get glimpses of the penetrating questions they’re asked throughout the book. Once in, they must undertake to keep the property completely uncluttered and regimented in line with Edward’s exacting standards. And every tenant so far has been a beautiful red-headed girl with determination and intelligence – facsimiles of Edward’s dead wife. Every one a vulnerable woman who has know grief and loss.

I’m always somewhat fascinated by the concept of the unreliable narrator, but it’s a tricky tactic to adopt in reality. This story follows two of the tenants – Emma and Jane – as they attempt to live up to the expectations of One Folgate Street, as they unravel the tragedies and stories relating to their predecessors. Because, for all its outward perfection, the house’s history is dark and sinister. Three people have died tragically – Edward’s wife and son amongst them. And Edward’s obsessive tendencies spill over into his control of the women sexually as well as mentally. He is looking for a pure relationship, unencumbered by convention, with a sense of simplicity and freedom on both sides. When it’s no longer perfect, each must be ready to move on, without regret.

Well written, cleverly plotted, interesting structure, well researched – and a runaway success. It took the author a decade or so to work out how to write the book, but she has captured something very special. It was well worth the wait.

I don’t pretend to be an expert in obsessive perfectionism, but it rings true. As does Delaney’s description of grief and loss, and the emotions around having a disabled child. Not surprising maybe as the author has herself lost a son, and has another one with a rare medical syndrome.

And the poignancy of this book is enhanced further for me by a report out the very day I finished it, about a five year high in the statistics for deaths relating to domestic violence in the UK. There is something particularly sinister about pathological behaviour behind closed doors. And Delaney has captured the essence of it in The Girl Before.

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