pandemic
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.
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!
Peace
Christmas blessings to you all and sincere thanks for visiting my blog
It would be all too easy to simply write ‘Happy Christmas, everyone!’ but I know that sadly this will not be a joyous time for many people. The wretched pandemic continues; lives have been wrecked by tragedy and injustice; mental health has suffered; and so it goes on. Shaky smiles have covered many a breakingheart. So instead, whatever your circumstances, let me wish you peace …
If you are currently facing devastating loss or grief,
may you be given the strength and courage to go on.
If you are caught in a spiral of stress and anxiety,
may you find a way through which guides you to a safer place.
If life is currently good and you have all you need,
may these blessings continue, valued and treasured.
If you are fortunate enough to enjoy a super-abundance of health and wealth,
may you have the wisdom, compassion and generosity to share wisely.
If you are in a position of power,
may you seek the humility and insight
to use it to influence others and effect change for the greater good.
‘Let there be peace on earth and let it begin with me.’
Life after Life
A bonus of lockdown was acquiring ‘new’ books from those donated to our outdoor bookshelf. 
One such was Life after Life by Kate Atkinson, about which I’d seen and read excellent reports. (I’m horrified to discover it’s eight years since it came out, and I’m only now getting round to reading it! Too many books, not enough hours in the day.) But somehow, living in this parallel universe of pandemic for the last eighteen months has made Atkinson’s premise – What if you had the chance to live your life again and again, until you finally got it right? – even more pertinent; so perhaps after all it’s a good time to read it.
The hook on the back cover is tantalising:
During a snowstorm in England in 1910, a baby is born and dies before she can take her first breath.
During a snowstorm in England in 1910, the same baby is born and lives to tell the tale.
What if there were second chances? And third chances? In fact an infinite number of chances to live your life?
An ingenious premise upon which to build a novel, huh? And it challenges us to think, What would I do differently, given the opportunity? Would I even want to change things?
Add to that the time period of the story – 1910-1967 – including two great wars, and the implications of a second chance assume even more momentous proportions.
What if a pretty English girl had shot Adolf Hitler in November 1930?
What if a pretty British girl was actually living in Germany when war was declared?
The historic detail relating to big events gives a solid skeleton to this story, but inevitably some factual accuracy is forfeited in the name of literature, as the author herself acknowledges: To find the truth as the heart of a book, a certain amount of reality falls by the way.
Ursula Todd, born in 1910, is a strange child with odd ‘powers’. Was it reincarnation, or clairvoyance, or deja vu, or living in a parallel universe, sixth sense, or what? Certainly her mother thinks she needs ‘fixing’. A Harley Street psychiatrist does his best when she’s 10, but as she grows up, and bad things happen to her, Ursula persists in wondering if death is the answer; she can then have another stab at life and hopefully a happier ending.
We follow her different lives through her rural upbringing with an indulgent father and a superior mother, adult life in London, during the Blitz, and in post-war Berlin. She goes from knowing child, to rape victim, abused wife, assassin, mistress, rescue warden. Back and forth. At times she doesn’t even recognise herself.
It was, I must admit somewhat discombobulating to live through a traumatic experience of the death of a child or young person, only to have them return later in the book very much alive because an alternative version of their lives is being narrated. Short of cataloguing each iteration, I couldn’t hold them all in my head, so went for simply enjoying the moment.
Something of the challenge underpinning this story is captured in these few lines of dialogue about half way through the book:
‘Don’t you wonder sometimes,’ Ursula said. ‘If one small thing had been changed, in the past, I mean. If Hitler had died at birth, or if someone had kidnapped him as a baby and brought him up in – I don’t know, say, a Quaker household – surely things would be different.’
‘Do you think Quakers would kidnap a baby?’ Ralph asked mildly.
‘Well, if they knew what was going to happen they might.’
‘But nobody knows what’s going to happen. And anyway he might have turned out just the same, Quakers or no Quakers. You might have to kill him instead of kidnapping him. Could you do that? Could you kill a baby? With a gun? Or what if you had no gun, how about with your bare hands? In cold blood?’
For me this book came into its own in the section A Long Hard War, where Ursula is a warden dealing with the aftermath of the bombings in London. It poignantly captures the fragility of life, the human tragedy on both sides, the courage and stamina people can find within them, and the importance of small things.
When asked what the book is about, Atkinson says, It’s about being English. That’s not what I took from it. For me it’s about something much more complex; an unravelling of our multi-layered selves, who we are in our imaginations as well as in different circumstances. And how our destiny can be determined by an accident of birth, or a chance conversation, or a seemingly casual encounter or decision. I’m still mulling over all that … and isn’t that one measure of a successful story?
Caring in a time of Covid
Yes, I know, I know … I went to sessions on this topic at the Hay Festival, and here I am again, attending more of the same at the Edinburgh International Book Festival. Sad soul. But for me it was well worth the element of repetition to hear the important messages spelled out so clearly by those who really know. We do have to learn from the horrors, and now is the time to do so. Just this week our First Minister, Nicola Sturgeon, has announced concrete plans to begin a judge-led inquiry into how things were managed in Scotland, by the end of this year. Sometimes, though, in the face of relentless coverage of the statistics and long term consequences, it can be hard to see beyond the negativity.
The line up of panellists included Dr Rachel Clarke (palliative care specialist and ex-journalist) and Kate Mosse (novelist and unofficial carer of three elderly relatives) again, but joining them was Dr Gavin Francis (Scottish surgeon and GP). The two doctors have both been working actively on the frontline throughout the last eighteen months, and deserved the spontaneous applause from the live audience. But they were quick to identify the reality: caring is a privilege.
Nevertheless, the deficiencies in the response to the impending crisis, and the slowness of the powers-that-be to mobilise appropriate measures to deal with it, did stir their anger. Indeed it was this pent up frustration that led to the books they wrote.
Much of what they said was known to me, but still shocked. And I was horrified to learn that, not only has the number of unpaid carers escalated colossally during the pandemic, largely because almost all official care stopped, but that they were left largely unsupported. As were young people with special needs, and those with dementia. What kind of a price have vulnerable people paid for this failure? The toll on mental health especially has been devastating, as we know.The full consequences will only emerge gradually.
On the other hand, it was heart-warming to hear that frontline workers had themselves been buoyed up by witnessing the best of human nature too. And as Kate Mosse said, it’s what we all want: a society that looks after each other, that cares, that pulls together. Dare we hope lessons will have been learned for next time? Those who work in the medical world seem sure of one fact: there will be a next time. Sobering thought, huh?
It’s been great to be part of this iconic Festival once again, albeit in a hybrid form this year. A big step up from the cancellation in 2020. And I personally salute all the teams working behind the scenes to make it work – almost without a hiccup this time for me! I guess the person who inadvertently broke a connection will be hiding their mortification in a dark corner somewhere. Come out, come out, whoever you are; all is forgiven.
Love, life, death in a time of pandemic
Rachel Clark was a television journalist before training as a doctor – that probably helps to explain her brilliance with words and her laser focus on exactly what happened, and when, in the early days of the pandemic.
Her latest book, Breathtaking, spans the first four months of the ongoing Covid-19 pandemic, January to April 2020. At its peak, during that first wave, a thousand people were dying each day. And every single day the grit and devotion of colleagues astounded her. She says she has never been prouder of, or more humbled by, the NHS and its people, but that doesn’t stop her probing beyond the heroism, the sacrifices, to the core of what went wrong.
She knew it would be impossible, and probably inappropriate, to try to convey her inside experience to non-medical friends and family, so she used her laptop to vent her feelings. Writing became an anchor, helping to distil her fears, a compulsion that took her through the night and into the early hours of many a morning. Looking back over her insomniac’s diary much later she discovered that what she’d thought of as an unrelenting stream of darkness was actually illuminated by pinpricks of light. Acts of kindness and solidarity, altruism and selflessness, resilience and decency, shone through the storms, and they glimmer throughout the book which evolved from her midnight ‘scribbling’.
Rachel Clark graciously acknowledges the public’s generosity and sacrifice in withdrawing from the public sphere, foregoing so much that makes society and relationship valuable, in order to protect NHS resources.
Invisible threads of everyday sacrifice tie the world outside to the one within the hospital.
But from the outset, she and her colleagues watched with growing horror and incredulity, the UK’s casual approach to the coming tsunami … the effects of deficient supplies of PPE … delayed restrictions … the exposure of the elderly and vulnerable to risk … the appalling gulf between public rhetoric and supplies on the ground … the Prime Minister’s defence of indefensible behaviour when his chief adviser flouted the rules he’d helped to devise … And she’s haunted by the sense that we are all complicit in the betrayal; the alarm should have been raised sooner, been more insistent, more strident.
She is shocked too, by the spin put on the tragedy. When the UK had the third highest death toll from Covid in the world, and was the worst hit in Europe, senior government figure were trumpeting ‘success’!
How very cheap, how spectacularly expendable, one human life must be to them if the avoidance of tragedy is consistent with the deaths of nearly 27,000 people.
(Since then, of course, the death toll has risen vastly – currently in excess of 128,000.)
For this palliative care specialist every person, every loss, every family, matters. And in her view, the only reason the NHS was not officially overwhelmed was because so much of its function was suspended. Real people suffered the consequences. Many felt abandoned.
The professional workforce too paid a heavy price. Entering the personal spaces of strangers steeped in the virus again and again involved massive risk.
The Covid ward is humid and restive. We are on the move, no pausing or lingering, with strained expressions and a twitchy hypervigilance that is as exhausting and stifling as the masks we wear. It is all around us, the virus. It coats our clothes, our hair, the backs of our necks, the keyboards we type on, the surfaces we touch. It hangs in the air, it drops on to our shoes, it floats and waits, ready to be inhaled by anyone too unwell to be masked up in a hot zone.
They endured appalling working conditions, worked ridiculously long hours, put themselves through agonising processes. Their own families suffered. Some professionals lived in hotels rather than put their loved ones at risk. Some gave their very lives.
And on top of that they were unable to relate as normal to those in their care.
Kindness, undeniably, is the glue that ensures patients feel safe and hospitals humane.
But now, everything human was taken away – contact, personal details, names, faces, relatives (the cruellest feature of all).
Covid, in short, necessarily compromises every instinct to deliver humane and compassionate care. It violates something at the heart of good medicine – and the cost to the team is profound.
All they could offer from behind the layers and layers of protection seemed …
grotesque, a parody of communication. It could not be less warm, and more wrong.
And even in extremis, as death approached, they could only clutch at the remnants of human contact, to ensure no one was alone for that final stage.
In the end, as death bears down, there is almost no situation that cannot be made better by someone reaching out, with love and tenderness, towards one of our own. What we have, in our grief, is each other.
Rachel’s own compassion and care and humanity, perfect attributes for someone dealing with people at the end of life in palliative medicine, pervade the book. And for her, words are the most powerful drug used by mankind.
No one knows this better than a palliative care doctor. When drugs run dry, when cure is no longer an option, I deal in words like my patients’ lives depend on it. Words build trust, allay fears, dispel myths, inspire hope. They clarify, challenge, encourage and console. Words leap beyond the constraints of masks and gloves and gowns. Titrated carefully, dosed just right, words can take a dying patient all the way from the depths of despair to a place of hope and even serenity … Above all, our word must be our bond.
In the midst of this revelation of the flaws and deficiencies that have characterised the pandemic, the pain, the frustration, the humility, the dedication, glimpsed in this soul-searching book, are themselves evidence of what is right with the practice of medicine. Beyond price, beyond value.
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.
Hay Festival: second instalment
They say authors should wait a decent interval before starting to write about pandemics. Well, who exactly are ‘they’, these authorities who know such things, huh?
Even before Covid struck, Val McDermid had already written a radio play about a scenario where a pathogen appeared which no drugs could treat, so she was way ahead of the game. Didn’t stop her publishing it. As she said: There’s nothing more dramatic than the end of the world as we know it.
She then collaborated with a graphic artist, Kathryn Briggs, to produce a graphic novel based on the play: Resistance. Their discussion at the Hay Book Festival with Louise Welsh about how they worked together, was both insightful and humorous. When Professor Welsh said that no person had been left unchanged by the experience of the last fifteen months, she hit on a fascinating fact leading into a fertile line of thought.
Lionel Shriver had just started her latest novel when the pandemic struck, and she’s woven topical lines and references into her story of a couple in their fifties, both medical professionals, contemplating a joint suicide when they reach 80. What would they miss/be spared? What possibilities might present? Dementia? A nightmarish Cuckoo’s Nest retirement home? The end of civilisation? A cure for aging? She has written, and included in the book, twelve alternative scenarios, all with different but parallel endings. As you know, assisted suicide has been an issue very much in my sights for many years, so I’m looking forward to reading Should we Stay or Should we Go. I loved the bit she read aloud, and reviews tell us it’s packed with humour as well as provocative thoughts.
And the pandemic theme even cropped up in a session where comedian/actor Frank Skinner was interviewed by fellow comedian/actor/satirist Marcus Brigstocke about his book, A Comedian’s Prayer Book. Skinner is a devout Roman Catholic and spoke movingly of his commitment, and response to taunts, revealing wide reading and studying alongside much heart-searching. Brigstocke said at one point: ‘I think you are this pandemic’s Galileo!‘ Skinner certainly had clever answers for anything thrown at him, chortling at the excitement of not being quite sure where any sentence would end up, but he came across as respectful of others’ opinions, non judgemental, eloquent and measured, whilst openly sharing his own moral code. The whole event was a magical mix of laugh-out-loud fun with serious and warming reflection. And a fitting ‘last Hay event’ for me this year.
Massive thanks to all who brought this fantastic festival to our homes. I for one, hope it will continue to offer an online version.
Man’s Search for Meaning
HEALTH WARNING: This week’s post may not be easy or desirable reading for those who are finding life tough right now.
In a week where the headlines revolve around the financial implications of a global pandemic, bitter in-fighting in the Scottish government, and the revelations of a woman who found the burden of royal life too much after a couple of years, coming at a time when a proud 99-year-old prince who gave up a successful career and the next 70-odd years of his personal ambitions, to always walk two steps behind his wife, lies ill in hospital … well, I, for one, was looking for perspective.
And I found it in the depths of the Holocaust.
During WWII, psychiatrist Viktor E. Frankl, spent three years in Auschwitz, Dachau and other concentration camps – as an inmate, not as a doctor. But he survived and went on to be professor of neurology and psychiatry at the University of Vienna Medical School until his death in 1997, the author of thirty books. So when he speaks about the importance of finding meaning in life, we ought, at the very least, to sit up and listen.
I certainly did. Man’s Search for Meaning: The Classic Tribute to Hope from the Holocaust – written in 1945 – has been described as ‘profoundly honest’ … ‘inspiring’ … ‘deeply sensitive’ … ‘influential and eloquent’ …’wise, kind, and comforting’. It’s all of those things. And it’s eminently readable to boot.
The bulk of this slim volume is not so much a fascinating account of his own three years of appalling treatment in one concentration camp after another, but his analysis of what suffering of this depth and magnitude reveals about mankind, and what he learned about himself through the experiences. Here he was, ‘stripped to naked existence‘, quite literally. With the exception of his sister, his entire family – father, mother, brother, wife – perished in the camps.
‘How could he – every possession lost, every value destroyed, suffering from hunger, cold and brutality, hourly expecting extermination – how could he find life worth preserving?‘
He dug deep to discover why.
He unpicked, with a kind of detached professional interest, the gradual dulling of emotion, which inured prisoners to horrific sights, sounds, smells and tastes, as well as a brutality and sadism normally unknown to them. He watched the apathy and blunted sensitivities helping his fellow inmates acquire a protective shell – a mechanism of self-defence which eventually detached them from the frequent beatings. He observed the detail of human behaviour in these appalling circumstances, translated it into psychopathological terms, and explained the ‘Why?’- why they followed like sheep; why they sought the centre of the group during marches; why they ripped clothes and food from still warm corpses; why they secreted their meagre ration of bread in their pocket, taking a crumb at a time throughout the day. Throughout his incarceration, he retained this sense of medical curiosity, pitting received wisdom against lived reality in these uniquely horrific conditions, and sometimes he found both medical texts and his own reservoir of knowledge wanting.
And gradually, over time, he discovered first hand ‘the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love.’ And that ‘love goes very far beyond the physical person of the beloved. It finds its deepest meaning in his spiritual being, his inner self.’ Even though he had no means of knowing whether she was alive or dead, nothing could touch the strength of his love for his young wife (she had in fact died aged just 23).
But good does not always prevail, and he saw his fair share of evil, before concluding that everyone has a choice as to how they deal with adversity. ‘The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or, in a bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his sufferings or not.‘ Dr Frankl himself found the courage and resources to make a victory of the experiences, to turn this humiliating life into an inner triumph.
One of the tactics he adopted to gain this inner strength and mastery over his present adversity, was to imagine himself giving a lecture on the psychology of the concentration camp! By this method he somehow rose above the present situation and observed the sufferings as if they were already in the past. Nevertheless, he remained humble and understanding and forgiving of others’ less robust approach. When he saw them steal, or act meanly or brutally, he refused to condemn: ‘No man should judge unless he asks himself in absolute honesty whether in a similar situation he might not have done the same.’ Nor would he judge any group as a whole, not even those who routinely harmed him. None were made up of all angels or all devils; indeed, in his thinking, there are only two races of men in this world – the ‘decent‘ and the ‘indecent‘.
But of course, he saw utter despair and hopelessness elsewhere in Auschwitz and Dachau. And it was through the inmates who were at rock bottom, contemplating suicide, that the psychiatrist in him recognised a fundamental truth. ‘When the impossibility of replacing a person is realized‘ – it could be a father to his child; or an author to his unfinished creative or scientific work – ‘it allows the responsibility which a man has for his existence and its continuance to appear in all its magnitude … He knows the “why” of his existence, and will be able to bear almost any “how”.‘ An understanding shared with Nietzsche.
And it was by this route, that Dr Frankl honed his own version of existential analysis – ‘logotherapy‘. Essentially logotherapy involves searching for the thing that stops a person committing suicide, the one thing that anchors him to life, and using this as the guide-line for psychotherapy, to help him find meaning in life. One is moved to ask, Who better to steer others away from the torments that are devouring them, than this exceptional man?
Part 2 of this little book is a brief capsule version of Viktor Frankl’s therapeutic doctrine: Logotherapy in a Nutshell. As he says himself, it’s a pretty hopeless task to try to collapse twenty volumes in German into thirty small pages in English! Not much hope I can do it in a couple of sentences, then. In essence though, logotherapy focuses on the meaning to be fulfilled by the patient in the future. Man inherently needs ‘something’ for the sake of which to live, and he desires a life that is as meaningful as possible. Using logotherapy, a patient is assisted to identify what this ‘something’ is, and is then reorientated towards the meaning of his life. Dr Frankl himself felt a deep desire to write the manuscript he had started before he was taken to the camps. That helped him survive.
Not your average Holocaust book; but a remarkable tribute to the triumph of hope and endurance against insuperable odds, and a potential doorway towards finding meaning and purpose in our own lives.
The Vanishing Year
Well, I can’t imagine many people will have been sorry to see 2020 vanish into the mists of history; some indeed are willing 2021 away now, given the dire statistics and predictions. A thousand deaths each day in the UK; a total now exceeding 80,000 – the worst statistics in Europe; 2 million lives lost worldwide. Our NHS struggling to cope; long term problems accruing with the overall health of the nation. 
Watching this horror emerging, we’ve all had to find ways of keeping hope alive and maintaining mental well-being. Icy conditions make even outdoor exercise treacherous, another lockdown forces us to stay at home … Eeh dear! Not surprisingly, for me – as well as countless others – books have played a major part in this struggle. It’s well recognised they offer escape and a way of making sense of the world and our place in it. Indeed, several people who took advantage of our pandemic bookcase went so far as to say books had saved their sanity.
Not surprising then, that one novel should pop into my head as we watched 2020 disappear in our rear view mirrors: this thriller, The Vanishing Year by Kate Moretti. Apposite title, but nothing to do with the pandemic, so forgive the tenuous link.
‘Sometimes I feel as if I am made up almost entirely of secrets.‘ That pretty much sums up the main protagonist, Zoe Whittaker.
Outwardly, Zoe has an enviable life – not yet thirty, a fabulous Manhattan home, a rich and charming husband, influence, looks, wealth, connections. But untethered, with too little to do. She feels like a marble in a huge jar, suffocating under the sense that she is accomplishing nothing. Useless, apart from her charity work supporting orphaned and disadvantaged children.
What’s more, in spite of her privileged life, she is haunted by her past, living in fear of being recognised. Because five years ago, Zoe wasn’t Zoe at all. And even her husband Henry doesn’t know her real name. Nor that she was penniless, unable to afford to bury her own mother, until that is, she became a drug dealer, addicted herself to pills and drink, peddling her wares in the presence of children. Until she confessed all to the police, testifying against two human traffickers to a grand jury. Before vanishing.
And now an attempt has been made on the life of the reinvented Zoe. Her home has been ransacked. Her credit card is missing. Someone from her past has come back for her. Threats are being made.
The old classic trademarks are there – control, manipulation, layers of issues, rags-to-riches, fear for life. And the plotting is so devious that, once you know the truth, you want to go back and read it again to see all the clues you missed first time around. An excellent diversion. And a good illustration of how books can give us respite from the stresses of real life, transport us into a different world and time and place – an invaluable bonus during this time of national crisis and mental fragility.
Speaking of a different world and being transported … this opportunity to tramp in a winter wonderland does wonders for my own mental health, too. And yep, it’s well within the current rules of staying local!
