Hazel McHaffie

ethical quandaries

Challenges and choices

The International Arts Festival is currently in full swing in our fair city, and it’s easy to get caught up in the exciting momentum of events and performances. Guilty as charged.

But of course, for many, far far more serious questions beset them than which actors, writers, musicians or artistes to support. I currently have six special people on my worry/prayer list all facing major challenges in relation to their health, life and death.

It’s not appropriate to be specific about them, but perhaps they are behind my extra sensitivity to the difficult choices so many face. For this post I’m thinking of those people who’re involved in the consequences of legal change, medical advances or financial restrictions associated with healthcare – my kind of workaday world. I’ll enumerate but a few (with links) reported in the national press in just 36 hours by way of illustration. All raise a number of thorny issues and I leave you to ponder those for yourself.

Relatives and health care workers caring for patients trapped in unresponsive bodies with minimal or no consciousness no longer need to go to court to resolve the question of withdrawing/withholding life sustaining measures. Decisions about dignified death can be made quietly and privately in a timeous way.

In figures released last month, the first trial of a pioneering immunology vaccine called DCVax has shown some real promise. DCVax essentially uses the patient’s own immune system to fight the tumour, tailoring treatment to their specific needs. This trial has already been running for 11 years and came to public attention when MP Dame Tessa Jowell was not eligible to receive DCVax for her glioblastoma. Sadly she died in May, but not before she had successfully campaigned for increased funding for brain cancer research. To date patients have needed to stump up £200,000 for this treatment.

New National Guidelines, known as Saving Babies’ Lives Care Bundle, have been issued in response to the alarming statistic that 600 babies could be saved from stillbirth annually if the mothers were adequately monitored.  SBLCB focuses in on the incidence of smoking, signs of failure to grow, reduced fetal movement, inadequate monitoring in labour – risk factors that were all known about decades ago when I was in clinical practice. Given that 3000 babies are stillborn every year in England alone this seems like an important area to concentrate on.

ASDA has apologised for selling a pregnancy test that issued false results leading a young woman in Devon to believe she was pregnant when she wasn’t. However the store has not recalled this product and insist it has been quality tested.

One in five people who have eating disorders have their lives cut short, but a considerable number are turned away from help because they are not skinny enough. And this in spite of National Institute of Health and Care Excellence guidance to disregard body mass index. (I found this to be true when I was researching Inside of Me.) A campaign is now underway to ensure the NICE guidelines are being adhered to.

News at the end of July was that more than half of Scotland’s population have pledged to donate their organs and/or tissues after death. That’s the highest rate in the UK and comes after a high profile awareness campaign. It’s good news for the 550 or so waiting for transplants and a significant factor in the discussion about whether we should change to an opt-out system, currently under review. Interestingly 90% of the population support organ donation, so one wonders about the mismatch.

I could go on but I promised just a brief snapshot. But I’m doing my best to keep perspective during my annual summer sortie into the world of drama and art.

 

 

, , , , , , , , , , , , , , ,

Comments

Thriller writing

It was probably a throwaway suggestion: ‘I think you should make your next book a thriller‘, but it’s stuck in my mind – especially as it came from someone in the book world whose opinion I respect.

Well, OK, I’m prepared to consider it at least. But first I need to understand what’s involved. Would my ideas thus far fit into this genre? Do I have what it takes to master this kind of writing? So I’ve been delving into the theory; what I’d need to do to create a good thriller. To date I’ve identified seven essentials.

1. Use dread and frightening possibilities to drive the story.

2. Make it action-packed from the outset. Maintain urgency and tension (short paragraphs, cliff hangers, surprises, active verbs, each chapter revealing something new, etc etc) throughout. Include confrontation.

3. Make the stakes high. Give the bad guys seemingly justifiable aims too.

4. Keep the reader guessing till the end.

5. Give the protagonists lots of baggage and emotional complexity, something to fight against and triumph over. Make sure they endure plenty of grief and anxiety along the way. Some characters at least shouldn’t be what they seem to be. Avoid stereotypes.

6. Build dramatic tension by means of multiple points of view.

7. Have an unforgettable take-home message/meaning.

ThrillersOK, some at least of the basics.

I’ve read plenty of thrillers over the years; indeed I’m a big fan of both Harlan Coben and Robert Goddard, but I fancied testing the theory using something new to me … Hmmm, how come I have so many unread thrillers on my shelves? … Right, let’s choose something with rave reviews … an acknowledged masterpiece … and maybe something medical?

Brilliant. Flashback by Michael Palmer, a qualified doctor cum very successful writer? Fits my bill perfectly.

Young neurosurgeon Zackery Iverson has left an understaffed, under-resourced hospital and dedicated team of colleagues to return to the place where he grew up, leaving behind a broken relationship and almost all his belongings. His new workplace, the ultramodern rejuvenated regional hospital in Sterling, New Hampshire, is thriving under the leadership of his older brother Frank. State of the art equipment, a growing team of specialists, ultra modern facilities, a veritable ‘juggernaut of technology’. Sounds impressive, but where is the heart?

Zack becomes increasingly concerned about the policies and politics behind the veneer of success. How can the hospital board own so much property? Why are poor patients shipped elsewhere? Why is a very senior doctor claiming harassment and a campaign to get rid of him? Why can a young patient recall events when he should have been anaesthetised during a routine operation? Why is Zach’s new friend and colleague, Suzanne Cole, so alert and bright immediately after her surgery; and why is she behaving erratically now? And why is Zach’s own brother resurrecting childhood rivalries?

Old doubts and insecurities raise their heads. Is Zach being naive and idealistic? Is the cut and thrust of a modern medical ‘business’ simply not for him? Should he have stayed as a champion of the underprivileged and poor?

Child's disturbed bedA growing sense of dread starts to unravel in his head when he’s called in to work with 8 year old Toby Nelms, a boy who’s so disturbed he’s stopped speaking, is having nightmarish flashbacks, and is wasting away.  Why is this lad so terrified of hospitals? How does he know about Metzenbaums? – only staff working in an operating theatre would use the word. There can be only one answer: somehow Toby was awake during his surgery for an incarcerated inguinal hernia. But how could he be? And how much of his suspicions dare Zach share with Toby’s desperate mother?

Could some of his colleagues be monsters masquerading as caring physicians and nurses? Is his own brother somehow implicated? Just where do the ethical boundaries begin and end?

Yep, I’d say this fits all of the above criteria. Thrilling! Unputdownable. I’m hooked, reading long after I should be tucked up asleep.

FlashbackBut I note something else important. There are lots of characters and subplots in this story – hard to keep a handle on initially, but gradually they become rounded out and emerge as … the shrewd controlling judge … the anaesthetist with a secret unsavoury history … the cardiologist with an abusive ex-husband and a young daughter … the nanny who has served her family faithfully but is now threatened with a nursing home … the nurse who can be bought … the shallow secretary chosen for her loose morals and voluptuous body. This steady drip of detail from various sources adds greatly to the suspense. You’re left wondering just who is the real baddie in all of this? who else is implicated in some way? Everybody seems to have mixed motives, vulnerabilities and dubious characteristics. And the links between them grow ever more tortuous. A tall order to achieve that level of complex interweaving. Could I manage it? Right at this moment I’m not at all sure I could.

Having a take-home message is less of a problem to me. In this case: how far would any of us go to uphold our personal moral standards? What if it became a question of love and loyalty over rules and systems? Familiar? Yep. My kind of territory.

OK. Let’s try again with another novel, another author … a medical mystery-cum-thriller, Damaged by Pamela Callow. Again stories within stories, lots of intertwined characters with mixed agendas, false trails. A blond dog-walker, a lawyer with a haunting past, an inscrutable judge with a murdered daughter, a rejected policeman … By now I’m hugely impressed by authors who can hold all this together so successfully.

One thing is definitely in my favour. Medicine’s a hotbed of ethical quandaries – that’s why I became a novelist in the first place, of course. All those folders containing ideas and research material amassed over the years? Ideal material for intrigue and mystery and dark deeds.

So, what do I think now? Well, I’m not ruling out a thriller this time around. Indeed I’m already trying to work out some kind of grid that would make my story-line work. But, boy, what an undertaking. I might be gone some time!!

 

 

, , , , , , ,

Comments