research
End of an era …
Ever since I first conceived the idea of writing a series of novels set in the world of medical ethics back in the early 1990s, I’ve collected information on potential topics in paper files. Anything that might help to inform or inspire or authenticate, in it went.
Dilemmas worthy of a book of their own included …
ORGAN DONATION AND RETENTION
ABORTION
ASSISTED DYING
FACTITIOUS DISORDER IMPOSED ON ANOTHER
ASSISTED CONCEPTION
ANOREXIA
GENETIC INHERITANCE
INFORMED CONSENT
GENDER DYSPHORIA …. and so on.
Some ran into two bulging files; others barely opened the spines of the folder. And the total width extended over the years to 20 inches of paper!
But the time has come to empty the drawers of my filing cabinet and accept the passing of an era. Because, of course, digital recording gradually overtook manual. Plus my own plans for future novels shrank. I’m retaining one fat folder on one last topic which I haven’t entirely ruled out for a last novel, but otherwise into the recycling bin they go.
I’ve had to psyche myself up to this radical clear out, but when it came to actually binning them it was surprisingly painless. And after all, the raw material has contributed to eleven published books; it has done its job.
A fresh new start for the next phase of life!
Research continues
In amongst all the other things punctuating life, the serious study on prayer continues quietly and unseen. It’s actually quite useful that I have mundane responsibilities keeping me out of the study for lengthy periods – gives the material I’m ingesting time to simmer and diffuse and settle.
That process has actually been helped by a friend who’s going through a very diffuclt time in his life questioning me about pain and suffering. Having to marshall my thoughts in order to give a semi-coherent response to his deep questions helps me sort out the theory from what I can accept or even believe. My own personal experience doesn’t bear out some of the most pious ideas, and I’m seriously allergic to platitudes.
Though I still have a lot of my own issues for which I can offer no satisfactory answer, I am gradually drawing up a workable framework within which to hang them. It’s a start. And I doubt very much if I will ever reach a comprehensive conclusion that covers everything. Some things may just have to be relegated to the category of ‘Mystery’ – which, when you’re considering the interface between heaven and earth, is just as it should be.
Next week I’m introducing the subject to a couple of quite different audiences and inviting their thoughts and reactions so that should help to refine my thinking too.
Best Interests
Wow! What d’you know! BBC 1 has just aired a remarkable drama all about medical ethics – yep, really – and I’ve been totally gripped. For an hour on four evenings, culminating two days ago, Best Interests tracked the case of a young teenager, Marnie Lloyd, and the struggle to decide whether she should be allowed to die.
Marnie (played by Niamh Moriarty) was born with a form of muscular dystrophy, which means a short life with major disability. Her devoted parents, Andrew (Michael Sheen) and Nicci (Sharon Horgan), are shocked by the diagnosis when she’s just six months old, but do all in their power to give her a happy childhood. Inevitably, though, their family life is an emotional roller coaster, chequered with crises, and spells in hospital, and a fine juggling act with Marnie’s older sister, Katie (Alison Oliver).
Then one day a severe respiratory infection leads to a cardiac arrest, prolonged deprivation of oxygen to the brain, and Marnie goes into an unresponsive state where she only reacts to painful stimuli. She can’t be weaned off the ventilator, and she starts to have seizures. The prognosis is grim.
The doctors caring for her recommend stopping treatment; the cost to Marnie herself is just too high, they say. But Nicci won’t hear of it. She clings to an outside chance that Marnie might smile again if her brain is given time to heal. ‘How can you let go of someone who still laughs?’ she asks – the poignant cry of a mother.
The hospital take advice from the Ethics Committee; they suggest calling in a mediator, but Nicci refuses to be involved in any negotiations; she has no confidence in the impartiality of any process.
When a Christian Pro-life group make contact she clings to the hope they give of support to fight this through the courts. They fuel her sense of injustice by telling her the hospital performs eugenics all the time, and doctors are more concerned with saving money than lives. What’s more, they quote three cases where parents have won against doctors in court – it’s enough for Nicci. And once they have the bit between their teeth, the legal team dig deep. They latch on to one incident in the past where a mistake in Marnie’s care might be used against the consultant physician, showing her to be a fallible person with flawed judgement at times. It speaks volumes that Nicci might even contemplate such a course of action against a dedicated woman who has cared for Marnie so devotedly since she was seven. Or that she might consider seeking experimental treatment from abroad – in spite of Andrew’s scathing ‘there is always some doctor from America or Italy who promises a miracle’.
But Andrew is in a very different place. Devoted though he is to these three women in his life, he simply can’t bear to be in the same house as Nicci in her single-minded battle. He believes the consultant when she says objective signs show Marnie feels pain, and that there is no realistic prospect of any recovery to a meaningful life. So he moves out, leaving elder daughter Katie torn between her loyalties to both of them, and with her own private battles to fight.
It’s a story of love and torment. It’s both heartbreaking and beautiful. It’s brilliantly acted. It feels real with shambolic kitchens and untidy people and chaotic relationships. And it poignantly captures the conflicting emotions, the stress on families, the impossible position of the medical team. It all depends where you’re standing what this looks like. As the judge says in her preliminary statement, the notion of best interests is very complex; everyone in the court room thinks they have Marnie’s best interests at heart, but they’ve come to different conclusions as to how those interests are best served. Even medicine is about opinions not just facts. And throughout the deliberations it’s imperative they all keep the child Marnie Lloyd at the forefront at all times.
I’m sure we can all relate to each member of the family. To Nicci as a mother wanting to hang on to her precious girl. To Andrew who sums up his own struggle to articulate how he feels, loving this child more than he can express, but not wanting her to suffer: he can’t talk about it; he can’t rationalise it; he can only feel it … to the depths of his soul. To Katie, torn by feeling of guilt and regret and impotence as the battle rages around her, and her beloved only sister lies unconscious in a hospital bed. All her life, whenever Marnie has been rushed to hospital, Katie has felt compelled to ask, ‘Is she going to die?’ And now that reality is closer than it has ever been. Each one feels so alone.
But as the judge emphasises, it’s not a competition. Rehearsing the arguments in the controlled atmosphere of a court of law, gives opportunity for everyone to hear and see the case for and against withdrawal of treatment. In reality the experience in the witness box at times feels pretty brutal, with lawyers straying into the realms of disrespectful comments and intrusive questioning, but others are on hand to correct the overload, and to expose unwarranted bias and shaky premises. And the judge in this case shows fairness, grace and understanding.
If there is a weakness in the film it’s the end scenes where the machines are removed, Marnie dies, and is taken to theatre to have her organs removed for transplantation. But perhaps a bit of artistic licence here is what we all needed after so much raw emotion.
I spent years studying this subject, being with real families facing these horrific decisions, and I was hugely impressed by this moving drama. I salute commissioners, screenwriters, film makers, actors … well, everyone concerned.
Learning from the master storytellers
Every now and then I like to read a book by an accomplished writer and analyse what makes it tick. It doesn’t have to be in my favoured genres; I don’t need to like the story; it just has to be well written. It acts as a kind of masterclass.
Cold Hit by Linda Fairstein falls into that category.
I’ve read Fairstein’s novels featuring Alexandra Cooper before and know she has brilliant credentials for writing from the perspective of an Assistant District Attorney; she herself is a former prosecutor and America’s foremost expert on sex crimes. I’m instantly inclined towards someone who really knows what they’re talking about. Safe hands.
As her narrator puts it:
… this is the most fascinating job in the world. How many people get up in the morning and look forward to going to work? You and I have never had two days that have been at all predictable in our entire careers, and no two that have been even remotely alike. And on top of it, you do a little bit of good for somebody else in the mix.
So one of the factors behind her success is authority.
And because she is who she is, I’m trusting her to be diligent in her background research. In this case that includes, not just the world of crime and law and forensic medicine, but famous artists and works of art. She drops enough specifics I do know about, for me to trust her in the rest.
Then there’s the meticulous plotting. So intricately woven is it, indeed, that a third of the way in I was wishing I’d kept a written note of who fitted where and how events knitted together. The author seems to have the kind of brilliant mind that can juggle umpteen balls, and know which is which all the time. But I guess, being able to hold details of many clinical cases in your head, and work simultaneously and effectively for all those victims, requires that kind of brain. I think I’d be emotionally swallowed up by just one of them.
Her characterisation is excellent too – each person rounded out and distinctive in their own way. I can see the author’s own professional and analytical eye observing, deducing, calculating, in her day job as well as in the penning of her novels.
Although we might justifiably take exception to some of the politically incorrect comments and attitudes, the dialogue is sharp, witty and appropriate to each person.
Then there’s the clever dropping of actual facts – eg. about art and artists, historical details, real live celebrities. It provides a ring of authenticity and credibility. Makes the whole thing more believable.
It’s a great exercise in unpacking some of the key elements that make writing great. But you’ll probably be asking, what’s the story about? In a nutshell, the corpse of a young woman in expensive silk clothing is pulled from the water strapped to a weighted ladder. Assistant District Attorney Alex Cooper, and her colleagues in the police force, hunt for the killer through luxurious apartments, famous auction houses and avant-guarde galleries. A string of deaths follow. What common factor can link the murders of a rich ex-wife, a convicted blackmailer and a famous art restorer? Big money, priceless paintings, rub shoulders with serious scams and bid-rigging and false death certificates. And now someone wants Alex herself dead.
Cold Hit has all the ingredients of a gripping thriller: high drama, chases, terror, corpses aplenty, police camaraderie, blind alleys. And even the title speaks of a supremely confident writer:
Cold hit = slang term used by scientists to describe what happens when a computer makes a successful comparison between DNA samples, linking a piece of forensic evidence with an actual human being.
Ticks in so many boxes!
Understanding alternative lives
In my former life as a university researcher, I had the amazing privilege of delving deep into the lives of people grappling with major problems and dilemmas related to their medical care, understanding their responses, exploring their opinions. I sat for hours and hours (the record being five and a quarter at one sitting!) with parents who had faced the terrible ordeal of losing beloved babies. I spent days in a hospice devoted to the care of patients with full blown AIDS at the height of the HIV crisis, watching helplessly as young men wasted away and died agonising deaths. I’ve sat in wards and clinics variously with infertile couples, prostitutes, terrified new mothers. Not only has my life been enriched by all these encounters, but I like to hope I’ve become more insightful and empathetic as a result.
And I’ve taken that same kind of philosophy into my current work. With each new novel my eyes, ears and antennae are tuned to anything that will give me deeper awareness and understanding. Along the way I’ve met and listened to the experience and opinions and inner thinking of organ donors and recipients; people who’ve changed gender; families traumatised by illness, death and dementia; patients themselves suffering slow degenerative illnesses; campaigners struggling to achieve justice and equality for the disadvantaged and neglected. Humbling and revealing.
At the moment I’m trying to get inside the skin of families and individuals who struggle behind closed doors, where relationships are fraught. A surprisingly large number of books on my shelves take me inside those facades, and three in particular have made painful reading recently, opening my eyes to the horrors some children endure and sometimes transcend.
The Little Prisoner by Jane Elliott reveals the seventeen years of horrific abuse one girl suffered at the hands of her depraved stepfather. She spent her entire childhood in fear and dread, controlled by threat and violence. Even when she did eventually find the courage to report him, even when he was locked up, he still managed to wreak fearful retribution on her via his relatives. Writing about her life, she was obliged to use pseudonyms to avoid worse. And her mother – her biological MOTHER! – was complicit in all this.
Behind Closed Doors by Jenny Tomlin tells the story of a young girl who also endured appalling abuse – physical, emotional and sexual – at the hands of her sadistic and depraved father. Again, a significant family member in a position of trust. Again the biological mother knew and turned a blind eye. In Jenny’s case the child grew up in a filthy flat forced to witness her mother being beaten and raped on a daily basis, her young sisters being sexually abused, her whole family being humiliated and ostracised. And yet a strong resilient woman emerged from this chaos, determined to foster love and trust and decency in her own children (one of whom is the singer actress Martine McCutcheon).
I Choose to Live (mentioned last week) is an amazingly frank account of Belgian Sabine Dardenne’s life during her kidnap ordeal. Her abuser was not a parent, he was a stranger, but she endured the agonies of feeling she had been abandoned by her family, and her relationships afterwards were significantly altered by the experiences, distortions and reactions everyone suffered.
To an extent we’ve all been exposed to the fact of child abuse. Most recently, simply hearing about the case of little Poppi Worthington, almost certainly sexually abused to death at the tender age of 13 months by her father, made the blood run cold. Evil of such magnitude, masquerading in an everyday disguise, is as hard to comprehend as that which leads dictators to massacre thousands in acts of ethnic cleansing. The images haunt our screens and thoughts – especially where the authorities can’t or don’t exact any form of justice. The chilling reality of these intimate tragedies is captured in these three books, revealed bravely by three women who endured such relentless nightmares. I felt hugely sad and sobered, despairing at times, simply listening to them.
‘Bullies can only operate when other people are too frightened, ashamed or embarrassed to talk about what is being done to them.‘ Jane Elliott
Evil is unspectacular and always human, and shares our bed and eats at our table. WH Auden
Will I have the courage and fortitude to see my own current novel to its end? Not that the subject matter is anything like as horrific as that described in these books, but any child suffering has the capacity to cut to the heart. Time will tell.
Body image
The end of a year is traditionally when one takes stock before resolving to do better in the future, so in this spirit, on the very last day of 2014, I shall share one of my (many) failings with you.
I’m one of those countless people who feel dissatisfied with what they see in the mirror … in spite of being told donkeys years ago by a lovely man (himself a skilled potter) in our church that it’s a sin to do so on the grounds that the insignificant clay pot has no business criticising its all-powerful Maker. Sorry Derrick, but I genuinely do sympathise with folk who don’t like the casing they come in for whatever reason, and my personal problems are compounded at this precise moment by the ongoing necessity to define myself as ‘ill’. Me? I’m the strong energetic type who can rise above all weakness and still live life at a hundred miles an hour … Not any more it seems – at least not until the cardiologists ‘fix’ me! Since October when these shenanigans with my recalcitrant heart began, I’ve been aware of the need to consciously work at keeping my mood buoyant in the face of physical frailty. I don’t like what I see or feel.
So I suspect it wouldn’t take the genius of Freud to deduce that that abiding angst has quite a bit to do with my present conflict with my writing about body image. I’m struggling with the effort of trying to stay inside the skin of some of my characters who are even more tortured than I am. Body image, huh? Big subject. Cue size zero models, toddlers dressed provocatively, the obesity epidemic, self harming, cyber bullying, celebrity culture, cosmetic enhancement … you know the kinds of things our society is obsessed by nowadays. So where am I with it at the end of this chequered year?
Remember this row of books I bought by way of research a while back? Well, I’ve now read them all. Phew. Good job I’m stubborn! You’ll have noted that I haven’t reviewed any of them in this blog. Why? Because I don’t think you’d be interested. But for my own records I kept a tally of my assessment of them as I went – just a brief resume and my score out of 5. Hmm. Only three stood out as an enjoyable read, but, in fairness, a large percentage are teen fiction which isn’t my bag. Having read them all, though, I’m confirmed in my resolve a) not to write for young adults; b) not to focus on anorexia but to embrace a wider context; c) to strengthen the hooks to keep readers reading.
Question now is: can this new, more-fragile me personally cope with taking on a story which presents a much more challenging set of issues? Only time will tell.
However, thus far, I haven’t been dragged below the plimsoll line of my own tolerances, but total absorption with this topic would definitely not be good for my mental health – goodness, I’m borderline neurotic as it is! I’m also conscious of another phenomenon: the more I grapple with my characters’ uncomfortable emotions, the less they disturb me. So it will be important to remember my own initial reactions in order to be sensitive to the potential shock or outrage or revulsion or whatever of my potential readers coming to this subject without preparation.
Work to do then. But there’s a silver lining. At least when I’m absorbed in the lives of my protagonists l’m not sighing at the mirror! And I did get a stack of Christmas knitting done as I ploughed through this set of books. So it’s an ill wind …
So, here we are at the end of 2014. Thank you so much for visiting my scribblings. Special appreciation to those who’ve taken the trouble to contact me; it’s so heartening to hear about your thoughts and reactions and simply to know you really are out there. And I wish you all – whatever your hang-ups and issues – peace, health and happiness in 2015.
Literary fiction: profound or sleep-inducing?
21 July 2016 , 0
An essential part of a writer’s life is reading. Reading voraciously. Reading widely. Reading critically. Reading. Reading. Reading.
OK. No problem there. I love reading. I read every single day. My shelves are permanently stacked with books. And I owe my career to the authors whose books I’ve devoured. But some are indisputably more daunting than others, and so-called literary fiction is one category that I have to approach with determination; as regular visitors to my blog know, I have a bit of a love-hate relationship with it. But maybe I should rapidly mend my ways.
Researchers at Stanford University found that fiction helps readers to empathise more with other people, and the deeper the book delves into the characters the more the reader ‘walks in their shoes.’ So it’s official! Just as we always knew. Reading not only broadens the mind but it makes one a more empathetic human being. Well, but hang on a minute … maybe the conclusion rings true, but see here as to whether or not this claim can really be justified from this particular study.
But I digress. I do actually make concerted efforts periodically to try to get a handle on what’s acknowledged by the literati as meritorious writing. And the summer time seemed like a good time to soak up some healthy rays and dig into an acknowledged high quality piece of writing.
So that’s why Penelope Lively‘s work came under my microscope. Now in her eighties, Lively has yards of prestigious awards to her credit, including the Booker Prize and the Carnegie Medal for British children’s books. An OBE, CBE and DBE track her recognition from 1989 till she was made a Dame in 2012. So she’s indisputably masterclass level, right? Sit at her feet and learn.
What then of her 2003 novel, The Photograph? It opens with the discovery of an envelope buried in a mountain of papers in a cupboard in widower Glyn’s house. Lightly pencilled on it is an instruction in the unmistakable hand of his deceased wife, Kath: DON’T OPEN – DESTROY. Compelled by curiosity however, he ignores the instruction and finds a photograph of Kath holding hands with another man. And not just any other man; a man whom Glyn knows very well. Glyn becomes obsessed by this revelation and one by one he drags others into his relentless and reckless search for the truth about the wife he thought he knew.
Sounds like a fair enough plot, yes? It was attractive enough to make me buy the book anyway.
But as with most literary fiction the pace is very … very … slow. The characters are revealed very … very … slowly with attention to tiny… tiny … details. What’s more the revelation when it comes is hardly earth-shattering; I guessed from early on how Kath died (not revealed until P208 of 236) and what troubled her. So what kept me reading? Sheer obstinacy – I’ve started so I’ll finish. Plus an appreciation of the mastery of the author’s language. Undisputed. A couple of examples will suffice:
‘No people here; the insect-crawl of cars. Glyn’s house is lost now, digested into the urban mass, a tiny box in a row of similar boxes. And the mass itself, the inscrutable complex muddle, bleeds away at its edges, getting sparser and sparser until it is lapped entirely by space. Or rather, by spaces – squares and triangles and rectangles ad oblongs and distorted versions of such shapes, edged sometimes with dark ridges. Dark spongy masses, long pale lines slicing away into the distance. Here and there a miniature version of the city density, a little concentration of energy at the confluence of lines. And then eventually space gives way – there’s a spillage, seepage, a burgeoning unrest that condenses once more into city format: the enigmatic fusion of now and then, everything happening at once.’
Aged 4, Kath is ‘a local distraction on the fringes of my [her 10-year old sister’s] vision.‘
And then there’s the resonance with the essential truths about people which Lively recognises:
‘Behaviour that is engaging in someone of twenty-five becomes less so at forty, let alone at fifty-eight. Where once she was beguiled, she has for many years been exasperated, though exasperated in the tempered, low-key way of long-standing acceptance.’ … ‘He remained in a time-warp of feckless adolescence.‘
‘She is fragmented now. The dead don’t go; they just slip into other people’s heads.’
‘The world smiles on the physically attractive …’
So, a classic example of literary fiction? A work of literary merit that offers deliberate social commentary or political criticism? Or one which focuses in some profound or moving way on the individual in order to explore some part of the human condition? Yee…esss. Or, if you’re a closet-philistine, a work as dull and pointless as reading the dictionary because nothing exciting happens? Which camp do you fall into, I wonder?
Booker Prize, Carnegie Medal, literary fiction, Penelope Lively, research, social commentary, Stanford University, The Photograph
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