Category Archives: Non fiction

Do No Harm by Henry Marsh

Do No HarmPeople who tend to be squeamish or prefer not to know about the internal workings of the human body, wouldn’t enjoy reading Do No Harm by Henry Marsh. It’s also probably best to avoid this book if you have a friend or relative who has been diagnosed with a neurological condition or is about to have surgery.

Marsh is a neurological surgeon with more than 30 years experience. In Do No Harm he offers insight into the joy and despair of a career dedicated to one of the most complex systems in the body. This is a candid account of how it feels to drill into someone’s skull, navigate through a myriad of nerves that control memory, reason, speech and imagination and suck out abnormal growths. If successful he can save someone’s life or extend their projected life span. But often he is millimetres away from catastrophe. One false move and the result could be death or paralysis.

Marsh frankly admits that in his career he has made mistakes. A few years ago, he prepared a lecture called “All My Worst Mistakes.” For months, he lay awake in the mornings, remembering the patients he had failed. “The more I thought about the past,” he recalls , “the more mistakes rose to the surface, like poisonous methane stirred up from a stagnant pond.”

On a visit to a nursing home for people with extensive brain damage he sees the result of some of those mistakes in the motionless forms of patients in their beds “To my dismay I recognised at least five of the names.” One of them is a schoolteacher in his fifties whose life he ‘wrecked’ (Marsh’s word) during a fifteen hour operation to remove a large tumour. In the final stages he tore part of the artery that keeps the brainstem, and thus the rest of the brain alive. The patient remained in a coma for the rest of his life. The experience haunted Marsh for years.

Yet without mistakes, he says, there would be no progress. And without the willingness of doctors to take risks, many of the greatest advances in his field would never have happened.

It’s one of the painful truths about neurosurgery that you only get good at doing the really difficult cases if you get lots of practice but act means making lots of mistakes at first and leaving a trail of injured patients behind you. I suspect that you’ve got to be a bit of a psychopath to carry on…

Henry MarshDoes that mean surgery is always the best course? This is a question discussed regularly in the daily case conferences Marsh holds with the junior doctors and radiographers who form his hospital team. Is it kinder to let someone die gradually than to undertake invasive surgery from which they may never recover or if they do, face life changing side effects? The team reach a clinical, unemotional conclusion but its down to Marsh to face the patient and explain the decision. It’s an encounter that requires a delicate balance of compassion and detachment.

Marsh suffers anxiety before such meetings, trying to resist the temptation to be overly optimistic about the likely outcome of any procedure. Often before surgery he is oppressed by “almost a feeling of doom’ and panic which only dissipates at the last moment when he sits in his operating chair and takes up his scalpel.

… full of surgical self-confidence, I press it precisely through the patients scalp. As the blood rises from the wound the thrill of the chase takes over and I feel in control of what is happening.

Marsh never set out to become a neurosurgeon. After completing his medical degree he caught a glimpse through a porthole of a patient “anaesthetized, her head completely shaven, sitting bolt upright on a special operating table.” The surgeon stood behind her, with a light fixed to his head, patting her bare scalp with dark brown iodine antiseptic. The image stayed in his mind, and struck him as “a scene from a horror film.”

But his second visit to a neurological theatre fascinated him. Unlike all the other operations he had witnessed which involved the handling of ‘warm and slippery body parts’, this was done with an operating microscope through a small opening in the side of the head using only a few microscopic instruments.

The brain continues to fascinate Marsh. He is awed by what he sees through his surgical microscope, which “leans out over the patient’s head like an inquisitive, thoughtful crane ” as the infra-red cameras in his GPS system shows he position of his instruments. The internal cerebral veins are like “the great arches of a cathedral roof” and beyond the Great Vein of Galen can be seen “dark blue and glittering in the light of the microscope.”

In Do No Harm he does a grand job of sharing that wonder with his readers and also the drama of the operating theatre. You don’t need extensive biological or medical knowledge to appreciate the level of difficulty involved in these procedures though a schematic showing what bits of the brain lie where would have been a useful addition to the book.

Every chapter is headed with the name of a type of tumour (who knew there were so many?) in which Marsh talks about some of the cases that involved those conditions. In between he shares his many battles with the bureaucracies and inefficiencies he encounters in the British National Health Service (NHS).

Surgeons kept waiting because of a decree that doctors can’t begin a new operation while another is in the final stages in an adjoining theatre. Or theatre staff forced to kick their heels because their next patient wasn’t allowed to change into their hospital gown while there were members of another gender in the same waiting room. The working hours of junior doctors changed without any consultation with the surgical leads. Computer systems that won’t co-operate when a bed is needed quickly. The causes of Marsh’s frustration range far and wide.

In one episode, which would be farcical in any other sector, he describes having to leave his clinic to repeatedly go up two flights of stairs to get a password so he can discuss an X-Ray result with his patient. “Try Mr Johnston’s,” he’s told. “That usually works. He hates computers. The password is ‘Fuck Off 45’.” It marks the forty-five months since the introduction of a highly-expensive computer system.

Back in his office, Marsh tries every possible combination of upper and lower case letters, adding spaces, taking them out, all without success. He runs up the two flights again. One staff member realises there’s been a miscalculation. The system has been in place two months longer than they recalled. So it turns out the password is now “Fuck Off 47.” All of this while the poor patient waits to hear if Marsh can save his life by operating to remove the cause of his elliptic fits.

His railings stem from a deep concern for his patients and a desire to want to do right by them (he even washes and dries the hair of his female patients before they leave the theatre). He tries not to let his feelings show but his mask slips regularly. Leaving the hospital one evening having told one man that an operation was not possible, he rails against the traffic as if it were the drivers’ fault

“ … that this good and noble man should die and leave his wife a widow and his young children fatherless. I shouted and cried and stupidly hit the steering wheel with my fists. And I felt shame, not at my failure to save his life — his treatment had been as good as it could be — but at my loss of professional detachment and what felt like the vulgarity of my distress compared to his composure and his family’s suffering, to which I could only bear impotent witness.

This is a book that I never expected to enjoy but it proved far more readable than I expected. I’m glad however that I didn’t read it before my friend had her own surgery to remove a brain tumour (from which she thankfully recovered). I appreciated there were risks involved, but never realised just how narrow the margin of error would be. Sometimes ignorance is a blessing.

Footnotes

About the Book: Do No Harm by Henry Marsh was published by Weidenfeld and Nicholson in 2014.  It was shortlisted for the Costa Biography Award, the Wellcome Book Prize and the Guardian First Book Prize. Marsh wrote a follow up in 2017. Admissions  was written as he prepared for his retirement.

About the Author: Henry Marsh worked as consultant neurosurgeon in London for about thirty years. In addition he travelled regularly to the Ukraine, donating his time to treat patients in extremely difficult situations and in the face of political opposition. H retired from full time work in the NHS in 2015 but continued to work in private practice until 2017.

Why I read this book: This was a book club choice. I probably wouldn’t have read the book otherwise. But I am so glad I did.

Howard’s End is on the Landing by Susan Hill

Howards EndUnlike author Susan Hill I don’t live in an old rambling farmhouse with aged beams and cosy nooks from which I can look upon “gently rising hills and graceful trees”. Nor sadly do I have an elmwood staircase that could take me up to a landing with overflowing bookcases. But I do know the sensation of coming face to face with a mountain of unread books.

Climbing the stairs one day in search of a book she knew was there, Hill discovers “at least a dozen, perhaps two dozen, perhaps two hundred” that she had never read. Among them are recommendations from the Richard and Judy book club, Booker prize winners, classics, childhood annuals (charmingly she still gets The Beano every year) and an old alphabet book.  She resolves to spend a year reading only those books already on her shelves, forgoing the purchase of new ones, which, she admits, is a strange decision for someone who is both author and publisher.

I wanted to repossess my books, to explore what I had accumulated over a lifetime of reading and to map this house of many volumes. There are enough here to divert, instruct, entertain, amaze, amuse, edify, improve, enrich me for far longer than a year and every one of them deserves to be taken down and dusted off, opened and read.

We get some delightful and often surprising titbits: about the time when as an English student at King’s College London, she  devoured detective stories as light relief from Beowulf (one can understand why!). Or the unexpected encounter with EM Forster in the London Library. Having bent down to pick up the book an elderly man had dropped on his foot she looks up to find herself looking into the watery eyes of one of the grandest of the grand old men of literature. But here he was “slightly stooping and wholly unmemorable.” and yet “the wonder of the encounter has never faded.”

 

I warmed to her after reading the chapter where she recollects the magic of receiving the gift of books as a child. It was impossible to disagree with her that today, with such easy access to books, we have forgotten how special they were in our past. For Hill growing up in the 1940s they were rare treats.  Every Christmas brought annuals that she read so often she could memorise the stories but the most precious gift she remembers is her first pop up book. Some of these she still has and one of the pleasures of her year of reading from her bookshelves is going through the collection.

Over the year, Hill draws up a list of 40 titles that she thinks she “could manage with alone, for the rest of my life”. It’s absolutely not a ‘best books ever written’ type of list but ones she considers has special meaning for her. The list tells you a lot about her taste and her foibles. Trollope gets two places, as does P G Wodehouse; Dickens is there with Our Mutual Friend, Virginia Woolf with To the Lighthouse and E. M Forster (not Howard’s End surprisingly but A Passage to India).

The list is significant for its omissions. There is little in the way of European authors unless you count Dostoevsky as ‘European’ – no Zola or Camus however. The Americans are represented by Edith Wharton (the House of Mirth) and Henry James (Washington Square). Her rationale for the poetry choices tell you that she is in essence a conservative reader.  “I do not read much poetry now, and rarely anything new,” she admits. “I know I should. Should. Ought. But I don’t and that’s that. Perhaps I don’t need to. I can recite the whole of ‘The Lady of Shalott’, after all.”

She is without question a woman of firm opinions. Some I found it hard not to agree with, such as her love of the physical feel of a book (she loathes e-readers) and her aversion to the fashion for reading the “very latest book everyone is talking about.” She has little patience with people who pretend to have read certain classics or who boast about the number of books they read each week (“Why has reading turned into a form of speed dating?” she asks). Jane Austen she finds boring but considers Penelope Fitzgerald’s The Blue Flower to be a masterpiece and Elizabeth Jane Howard’s work is long overdue for a re-issue.

The interjections spice up what could easily have become a pleasant but otherwise inconsequential journey through one woman’s reading preferences and habits. Hill has an edge that nicely counterbalances the sometimes whimsical tone and in her final selection of 40 has made certain to stir up debate.

A Room of One’s Own by Virginia Woolf [book review]

room of ones own-1Virginia Woolf’s essay  A Room of One’s Own is a landmark text of feminist literary criticism and, as such, is required reading for students of literature around the world. But I was a student at a time when feminist criticism was not even in its infancy so though we studied Woolf’s fiction, no lecturer ever thought to direct us to her seminal non-fiction output. My experience of this essay has been fragmented as a consequence; I’ve mostly encountered it as references in other works such as Elizabeth Showalter’s A Literature of Their Own.

Now I’ve read the essay in its entirety I could better appreciate the full impact of Woolf’s assessment of the difficulties and obstacles facing women writers and how they have risen above those challenges.

The first challenge Woolf identifies is one of attitude. Woolf dramatises this through her narrator’s experience of undertaking research at one of the Oxford colleges. First she is told in no uncertain terms that it is forbidden to walk on their grass (is there a fear she might contaminate them?) and then that as a woman she has no right of entry to the college – such hallowed halls of education are reserved for male students only.  After a day at the British Library perusing the scholarship on women, she discovers that little has been documented about the everyday lives of women; what does exist has come from men who seemed to have been writing in anger.

What I find deplorable … is that nothing is known about women before the eighteenth century. I have no model in my mind to turn about this way and that. … I am not sure how they were educated; whether they were taught to write; whether they had sitting rooms to themselves; … what in short they did from eight in the morning till eight at night.

The second issue is one of practicality. Reflecting on the different educational experiences available to men and women as well as on more material differences in their lives, she concludes that women were kept from writing because they had no money of their own. Significantly Woolf is writing at a time when the law had only recently been changed to allow married women to own any money they earned.   Without money of their own, and without any space of their own (out of the question, unless her parents were exceptionally rich or very noble), their creativity is stifled she argues. And she points to the Romantic poets and those of the nineteenth century for evidence – all but three of them were university men and of those three it was only Keats who was not well to do. Poverty and poetry were impossible bed fellows.

“Intellectual freedom depends upon material things. Poetry depends upon intellectual freedom. And women have always been poor, not for two hundred years merely, but from what the beginning of time . . Women have had less intellectual freedom than the sons of Athenian slaves.”

In Woolf’s view the lack of money and lack of privacy influence also what women wrote. Women turned to the novel form ( considered  a very poor second to the art of poetry) because it was easier to put down and pick up again without loss of imagination. If you had to do your writing in a public space like a drawing room rather than in the private male space of a study or library, then you would have to contend with frequent interruptions. And learn, as did Jane Austen, to hide her manuscripts and cover them with blotting paper when anyone approached her corner of the communal sitting room.

Woolf seemed to then suggest that the quality of what women writers produced was somehow inferior to that of male writers. Having highlighted people like Austen, George Eliot and the Bronte sisters ( Woolf rated Emily as superior to Charlotte) she ponders how much better their work could have been if their experience of life had not confined to house and hearth. How enormously their genius would have benefited if only they could have travelled or gone to a war as did Tolstoy. In Woolf’s mind, War and Peace could not have materialised if Tolstoy had spent his life in domestic seclusion. Well clearly not – it would have been nigh on impossible to write so vividly of battles if he hadn’t witnessed them at first hand during the Crimea war.

There were a few points in Woolf’s argument I found myself challenging. One was the premise that these leading female writers seldom moved beyond the house yet Charlotte’s portrayal of the plight of Victorian governesses is all the more real because it came from her own experience. I doubt Tolstoy could have written so astutely about the position of a woman who was on close intimate terms with a family yet not regarded as one of them or as a servant. Nor does it allow for the role of the imagination – Wuthering Heights owes much of its power to the evocation of the wild moorland Emily Bronte knew well but the portrait of evil and malice in Heathcliff came from her imagination, not knowledge.

Then there is the idea that the challenging conditions under which such novels were created gave rise to a style of sentence alien to women’s nature..

“To begin with, there is a technical difficulty -so simple, apparently; in reality, so baffling- that the very form of the sentence does not fit her [the woman]. It is a sentence made by men; it is too loose, too heavy, too pompous for a woman’s use.”

Instead of trying to ape male writers, Woolf encouraged her sisters to turn their exclusion from the opportunities afforded men to their benefit – by learning to write what she calls “a woman’s sentence.”

It’s a point which I found hard to grasp because Woolf never really gives any examples of what she means. Jane Austen’s work as a guideline (but which one of Austen’s sentences we want to ask!) What is more clear for Woolf is what a woman’s sentence is not: it is not the same as a man’s sentence.

Im confident that I have merely scratched the surface in trying to understand Woolf’s essay and to fully do so I would need to spend many hours taking it apart point by point ( it gets convoluted many times as she wrestles with her own thoughts). But she ends strongly by positioning fiction by women as on the verge of something unprecedented and exciting, and exhortating ther audience of women to take up the baton bequeathed to them and to pass to their own daughters.

Footnotes

About the Book: A Room of One’s Own is an extended essay by Virginia Woolf. First published in 1929, the essay was based on lectures she delivered at Newnham College and Girton College,  Cambridge the previous year. The title of the essay comes from Woolf’s conception that, “a woman must have money and a room of her own if she is to write fiction”.

Why I read this book: Partly from a sense of guilt that I claim to be keenly interested in literature yet have not read this essay. Hence why I added it to my #20boksofsummer reading project.

Hidden voices of Chinese women [book reviews]

good women of china-1Maybe I was spoiled by the brilliance of Wild Swans by Jung Chang but any thoughts that The Good Women of China by Xinran would be similarly revealing about the lives of Chinese women today were sadly quashed.

Xinran is a journalist who worked for eight years as a presenter at a Chinese radio station. Touched by many letters she received from women she persuaded her bosses to let her reveal some of their stories. It was a bold move because some of those stories were critical of Chinese society and it’s ruling elite — exactly the kind of story subject to the country’s strictly enforced censorship rules. Though Deng Xiaoping had started a process of opening up the country in 1983, it was still risky to discuss personal issues in the media. But Xinran prevailed. She was, she said:

… trying to open a little window, a tiny hole, so that people could allow their spirits to cry out and breath after the gunpowder-laden atmosphere of the previous forty years.

Over time she began pushing the boundaries, taking a risk that one mistake – even one comment – could endanger her career if not her freedom. Such was the popularity of her program that the radio station had to install four answering machines so women could call in and record their comments.  Words on the Night Breeze became famous through the country for its unflinching portrayal of what it meant to be a woman in modern China. Xinran was hailed as the first female presenter to ‘lift the veil’ of Chinese women and delve into the reality of their lives. Her programme dealt with sexual abuse, attitudes towards disability, forcible removal of children from their mothers and a practice of pushing intelligent women into unhappy marriages with government leaders — marriages they could not leave because of the resulting damage to the husband’s reputation. Her stories concerned women of all different classes and ages and degrees of experience.

The most moving for me was the story of  Xiao Ying, a survivor of an earthquake in Tangshan in 1976 which killed 300,000 people.  In the subsequent chaos she was gang raped by soldiers. When her mother found her in a ditch, she kept pulling down her trousers, closing her eyes and humming. Xiao Ying was sent for psychiatric treatment. She seemed better after two and a half years, but the day before her parents were due to take her home, she hanged herself. She was 16.

Xinran was deeply affected by what she discovered, travelling the breadth of the country to track down some of the women whose stories she had heard. One of them lived in a poor shack next to the radio station, keeping body and soul alive by scavenging though Xinran discovered her son was a wealthy party official. Another woman she found in a remote hotel in shock after meeting again the boyfriend from whom she’d been separated 45 years earlier. Xinran sat with her throughout the night, slowly giving the woman the courage to speak about her life.

Centuries of obedience to the principles of “Three Submissions and the Four Virtues” (submission to fathers, husbands and sons), followed by years of political turmoil had made women terrified of talking openly about their feelings. Xinran won their trust and, through her compassion and ability to listen. Repeatedly they told her that she gave them a space in which to express themselves without fearing blame or other negative reactions.

If the ability to tell their stories, changed these women, hearing them also changed Xinran. Her youthful enthusiasm gave way to pain the more she learned and the more she understood.

At times a kind of numbness would come over me from all the suffering I had encountered, as if a callus were forming within me. Then I would hear another story and my feelings would be stirred up all over again.

By 1997, after a particularly traumatic visit to a community where women were denied sanitary product, whose wombs had collapsed through constant childcare,  the pain became too much and Xinran left China for England. She wanted, she said to breathe new air and to feel what it was like to live in a free society. But she didn’t want to abandon the women who’d been encouraged by her programme – so she wrote her book to teach the west what it meant to be a woman in China.

It’s a worthy cause and there is little doubt that Xinran gave hope to thousands of women whose stories she heard and the millions more who listened to her programme. But it doesn’t make for a very good book. By the very nature of its subject The Good Women of China is an episodic book and each of the 15 personal stories she relates is touching. But it lacks objectivity and analysis. Instead of stepping back from a story and reflecting what this tells us about Chinese society, she’s onto the next example and the next and the next. Without analysis and reflection on whether these conditions have changed, it’s hard to comprehend if these are isolated examples or how representative they are of real life. Reading this book left me with too many unanswered questions.

Footnotes

About the bookThe Good Women of China: Hidden Voices is translated by Esther Tyldesley. It was published in 2002 by Chatto and Windus in the UK.

About the author: Xinran (the name means “with pleasure” ) was born in Beijing in 1958 and lived with her wealthy family until the Cultural Revolution separated them when she was seven. After working in a military university she became a radio journalist. Her talk show, Words on the Night Breeze, started in 1988; within three weeks she was receiving 100 letters a day, mostly from women. She moved to the UK in 1997, where she compiled their stories in The Good Women of China. Xinran is a columnist for national newspapers in the UK.

Why I read this book: I’ve been fortunate enough through my job to visit China and to meet many people from that country. The stories of their culture and how this is under pressure as the country becomes an economic power house and a force in international affairs, has fascinated me. I thought The Good Women of China would help me better understand the people of this country. This book is part of my 20booksofsummer reading list.

 

Thanks to this book…..

Marking Thanksgiving in the USA, The Broke and the Bookish has decided that the Top Ten Tuesday challenge this week is to identify 10 books for which  we are thankful. Many of my choices are non fiction.

1. Roget’s Thesaurus: this has been my lifesaver throughout all the years when I had to write newspaper stories and then speeches for executives or internal articles. I still have the large hardbound version I acquired about ten years ago though often I now use on line synonym/antonym tools.

dailymirror2. Daily Mirror Style Guide by Keith Waterhouse: Many of the big media outlets create a style guide for their journalists, giving direction on which terms to capitalise, how to represent numbers etc. The Daily Mirror guide is rather different however because Waterhouse (one of their leading columnists) delves into cliches that are too commonly used. For example,  tabloid newspapers always write that ‘police swooped’ on a house conjuring up pictures of flying detectives descending from the skies. He also tackles the headline writer’s propensity for puns, complaining that most of them are too obvious like the story where a comedian going into hospital was said to have been bound to have nurses in stitches. It’s great fun to read but was also my guide when I was a young journalist.

3. Delia Smith’s Complete Cookery Course. A weighty paperback that I acquired as part of a prize from the Economist in about 2001. Delia was at one time a cookery expert that was on the BBC with primetime TV shows, books and other spin offs – a bit like Mary Berry is today. Her inclusion of an item in a recipe was enough to clear the shelves in the supermarket. One tiny company found itself bombarded with orders when Delia recommended their omelette pan. Many food writers leave out some key elements of their method or recipe so the result never looks the way it does in their book. Not so Delia – you know if you follow her step by step, you will have success.

4. Why Most PowerPoint Presentations Suck by Rick Altman. Remember the days when you didnt get confronted by slide after slide in meetings? Today it seems we treat Powerpoint like a dummy without which nothing can ever be discussed in a meeting. The slides are usually rubbish – too many fonts, too much text, etc. Altman’s book doesn’t cover the same ground you find in most other books – he shows how to cut down text and still make it meaningful and how to do clever things with pictures and graphics. The templates he uses are also available on his website. Highly recommended you get this if you ever have to do presentations.

5. Make the Connection: Ten Steps to a Better Body and a Better Life by Bob Greene

Greene is the guy who Oprah Winfrey turned to when she wanted to get her weight back under control. He took her from a 17 minute a mile walking pace to a marathon. I came across this by accident one holiday when I got some time to browse a bookstore in Alexandria, just outside Washington DC. I’d been trying exercise programs for years with not a lot of success – this book was the first time I learned that the key to success was exercising at the right heart rate and I had been doing it all wrong. I immediately went out and bought a heart rate monitor and a new pair of trainers and started following the program. The weight dropped and I felt fitter than ever before. Now,when I have slacked off a bit, this is the book I go back to for help and motivation.

6. Colour me Beautiful Ok, this isn’t a book as such but it is printed material so I’m counting it. It’s the little wallet of colour swatches that I was given after my style session with my sister. I take it with me whenever I’m going shopping as a reminder of what particular shade of red or orange works best for my skin tone. It’s saved me from some expensive mistakes! Other shoppers do give me an odd look though whenever I get it out and start holding up to the garments

7. A-Z of Alternative Words from the Plain English Campaign. Anyone who has worked in the corporate world or in the public sector will know that plans and proposals usually sound stuffy because people use words that they wouldn’t normally use in every day speech. Somehow they have gained the idea that certain words sound more important so if they want their document to have credibility they need to use those words. But often the effect is just to make the document sound stuff at best and at worst impenetrable. All hail to the Plain English Campaign for their tireless efforts to get companies and government bodies to understand that simple words are best. The A-Z of Alternative Words is a slim but effective pamphlet. If you’ve ever been frustrated by colleague who insist on using “as a consequence of” instead of the simpler “because” or “emphasise” instead of “stress”, this is for you.

8. Macbeth by Shakespeare ( as if you needed telling who the author is). I credit this play with setting me off on a path that led to a literature degree and a career where I could indulge my love of words. Until this play was introduced to our class I had been a fairly middling student. But something clicked that day in class. By the next day I could recite all of Act 1 Scene 1 much to the astonishment of the teacher and my class mates.

9. Middlemarch by George Eliot My favourite novel of all time and the one I would take to a desert island if I knew I was going to be stranded. It has such depth of meaning and so many ideas that it rewards re-reading and re-reading

madwoman10. The Madwoman in the Attic by Susan Gubar and Sandra Gilbert My university days coincided with the publication of this landmark text of literary criticism in which the authors examine the idea that women writers of the nineteenth century were confined in their writing to make their female characters either embody the “angel” or the “monster.” It was my first introduction to feminist critics. A complete revelation. I’ve had many occasions since to refer back to this book – hence it looks rather battered around the corners

 

Five Days at Memorial by Sheri Fink: A Storm of Ethical Questions

Through the power of 24-hour international news coverage, the world saw the devastation and human tragedy caused when Hurricane Katrina moved ashore over southeast Louisiana and southern Mississippi early on August 29, 2005. It was one of the deadliest hurricanes ever to hit the United States, causing an estimated 1,833 deaths and leaving hundreds of thousands of people homelessHurricane_Katrina.

What the world didn’t know was that at New Orleans’ Memorial Hospital, right in the centre of the maelstrom, life and death decisions were taken that would become the focus of a legal battle. At the heart of the battle lay challenging questions on whether medical practitioners have a duty to protect lives at all costs or whether – in exceptional circumstances – it is acceptable to ease the path of patients to death.

I would have been ignorant of that battle but for an article in The Sunday Times magazine in 2012 (based on Sheri Fink’s award-winning book Five Days at Memorial) which revealed the horrendous conditions at the Medical Centre where thousands of people were trapped for five days without power. Doctors and nurses worked tirelessly in humid, fetid conditions to care for their patients and to get them out as soon as rescue looked possible. But then those very medical staff were arrested and charged with murder when suspicious amounts of morphine were found in the bloodstream of 20 of the 45 patients who died.

Five Days at Memorial grew from a Pulitzer Prize-winning article written by Fink and published in The New York Times Magazine in 2009. She was drawn to the subject because of her experience as a doctor working in areas of conflict and as a journalist reporting on hospitals in war zones. It’s a deeply impressive piece of journalism which draws on more than 2 years of research and interviews with some 500 plus people, from patients to their family members and from hospital staff to legal representatives.

The story she pieces together from emails, phone logs, witness testimonies and floor plans, traces the events from shortly before the hurricane hit land. All her research points to how hopelessly inadequate were the plans of both the hospital, its owners, federal agencies and the city government. Lack of investment in flood water protection and drainage coupled with bad design decisions taken decades earlier meant the hospital quickly lost power for lighting, air conditioning, sewer systems and essential medical equipment. Day after day those trapped in the building waited for rescue by helicopter or boat. Controversially, staff adopted a triage system which saw those with “do not resuscitate” orders placed last in the list for evacuation. What happened on the fifth and final day is clouded with ambiguity. According to prosecutors some medical staff decided to hasten the death of the most critical patients with lethal injections of morphine. Those arrested protested their innocence but for more than two years multiple murder charges were pursued against one doctor and two nurses.

Five_Days_at_MemorialIn part 2 of the book, Fink focuses on the investigation against those staff members (a Special Grand Jury refused to indict the three so the charges were dropped) and then examines the ethical issues surrounding euthanasia and health care in disaster scenarios.

Fink doesn’t pull any punches in her assessment of what went wrong at Memorial, seeing it as a microcosm of the larger failures that assailed New Orleans during Katrina, “with compromised physical structure, compromised operating systems, compromised individuals. And also instances of heroism.” She also points to a broader issue in America at that time with emergency preparations skewed, in the light of post-9/11 fears, towards acts of terrorism, not natural disasters.

By 2005, more than a billion dollars had been made available to the nation’s roughly 5,000 hospitals to promote bioterrorism preparedness. Memorial’s most detailed and by far its longest emergency planning scenario was written shortly after the 2001 attacks. This bioterrorism plan ran to 101 pages, as opposed to the 11 pages devoted to hurricanes.

Nor does she let the owners of Memorial off the hook, showing from email traffic how responded with indifference until the acute nature of the problem was staring them in the face. Staff felt their employer had abandoned them despite the extraordinary dedication they had shown in those five days. They received no thank you letter for their efforts and only partial pay when the hospital was closed for a six month clean up.

What lessons can be learned from the events at Memorial, Fink asks in the final sections of her book. She is in no doubt that some kind of crime took place at the hospital though she tempers this with respect and sympathy for the exhausted medical team and the conditions they endured.  They took action for the best of intentions but in the absence of any agreed protocols to decide how to ration medical aid, how could they be sure those were the right decisions?  “Moral clarity,” she writes, describing the moment the patients were injected with a powerful cocktail of drugs, “was easier to maintain in concept than in execution.”  And therein lies Fink’s key point, ethical questions of this magnitude cannot be resolved in the heat of the moment, under what are effectively war time conditions when judgements can be clouded.

To the extent that protections and plans have been put in place since Katrina, recent events have shown them to be inadequate or misguided. Life and death in the immediate aftermath of a crisis most often depends on the preparedness, performance and decision making of the individuals on the scene.

It is hard for any of us to know how we would act under such terrible pressure.

But we have the luxury to prepare and resolve how we would want to make the decision

Five Days at Memorial is a masterful and compelling piece of journalism though not a comfortable reading experience given its subject matter. It was tough going at times because of the sheer weight of information – I became quickly lost in a fog of names of doctors and patients and the finer points of the responsibilities of each federal agency – but the desire to want to know what happened and why kept me reading.  The reviewer for the Star Tribune in Minnesota exactly captured my reaction when he described it as “an important book that will make your blood boil no matter which side of the issue you support”

End Notes

Five Days at Memorial by Sheri Fink was published in the UK by Atlantic Books in 2013

My Life in Middlemarch by Rebecca Mead

RoadtoMiddlemarch

I remember vividly the first time I read Middlemarch. It was my second year in university and the reading list for the module on nineteenth century literature was HUGE. They didn’t come much bigger than Middlemarch. With a seminar and then essay looming the only way to get through this text was to lock myself in my room and read – from morning until evening. No time to really absorb the text etc, I just had to get enough of a sense of the plot and themes so I didn’t sit in embarrassed silence in the seminar. I made it but I wasn’t enamoured. And then within a few months had to read the whole thing again in preparation for the end of year exam. I packed it away with a feeling of joy that I’d not have to plough through it again.

Well that wasn’t really what happened. Many years later when I felt the grey cells gathering dust I embarked on a Open University degree  which had a module on nineteenth century literature. Which, guess what, had Middlemarch as a set text. I couldn’t avoid it since it featured in a compulsory question. I gritted my teeth and embarked on my third read.

Whether my more mature self was able to more fully appreciate Eliot’s writing  I’m not sure. Virginia Woolf did describe this as “one of the few English novels written for grown-up people” so that may well be the case. The development of literary criticism in the intervening years also helped because they opened up new ways of reading the text. To my my surprise I found I was enjoying this chunkster. I enjoyed it even more on a fourth reading. I’ve now read it seven times and my appreciation of Eliot’s masterpiece deepens every time.

Given that experience I opened Rebecca Mead’s My Life in Middlemarch wondering if she too had gone through the same learning curve. Part biography, part autobiography, part bibliography, it’s a personal reflection on the novel and how it has impacted her life. She first read it as a 17-year-old living in the southwest of England who, each week went to the home of a retired teacher of English literature to talk about books and prepare her for university entrance exams. From the first words she was enraptured,  continuing to read it through her early career years as a journalist and into love, marriage and a family.  Sometimes the connections she makes between an episode in her life and an episode in Eliot’s life or that of one of her characters, feel laboured. As for example when she draws a parallel between her own role as a stepmother to three sons to George Eliot’s devotion to the children of her partner George Henry Lewes.

Mead is conscious however of the dangers of over identification with characters one encounters in fiction:  “such an approach to fiction – where do I see myself in here? – is not how a scholar reads, and it can be limiting in its solipsism,” she declares. Eliot herself was scornful of women readers who imagined themselves as the heroines and the most admirable character in the novel.She hoped for a more nuanced engagement from her own readers. What Mead argues is that the book is different for each individual reader who makes and re-makes it according to their own experience. So Mead’s Middlemarch is not the same as my Middlemarch or of yours but is no the less valid.

Identification with character is one way in which most ordinary readers do engage with a book, even if it is not where a reader’s engagement ends. It is where part of the pleasure and the urgency of reading lies. It is one of the ways a novel speaks to a reader and becomes integrated into the reader’s own imaginative life. Even the most sophisticated readers read novels in the light of their own experience. and in such recognition sympathy might begin.

As I experienced personally, Mead learned that favourite works can mean different things to us at different stages in our lives. In her twenties she empathised with Dorothea’s admiration of Casaubon as a man of knowledge and experience who could lead her out of the narrow world in which she had lived so far. Bent time she reached her thirties she felt the same scorn towards  Casaubon as do Ladislaw and most of the Tipton community aghast that a young woman like Dorothea should ‘throw herself away’ on this dusty old scholar. As a mature reader however she feels more tender towards a man fearful that the academic work to which he has devoted his life will not be acclaimed by his peers. Moreover a man who feels his wife, in pressing him to publish the work, is deliberately trying to undermine him. Fear of failure seems more tangible as the years advance finds Mead.

 

This is a thoughtful book which argues for the transformative power of art and of reading in particular. For people who know Middlemarch well, the book may not offer then a significant amount of new information but for those relatively new to the book and Eliot well, there is a lot to discover. Mead has done her research thoroughly, visiting houses and other places associated with different points of George Eliot’s life, delving  through archives, holding the pen with which she wrote her novels and letters and reading Eliot’s letters themselves.

One of the lasting impressions for me was a vignette in which Mead asks us to imagine a stout couple waddling along a road in London. To most passers-by they would not have attracted even a glance yet Eliot and her partner Lewes were some of the finest minds of their era and their unconventional lifestyle was considered scandalous. Together this unremarkable looking pair ambling along in suburbia were responsible for some of the most pleasurable moments in my life.

End Notes

My Life in Middlemarch by Rebecca Mead was published in USA 2014 by Crown Publishers, a division of Random House. 

Rebecca Mead is a staff writer for The New Yorker. My Life in Middlemarch started life as an essay in that magazine.

 

A reader’s bad habit

Seeing that comment in  Simon Heffer’s column in yesterday’s Daily Telegraph column, I nodded in agreement and also felt it was a bit of an obvious comment. Who but a fool (or maybe people with compulsive buying habits) would fork out to buy something they wouldn’t use?

Unless they are someone who buys a book with very good intentions of reading it even though there is that voice in their head muttering “don’t kid yourself you’ll get round to reading this.” Someone like me in fact when the transaction involves the purchase of non fiction books.

Which is why I have a large stack of them. Unread. Not even opened.

Sure I have a large pile of unread fiction titles but I do pick some out and read them (doing pretty well on that front so far this year in fact).

But the non fiction titles? Forget it.

Some date from at least 10 years ago when I thought I should learn more about the sustainability issue than I could glean from newspapers. Others were bought in a vain attempt to keep up to date with the latest business theories (I did manage three chapters of Jim Collins’ Good to Great and about the same with The Innovator’s Dilemma by Clayton Christensen). But some books about the political changes in China remain undigested beyond about page 3.

The only non fiction titles I’ve read in recent years have been either book related like the World Guide to Literature  or craft related. I’ve not read a history book in easily 20 years. And yet I still buy non fiction. Last year I bought:

beard-classics-cov_2508344a

Zola victorians

Both seemed eminently readable – I scanned them in the shop to make sure they were not top heavy factual tomes.

Have I read them? Er, no.

Will I do so soon? Er, not likely

And yet what did I do just last week? Why of course, I went and bought some more non fiction. Namely The Time Travellers Guide to Medieval England by Ian Mortimer and Daniel Levitin’s The Organized Mind ( oh the irony of that purchase).

Most likely they will still be sitting in the same place on the shelf this time next year.

Don’t ask my why I do this. I have no idea. But I know its a bad habit I need to get out of.

 

Talking About Jane Austen in Baghdad

Austen in BaghdadIt began with a question in an email. Bee Rowlatt, BBC World Service journalist in London, wanted insight on how women in Iraq felt about the recent elections and what was happening in their country. Over the course of the next few months, emails zipped between her and May Witwit, lecturer in English at Baghdad university. May proved a lively correspondent; one minute talking vividly about the dangers of living in the cross fire between the  the danger she faced in getting to work each day and the next to 

From this unusual beginning,  a friendship blossomed as each woman became fascinated by the life of the other and wanted to know more about what was happening in their very different worlds.

In Talking about Jane Austen in Baghdad, Bee and May’s  lives are juxtaposed as they kept up a correspondence, supplemented by an occasional text message and a rare phone call. Bee learned about May’s fears for her husband trapped in their apartment because he was a Sunni Muslim, the strange regulations imposed at her workplace and her attitudes towards Sadam Hussein. In return May’s in box contained epistles featuring the quotidian life of a mother of three in a London suburb, a woman whose frustrations extended to dealing with sick children, organising fund raising events for the local school and what to wear to work.

The nature of the emails change once Bee hits on a plan to get May and her husband Ali out of the dangers of Iraq. Bee continues to talk about her endless cups of tea, about her lectures on Nathaniel Hawthorne and Ernest Hemingway and about her thesis on the theme of love in Chaucer , but now her emails are also full of the frustrations involved in penetrating multiple levels of bureaucracy to try and get visas.  Set back follows set back, sending May into cycles of despair in which she feels there is no way out.

What does all this have to do with Austen? This title was chosen by the publishers (Penguin) whose decision to publish the book provided May with the money needed to fund her new life in London. I presume they thought the use of Jane Austen’s name would attract attention but it’s misleading since Austen’s name comes up only a few times. Bee asks at one time “how can you teach Jane Austen in Baghdad?” “How can [your students] make sense of it?”, bringing the response from May that it was for her students a form of escape; a “transportation to another world.” that gave them the strength to continue.

What made this book fascinating was to witness the blossoming of the friendship. The formality of the first emails with their salutation Dear Bee quickly evaporated and became simply ‘ Bee’ or, touchingly ‘dear sis’ . It’s to May that Bee turns when she wants to know should she have a fourth child or to vent after an argument with her husband. Neither Bee nor May hold back from sharing their emotions, littering their emails with strings of exclamation marks or shouty subject lines.

The lack of self consciousness in their exchanges makes this a tremendously engaging book. It wanes a little bit in the final quarter where the bureaucratic machinery gets ever more tortuous and I had the feeling some subjects were introduced just to pad out the story (by then, they knew they had a publishing deal on their hands). But I forgive them because they had been such wonderful company on my drive to work for so many days earlier.

Endnotes

Talking about Jane Austen in Baghdad is available in paperback from Penguin Books or in Audio format from Chivers.

If you want to know what happened to May Witwit, take a look at this interview in which she talks about her life as an academic in the UK.

Vincent Van Gogh in his own words

Vincent_van_Gogh_-_Self-Portrait

Vincent van Gogh – Self-Portrait Licensed under Public Domain via Wikimedia Commons

My knowledge of Van Gogh is sketchy to say the least. Like millions of people I’ve stood looking at his paintings in awe and wonder but my understanding of the man behind the work is limited to the facts that pretty much everyone knows (his spell in an asylum, his friendship and then conflict with Gauguin, his close relationship with his brother Theo).

I never realised that he had been deeply religious as a younger man and had aspirations for a career in the church, nor that he had worked for an art dealer in London at one time. Still less did I appreciate how relentlessly he tried to find his true destiny, the fantastically high standards he set for himself and his work and his yearning for recognition.

Fortunately Van Gogh was an inveterate letter writer. By the time of his death in 1890, he had written about one thousand letters, mainly to his brother Theo, through which the character of the man is revealed. More than 265 from more than 800 which have survived, are available in Ever Yours: The Essential Letters published by Yale University Press.

The man who emerges from these letters is clearly one who was not the easiest person to like. According to the three editors of this book, van Gogh  was “almost always convinced that he was right”,  but he understood what made people turn away from him:

Don’t imagine that I think myself perfect — or that I believe it isn’t my fault that many people find me a disagreeable character. I’m often terribly and cantankerously melancholic, irritable —yearning for sympathy as if with a kind of hunger and thirst – I become indifferent, sharp and even pour oil in the flames if I don’t get sympathy.

But neither you nor anyone else who takes the trouble to think about it will, I hope, condemn me or find me unbearable because of that. I fight against it, but that doesn’t alter my temperament. And even if I consequently have a bad side, well damn it, I have my good side as well, and can’t they take that into consideration too?

Van Gogh attributed his anti social behaviour to a feeling of nervousness when in the company of other people. In one letter he said that he found talking to people and dealing with them painful and difficult.  He suffered periods of fragile health and melancholy resulting from over work and lack of rest but viewed them as a sacrifice necessary to stimulate his creativity. In a letter to his brother written in Arles, July 29 1888, Vincent commented: “The more I become dissipated, ill, a broken pitcher, the more I too become a creative artist in that great revival of art.”

Ever YoursThe letters show his troubled, intense nature, his relentless quest to find his destiny and his frustration with the lack of recognition of his talent. Evident too is his close bond with his brother with whom he exchanged letters discussing attitudes to art and to whom he revealed his hopes, and then despair, as his friendship with Gaugin collapsed.

Ever Yours: The Essential Letters contains 265 letters, from a total of 820 that still survive.  The editors Leo Jansen, Hans Luijten and Nienke Bakker apparently spent 15 years creating a  six volume set of the correspondence which was published by the Van Gogh Museum in Amsterdam in 1999.  This (shorter) edition contains historic family photographs, reproductions of some of the letters in chronological order plus sketches by the artist and a general introduction highlighting the main events of his life.

If you want a fascinating glimpse of the man and the artist, this book will deliver. And if it makes you hungry for me, there is a free online transcription of all Van Gogh’s letters at vangoghletters.org

End Notes

Ever Yours: The Essential Letters Vincent van Gogh, is published by Yale University Press

Thanks to NetGalley for providing a copy in exchange for an honest review

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