Category Archives: Book Reviews
The Cruelest Month by Louise Penny
Take one idyllic village buried deep in the Québec countryside
Add a bunch of memorable characters who include a duck loving poet and a rather portly host of the village bistro.
Finally, mix in a police chief with a penchant for Marcus Aurelius and an instinctive understanding of human nature.
This, in essence, is the recipe for the highly successful Armand Gamache series of crime fiction by Louise Penny.
There are 14 novels in the series to date – the 15th comes out in the next few weeks. I’ve read eight and there hasn’t been a dud among them.
My latest venture into Armand’s world was via The Cruelest Month which is book number three in the series.
It takes its title from the most frequently quoted line in T S Eliot’s poem The Waste Land. And it picks up Eliot’s theme of rebirth and new life.
Gamache took the bread to the long pine table, set for dinner, then returned to the living room. He reflected on T.S. Eliot and thought the poet had called April the cruelest month not because it killed flowers and buds on the trees, but because sometimes it didn’t. How difficult it was for those who didn’t bloom when all about was new life and hope.
The spirit of re-birth is alive in the tiny village of Three Pines. It’s Easter. Spring is on its way. And the villagers are celebrating the first signs of new life in the trees and in their gardens.
But the fun and festivity of the annual Easter Egg hunt is overshadowed by an evil from the past.
On a hill above the village stands the old Hadley House, the scene of some very nasty events in the previous novel A Fatal Grace. The atmosphere of malevolence has never completely gone away.
When a group of friends hold a seance in the house to rid the place of its past, one of them dies. Of fright? Or was she murdered? That’s the question Chief Inspector Armand Gamache and his team must answer.
As they uncover long-held rivalries and secrets, Armand Gamache has to confront his own worst fears. Someone seems hell bent on damaging his reputation and destroying his career.
Just like the other books in the series, The Cruelest Month has a plot with enough twists and turns to keep you turning the pages. But the plot isn’t the most important aspect of this novel.. It’s the setting of the picturesque Québec village of Three Pines and the character of Armand Gamache that give this book, and indeed the whole series, its edge.
Enticing Magical Village Setting
The Cruelest Month takes us once more to Three Pines; a place so tiny that it doesn’t even figure on a map. Yet it boasts a bistro that becomes a home from home for the detectives (food figures large in every book) and a bookshop presided over by Myrna Landers, a black psychologist. It’s residents include Ruth Zardo, a blunt-spoken award-winning poet with a pet duck and Clara Morrow, a respected painter.
It’s the kind of place in which I could happily take up residence. In fact I cherish the hope that one day one of those cottages will come up for sale….. Until then I have to see it through Gamache’s eyes.
The mountains rose graciously on the far side, folding into each other, their slopes covered with a fuzz of lime green buds. He could smell not just the pine now, but the very earth, and other aromas. The musky rich scent of dried autumn leaves, the wood smoke rising from the chimneys below, and something else. He lifted his head and inhaled again, softly this time. There, below the bolder aromas, sat a subtler scent. The first of the spring flowers.
That setting and its comfortable social structure is of course one of the hallmarks of a traditional murder mystery. But although Louise Penny uses this – and other traditional devices like a careful questioning of suspects and well reasoned deductions – she goes also one step further with a psychologically astute dimension.
Behind every crime Armand Gamache investigates lies a tale of raw emotion and human tragedy. In The Cruelest Month we’re talking of jealousy and how kindness can turn to murderous intent.
Astute Psychological Insight
What I love about this series is how Louise Penny introduces a new psychological concept in each novel. Gamache has a natural ability to see beyond the facts to the emotion that often his suspects are at pains to hide. But in The Cruelest Month, his resident psychologist suggests what he’s dealing with is “the near enemy.”
Two emotions that look the same but are actually opposites. The one parades as the other; is mistaken for the other, but one is healthy and the other ‘s sick, twisted. … Attachment masquerades as Love; Pity as as Compassion and Indifference as Equanimity.
While I love the settings and the characters of these novels, it’s the psychological dimension and the way they draw upon other influences that I enjoy the most. How often do you come across another crime novel which as seamlessly incorporates psychological theory as it does poetry, Marcus Aurelius and the Bible?
The Cruelest Month: Fast Facts
- The Cruelest Month is the third title in the series of novels by Louise Penny featuring her Canadian chief police inspector Armand Gamache.
- The series began with Still Life in 2006. The latest episode , A Better Man, is due for publication end of August 2019
- Each of the books in the series is meant to be a stand-alone tale although Louise Penny does recommend they are read in order. Her advice is based the progression of the characters from book to book.
- Based on my experience with this series I think if you read out of sequence you’ll miss a lot of the drama of what happens to Gamache himself
- Details of each book be found on Louise Penny’s website
- If you like what you find there there is another site she calls her ‘virtual bistro’ where she reflects on each book and explains what inspired her thinking and readers can post questions/comments.
Novelists who write about slavery seldom shy away from depicting the immense cruelty and inhumanity of this system.
They pull at the heartstrings with historically accurate scenes of brutality and deprivation and characters forced to experience injustice and degradation.
Few authors dare to introduce any element of comedy into their work.
Few that is except for Andrea Levy in The Long Song.
A Different Form of Slavery
This is the story of Miss July, a child conceived as a result of the rape of Kitty, a field slave on the Amity sugar plantation in the early 19th century. She is destined for a hard, and likely short life, toiling in the fields with her mother.
But the plantation owner’s sister, recently arrived from England to live at Amity, spots the child. On a whim she decides this cute child will become her maid. So at the age of eight, July is separated from her mother and moved to the great house.
It’s an improvement on working in the fields. But she’s still a slave and not even allowed to keep her own name. She’s set to work sewing and waiting hand and foot upon this fat and temperamental woman.
The Long Song is set in the turbulent years before the abolition of slavery in Jamaica.
July experiences the violent retribution enacted by white settlers upon their slave populations in the aftermath of uprisings in 1831. She lives through years when rumours of freedom run through the plantations. But when freedom does happen in 1838, it doesn’t bring an end to hostile relationships between the slaves and their former masters.
Not much scope for levity you’d think.
But surprisingly, without ever trivialising her subject, Andrea Levy manages to inject a fair degree of humour into this narrative. She clearly has a gift for finding the comedy in the most unlikely of situations.
Light Amid The Darkness
July is a mischievous figure, happy in the midst of chaos. One scene has her ruin her mistress’s Christmas lunch by using an old bed sheet instead of an Irish linen table cloth. Another sees her hiding under her master’s bed, desperately trying to control her bladder while he paces the room.
Switching between third-person past and first-person present, Andrea Levy mixes the earthy Jamaican patois of the young girl with the more sophisticated and reflective voice of the older woman.
The Long Song is told in the form of July’s memoirs. Her son Thomas, a wealthy printer, intends to publish the book in an attractively bound edition with sugarcane on the cover.
But he and his octogenarian mother comically don’t see eye to eye on how this book should be written. Thomas remonstrates with his mother when he thinks she is misleading readers or leaving out significant episodes. But to Miss July, its all “fuss-fuss.“
July is, as she has always been, a shrewd, independent-minded woman. This is her story and no-one is going to tell her how is should be told, not even her son.
She will not, she tells us, dawdle over descriptions of trees and grass. Nor will she fill her memoir with the “puff and twaddle ” found in books to satisfy “some white lady’s mind”.
… your storyteller is a woman possessed of a forthright tongue and little ink. Waxing upon the nature of trees when all know they are green and lush upon this island, or birds which are plainly plentiful and raucous, or taking good words to whine upon the cruelly hot sun, is neither prudent nor my fancy. Let me confess this without delay so you might consider whether my tale is one in which you can find an interest. If not, then be on your way, for there are plenty books to satisfy if words flowing free as the droppings that fall from the backside of a mule is your desire
A Reliable Witness?
Can we rely upon her as a narrator? Only in part….
She describes one milestone event – the symbolic funeral that marked the end of slavery on 31 July 1838 – only to later admit she was in the house with her mistress at the time.
July cheekily challenges any reader who disputes her version of events, to do their own research. She, herself, will not be weighed down by any burden of proof. But she warns these readers: if you find yourself in agreement with the views expressed in one publication Conflict and change. A view from the great house of slaves, slavery and the British Empire, “then away with you – for I no longer wish you as my reader.”
July is a fantastic character; vulnerable yet proud. “Me be a mulatto, not a negro,” she insists when trying to get admission into a Friday night dance. She’s more successful at gaining entry into the bed of her mistress’s new husband, Robert Goodwin, a pretty-faced, naïve new overseer. But his belief in abolition is thrown out of the window – and July out of his bed – when the newly freed slaves refuse to obey his commands to work. They’d rather be tending to their own crops than bringing in his harvest.
Andrea Levy shows the reality of plantation life: the extreme physical hardship and the brutality meted out casually to the slaves. Women are raped, slaves are flogged and hanged or locked into a rat infested prison. But she never descends into crude sensationalism or allows the narrative to be weighed down by obvious messages. The novel is all the better for that.
The Long Song: Fast Facts
- The Long Song was published in 2010 and shortlisted for the Booker Prize the same year.
- It was the recipient of the Walter Scott Prize for historical fiction in 2011.
- Andrea Levy was born in London to Jamaican parents in 1956. Levy began her career as a costume assistant, working part-time in the costume departments of the BBC and the Royal Opera House. She began writing in her mid-30s after her father died.
- She struggled to gain acceptance initially but achieved critical success with her fourth novel, Small Island , which deals with the immediate outcomes of World War II and migration on the Windrush generation. It was subsequently adapted for television and stage.
- A three-part adaptation of The Long Song was broadcast by the BBC in December 2016.
- Andrea Levy died in February 2019. The Long Song was her final novel.
Breakfast at Tiffany’s by Truman Capote
Today she’d be classed as a ‘celeb “ or a socialite. The kind of girl whose party-loving, free-wheeling lifestyle fills newspapers and magazines with gossip and sparkle.
Holly Golightly was not the original “IT” girl but she is the character forever synonymous with a dazzling, sophisticated, glamorous way of life. It’s an image cemented into the public consciousness by Audrey Hepburn in the film version of Breakfast at Tiffany’s. Hepburn’s Holly is chic, carefree and charismatic.
However, Truman Capote’s novella provides us with a far more complex figure. His Holly Golightly is rather a lonely figure, a girl whose carefree persona is a front, and one she protects fiercely.
Breakfast at Tiffany’s is set in New York, mainly around a brownstone building in Manhattan’s Upper East Side. The un-named narrator, an aspiring writer, gets his first glimpse of Holly when she arrives home late at night, and tries to rouse another tenant because – once again – she’s lost her apartment key.
… she wore a slim cool black dress, black sandals, a pearl choker. For all her chic thinness she had an almost breakfast-cereal air of health, a soap and lemon cleanness… A pair of dark glasses blotted out her eyes. It was a face beyond childhood, yet this side of belonging to a woman.
Holly, he learns, has no job. She lives by socialising with wealthy men who take her to clubs and restaurants and give her money and expensive presents. She hopes to marry one of them.
Is Holly Golightly a prostitute?
This was a question Capote tried to address in a 1968 interview with Playboy. Holly Golightly, he said, was a modern day version of a Geisha girl.
Holly Golightly was not precisely a callgirl. She had no job, but accompanied expense-account men to the best restaurants and night clubs, with the understanding that her escort was obligated to give her some sort of gift, perhaps jewelry or a check … if she felt like it, she might take her escort home for the night. So these girls are the authentic American geishas, and they’re much more prevalent now than in 1943 or 1944, which was Holly’s era.
Holly, with her curious lifestyle and outspoken views, fascinates the narrator. Over the course of a year, they become close friends.
Who is the real Holly Lightly?
The narrator only gets a glimpse of her past through the fragments she occasionally reveals. She talks about her childhood as “an almost voluptuous account of swimming and summer, Christmas trees, pretty cousins and parties: in short, happy in a way that she was not”.
We never know if Holly is making this up or if she’s describing her actual childhood, but the narrator doesn’t think it squares up with the girl he has come to know.
But when he asks any direct questions, she clams up again.
She has, it turns out, one obvious reason to be secretive.
Holly Golightly is actually Lulamae. And she’s not a single girl but a child bride who ran away to New York to escape her hillbilly husband and her step-children.
Capote’s narrative presents us with a subtler reason, one that gives us more more reason to sympathise with this girl.
Orphaned as a young child, she’d been sent with her brother to live with relatives who treated them badly.
Well, you never saw a more pitiful something. Ribs sticking out everywhere, legs so puny they can’t hardly stand, teeth wobbling so bad they can’t chew mush. … She had good cause to run off from that house.
Secrecy as a form of protection
Too damaged to have a deep emotional connection with anyone but her brother, she has fabricated a new identity as a form of protection. If she can isolate herself emotionally from other people, then she can always be in control.
She won’t even allow herself to become attached to the cat she found by the river one day. ” We don’t belong to each other: he’s an independent and, so am I”, she says at one point. And later on, when she is about to leave the country; she defends her decision to let the cat loose.
We just met by the river one day: that’s all. Independents, both of us. We never made each other any promises. We never – ” she said, and her voiced collapsed …
Holly tries to convince herself that she’s happy being alone. But is she? I’d like to imagine her enjoying her new life in Argentina but reading between the lines, I suspect not.
Though I’ve enjoyed the film version, I prefer the novella’s more complex portrayal of Holly Golightly. Capote gives us plenty of reasons not to like this girl. She steal’s another girl’s fiancée, shows little concern for who she inconveniences as long as she gets what she wants and acts as a messenger for an imprisoned gangster.
But Capote has also made Holly Golightly a sympathetic character; one that embraces the good things in life as a way of hiding from its darker side. By the end, we wish her well.
Breakfast at Tiffany’s Fast Facts
- Breakfast at Tiffany’s was bought by Harper’s Bazaar. A change of editor resulted in requests to change some of the language which was considered too ‘tart’ and unsuitable. Capote was incensed and sold his work instead to Esquire magazine who published it in 1958.
- Holly was originally named Connie Gustafson. Truman Capote later changed her name to Holiday Golightly and then Holly. He apparently based the character of on several different women, all friends or close acquaintances.
- The novella was loosely adapted into the 1961 movie Breakfast at Tiffany’s directed by Blake Edwards. The movie was transposed to 1960 rather than the 1940s, and had the narrator and Holly fall in love.
- I read this as part of my #15booksofsummer reading project and my Classics Club project.
Forget about glowing author testimonials and ‘award-winning’ stickers.
What some novels really need is a health warning on their cover. A warning that reading this book will not just stimulate your mind, it will stimulate your appetite.
Because these are novels that contain fulsome descriptions of ingredients purchased, dishes cooked and meals ordered. Characters in films seem only to sit at a table and play with their cutlery. You hardly ever see them take a sip of wine or a mouthful of food. Meanwhile their book counterparts are tucking in heartily.
Reading these novels is a dangerous activity. Certainly not one to be embarked upon if you’re trying to restrict your calorie intake or you didn’t get a chance to eat yet.
Dangerous because just reading about food is guaranteed to:
- sharpen your appetite;
- send you running to the biscuit tin or
- get you foraging in the fridge/freezer
Here’s a shortlist of novels that really shouldn’t be read on an empty stomach.
The Cruelest Month
Louise Penny’s Chief Inspector Gamach series is guaranteed to have you salivating.
Much of the action takes place in Olivier and Gabri’s bistro in the picture-postcard Canadian village of Three Pines. It’s a home from home for the Chief Inspector; a place where he and his deputy, Inspector Beauvoir, can reflect on the progress of their latest investigation. Policemen clearly need their sustenance.
Gamache’s coq au vin filled the table with a rich, earthy aroma and an unexpected hint of maple. Delicate young beans and glazed baby carrots sat in their own white dish. A massive charbroiled steak smothered in pan fried onions was placed in front of Beauvoir. A mound of frites sat in his serving dish.
Beauvoir could have died happily right there and then but he’d have missed the crème brülée for dessert.
Stay the night in the bistro’s B&B and you can be sure that breakfast will be a step up from packets of cereal and thin orange juice.
Yummy, yummy, said Gabri, placing the platters in front of his guests.Each held two eggs on a thick slice of Canadian back bacon which in turn rested on a golden toasted English muffin. Hollandaise sauce was drizzled over the eggs and fruit salad garnished the edges each plate.
I’ll skip the fruit salad (fruit and eggs absolutely no not belong together) but otherwise yes, yummy, yummy indeed.
If your tastes run to something more adventurous, perhaps my next book will be more to your taste.
How does “Pan roasted breast of Peking duck rubbed with berbère; grapefruit crumble à la Jamaïque with shallot confit” sound?
This is the kind of dish favoured by Pierre Athens, the greatest food critic in the world. He is dying after ” decades of grub, deluges of wine and alcohol of every sort, after a life spent in butter, cream, rich sauces, and oil…”
In his final hours, his mind returns to some of the most sublime flavours he has ever experienced. They were not always the most complex of dishes.
The raw tomato, devoured in the garden when freshly picked, is a horn of abundance of simple sensations, a radiating rush in one’s mouth that brings with it every pleasure. . . . a tomato, an adventure.
I wish I could discover where he buys these tomatoes because it’s years since I experienced any that had any flavour.
How about something a little more indulgent than tomatoes? Pierre, it turns out, holds sugary treats in high esteem.
Pastries . . . can only be appreciated to the full extent of their subtlety when they are not eaten to assuage our hunger, when the orgy of their sugary sweetness is not destined to full some primary need but to coat our palate with all the benevolence of the world.
Next time you experience pangs of guilt for picking up an éclair, just remember that you’ll be bringing joy to the world when you eat it.
For unsurpassed joy however, it’s not a pastry you want, but chocolate. the plot and characters in Joanne Harris’ novel may be rather twee but for a chocoholic, it represents absolute bliss. Almost every page oozes with the stuff.
Not everyone who lives in the village of Lansquenet-sous-Tannes is delighted when the young widow Vianne Rocher decides to open a chocolatier in a disused bakery.
Her timing is unfortunate. It’s the build up to Lent and the villagers have pledged to forgo sweet delights. But all it takes is one whiff of the aroma from the shop and their resistance melts away.
The air is hot and rich with the scent of chocolate. Quite unlike the white powdery chocolate I knew as a boy, this has a throaty richness like the perfumed beans from the coffee stall on the market, a redolence of amaretto and tiramisù, a smoky, burned flavour that enters my mouth somehow and makes it water.
Vianne’s mouthwatering bonbons, steaming mugs of liqueur-laced cocoa and flaky cream-filled patisserie become the battle ground between her and the village priest.
I know whose side I’d be on in this battle. How about you??
Big Sky by Kate Atkinson
I’ve fallen in love again.
My admiration for Kate Atkinson collapsed in the last few years when she began to experiment with time-shifting novels like Life after Life. Her latest novel, Transcription, was also a huge disappointment.
Where was the energetic prose, the intricate plots and witty characterisations that had made reading her work such a pleasure in the past? I feared she’d gone completely off the boil.
But my fears were unfounded.
For “my” beloved Kate Atkinson is back. And with a vengeance.
Brodie is older (of course) and still rather world-weary. But he hasn’t lost his natural inclination to help or rescue other people. If he can prevent them suffering, as he did in his own life, he will, even if that means diving into the sea or jumping off a cliff.
Big Sky sees him living in Yorkshire in the occasional company of an ageing Labrador and a taciturn teenage son (both on loan from his ex-partner Julia.
Evil lurks in seaside towns
It’s a picturesque location but one that has a sinister side.
The seaside towns of Whitby, Scarborough and Bridlington were once the hunting grounds for a paedophile ring. Though the organisers were jailed, two young female detectives have started to investigate other suspected participants, including high profile members of the establishment.
What police don’t realise is that the area’s sordid past lives on through three men who’ve made a lucrative business from human trafficking.
There were only so many washing-machines you could sell, but there was no limit on the trade in girls.
Their prey are young women from Eastern Europe who are duped into believing hotel jobs and a better life await them in England. Instead they become sex slaves.
Tightly woven web of plot lines
Past and present come together in an artfully constructed plot with multiple strands that initially appear unconnected. Slowly the threads are drawn together with the help of a few coincidences and red herrings. By the end, everything is explained clearly for those readers who had a hard time keeping up.
Big Sky is a novel that begins slowly. Atkinson is clearly in playful mode, introducing one set of characters only to abandon them for many pages while she brings another cast to the stage. We get to know three golfing buddies; their wives; a pair of super-organised, keen as mustard female detectives, and – fleetingly– some of the trafficked girls. Figures from previous novels flit in and out like Tatiana, the Russian girl Brodie knew from “another lifetime when she had been a dominatrix and he had been fancy-free.”
Having set all the balls in motion, Atkinson cranks up the pace in the final quarter with chapters chock full of kidnapped children, suspicious vehicles, rescued girls and shootings.
Blue Sky is a fabulously entertaining book that is a significantly superior beast to most crime novels.
Humour amid the darkness
That’s because of its beautifully drawn characters and a waspishly witty element of humour. Just take a look at Vince, a “middle-aged, middle-of-the-road, middle-class man” who’s been kicked out of his job and his marital bed.
He was grinding towards fifty and for the last three months had been living in a one-bedroom flat behind a fish-and-chip shop, ever since Wendy turned to him one morning over his breakfast muesli – he’d been on a short-lived health kick – and said, ‘Enough’s enough, don’t you think, Vince?’ leaving him slack-mouthed with astonishment over his Tesco Finest Berry and Cherry.
It’s that detail of the Tesco brand cereal that makes all the difference in this sentence. There are plenty of other examples that demonstrate Kate Atkinson’s knack of nailing a character in just a phrase or a few sentences.
One wife gets put down like this:
She shopped from the Boden catalogue and was proud of having grown a horrible stunted little tree.
Another woman (one of the most complex in the book) is every inch the trophy wife:
Crystal was hovering around thirty-nine years old and it took a lot of work to stay in this holding pattern. She was a construction made from artificial materials – the acrylic nails, the silicone breasts, the polymer eyelashes. A continually renewed fake tan and a hairpiece fixed into her bleached-blonde hair completed the synthetic that was Crystal.
But having framed her as the archetypal arm candy blond, ex model, and manicurist; Atkinson then proceeds to confound our expectations. Crystal turns out to be a shrewd and determined woman who refuses to allow the evils of her past get in her way. Women, in this novel, do ultimately get their revenge on those who treat them as disposable goods.
Do you need to have read all previous Jackson Brodie novels to enjoy this one?
I’d never want to dissuade someone from reading all of this series but you don’t have to in order to appreciate Big Sky. Atkinson provides enough of the back story about Brodie and his tangled love life that you can read this as a stand alone novel.
I’m certain once you’ve read this one however, you’ll be ultra keen to start right at the beginning of the series. Yes, Big Sky really is that good.
- Kate Atkinson was born in York and now lives in Edinburgh.
- Her first novel, Behind the Scenes at the Museumwon the Costa (formerly the Whitbread) Book of the Year prize with her first novel, Behind the Scenes at the Museum.
- She won the Costa Novel Award in 2013 with Life after Life (see my review here) and again in 2015 with A God in Ruins.
- Her first novel to feature Jackson Brodie was Case Histories, published in 2005. Stephen King called it “The best mystery of the decade.”
- Big Sky was published in June 2019 by Doubleday
Want to know more?
The Penguin website has an extract from Big Sky which is taken from the first scene involving Jackson Brodie.
In an interview with The Guardian newspaper, Kate Atkinson talks about the impetus to write Big Sky.
This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay: book review
If you’ve ever required treatment at a National Health Service hospital, you’ll know how frustrating that can be:
- Lengthy waits to see a specialist/consultant.
- Clinic appointments running hours behind schedule
- Surgery dates postponed or cancelled.
It’s easy to feel after those experiences, that the much-lauded public health service in the UK has reached a breaking point. That it’s on the point of collapse.
Adam Kay’s memoirs make it evident it’s the selfless efforts of junior doctors that prevent it from collapsing.
Equally clear however is that their dedication comes at a huge personal cost.
This is Going to Hurt is a painfully honest memoir from one junior doctor on the frontline of the NHS. Adam Kay worked in hospitals for six years. He hung up his stethoscope in 2010 after a traumatic experience with a mother and baby in his surgery.
I’ve read enough newspaper reports to know that junior hospital doctors (those below consultant level) are poorly paid and over-worked. In 2016, in a bitter dispute over employment contracts, they staged the first strike in the history of the NHS. The dispute was settled only this week.
Undermined by bureaucracy
What I hadn’t realised until reading Adam Kay’s book was how much these professionals are undervalued and their expertise undermined.
Junior doctors give up their personal time and put marriages and friendships at risk rather than walk away from patients whose lives are in danger.
Yet scandalously ….
….they get charged for parking their car at the hospital. And fined when they over-stay ( even when their delay was caused by an emergency patient);
… doctors have to find their own cover when they inconveniently fall ill and
… they are not allowed to sleep on a spare patient bed after an 18 hour shift. They have to make do with a chair.
I was astounded to discover just how relentlessly gruelling are the lives of junior doctors. The system makes it virtually impossible for them to have any kind of life outside their work.
It was not unusual for Kay to work a 100 hour week.
He describes times when he fell asleep in his car, in the hospital grounds, or at the traffic lights. Once he nodded off while sitting on an operating theatre stool waiting for his patient to be wheeled in.
On one occasion he was recalled from a long overdue holiday in Mauritius because the doctor meant to be covering his shift was ill. The hospital refused to pay for a locum. He lost count of the number of anniversaries, birthdays, weddings and theatre performances he missed “because of work.”
What kept him going was the positive feeling he would get after a shift in which he delivered multiple babies or aided infertile couples to become parents.
Comedy amid the tragedy
Although Kay doesn’t hold back from describing tense situations, when the life of his patient hung on a thread, he balances the darkness with flippancy and witty repartee.
When the doctors and nurses are not attending to patients, they’re busy swapping jokes and anecdotes about the bizarre conditions presented by some of their patients. I suspect this is the kind of black humour often used by police officers and firemen. It’s a kind of release valve for people working in the emergency services.
Adam Kay has plenty of stories.
There’s the one about the drunken woman who climbed over a fence to get away from policemen. She slipped and ended up in emergency with a metal pole thrust through her vagina. After removal she calmly asked if she could take the pole home as a souvenir.
Or the tale of another woman who secreted a Kinder egg containing an engagement ring, intending to give her boyfriend the surprise of his life. It worked, though maybe not the way she intended, when the egg got stuck…
As a specialist in obstetrics and gynaecology he encountered a surprisingly large number of people who arrived at hospital with foreign objects in their rectums. The staff are so familiar with the problem they’ve even found a name for it: “Eiffel syndrome” (to understand the joke you need to say the following words aloud – “I fell, doctor! I fell!”).
Not all encounters generate humour. Medical staff are often confronted by aggressive patients and family members, or patients who make unreasonable demands. There’s a particularly yucky case he mentions in which an expectant mother wants to eat her placenta. He gets his revenge by ‘accidentally’ revealing the gender of the baby to the most aggressive of the expectant parents.
Lack of investment
This Is Going to Hurt swings between flippancy and frustration. Some of Adam Kay’s criticism is directed at hospital administrators for their propensity to introduce ever more new rules. But he lays the greatest blame on the shoulders of politicians who had failed to invest in the NHS over several years, leading to staff demoralisation.
My over-riding impression however is that Adam Kay loved the NHS and preferred to work in the public sector even when private practice would have been more financially rewarding.
Asked to represent the medical profession at a school’s careers event he decides honesty is the best approach:
So I told them the truth: the hours are terrible, the pay is terrible, the conditions are terrible; you’re under-appreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.
This was a fabulously engaging book that was a good companion to Do No Harm by the neurosurgeon Henry Marsh that I read earlier this year.
Funny, informative and poignant it ends on a note of frustration, particularly when Kay describes the agonising event that prompted his resignation. It let to the death of both baby and mother following a caesarian operation. Although Kay had followed all the correct procedures, he still blamed himself. He suffered a period of depression but was not given any therapy by the hospital or allowed time off to recover. After a few months he handed in his resignation.
This Is Going to Hurt: footnotes
This is Going to Hurt was published in 2017 by Picador.
It’s written in the form of diary entries that were maintained by Kay during his medical training and his time as a hospital doctor. The diaries were intended as a “reflective practice” in which he could log any interesting clinical experiences he experienced. He used the material, suitably anonymised to write his book.
He has since embarked on a career as a comedian and scriptwriter. His new book Twas the Nightshift Before Christmas, is published in October 2019.
Read an interview with him in The Guardian newspaper.