Category Archives: Medicine

A very nasty war

This novel is not in fact specifically about the war in Vietnam. It opens in 1963 in Saigon. So the Americans are still there and everywhere, an enclave of army, navy, CIA and the medical contingent and their wives. Absolution is about the wives. The narrator, Patricia, is looking back over a period in her married life which remains vivid and contained. Her husband, Peter is an engineer (and probably CIA) and as a newly wed wife, she is shyly presented to the cocktail, dinner circuit. Almost immediately she is taken up by a much more articulate, forceful and determined woman, Charlene.

In the second part of Alice McDermott’s novel, another voice now in the present, has been looking for her mother’s old Vietnam contacts, partly because quite by chance she has met one of them, an elderly man with his Down’s Syndrome son; Dominic and Jamie are neighbours, living next door to Douglas and Rainey’s country house, and one day the connection reveals itself. Charlene, her mother is long dead, but the connection stirs something in her. It is to Rainey that Patricia is talking in Part One

The final part we return to an episode in Saigon, in which Tricia, as Charlene always calls her, follows blindly into one of Charlene’s plans, only to find that she is its centrepiece. Once again, seemingly a bystander in a drama not of her making.

The detailed observation of the way women behaved around their menfolk in the 1960s, their constrained lives and the shallowness of their society, is offset by Patricia’s reminiscences of her rebellious childhood with her best friend, Stella. What transpires though is that she has always been a follower.

There is a lot to take in, in this novel. A brief reminder of some of the things we have forgotten about that turbulent period in American history.

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Not Frankenstein but…

The planet has been invaded by aliens, humans have been exiled to Antarctica with twenty four hours of notice. Many will not make it even if selected for the journey. Cold People follows the lives of the survivors.

There are three survivor settlements and a more important centre at McMurdo Sound. Here all the eminent scientists, engineers and practical specialists are busy. Invitations for surrogate motherhood are made and children are born. Echo is one of them, she is born to Liza, one of the survivors whose previous life we have been party to and her partner, Atto who she met only a few days before the alien invasion. She is impregnated artificially and gives birth to one of the new generation of cold people.

Cold People is set at some point in the future and we follow various strands throughout the book, jumping forward twenty five years, and following different characters stranded on the frozen wastes.

Tom Rob Smith has created a spectacular adventure, full of verve and surprises, almost anything can happen when survival at any cost is at stake. All previous rules and moral strictures go out of the window when survival of the species is the aim of the game. Echo and her ilk are created by manipulating the genome to make them less susceptible to cold, it works after a fashion. But like AI, are the creatures quite what their creators imagined?

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Not The Gift but…

Anyone who has listened to The Gift on BBC Radio 4 will know that occasional mistakes are made in IVF treatments, very occasionally the wrong sperm reaches the wrong egg. Seth, a baby born by IVF and a surrogate mother, to Alaric and Mary is unusual, but not more than any other neurodivergent young person. He seems to have no concept of risk and an unusually keen sense of proximity, to animals and people. As a young lad he is bullied at school, but like many others says nothing.

Sebastian Faulks is once again exploring what it is to be human, this time through the life of a child that has been created artificially, in this case with intent. The ramifications of this novel are startling, in the light of several experiments that are already in the news. The concept is dangerous and radical but whether actually possible or not is less clear.

The Seventh Son is a beautiful narrative about a much loved child, loved by his parents and also in a different way by his surrogate mother, whom he only gets to meet after he is twelve. The institute which engineered his birth follow his progress through life, but he is among seven others being monitored, so there is no particular worry there, until rumours begin to circulate, Seth just happens to be Number 7. A blind testing that has surfaced rather suddenly to the detriment of the institute and everyone concerned.

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Even more reading between screenings

Without a doubt, these are masterpieces. I read Cutting for Stone when it came out in 2004, so was delighted to find that Abraham Verghese had written another novel (actually his third). So I read The Covenant of Water and then re-read Cutting for Stone.

Both novels have a basis in truth, they are not autobiographical, but the background and the medical knowledge belong firmly to the author, not now a practicing doctor, but a lecturer. Cutting for Stone is set in Addis Ababa during the time of Haile Selassie. Two Indian trained nuns are posted to Abyssinia to start a mission hospital, many things go wrong almost at once, and only one of them survives to reach the country. There she too experiences a dreadful trauma, and her flight takes her to Addis Ababa for no better reason than she met an English doctor on the ship carrying her from India, and she knew he was heading there. Anything else would be a plot spoiler, so to persuade you to read this remarkable novel, let me just say that it remained on the New York bestseller list for over one hundred weeks and has been translated into twenty seven languages. The Covenant of Water is also steeped in medicine, its practice and the other things that surround it, this novel is set in Kerala, along the Malabar coast, with an occasional foray across the continent to Madras. And it is right up there with Cutting for Stone. You will not be disappointed if you read them, or only read one, they are exquisite. I shall be “lending them” to my wonderful consultant at Guy’s hospital because I think he will really love them.

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Booker Longlist 2023/4

First I apologise to the author – I am not able to replicate the diacritics required for the names in the Nigerian languages.

This is a brave novel by any standards. Gripping as a narrative and rather terrifying in its exposure of Nigerian society. Ayobami Adelbayo (and if you look at the cover you will see what I mean about diacritics) has chosen to place her story in a contemporary city. Two families so far apart in status and wealth, that you would think their lives could never touch each other, are linked by a violent event.

A Spell of Good Things covers two main themes: the extremity of poverty as it touches upon the life of Eniola and his sister, Busola. Their father has been unemployed ever since the education system was reorganised and thousands of teachers were made redundant at a stroke. Ever since then, the family have been unable to pay for the most ordinary things, food, rent and the school fees. The mother has sold everything she can, and they are reduced to begging. The other theme is that of wealth and politics and how they are inextricably combined. This family we meet mostly through the daughter, a doctor who is working through her residency. Her elder brother has decided not to follow his medical training, but to pursue a different career as a newscaster, a profession that his parents disregard.

An example of the distinct bravery of this book is its casual exposure of endemic corruption, bribery and violence. In an early scene, Wuraola’s father is approached by his friend Professor Coker for support in his political campaign. Otumba refuses, explaining that he has been supporting the other candidate for years, and for business reasons cannot change sides now as he will lose all the lucrative contracts that he has benefitted from, through that financial arrangement.

However, the Fates have other ideas. The narrative arc forces the reader to consider all the options available to these characters in this highly stratified and ceremonial society. The elders live with a code in which status and birth are of paramount importance, but as anything can happen, the wives would be wise to prepare for the worst – hence the hoarding of gold jewellery against a rainy day.

There are many words that describe dress, food and family relationships which are in (I think) Yoruba; whole phrases are not translated, though one can roughly guess the meanings. Lengthy discussions of colours and materials to be selected for important events are fascinating, and one would benefit from a short glossary because many of the items of clothing are quite unique and cannot be guessed at. I would love to know what some of the meals that are described were made up of.

This is a breathtaking piece of writing, an unputdownable novel. The writing has pace, wisdom and compassion but does not shrink from the truth, whether in the personal, professional or political relationships that grind out the trajectory of this extraordinary book.

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Young adult reader

Wonder was recommended by my 10 year old granddaughter. I am so glad that she is an avid reader, just like me, and she lent me her copy to read. It is suitable for any child of around 8 onwards and would be a good book to share with a child who is about to start “proper” school. That is to say, not kindergarten but primary school, or even secondary school.

August Pullman is going to school for the first time. He has been home-schooled up to this point because he was born with severe anomalies which have entailed a lot of operations, twenty-six so far, to correct a cleft palate and other cranial problems. These have left him looking different. He arrives in middle school and the results are complicated and challenging.

Wonder is how he copes, the people he comes across and the various ways in which he makes a difference to the lives of the other children. R J Palacio was inspired to write this story as a result of someone she saw, a small child, being teased outside an ice-cream shop.

Physical differences, or disabilites can be very challenging for young children. They are both curious and uninhibited, they will stare or ask questions and this can be uncomfortable for the adults and for the child. Auggie copes courageously with the people he encounters even though he experiences some markedly different reactions. Auggie has a particularly extreme complex, the medical term is mandibulofacial dystosis which has left his face much more disfigured than say a cleft palate reformation. Very small children are actually frightened, older ones can be very unkind.

In Auggie & Me we meet three young people who have encountered Auggie. The first is Julian, and this section untangles some of the impulses and actions that Julian has meted out to Auggie when he arrived at Beecher’s Prep School. The second section is a friend from way before school, Christopher’s mother and Auggie’s mother were pregnant at the same time and formed with two other mother’s an unofficial mum’s group, all of them and their children hung out together, until Christopher moved away and they rather lost touch. The final section in Auggie & Me is the voice of Charlotte, whom we also met in Wonder.

Both these books look kindly upon all the characters that we meet, not excusing bad behaviour or sanctifying the better natured children. They are a way of helping young people to come to terms with difference and to be kind, to themselves as well as to each other. To value kindness as a gift that they can receive and give. Important lessons that we could all learn from.

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Outrage transposed

Much has been written about Charles Dickens‘ novel David Copperfield. Ir is his most autobiographical, it is a study of child poverty and abuse, it is about loss and death, and, I suppose, a novel that begins with a birth, is inevitably heading that way. Barbara Kingsolver goes for the outrage that is expressed on every page. In Dickens it lies in names, incidents and detail and so it does in Kingsolver.

Demon Copperhead is a riff on the Dickens, right up to the similar names and beyond, but transposed to twenty-first century America, the Appalachia. Lee County the dog-end of America. Damon is born in a trailer, parked on a lot that belongs to the Peggots. He and Maggot (Matthew) Peggot hang out together a lot, go to school together and are “besties” for a while. Damon’s mother is a drug addict and alcoholic, his father dead. Mum shacks up with Stoner, who dislikes Maggot (a gay child obviously and therefore a bad influence) and also finds Damon difficult. Then Mum overdoses and that’s it, Demon is put into childcare foster home while Mum is in rehab – if you have read David Copperfield you will see where this is going…

To understand where Barbara Kingsolver is going with this does not take many pages. This is about poverty, about the absolute poverty of the land poor in a part of the world where struggle is endemic; it is about the neglect of the social services and it is absolutely and profoundly about the opioid crisis. Throughout the book you can pick up the references to Dickens’ novel, but Dickens’ was concerned with the poverty, not with the gin addiction. Kingsolver is about the drug companies that promoted opioids for pain, depression and everything in between in a place where these were the conditions. This was a field day for the drug companies, these people were so dirt poor that they would take anything to make the misery go away.

This is a masterpiece of writing, a polemic dressed as a resoundingly good narrative full of characters that you want to get to know, in situations that are heart-breaking and also believable; and there is death, loss, love and all that driving the story along, and the appalling effect on child and adult alike. The outrage is palpable – Kingsolver is right to use the Dickens as a matrix, hopefully it will drive readers back to the original (myself included) or knowledge of the original will drive readers to Demon Copperhead, either way a win-win.

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An unusual occupation for a woman

A phrase that starts “that woman” is frequently a negative follow through. It can apply to a politician, a musician, a chef or, in this case a bonesetter.

Set in Georgian England, and based on two real-life characters, Frances Quinn has chosen the strange life of a large, ungainly girl, Endurance Proudfoot. Durie’s sister, Lucinda is pretty, blond, winsome and delicate (also slightly air-headed to be honest) while Durie is clumsy, large, ugly and determined.

She is determined to take up her father’s profession, she is strong enough and after witnessing his resetting of a dislocated shoulder, she is convinced that this is the profession that she was made for. Reluctant at first, her father is impressed by her skill, but the place is not for a woman, the skill passes from father to son; there is a son so Durie is likely to be passed over.

Just as she thinks she has a foot in the door, Lucinda goes and spoils it all.

That Bonesetter Woman describes precisely the difficulties that women had in any profession, but especially one in which men had undue influence. Durie finds her way through this maze with dignity and courage, but it turns to ashes in her mouth. The lives of women at that time amounted to little more than chattel, from father to husband, they were bound hand and foot, whatever they had passed to a husband, and that was the law.

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Oh LucyBarton!

By now you should recognise this format. A small book that packs a punch. Lucy Barton, resident in New York has recently lost her second husband, David. Her ex-husband, William, a scientist suddenly orders her and their daughters to move out of the city.

This is a pandemic novel, it is written as if it were Lucy’s pandemic diary. At first she doesn’t understand what is happening, and then she does and becomes fearful and distracted.

Elizabeth Strout completely captures those first few months when no one quite knew what was happening exactly, and when it would stop. William has moved Lucy to a house in Maine, right by the sea and she is shocked by the wide open spaces, the great expanse of it all. They quarantine, they meet people outside and safely distanced, they lose friends – we know, we all went through it.

Look, I love these books in a way that I never quite took to the Olive Kitteridge ones, Olive gets a reference here too and it reminded me that she too is a great character and definitely worth meeting, if you haven’t already.

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Open that door – it might change your life!

One day, when visiting her friend, Bonnie, in hospital, Ruth Coker Burks did just that, opened a door and changed her life. Ruth was a single mother, with one daughter Allison, her friend had cancer and she visited her regularly during the treatments; on this occasion, she was waiting in a corridor outside the ward, at one end was a door with a red label on it – on closer inspection Ruth saw it said Biohazard. But beyond the door, she could hear someone calling weakly for help; none of the nurses seemed willing to go into this area, but Ruth did and there she met her first AIDS patient, Jimmy.

It is hard to remember the crisis that engulfed the gay community in the 1980s, so another world pandemic is a salutary reminder of how wrong assumptions can be about the outbreak of a new virus. How it is transmitted being Enemy No 1 for all the population. AIDS and the Coronavirus are similar in that respect, to start with there was the assumption the Covid19 could be caught by touching something that had the virus on it; as a result, hand washing and santiser became the order of the day, a 72 hour delay before transferring shopping from outside to inside your house to prevent the virus contaminating your space – as if that were even possible for most of the population and then belatedly, it was found that transmission was aerosol and everything changed to handwashing, santiser, social distancing and mask wearing.

With AIDS, there was an added dimension, it seemed to affect only gay men. The reactions, though, were similarly bizarre. Before the true nature of transmission, bodily fluids, became known and established, whole communities closed ranks, families shut their doors and thousands of young men (and women) contracted the disease; not even to mention the number of people unwittingly infected with AIDS related blood products before screening was implemented.

Ruth lived in Hot Springs, Arkansas. Not quite, but almost, Bible Belt America and many of these young men returning hopefully to “home” were Pentecostalists, not the most forgiving Christians. The families were horrified: to have to admit to having a homosexual son, and one with a disease was a step too far; their Church condemned them, the disease was God’s punishment and it was not coming to their door. So who would care for these people?

The answer was, at least to begin with, people like Ruth. Single-handedly, Ruth Coker Burks began to look after the growing number of dying men; she raided dumpsters for food, she helped them get housing assistance, she badgered doctors for medication and when they died she oversaw their funerals (all cremations as no one would accept a burial) and she buried their ashes in Files Cemetery.

Ruth had Files Cemetery at her disposal because her mother, who was somewhat unbalanced, had one day bought all the available plots to prevent her brother from ever being buried in the family graveyard – they do say that God moves in mysterious ways.

In All the Young Men we meet a very small sample of her friends, her family of men that she loved and cared for, starting with Jimmy. We follow her through all her trials, her tremendous efforts to learn more about HIV and AIDS and to teach other people about safe and safer sex; to advance anonymous blood testing and to find allies in her single-minded campaign – precious few. There was tremendous opposition and colossal ignorance, even the Klan began burning crosses on her lawn, but stoically she and Allison carried on their lonely lives, shunned by their community and loved by the men they looked after.

Ruth had one secret weapon – she had grown up with William Clinton, though she was a few years younger than Bill, her father and his father were close associates, and these two young people would meet at gatherings of veterans and senior citizens as they drank and organised the community. Bill Clinton became Governor of the State at a time when Ruth was struggling with her young men and their needs and she wrote copious letters to him describing their plight and her efforts; and late one night Bill rang her to tell her he was running for President – the rest is history.

This is a marvellously vivid and desperately sad book. Looking back even to the “Diana moment” it is hard to carry one’s mind back to the thousands that died of AIDS before retro-virals were found to contain the disease. Co-written by Ruth and Kevin Carr O’Leary it is another book where it is essential to read the acknowledgments at the end of the book.

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