Category Archives: Medicine

The choice is not solely yours

In this complex and engaging novel, Emily Edwards tackles the tricky subject of vaccines. Not, as it happens, Covid-19 but MMR. The story is set in a period before the pandemic, but at a time when there was still some anxiety (now proven to be unfounded) about whether or not there was a connection between autism and the multi-vaccine as a protection against mumps, measles and rubella.

Two families, two children both living in the same street. A birthday party is planned. Faced with a direct question in an email, one set of parents prevaricate. The result is a court case for parental negligence.

This has all the hallmarks of a polemic, but it is so skillfully handled that vaccinating and not vaccinating ones children against these sometimes dire illnesses, is dealt with in an even handed and fair way. In the narrative of The Herd, herd immunity is an issue. The fictional place, Farley, where these families live has an unusually high number of non-vaxxers (as we have now, so recently, come to know them) and there are some specific reasons for this; some less specific reasons; and for whatever reason unvaccinated children are at risk – and then there is an outbreak.

The novel was being written before the pandemic started and the author makes her position on vaccination clear in a short Author’s Note at the end of the book. Not all reader’s bother with this once they have finished the novel. In my view, missing out of this is a mistake, it is often very enlightening, as it is in this instance.

I hold my hand up here, I know Emily. But this has not in any way coloured my opinion. This is a nuanced, but entirely realistic portrayal of the dilemmas that face young parents today; with ever more illnesses and diseases coming under the vaccination cosh: influenza, Covid, some cancers, and all the old illnesses which are covered by MMR, smallpox, diptheria, TB and any added ones caused by travel abroad, our children face an endless succession of needles. The choices we make affect our children and also, the rest of society – what is the right thing to do?

I am heartily glad that this is not a dilemma that I have to face.

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3 – but not of a kind

A short break and lots of reading.

Ann Cleves has added a second story to her North Devon Series to follow on from The Long Call. The Heron’s Cry is a thriller, the detectives are Matthew Venn and his assistant detective, Jen. In the opening chapter, Jen is at a party where she meets Nigel Yeo, by the end of that night or early the next morning, Yeo is dead, murdered in a gruesome, gory and horrific way. The best thing about Anne Cleves’ series is that they are stand alone, you do not have to read every Vera novel, or every Shetland novel to enjoy the one in your hand, and the same is true of The Heron’s Cry.

The God of that Summer is, and you can see this from the book jacket, a Second World War novel, translated from the German by Shaun Whiteside. This is not precisely a follow on from Ralf Rothman‘s previous novel, To Die in Spring, there are no familiar characters, though the background covers the same war, the same grief and the same hardship. This novel follows the experiences of a young girl, living in Northern Germany, therefore right in the path of the Russian advance. Lucia is very naïve, and innocently asks burning questions about sex, and specifically rape, as she has overheard someone say that the Russians are raping women indiscriminately. There is also a problem with her family: her step-brother-in-law is a flagrant and proud Nazi, her own father a less proud, but card carrying, Nazi, a trader in Kiel but verging on the black market, while her sister lives grandly on the proceeds. How will this work out for all of them, since the evidence seems to suggest that Germany is losing – though this is not something that can be openly discussed? The novel explores the dilemmas that confronted ordinary women, whose choices were limited and decided by their husbands’/brothers’/fathers’ activities in war and in peacetime.

Love Marriage brings us right into the twenty-first century. Two young people, Joe and Yasmin, are engaged to be married. Both of them, for very different reasons, live with their parents. In Joe’s case, with Harriet Sangster, a rather well known feminist writer and broadcaster in Primrose Hill. Yasmin with her father, Shaokat/Baba, a semi-retired GP and her mother, the housebound, housewife, Anisah and her wayward brother, Arif in South London. Monica Ali explores all the tensions of life, the complications and compromises, the desires, needs, and traditions that bind and fracture a family; in this modern comedy of manners everything comes under the hammer: race, class, tradition, parenting, sex and a whole lot more. Set against a background of the NHS, it is full of interest. Yasmin is training to be a doctor, and is working in a geriatric ward with all the complications and compromises that can involve. Joe is already a doctor, working as a pediatrician. All this is told in a fragmentary, anecdotal way which beguiles and entices the reader with little snapshots that together make up the bigger picture; each scene uncovers the uncertainties, secrets and insecurities that together make life interesting and complicated. Brilliantly and vividly skewering the dilemmas of today’s culture.

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The courage of a long novel

It is a brave author who writes a novel of 700plus pages; to Paradise in 704 pages is quite a reader’s marathon, and To Paradise is just such a book.

You will know that I am a great admirer of Hanya Yanagihara, and although I was not as enthralled by this novel as I was by A Little Life, I certainly began to enjoy it more and more. It is a complex, layered novel arranged in three parts over a long period. The opening part, which covers a period around 1893, therefore only a few years before the turn of the century, is devoted to the lives of the extended Bingham family, most especially the eldest son, David who lives with his father in Washington Square, New York. At the time of the opening narrative, David is still unmarried but a partner has been found and a degree of intimacy reached, when out of the blue David meets another person in whom real love and affection is involved, although the prospects are limited. To choose safety, security and social acceptability or to seek paradise?

Once the methodology of this narrative becomes clear, it does get easier to follow the trajectory. In the second part, the names are familiar, there is another David Bingham, but his situation is very different from the man in 1893, it is now 1993, the house in Washington Square still figures, but David’s position is very different and how different, and why only becomes clear after a long epistolary explanation comes into his hands (or ours).

Thus it is no surprise to find all changes in the final part of the book, set in a very changed New York in 2093. A further complication is that this part, the longest, also switches backwards and forwards over a period of roughly fifty years to 2043. The backstory mostly being revealed in an epistolary form.

The themes are easier to spot: family, loyalty, friendship, love and survival. There is still something of a pioneering spirit in the first part; but by the middle part the New York scene has changed, AIDS has arrived and accommodation is being made for its changing attitudes and habits; by the final part (incidentally probably being written even as a global pandemic was raging outside) there have been several global pandemics and another even more deadly virus is slowly moving round the country, the State is all powerful and the Bingham/Griffith legacy is affecting the lives of the family, more and more.

In each case, in the end the question is: what will one do to survive and to find a better life, and is it worth the risk? Will it, in fact, be better?

Reading the back of the book jacket, it appears that other people were also enthralled and captivated by A Little Life, but To Paradise is harder work, but just as profound and engaging once you figure out the ramifications, which are many, of the convoluted plot involving all things: country, place, family and State. Definitely give it a go.

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2022 – Re-readings 1

I have decided to re-read books at random from my shelves, and then keep or give away ones I will not want to read again. This is one of each. I will keep Americans in Paris, it is informative and interesting, it is about a city at war and under occupation and the people, American citizens, who decided to stay and what they did.

Sylvia Beach is probably the best known, her bookshop, Shakespeare and Company was envied and eyed up by the Germans, but she managed to keep all her books, selling a few and lending others all through the war, and when she died, she left the remainder to the American Library in Paris. The shop that now bears the name, near to the Notre Dame Cathedral is not her shop, but a homage to her.

There were many others, some like Charles Bedaux, whose name was mired in infamy, who worked both for and against the Germans, somewhat like Schindler, although not as benign; Charles did try to protect a few Jews, but mostly what he wanted to protect were his factories. His end was messy and unresolved; others like the De Chambruns lie in that shadowy Rizla paper-thin area between collaboration and survival. Countess Clara remained in Paris, and eventually took over the running of the American Library in Paris, her relationship with one of the Germans in authority, Dr Herman Fuchs, led people to assume something very ugly, but it was entirely other, simply a means to an end: saving the library, as was the role of her husband who took over the management of the American Hospital of Paris when the principal doctor Richard Sumner Jackson (and his family) were incarcerated by the Germans, (thereby ending one of the underground routes that were so vital in returning downed pilots back to Britain and in which the hospital, right under the noses of the Germans, was implicated).

Charles Glass has meticulously researched the background and activities of all these people and many more, who acted heroically, clandestinely, foolishly, criminally and somewhere in between all of those. It is an absorbing and fascinating picture.

Hotel of Dream is a fictionalised biography of Stephen Crane, an American author who died fairly young of consumption. In his papers, Edmund White has found a slight reference to a homo-erotic book that Stephen was writing at the time of his death; no such manuscript has ever been found, so Edmund has written it for him (who better?) It is told as if Cora is taking down the story as Stephen narrates it from his limited resource of energy. The novel describes Stephen’s imagination, his actual experiences and his strange but poignant relationship with Cora while at the same time, also exposing the lives of New York street boys, the underbelly of the homosexual world at a time when AIDS was just beginning the scourge of disease and death that it was to become.

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Why I re-read A Little Life

A Little Life was shortlisted for the Booker Prize the year it was published. [my post is somewhere here if you search for it]. It did not win but that did nothing to diminish its brilliance. A few books ago, I read a new novel that, while in every way different, reminded me of Hanya Yanagihara‘s narrative style. So I picked her book off the shelf and read it again. She has recently published another novel, To Paradise, and that will be in the TBR as soon as I get a copy.

A Little Life is about four young men who meet at college. They are in every way very different, but they become friends. JB is an artist and will become feted and famous, Malcolm is an architect, who will also become famous, Willem is an actor and will become famous, and Jude – around whom the entire novel is centred – will become a brilliant lawyer, starting in the US Attorney office as a prosecutor and changing to a corporate firm to become a defender of the very same sorts of people that he had been prosecuting before.

The timeline follows these men from around the age of eighteen, through to their forties and fifties. Beneath it all, running like a flaw in white marble is the years Jude spent until the age of fifteen, a secret so buried that he cannot share it with anyone, so corrosive that he cannot trust it with anyone at all, even the people who love him.

Along the way, although this is a novel that details and examines friendship and love, it is also a love story between two men, though not in any way a “gay” novel. In spite of the fact that I sob silently through the last 90 pages, it remains for me a brilliantly cathartic reading experience. I live the little life, laugh, love the food, love the ambiance, the places and the people and cry when things go so badly wrong.

In a few posts from now, I will be writing about another book I am reading called Wonderworks. This is a non-fiction study of the importance and development of literature, written with a neuroscientific study of what literature does to the brain, and how even as far back as the Ancient Greeks and beyond, even without the science to back it up, they knew that story-telling was healthy and a helpful way to negotiate our little lives. I heard about Angus Fletcher‘s book on the radio and the content gave me reason to smile, as my head is, as often as not, buried in a book. Wonderworks is the book that justifies my choices and my habit of reading.

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The Beekeeper’s Daughter

From a postcard of some maids that worked at The Orchard House, in Granchester, now The Rupert Brooke Museum, Jill Dawson has created a fictional maid, Nell Golightly, the beekeeper’s daughter and around her she has drawn a picture of “her” Rupert Brooke.

Rupert Brooke, famously, stayed at The Orchard House and at The Old Vicarage and he immortalised it in his poem, with the lines “and is there honey, still, for tea?” Nell, who works as a maid at Orchard House, meets Brooke in many forms and ways, all of them entangling the two of them in a complication of attraction and fury. In The Great Lover, Brooke falls in love with Nell, but cannot fully admit it as she is working class and it would not “do”. Nell, for similar reasons, tries not to be engaged with this fascination, but he confuses her all the time with his mixture of seriousness and cruelty; teasing and embracing.

Rupert Brooke’s character can be deduced from his substantial archive of very personal letters, and from his poetry and prose. Jill Dawson did not need to invent much to bring to life this strangely tortured poet, a man whose sexuality was probably fluid, he certainly had both male and female lovers; as well as a much larger number of friends (of both sexes) who would happily have gone further, some of whom must have hoped that it would to lead to marriage.

The earliest biographers, namely Christopher Hassall and others, gloss over Brooke’s time in the South Seas, but an extraordinary letter, sent by Taatamata to Brooke, which was discovered many, many years later, from the wreck of The Empress of India which sank in the St Lawrence Seaway, revealed that she was pregnant. Dudley Ward, to whom the letter was eventually sent, as Brooke’s executor, did make enquiries, but somewhat half-heartedly, since an illegitimate daughter of one of England’s great hero-soldier-poets would not have sat well with the Establishment.

Rupert Brooke would have fought at Gallipoli, however (perhaps mercifully) he died of septicaemia, possibly from an infected mosquito bite, before the attack began. His poem, with the lines “think only this, of me” with the Granchester poem are possibly the most well-known and often quoted of his poems, but the poem from which this novel’s title comes, The Great Lover, written in full at the end of the book is one of his loveliest, full of everything for which he is well known and admired. He is buried on the island of Skyros, Greece.

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All in the mind

Snow Country is the second in a promised Austrian trilogy. The novels stand alone but have a common thread centring on a mountain retreat for people suffering from stress or anxiety, and with mental challenges that are more genetic. Even if you have already read Human Traces, you would be forgiven for not remembering all the details, since it was first published in 2005.

Sebastian Faulks may have come back to it and decided on a trilogy, or it may have been in his mind all along. Human Traces begins in France with the work of Professor Charcot in Paris, two men, Jacob Rebière and Thomas Midwinter, meet under his influence, working on ways to help patients who are not clinically ill, but who nevertheless suffer all the aspects of illness. The book opens in 1876, and by the end Thomas and Jacob have established a safe haven for these people, in Austria. Not without much difficulty, personal loss and financial ruin along the way; Snow Country follows the lives and fortunes of three or four main characters who eventually end up, for one reason or another in Schloss Seeblick, the sanatorium set up by Thomas Midwinter and now run by Martha, one of his twin daughters.

The first volume ends with The Great War, it is a masterpiece of skillful storytelling underpinned by an emotional charge as the characters struggle with the new thinking about mind/body and the interplay of one upon the other. Snow Country begins in the between war period, Lena (pronouced Layna) is a young girl, her chaotic mother Carina has had many children, all sent to orphanages, but Lena she keeps, and for a while she works at Schloss Seeblick. Rudolf Plischke meets Lena in a hospital, he has a broken leg; she is there because when she is working, Carina has nowhere else to leave the child. Anton Heideck, as aspiring journalist meets Lena in strange circumstances and then forgets her. His love and soul mate, Delphine is the one he yearns for.

Snow Country covers the years between, opening in a field hospital in 1914 and ending just before Hitler seizes power, though he is on his way. As a journalist, Anton travels a great deal, and in fact is in Paris covering an important trial when the First World War breaks out.

Both these books, in the hands of a master, pack a huge emotional punch. They are, at heart, love stories but so much more. Through the thoughts and serious studies of the men, who are just beginning to delve into the complexities of the mind and identity, we are taken on a journey through the very early stages of psychotherapy and psychoanalysis, and the fumbling, sometimes cruel ways in which the human flotsam and jetsam of the mentally ill were treated. Both Jacob and Thomas struggle to see their ways towards a more humane and understanding method of helping and treating these people; treatment that does not include chaining them up in stables. By the beginning of Snow Country, Thomas has died and Jacob has retired, at its end both of the current doctors are due for retirement. World War II looms, though obviously none of the characters in the novel know this yet.

This is a most ambitious project. How to keep the narrative jostling along while exploring that most fascinating subject, identity and the human mind? There are descriptive passages of sublime delicacy, as well as of the depths of human depravity. Between the wars Vienna saw itself as primus inter pares of all European cities: cosmopolitan, gay, daring and forward looking. Concerts by Mahler and Schoenberg were all the rage, theatre and opera for the elite; line girls along the streets and sexual freedoms were on offer (though syphilis was rampant and unwanted pregnancy always a risk) who cared? Just drink more champagne and join the parade. All the usual social ills and fortunes staggered along side by side, it simply relied upon which way you looked.

I do hope we don’t have to wait another sixteen years for the final volume. I might miss out all together!!

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Up or down on the therapist’s couch

This is a very, very good novel and I am about to make a reveal that you might not want to know before you read it. It is not a plot spoiler, but an observation. So, be fairly warned!

Graeme Macrae Burnet is known for skillfully creating an entirely believable backstory to his writing of any given novel. He did it in his shortlisted Booker Prize novel and he has done it again in Case Study. Such is the backstory, that the reader feels compelled to check Wikipedia or The Oxford Encyclopaedia of Literature, or some other equally learned resource like Google, where if you have checked the latter, you will find GMB chortling to himself. “Gotcha!!!”

Case Study, as it suggests in the title is a combined biography (written by GMB) of a therapist, Collins Braithwaite, together with CB’s notes on one patient and another patient’s notes upon her own therapy and the reasons why she went into therapy in the first place.

Filled with plausible real life characters, including RD Laing, our therapist, [Arthur] Collins Braithwaite waits in his lair in Ainger Road, Primrose Hill, London for his ‘visitors’. He does not call them ‘patients’ as he has no qualifications to ‘treat’ anybody, he is neither a doctor and therefore not registered as a psychotherapist, nor is he an analysand, and therefore not qualified to be a psychoanalyst. Nevertheless, as he puts it “if anyone is prepared to pay £5 for me to listen to their problems, why not?”

GMB was researching Collins Braithwaite when he was sent some notebooks to augment his work. Having exhausted the archive in Durham, where Braithwaite’s works were stored, these notebooks, written by one of Braithwaite’s patients was strong meat indeed and further fired the author’s investigation, hence the novel…

It is both a very telling narrative, and a very intriguing plot. There are moments of almost hilarity, and also sadness. At a time when young people’s mental health is very much in the news, a novel which deals with an entirely fictional case of metal collapse could be seen as helpful, a warning to seek only the most qualified assistance, or simply as a exploration of Identity and Self, and the many disguises that we adopt in order to ‘fit’ into whatever world we want to belong to.

In this case, one person and her alter-ego clashing horribly and each making the other, deeply unhappy and ill. All in the mind, as they say.

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‘Is anybody there?’ said the traveller

My title comes from The Listeners by Walter de la Mare written some time in the 1900s. How many thousands of displaced persons, migrants, and other travellers must have hoped that there would be an answer.

In The Wrong End of the Telescope, there is a triangular dialogue going on. Mina, a doctor from Chicago has arrived in Lesbos, summoned by her friend Emma, who says the situation is in crisis and Mina is needed urgently. Still jet-lagged and disoriented, Mina arrives to find that as the weather has deteriorated, the boats are not landing on the beaches, and there is, after all, not so much to do.

Mina, who is trans, has been cut off and disowned by her family, all except her brother Mazen, who will arrive in Greece soon. The other person in the triangular dialogue, apart from the reader, is a writer who cannot write about the immigrant crisis in Lesbos. He shares many of his stories with Mina, but Mina adds her own and thus we, three, learn the heartache, grief, loss and horror of the desperate refugees from Syria, Afghanistan and all over.

Lampedusa and Lesbos have rather dropped from the headlines recently, Dover having taken their place temporarily (evidently the word on Priti Patel has not reached France or they wouldn’t come).

One boat does arrive, and it is one family that Mina’s story focusses on, as they struggle to understand what lies ahead.

Rabih Alameddine develops this narrative in a tender and documentary language. The chapters are short, with descriptive headings and each one expands on Mina’s life, and choices as well as the choices made by and for the hundreds and thousands of destitute people in the camps on Lesbos. Moria, the most populous and a slightly smaller one, Kare Tepe where Sammy, Sumaiya and their children are housed. Sumaiya is very ill and Kare Tepe has better medical facilities, marginally. This was written before the fire that destroyed much of the Moria camp in September 2020.

Woven into the narrative, as well as Mina’s life and the transition from Aylan, is the story of the writer, referred to throughout as You, we hear his life, also one of displacement. By braiding together, the stories of the people in the camps and Mina and the writer, Alameddine has presented us with the facts, although this is a novel: we can only begin to imagine what all these losses do to one’s identity.

The Wrong End of the Telescope is a dialogue about identity, belonging and not belonging; in referring to some of the stories, Mina uses the Greek myths to underline the point: Tiresias who angered Apollo by wounding two copulating snakes and was turned into a woman; Daedalus and Icarus, escaping from the tower, early migrants; this is a conversation with one voice and many languages.

O thievish Night,
Why shouldst thou, but for some felonious end,
In thy dark lantern thus close up the stars,
That nature hung in heaven, and filled their lamps
With everlasting oil, to give due light
To the misled and lonely traveller?

John Milton Comus Line 195ff

How dark, appalling and terrifying must that dreadful sea crossing be, and of the thousands that made it to shore, never forget the many, many others who did not.

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Maladie sans frontières

It is, I suppose, inevitable that some novels will reflect in their content or their tone, the devastating effect that Coronavirus had on the world; but were I to choose which author to read, top of the list would be someone like Sarah Hall.

Burntcoat is the story of two people caught up in a world catastrophe, which like Coronavirus, slowly overtakes them.

Edith Harkness has had a difficult childhood. When she was eight, her mother had an ischemic haemorrhagic stroke, which profoundly altered her mind and character and to the child’s perception the mother disappeared and came back as Naomi. Increasingly frustrated, Edith’s father finally leaves and the two women struggle on in a remote cottage.

By the beginning of the novel, all that is long behind Edith. She is a well known sculptor, mostly in wood which she has treated with a Japanese technique called shou sugi ban, which involves burning the wood, dowsing the flames and then scraping back the charred surface to reveal the grain. Her public works include a large female figure at Scotch Corner, which she calls Hecky, rising from the gorse and welcoming travellers to The North, for this effort alone, Edith has won a substantial prize.

With this fortune, which she can scarcely believe herself, she has bought and refurbished a disused warehouse/factory building by a river, called Burntcoat, which she finds has an implicit synergy. She has few friends, but those are precious. They meet, often enough, at a restaurant owned and run by an immigrant from Turkey, called – well he has two names.

An insidious, deadly and rapacious virus is slowly spreading across the world, it arrives in March and the Prime Minister (in this case a woman) first minimises the danger and then, all at once, closes everything down: curfew, shops shut, food shortages, hoarding; hospitals overflowing and deaths: hundreds then thousands.

Halit shuts his restaurant and moves in with Edith, this was not so much a plan as a progression.

Sarah Hall writes with a spare, lucid and tender vocabulary, even the most violent passages present a graphic, but not disgusting, vision of violence; the same is true of her description of the virus, which is not Coronavirus but another (fictional) disease which begins not unlike Shingles, with blisters and pain but which steadily gets worse.

Burntcoat is an exploration of creativity, it is, above all, a love story and also a meditation upon what we have all been going through. In one passage she writes:

The world doesn’t come back as it was before. The seas and mountains remain, the cities slowly fill up again, jets take off over ochre and turquoise aprons. Finance begins to move. Children are allowed to play together. Humanity is re-established. There is grief, its long cortège; the whole world joins and walks. Such shock is both disabling and enlivening; everything before was a mistake. We will do it differently; we’ll repent. Consume less, conserve more, make sense of our punishment. it’s been said the virus reached levels of superiority other pathogens never have. Like the vastation of ice ages, and condensed gene pools, language, blood and milk, it will evolve us. Of course, the old ways return. Our substance is the same; even with improving agents. We are our worst tendencies. We remain in our cast.

Burntcoat p186

In recognising this, Edith understands much; as will the reader. She has survived and learnt from her experiences, now looking back in old age, she is reconciled and ready for the next journey.

This is a short, exquisite piece of writing, true literature. Exploring, exposing and examining: love, lust, loss, grief, human fragility, resilience. It is all there. A masterpiece for our time.

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