“Only this morning, brushing her teeth, she’d listened to a young woman on the radio announcing that her father was being denied treatment, then an interview with a minister about rationing and resources and so on. As though every drug, every penny, has to be made available for every treatment. All the while printers breaking, then nurses, then doctors.”
Histories, by Sam Guglani, is a set of interlinked stories – histories – of the nurses, doctors, patients, porters and cleaners who populate the oncology department of an NHS hospital during the course of one week in October. It is a humane, devastating exploration of the effect of sickness on those who suffer, observe and treat it. Beautifully written it offers an empathetic observance of the many types of people encountered and their coping strategies when dealing with death.
Unlike other books written by doctors this one does not emphasise the stresses caused by the long hours worked. Rather it looks at the relationships between medical staff at all levels, their expectations, and those of patients. Doctors are not homogeneous; they each cope differently with a job that demands they save lives when what they are doing on a daily basis is trying to postpone death.
The consultants featured are at different stages in their careers. One is wealthy and arrogant, believing that patients want their doctors to appear confident and professional, even on days when they may feel crumpled and rushed. He is growing his private practice, the status conferred by the cost of treatment making certain patients consider him the best.
“It’s no big secret. The more elusive or expensive or glamorous a medical opinion, the more hope a patient invests in it, the more trust. He’s convinced of it. Desire and trust are so perfectly aligned in the practice of medicine.”
He talks of the need for self-care, that he always ensures he takes breaks. He is accused of not caring for those requiring consultations, of finding time for his private patients when those coming through the NHS must wait.
“Look. I get that you’re clever. Busy, capable. All that
I know you can do it all, Nathan. But you give nothing.
What do you want me to give?
It’s just a set of tasks for you, isn’t it? Medicine. While you stay intact.
You want us – what? You want us to break?”
Another consultant becomes frustrated when patients demand tests and treatments that she does not consider necessary. They accuse her of withholding due to their age. They ask for a second opinion from someone more senior. She feels relief and then guilt when she signs them over to someone else.
The junior doctors are still finding their way, struggling to deal with the daily experiences and fear of missing signs of illness progression, or of being blamed for unnecessary escalation. The nurses and other staff members at times resent the doctors with their sometimes acerbic discussions of patients in their care. Yet all are affected by the age and demeanour of the never ending stream of patients.
“We’re drawn to the young and the beautiful in hospitals. We flock to them. We meet them differently to the elderly, say, or the obese, the vast majority of mentally and physically fraying persons that fill these buildings. […] As though, at some level, we really do believe that beauty renders us invulnerable to suffering.”
Patients’ loved ones talk of the unfairness of this suffering, asking why them? as if illness should be deserved. The medical staff have learned what is almost a script in order to deal with the human pain that daily surrounds them. They may care but cannot survive the job if they care too deeply.
In spare yet emotionally unsparing prose the author presents a cast who are at moments of medical crisis. Their stories are told with sympathy but also realism in an environment where patients are demanding miracles. This is a powerfully understated, beautifully written portrayal of life in a hospital, from many perspectives. A recommended read for anyone who may one day require medical treatment.
My copy of this book was provided gratis by the publisher, riverrun.