Book Review: Under the Knife

Under the Knife: The History of Surgery in 28 Remarkable Operations, by Arnold van de Laar, offers an eye watering, riveting, always accessible account of surgical techniques and development from biblical times through to the present day. The operations detailed focus on well known names – figureheads, tyrants and celebrities – as well as the medical practitioners who pioneered new practices, mostly without anaesthetic. Along the way technical terms commonly used by doctors are explained.

With the benefit of hindsight the unhygienic conditions that prevailed for so long may horrify, as will recurring treatments such as blood letting. For centuries surgeons and doctors were regarded separately, each developing their skills but rarely working together. Progress was sometimes accidental with a key observation or new practice ridiculed by peers until accepted by a high profile patient.

“in the Middle Ages common sense was obscured by tradition. Rather than looking at the results of their actions, our medieval forefathers would follow what some great predecessor had written in an ancient book.”

The Hippocratic Oath, historically taken by medical students as a step towards qualifying as a doctor, used to contain the line ‘I will not cut for stone’, implying that such dangerous practices as lithotomy – stone cutting – should be left to experts. The first operation detailed in the book involves a Dutch man who ignored this advice and, in desperation, cut out his own bladder stone at home. It was larger than a chicken’s egg and somehow he survived. The formation of such stones is explained as is the more standard operation to remove them and how this has changed over the years. Bladder stones are caused by bacteria. What was once an everyday complaint is now rare.

Treatment for asphyxia – problems with breathing – is then explored by detailing treatment of a very famous patient following a shooting – President John F. Kennedy. As we know he did not survive, following in the footsteps of the first president of the United States, George Washington, who suffocated after his doctors refused to perform a tracheotomy – a cut into the windpipe to allow air into the lungs. This and similar treatments are described along with when and why they may be needed.

Further chapters cover other common complaints: wound healing, including reasons for circumcision; shock, which in medical terms means a failure of the blood’s circulatory system; obesity and its complications, recurrent amongst popes over the years; fracture; varicose veins and other problems caused when our ancestors decided to walk on two legs; peritonitis, which killed Harry Houdini; narcosis and the introduction of anaesthetics for which Queen Victoria was thankful; gangrene; aneurysm; castration; hernia; stroke and more.

Bob Marley died because his religion forbade him from accepting required treatment. Alan Shepard became the fifth man to walk on the moon thanks to a placebo. Lenin suffered multiple strokes throughout his life, the causes and effects of which likely contributed to making him the tyrant he became, although he may have been felled due to lead poisoning from a bullet that remained in his body following a shooting years previously.

As well as detailing key operations, methods of diagnosis are discussed along with complications that can arise due to surgical error. Successful surgeons can become much sought after, especially by those willing and able to pay. Michael DeBakey was one such man in the twentieth century. Described as a maestro by his famous patients he enjoyed to the full his reputation and fame. Nevertheless he dismissed an assistant’s concern during an operation and did not follow through when the patient, the deposed Shah of Iran, developed worrying post operative symptoms which ultimately led to the former leader’s death.

“great surgeons can sometimes make a mistake. Complications are, after all, part and parcel of operations and the risk of problems can never be counted out, no matter how great you are.”

Each of the twenty-eight chapters offers a fascinating insight into surgical developments and subsequent treatment. They are written with sympathy and wit in a style that enables lay readers to understand and learn more about doctor’s reasoning, vernacular and limitations.

For anyone interested in little known medical issues suffered by the famous over the centuries, in how their own body functions and the work of those who may be called upon to keep it going, this is a well structured, digestible, recommended read.

My copy of this book was provided gratis by the publisher, John Murray, via Bookbridgr

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Book Review: Sight

This review was written for and first published by Bookmunch.

“how simple things would be if only I could know myself or others; […] but instead there is only this excavation, a digging in the dark: precarious, uncertain, impossible to complete.”

Jessie Greengrass’s short story collection, An Account of the Decline of the Great Auk, According to One Who Saw It, demonstrated her confidence and competence as a writer of innovative, piercing fiction. In Sight, her debut novel, the clarity and conviction of her prose is again in evidence. Written mostly in the first person, with occasional digressions to explore the histories of key medical advancements – x-rays, human anatomy, psychoanalysis – it reads as an intensely personal, non linear series of reflections. It is a search for knowledge, an attempt to make sense of the most challenging emotions – the multifaceted viscerality of love, desire and grief.

The story opens with the narrator “pregnant again”, watching through a window as her toddler daughter, and partner, Johannes, play in the garden. She feels the distance between them, a distance that she recognises will increase as her daughter ages. She understands that this is as it should be, that a child should be raised able to one day cope without parents.

The relationship between mothers and daughters is at the heart of the novel. The reader is offered snapshots of the narrator’s childhood, of time spent with her grandmother, a psychoanalyst who had raised her child alone. It was only later that the narrator came to understand that her mother was also a daughter, and that the grandmother was trying to help and protect her, especially when the mother’s errant husband finally left for good. At the time the young girl felt resentment that she was being kept from her loving mother by a grandmother who required the child to accept more independence.

The inner monologue by which the story is told may be introspective but the author demonstrates her ability to articulate the essence of emotion without hyperbole. Even when recounting the long months leading to her mother’s death and her subsequent grief – a time when she spent day after day in the Wellcome Library – she is seeking an understanding of how she reacted to events.

“The things which I learned without noticing all through that year recur to me still, those images from medical textbooks, the bodies dissected or described, the case notes and the cabinets and all the many ways there are to see inside ourselves, and still I feel that, correctly understood, they might constitute a key”

The narrator is “young, adrift, bereft” when she meets Johannes. After a time, the possibility of having their child is considered. The narrator desperately wants to be a mother but fears that this is for selfish reasons rather than for the benefit of the being she would create. She also fears the inevitable changes motherhood would bring; the uncertainty of what she would become and how she would cope with this. Johannes is supportive, willing to accept whatever she decides but requiring that a decision be made to end the unsettling prevarication.

After her mother died, the narrator disposed of her possessions. She retained memories rather than mementos. Pregnant, watching her daughter she ponders:

“I wonder what they will keep of me, later; what off-cut memories will remain to be re-stitched, their resemblance to myself a matter of perspective. I want only what I think we all must want: to come off as better than I ought, more generous, more sure – kinder than I know myself to be; but I want also to be known, to be counted and to be excused.”

The depth of feeling and insights offered into the distances that exist in even the closest of relationships make this an intense, compelling read.

Any Cop?: The writing is rich yet pithy, the story stark in places yet emotionally resonant.

 

Jackie Law

Book Review: Yuki Means Happiness

This review was written for and first published by Structo Magazine.

Having enjoyed Alison Jean Lester’s debut, Lillian on Life, I was eager to see where the author would take her readers in this, her second novel. Lillian was a woman of a certain age looking back over decades lived. This latest work is again told as a recollection, this time of a much younger woman looking back to a pivotal few months when she was in her early twenties. From the first sentence of Yuki Means Happiness the reader is aware that the adventure will not end well.

The story opens in Boston, Massachusetts, in 1996. Diana, a trained nurse, is meeting Naoki Yoshimura, the father of two year Yuki. Naoki had employed Diana as a maternity nurse when his wife, Emi, travelled to Boston to give birth. Now he informs her that Emi has left him. He offers Diana a generous salary to work in Tokyo as Yuki’s nanny. Diana is in a relationship but unsure of the commitment she is willing to offer. She regards this job as a chance for adventure and also escape. Key events in her life to date have made her wary of men and their intentions. Her boyfriend is ignorant of this personal history and declares his willingness to wait.

Diana travels to Tokyo unable to speak any Japanese. Naoki’s home is next door to that of his wealthy parents – it was built in their garden. Naoki’s mother is polite but distant. She helps with Yuki when requested and keeps a watchful eye on her son’s interests.

The sense of place evoked as Diana settles into her new role is beautifully rendered. As a young and inexperienced woman Diana finds herself irritated but compliant with the demands made on her time by her employer. She grows to adore Yuki and relishes the insights she is gaining into the culture and expectations of the Japanese.

Life within the Yoshimura household begins to shift when Naoki brings home a new girlfriend. Meanwhile, Diana has started meeting up with Naoki’s ex-wife, discovering that their marital breakup was not everything Diana had been led to believe. When she is accused of leaving Yuki in the care of a man, Naoki displays an anger that frightens the young nanny. His subsequent actions suggest Yuki could also be in danger.

The unfolding tale is nuanced and layered, presented with a subtlety that belies its depth. The emotional threads of the novel may be complex, but the writing remains accessible and engaging. Japan is portrayed with warmth and honesty, while its customs, however alluring, are shown to provide a means to exert dominance.

The understated intricacy of the story development is impressive, and the setting, plot and structure are deftly painted. There is much to reflect on after turning the final page.

Yuki Means Happiness / Alison Jean Lester / John Murray / 27 July 2017

Jackie Law runs the book blog Never Imitate and is a regular contributor to Bookmunch. She lives in rural Wiltshire with her family and back garden hens. You can find her on Twitter @followthehens.

Gig review: An Evening with Mick Herron

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On Wednesday evening of this week I returned to Waterstones Bookshop in Bath to listen to Mick Herron discussing his books and writing habits with Sarah Hilary. In preparation for the event I had read the first of Mick’s Slough House series of spy novels, Slow Horses (you may read my review here). Having enjoyed this first foray into his work I now wish to read everything he has written – oh for more time.

The event host was Waterstones’ Senior Bookseller, Steve Andrews, who impressed me by recognising and welcoming me when I arrived. He provided a glass of Prosecco and I took my seat.

Steve opened the discussion by introducing Mick as the finest espionage writer of our time, and pulling from his bag a recently acquired early proof of Mick’s next release, Spook Street. I made sure to approach Yassine, publicity manager at John Murray, to beg a copy for myself afterwards. I do hope he remembers to pop one in the post.

Steve invited Mick to give a reading. Chosen was a short section from Real Tigers, his latest book available for all to buy.

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Sarah then took the helm. She is obviously a fan of Mick’s work. She commented that his character Jackson Lamb, the head of the band of misfits and mavericks banished to Slough House, is one of the greatest grotesques in fiction. Mick explained that what drives Jackson is his view that the Joes – spooks working in the field – must be protected at all costs. Mick doesn’t plot his novels; his characters dictate the action. Although he knows how each story will start he allows his characters room to breath and follows wherever subsequent ideas lead.

Sarah regards Mick’s characters as a team, a type of oddball family. The way their observations and interactions slot together are a joy to read. She asked if they whispered in Mick’s ear.

Mick informed us that Jackson shouts! There is so much more to him than his sometimes monstrous behaviour. Mick hopes that the reader will love each character even if rationally perhaps they shouldn’t.

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One of the more amenable characters is Catherine Standish, a disgraced PA to a late senior spook. Sarah regards her as one of the best female characters in spy fiction. She asked Mick about any difficulties he faced writing a women.

Mick sees Catherine as the moral centre of the team. She is a recovering alcoholic, vulnerable but with a deep inner strength. He mentioned that in Real Tigers she is kidnapped and left with a bottle of wine. He was riffing with Hitchcock and the suspense of a ‘ticking bomb’ in a closed room. This allowed him to get inside Catherine’s mind, something that isn’t always possible in a thriller requiring tension and a fast pace.

Sarah mentioned that Jackson sometimes taunts Catherine but that his apparently crude actions end up displaying compassion. Things are rarely black and white and Mick is a master at showing the grey.

There was discussion of the humour in the novels, the cinematic openings and the crossovers of characters between each of Mick’s published works. Sarah commented that these characters are such a gift, the reader can’t help but want to get to know them better. Mick mentioned that contracts for television or film rights are for individual characters and these crossovers can be problematic when not all his books are to be included in the deal.

Here it was clarified that Mick has published two series – Oxford, and Slough House – as well as two standalone novels. Some of the crossover of characters occurred when it was unclear if a former publisher wished to put out the next Slough House book. Although screenplays have been written for a four part television series it is still unclear when this might be made.

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Mick talked of how he names his characters, and how their personality and actions can slide into place once they have acquired the right moniker. I was highly amused by his take on the name River, his choice for a younger character which he struggled to find for some time. He does not regard River as a real name but rather as something invented by hippies or celebrities. I made sure to pass on through Sarah afterwards that this is the name I chose for my now eighteen year old son.

Mick told us that he does almost no research. His knowledge of the secret service has been gleaned from other spy novels or entirely made up. However, the building known in the books as Slough House actually exists. He passed around photographs as proof.

Mick is often asked if he has any personal experience of espionage, which he denies. The question amuses him as it was not something he was ever asked when writing about a personal investigator.

This led to a discussion about genre and where spy novels fit in. Mick sees crime as asking ‘what happens?’ whereas thrillers ask ‘what happens next?’

An audience member asked Mick how he had switched from character driven novels to action driven. He replied that he had removed his use of the semi colon. This cut out much of the imagery and increased the pace.

He was also asked where his characters came from. He claimed they were aspects of himself. He prefers to deal with issues and creates characters who will deal with these in different ways.

With no further questions the evening concluded with the signing of books and Mick was quickly surrounded. It is clear that, in Bath at least, he has a solid fan base. Given the quality of his writing this is only likely to spread.

Book Review: Slow Horses

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Slow Horses, by Mick Herron, is the first in a series of modern day spy novels featuring members of the British intelligence service put out to grass in a unit nicknamed Slough House. Their banishment to this premises is a punishment for a variety of on the job cock-ups and misdemeanours. Amongst them is River Cartwright, a young man harbouring bitter resentment at being shouldered with the blame following a failed operation. The unit is overseen by Lamb Cartwright, an overweight and often repellent individual who is not as incompetent as he encourages people to think.

The inaccurately named operatives of Slough House are incensed when one of their number is tasked with covertly obtaining information from a disgraced journalist. It is understood that they are given only the most menial and mind-numbing tasks, although each hopes that eventually they will be permitted a return to active service at Regents Park. River regarded his most recent job, collecting and investigating the contents of a rubbish sack, as simply another unpleasant test of his willingness to follow orders. When it ties in with what looks like real spy work he determines to find out more.

All attention then turns to the abduction of a young man whose bound and hooded image is uploaded onto the internet alongside a threat to behead him within forty-eight hours. River sees this as a chance to redeem himself but is denied the opportunity to become involved. Wondering if the abduction could in any way be related to the journalist, from whose home the rubbish sack was taken, he takes matters into his own hands. When his actions go catastrophically wrong each member of Slough House becomes involved.

Unsurprisingly, there is nepotism and corruption at the highest level. It is still shocking how far certain powerful people will go to further their personal agendas. The slow horses are not slick and efficient spies, but they are capable of using their training and wits. Their manoeuvrings are often unexpected but gratifying to read.

This is a tightly written, sardonic and grimly prescient work of spy fiction. It is also rather fun in a stylishly mordacious way. The author ensures that readers get behind his flawed and often flailing creations. This was my first foray into his work; I hope it won’t be my last.