On Tuesday of this week I attended a friendly and fascinating event at Toppings bookshop in Bath. Sam Guglani, author of Histories, and Katy Mahood, author of Entanglement, were in conversation, discussing how the intersections and collisions of human experience can be explored in fiction. Originally the evening had been intended to be a discussion between two doctors about how their work in medicine inspired their writing. Unfortunately Joanna Cannon had to cancel due to illness so Katy stepped in. She proved a fine replacement.
The evening opened with introductions and readings. The authors then questioned each other about aspects of their books. I provide below a summary of their discussion.
Histories is set in a hospital over the course of a week and is structured as a series of interlinked stories told from the points of view of a variety of people who inhabit the place. Katy asked Sam if he used the hospital as a vehicle to explore characters or if the characters were a means to explore how a hospital functions.
Sam talked of how a patient arrives at hospital, presents their symptoms and expects a diagnosis. The reality is a lot more messy. Hospitals are often large and sprawling. Patients are ill so not at their best. Doctors will have differing areas of expertise, skill levels and experience. All of these factors collide in their interactions. Discreet people and events combine in ways that they cannot know, becoming more than the sum of their parts.
Entanglement is about the ripple effects interactions create. It was inspired by Katy’s interest in quantum entanglement (a physical phenomenon which occurs when pairs or groups interact in ways such that the state of each can no longer be described independently of the other(s), even when separated by a large distance). She talked of meeting her husband when she was sixteen years old and discovering that they lived a few hundred yards apart. They must have met before – at playgroups, schools or social events – but weren’t aware. She was propelled to write her story by her husband’s illness which created a sudden awareness of mortality, something always there but not noticed.
Katy asked Sam if his exposure to life changing moments in his work as an oncologist had been a catalyst for Histories.
Sam quipped that his children tease him about being obsessed by death. He mentioned a junior doctor who asked a registrar how he coped with the inevitable deaths. The answer was that at least in oncology the doctor cannot mess up, patients are going to die anyway. Although appearing flippant, this is a reminder that as a society death is regarded as remote, its possibility denied, yet all medicine is an encounter with death. In Histories the characters are facing mortality, theirs or those they know. Fiction offers a way of presenting such truths. Sam reminded us that we live in a post enlightened world where an oncologist can request massively expensive tests yet struggles to find funds to provide oral hydration.
Katy mentioned Joanna Cannon’s latest book, Three Things About Elsie, and how it explores attitudes to people’s changing abilities. She mentioned a blog post Dr Cannon had written about how to talk to a patient suffering a terminal illness (do read this). Histories brings out what being a good doctor means, and the uncertainty that always exists.
The authors were asked if they thought that, in the last few years, there had been an increased interest in both the positives and negatives of healthcare.
Katy talked of the expectation of infallibility and the constrictions caused by the threat of litigation, how this affects what doctors can say to patients. She offered an analogy with motherhood. There is a desire to be a perfect mother, yet all that any mother can hope for is to be good enough. Perhaps society needs to accept good enough doctors.
Sam mentioned that we live in a world that is now far less trusting of authority – understandably. He asked how we square this with providers of healthcare when doctors face crisis at every moment.
Katy talked of the care her husband received, which was not always as it should have been. Yet she recognised that doctors are human and working within the constraints of a far from perfect system. She felt it important that we differentiate before ascribing blame.
Both Sam and Katy read again from their books before talk moved on to a discussion of the use of language, and empathy.
Katy commented that Histories has dexterous language and asked if this could enable or disable the practice of medicine.
Sam talked of providing compassionate care and what this means, that it should not just be a task on a tick list. Language is the currency humans use and there are ethical as well as technical arguments for certain words, for example madness. He talked of culpability, which is explored in Entanglement, what happens to others as a result of our actions but of which we remain unaware. Kindness is a power.
Katy talked of how kindness shapes those around. For some who show care it becomes their prism – they define themselves by other’s outcomes as a result of their acts of kindness.
When questions were invited from the audience one lady told of her experience of a rare illness being diagnosed because an expert happened to be to hand. She wished to stress the importance of everyone bringing their best to their job. She felt that doctors should be more truthful about what they know and can do.
A question was then asked about media representations.
Sam replied that to get away from the false and sentimental it was necessary to be gritty in his writing, to present the internal troubles of his characters. Doctors cannot know exactly how others feel but can understand fear and pain. He chairs a clinical ethics committee and most discussions are not around great moral dilemmas but much more day to day concerns – how much should be told and shared, how to be with patients. It can be tricky arriving at a reasonable stance.
Sam referenced Seamus Heaney’s essay in which he differentiated between craft and technique in writing: craft is the skill of making, it wins competitions, it can be deployed without reference to feelings or the self; technique defines a stance toward life, a definition of a writers own reality.
And with that the discussion was drawn to a close. The audience were rapturous in their reactions to the discussion and eager to talk to both authors. I managed to catch a few words with Sam when I asked him to sign my copy of his book. When I looked for Katy she was surrounded, deep in conversation, and I was by now out of time. I did manage to introduce myself to Ann Bissell who was representing The Borough Press. It is always lovely to put faces to names I follow on line.
This was another excellent author evening organised by Toppings. If in Bath do check out this fabulous independent bookshop.
Histories is published by riverrun (click on the cover above to read my review)
Entanglement is published by The Borough Press