Book Review: Fragile Lives

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“A successful cardiac surgeon is a man who, when asked to identify the three best surgeons in the world, has difficulty in naming the other two.”

Fragile Lives, by Professor Stephen Westaby, is a memoir that is both awe inspiring and heart-rending. It tells the story of the medical career of a man raised in working class Scunthorpe who became a world class, ground-breaking cardiac surgeon before watching his life saving profession being stymied by the NHS bureaucracy that we know today.

The first few chapters cover Westaby’s childhood, inspiration and medical training. Born in the post-war baby boom years he decided young that he wished to be a heart surgeon after watching a television programme, ‘Your Life in Their Hands’, in which American surgeons were able to close a hole in a patient’s heart thanks to the newly created heart-lung machine. Westaby gained entrance to a local grammar school and from there worked towards his dream of medical school. As a teenager he took menial jobs at a hospital, learning as much as he could through observation. His years of medical training at Charing Cross and the Royal Brompton in London brought him to his first surgeries, where he learned that a certain arrogance is necessary for a successful outcome. A surgeon must believe in their own abilities if they are to innovate and thereby save more lives. When a patient is cut open on an operating table the surgeons cannot know exactly what problems they will be required to deal with.

Subsequent chapters look at particular patients whose medical issues Westaby tackled in new ways. Not all of them survive, and those that do are changed.

“extra life is not ordinary life. There’s a price to pay and a second dying to come”

These cases are fascinating if poignant to read. There is an amount of medical detail included but the language used is accessible. Westaby’s confidence in his abilities and willingness to take risks not only saved many of the lives he held in his hands but also led others in his field to do the same. These world class doctors worked together, sharing techniques and outcomes for the good of their patients as well as furthering their own careers.

“For the unfortunate patient, any prospect  of survival depends upon having an experienced trauma surgeon at hand. Few are offered that privilege.”

Westaby worked all over the world and experienced many levels of both staff competence and facility provision. When dealing with a patient who will surely die without intervention, risks seem a price worth paying. This is the way, the only way, that new techniques and treatments can be developed.

A cardiac surgeon must retain a certain detachment as they are dealing every day with the dying who often harbour multiple health issues. Success rates matter. The monetary cost of surgery is high and those controlling the purse strings wish to invest only in proven drugs or equipment.

Pioneering surgery is now threatened by the blame culture. Even proven techniques are being rationed due to the focus on cost, whatever the benefit.

“When a surgeon remains focused on helping as many patients as his ability will allow, some will die. But we should no longer accept substandard facilities, teams or equipment. Otherwise patients will die needlessly.”

By the end of his career Westaby had become disillusioned with the NHS. He had watched too many of his patients die due to a lack of drugs and equipment simply because they are deemed too expensive by non medical decsion makers.

“What mattered was keeping down costs. Death comes cheap.”

Inevitably he looks back on his own younger years with a degree of pride and with more regard than he offers today’s trainees. Setting this aside there is a warning to be heeded. It is understandable that cardiac surgeons feel frustrated with the constraints placed on their ability to work effectively. What this means to the individual patients and their families is the difference between life and death.

Those who believe that the drama of medical TV shows is overplayed should read this book. It is a fascinating account of a career that observed and facilitated huge medical innovation. The effect this had on the patients whose cases are included had me in tears of both sorrow and joy. To anyone with an opinion on the value of national healthcare expenditure, this is a recommended read.

My copy of this book was provided gratis by the publisher, Harper Collins.

Book Review: Worlds Apart

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Worlds Apart, by Azi Ahmed, is straplined A Muslim Girl With The SAS. As the book is described as a true story, and is written in the form of a memoir, this is perhaps unfortunate marketing as the veracity of the army section appears questionnable.

I read the book in a sitting. There is a lot about it that I found interesting. There are also elements that lead me to do further research as they did not ring true. As I gleaned my information from the internet it is hard to know what to believe but it took the shine of what could have been a fine story had it been written as a work of fiction.

The tale takes the reader through the early life of a young girl growing up in a traditional Muslim household in working class Manchester. Azi is the youngest of five children whose parents came to the UK from Pakistan a few years before she was born. They worked hard and saved, eventually opening up their own business selling halal meat. Azi describes her mother as illiterate. All her children were encouraged to gain good grades at school.

There are incidents of bullying and racism. Azi was raised to be subservient to men, trained to be a good wife and compliant member of the Muslim community. It was assumed that her parents would arrange a marriage for her. She had little knowledge of anything that went on outside of her own culture and lived a sheltered if frustrating life.

The first event that made me question the authenticity of what was being recounted was the means by which Azi attained her place at Central Saint Martins, an art school in London. It is hard to believe that such a prestigious establishment would offer a place in this way. Setting that aside, once Azi moves south, away from her family, she discovers a world she is eager to explore. Although never managing to fully shake off the shackles of cultural expectations she enjoys her freedom. She has a surprising amount of luck finding work placements and goes on to set up her own business. When this is no longer enough of a challenge a friend jokingly suggests she joins the TA.

The story of how she ends up in the army, like that of how she got into college, seems suspect. My research suggests she may have joined something like a since abandoned prototype training scheme for women wishing to experience the armed forces. It seems unlikely this was for the SAS.

Nevertheless, the reader is taken through months when Azi’s army experiences challenge her to the limits. Sometimes what she claims to achieve is quite hard to believe but I am not an expert in how much a small and slight body could endure. She comes out the other side changed. There is then a period over which few details are shared.

The final section recounts her decision to go into politics. Here the narrative comes across as somewhat self-aggrandising, which had not been the case before. If anything her childhood had been the opposite. Although she struggled with the strictures imposed on her life by her parents, she seems to have willingly worked hard and developed a strong self-reliance that stood her in good stead when she broke away.

I enjoyed reading the early chapters and valued the opportunity to learn more of a family life that is rarely opened to outsiders. It was interesting to read that Azi also considered she had no idea how those from other cultures lived. She resented the preconceptions others held about her people, the assumptions about how she must think. Nevertheless she recognised that she too harboured prejudices as was demonstrated when she discovered that a friend she valued was gay.

The writing style reminded me of celebrity memoirs I used to read. These were ghost written leading me to ponder who penned this work.

When a book is marketed as a true story and subsequently uncovered as inaccurate it can make readers angry as they feel hoodwinked. Whatever elements of this tale are true, it is an easy and often entertaining read. As an army memoir it has been badly received by those who know more about this way of life than me.

My copy of this book was provided gratis by Bookollective.

Book Review: The Last Act of Love

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The Last Act of Love, by Cathy Rentzenbrink, is a raw and heartfelt account of sibling love and loss. In the summer of 1990 the author’s brother, Matty, was knocked down by a car on his way home from a night out. Eight years later she and her parents went to court for permission to withdraw all life-sustaining treatment, including nutrition and hydration, to allow him to die. This is the story of how they got to that point, and the effect those eight years and their aftermath have had on Cathy’s life.

At sixteen years old Matty was already over six feet tall. He was a popular, handsome, intelligent young man. He and his sister helped out at their parents’ pub, located in a small Yorkshire town where they were well known and liked. The family was incredibly close.

The children smoked and drank, worked hard and played hard. The were lively and confident, relishing the life opening up to them. Matty had already renovated an old motorbike, learned to drive a car on private land. Although younger than her by a year, he looked out for his sister and she felt proud that he did.

When Matty was taken to hospital after the accident the doctors recognised the seriousness of his injuries but the family retained the belief that he could one day recover. They modified their lives and then their home to accommodate his many needs. Each time he suffered a life threatening setback they asked that he be treated. It was many years before they accepted that this may not be in his best interests, that death is not the worst thing that can happen to a person.

Getting to that point changed Cathy forever. Living with having chosen to let her beloved brother die proved devastating. She hid much of what she was feeling from the world. The excesses she turned to in an attempt to distract herself from her grief enabled survival but created their own regrets. That she made it out the other side is an achievement.

I found this quite a difficult book to read, not because of the writing, which is fluid and gripping, but because the pain Cathy conveyed felt so real. I was hurting for her loss, empathising with her guilt and understanding that the hole Matty left could never be filled.

Cathy found some solace when she learned more about Matty’s condition after his death and realised that others who had been through similar experiences felt as she did. She began to learn how to move forward, damaged but no longer feeling the need to hide her scars.

Her story has the potential to help others who have loved and lost as well as those who wish to support them. It is a powerful read.

Book Review: The Outrun

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The Outrun, by Amy Liptrot, recently won the 2016 Wainwright Prize, this after being shortlisted for the 2016 Wellcome Book Prize. Although I would not normally be drawn to read memoirs, the judges’ comments persuaded me to pick this one up. I am very glad I did.

Amy was born and raised on a farm on the remote island of mainland Orkney. Her father suffered mental health issues which triggered psychotic episodes so severe he would, from time to time throughout her childhood, be sectioned under the Mental Health Act and removed to a secure unit in Aberdeen. Her mother was a Charismatic Christian whose Church influence and disciplines led to Amy developing a strong aversion to religion. Her parents divorced after her father had an affair.

As an adolescent Amy eschewed what she regarded as a subtle conspiracy to present Orkney as an island paradise. She describes herself as:

“a physically brave and foolhardy child […] Later I plunged myself into parties – alcohol, drugs, relationships and sex – wanting to taste the extremes, not worrying about the consequences, always seeking sensation and raging against those who warned me away from the edge. My life was rough and windy and tangled.”

As a teenager she wanted nothing more than to leave the island, dreaming of glittering success and excitement in London. When she got there she immersed herself in a social whirl fuelled by alcohol and drugs. Over a hedonistic decade her life spiralled out of control. Eventually she determined to undo the damage she was inflicting upon herself and enrolled in rehab, taking steps to manage her alcoholism. She returned to the islands to recuperate, not expecting to stay.

The book opens with this return, with her visiting the farm she grew up on. Her story is told from the perspective of a recovering alcoholic looking back on events that brought her to where she is today. Woven into her tale is the island, its weather and wildlife, history and topography, as much an influence on what she is and was as any people she has known or choices she has made.

It is a study of nature and of life. Amy is aware of how the land was formed, how it affects what it supports with all changing and adapting over time. Yet still there are events that cannot be fully prepared for – asteroids, severe storms, addiction. She writes of the place of which she is a part.

She spends a winter on Papay, a small island north of the mainland, with a population of seventy. She describes how a community such as this gets by:

“Here I have been mixing with people of all ages and backgrounds – we have to – whereas in London I was in a bubble. I went to the city to meet new people, to expand my ideas and social circles, but ended up meeting people more and more like myself. We curated our experiences into ever narrower subsections until we were unlikely to encounter anything that made us uncomfortable.”

Amy’s parents came to Orkney from the South of England so, although she was born there, she was still considered an incomer. With so many young people choosing to leave incomers are now welcomed as necessary to keep the small communities viable. Just as wildlife must adapt to change to survive so too must people.

Amy enjoys the apps and information available via modern technology. She keeps in touch with life beyond the island through the internet:

“Many of them I’ve never met in person but we’ve vaguely followed each other’s lives for years. Often I feel as if my real life is inside the computer while my time back in Orkney and the people I see here are just a temporary intrusion. I know people on Twitter I’ve never met better than people I’ve sat opposite for months at work or people I went to school with.”

Amy watches the skies, swims in the sea and takes long walks. She describes the land and the wildlife she encounters, recalling the history of the place and the changes over time. She considers her own existence alongside that of the birds and sea creatures whose habits and habitats she studies and presents. The story told is poignant and perceptive but it is the quality of the prose which sets this book apart.

The writing is sublime. This is a memoir but also an appreciation of the nature of which we are all a part. There is raw beauty but also acknowledgement that change is inevitable. Amy chose to adapt to survive.

Book Review: The Duchess of Bloomsbury Street

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The Duchess of Bloomsbury Street, by Helene Hanff, is a sequel to her earlier epistolary publication, 84 Charing Cross Road (which I review here). It is advisable to read them in order. The copy of the book I was gifted, pictured above, unexpectedly contained both works.

‘Duchess’ is a memoir of the author’s visit to London following the publication of ’84’. It is based on diary entries written during her stay and chronicles the events she attended, the people she met and her impressions of a city she had long dreamed of experiencing.

As with her first book, the appeal of this journal are the characters who emerge through her words. Her observations on those she encounters are entertaining as are her impressions of the places she searches out.

As a financially stretched, obscure writer she is amused by the interest she generates. For a brief time she is treated as though famous, wined and dined by the great and the good. Her desire to relish every aspect of her trip shines through.

There are now numerous, humorous travelogues and this short offering is, perhaps, a precursor to these. The anecdotes and musings are both charming and perceptive. It was both a joy and an education to see a familiar city through new eyes.

I missed the understated contributions of Frank Doel which I felt counterbalanced Helene Hanffs writing style in ’84’. Like her first book though, the kindnesses offered this lone traveller suggest a benevolence that can so often appear to be lacking in society. This is a vivacious and engaging quick read.

Book Review: 84 Charing Cross Road

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84 Charing Cross Road, by Helene Hanff, is an entertaining, evocative and moving collection of letters sent by the author, from her home in New York, to the staff at an antiquarian bookshop in London. Their correspondence spanned twenty years and resulted in a valued friendship.

There is an essence of the various writers in each letter. The author offsets her impatience with humour. Frank Doel, her main contact at the shop, displays a courteous formality underscored by his obvious wit. The other ‘inmates’ at Charing Cross Road are more curious and open. Even Frank’s wife, their neighbour, and some of the author’s friends eventually become involved.

Each letter is short and concerns the acquisition of books alongside little personal asides. Occasional gifts are exchanged and thanks sent. All parties express an eagerness to one day meet.

It is hard to fathom why such a little book could be quite so captivating, other than the obvious quirks of the writers that are divulged in their writing. The shared love of literature and of the books themselves are appealing to any bibliophile. The historical detail referenced – post war rationing, a coronation, the purchase of a first car, the Beatles – adds to the sense of time passing and the world changing. Little is mentioned of how each correspondent looks allowing the emphasis to be rightly reserved for the people they are inside.

Perhaps it is the lack of explanatory text. The letters are allowed to tell the story and they are enough.

This is a meeting of minds, a shared love, a poignant reminder of what friendship can be. It is a gentle and beautiful read.

 

Book Review: Reasons to Stay Alive

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Reasons to Stay Alive, by Matt Haig, chronicles the author’s experience of crippling anxiety and depression, and how he emerged from his worst period of disintegration changed but better equipped to cope with these debilitating conditions when they recur. Although he had the good fortune to have a loving partner and family to support him throughout, the feelings he shares and the advice he gives are sound even for those who do not have such privileges. He acknowledges their worth but still had to deal with this himself.

Starting with the onset of his illness, in Ibiza in 1999, he takes the reader through why he did not commit suicide but instead went back to his parents’ home in Nottinghamshire where he was barely capable of leaving the house for months. He talks of how others view the depressed, and how the sufferer views himself. There is the fear of madness, the monstrous scenarios imagined and how real they feel, the slowness of time as he battled to get through each hour of each day.

The author did not find that medication helped but gradually built up an arsenal of weapons to enable him to fight in a way that better suited him. He eschewed all drugs, including alcohol. He took up running, yoga and meditation. He read voraciously and started to write. He gradually faced his demons, sometimes retreating but then returning a little stronger to try again.

Although this is a dark and difficult subject it is presented in a way that gives hope. He survived. He can now see that the worst periods do end and that there is the possibility of good times in a future that itself once appeared an impossibility.

“Depression is also… Smaller than you. Always, it is smaller than you, even when it feels vast. It operates within you, you do not operate within it.”

In looking back he believes that he is richer for the experience, however high the toll of his suffering. What he describes as his thin skin enables him to feel the good in life as well as the bad. He appreciates what he has and knows that, when the black feelings return they will pass.

Mental illness is prevalent yet still carries stigma. Books such as this serve to remind sufferers that they are not alone, that many have suffered and gone on to live lives containing many worthwhile moments. It suggests things that may help but more than that it reminds us that all things must end, that we should sip and savour the bottle of wine that is our allotted time.

“We are alone, but not alone. We are trapped by time, but also infinite. Made of flesh, but also stars.”

Highly recommended to anyone who suffers mental illness or who knows a sufferer. I suspect that covers just about everyone.