Book Review: War Doctor

In a growing field of medical memoirs War Doctor stands out for its purpose – to increase awareness of the reality of modern warfare on the individuals and communities directly affected. The author has volunteered his services as a trauma surgeon in active war zones including: Afghanistan, Sierra Leone, Liberia, Chad, the Ivory Coast, the Democratic Republic of the Congo, Sudan, Iraq, Pakistan, Libya, Gaza and Syria. He pulls no punches in his descriptions of the horrific injuries and personal dangers encountered in each of these places. By describing the treatments offered as he attempts to patch up bodies torn apart by weapons designed to inflict maximum damage, his story avoids polemic. Rather it is a humane account of the many good people risking their lives to help those caught up in evil deeds carried out by those seeking to gain or hold on to power in a region.

David Nott spent his early years in rural Wales before moving with his parents to England. He studied medicine at the Universities of St Andrews and Manchester, staying in the north of England for his Junior Doctor years. He realised during this time that he wished to work in war zones where his surgery could make a significant difference. He set out to gain relevant experience.

“I’d need a fantastic breadth of knowledge in general surgery, which I was on the way to achieving. And I realized it would also be good to know a lot about vascular surgery, too: if I was to spend time in dangerous places, I’d be seeing and dealing with a lot of injuries from bullets or bombs, and knowing how to clamp off blood vessels would be essential.”

Nott’s first consultancy post was at Charing Cross Hospital in London. Surgeon friends there told him about Médecins Sans Frontières, an organisation offering short placements abroad for medical personnel. With agreement from his employer, Nott was able to take unpaid leave from the NHS and go on his first mission – to Sarajevo in 1993.

Over the course of the following decades he would travel to sites of conflict gaining a wealth of experience working in the most challenging environments, often with minimal supplies and equipment. Chapters detail a number of these placements focusing on patients who left key impressions. As a reader it is difficult to comprehend how those who caused the injuries could inflict such pain and suffering on their fellow human beings.

Much of the book focuses on memorable surgeries carried out in makeshift hospitals. With a constant stream of all but destroyed bodies arriving, decisions needed to be made quickly about who it would be worth treating. On one occasion a man required every unit of blood available in the city. When he subsequently died the question of how many others would die for want of a blood transfusion lingered.

On a mission in Africa Nott treated pregnant girls as young as nine years old – victims of rape whose pelvises were not developed enough for full term births – who were brought to the camp hospital after many hours in labour to have their now dead babies removed in an attempt to save the mother’s life. In Afghanistan he witnessed the public spectacle of punishments meted out under Sharia law, Taliban style.

“women being stoned to death after being buried up to their necks in sand; women being placed beside a wall they had built with their bare hands and killed after a truck was driven at the wall at high speed. […] I was astonished and sickened by the cruelty that one human being could bring to bear on another, and it filled me with revulsion. The football stadium was full of people watching and I wondered what they all felt. Were they completely inured to it?”

The impressions left by such monstrous behaviour increasingly affected the doctor when he returned to his job in London. During a private consultation he all but lost it when a patient complained about how she suffered due to unsightly thread veins.

On a mission in Aleppo, Nott noticed that patients would arrive with similar injuries that changed each day.

“Abdulaziz told me that he’d heard that the snipers were playing a game: they were being given rewards, such as packs of cigarettes, for scoring hits on specific parts of the anatomy. […] This sick competition reached its nadir towards the end of my time there when it appeared that one particularly vicious and inhumane sniper had a new target of choice: pregnant women.”

The author treated several of these women whose babies had been shot in utero. It was this experience that finally drove him to try to publicize the horror of what was happening in Aleppo once he returned to London. The media showed interest and he began to offer interviews and share pictures taken. Harnessing his increasingly public profile, Nott sought to help those now trapped and in imminent danger in Syria.

Given the horrors recounted, this book could be challenging to read yet much of it comes across as hopeful due to the determination of the medical teams to continue to offer treatment whatever else is happening in their vicinity. Nott includes many instances when his efforts were unsuccessful, and examples of risks he took that with hindsight were foolish. He does not paint himself as a hero but rather as a man who relished the adrenaline rush of danger. Nevertheless, it is hard to do anything but admire the tenacity and bravery of all the medics.

The writing is precise and succinct but retains a compassion for the suffering of those whose lives have been stripped to a struggle to survive in unimaginable conditions. Details of the medical procedures are fascinating and described in accessible language. And yet, with so many wars included there is a feeling of despair when considering what man is capable of inflicting. Nott admits that his work has left him in need of therapy for PTSD.

I mentioned that the stated purpose of the book was to raise awareness and in this it succeeds. It is, however, difficult to know what to do with such awareness in a world controlled by the egocentric – venal governments willing to turn a blind eye to atrocities carried out by extremists. Whilst being a moving, balanced and insightful account of the horror of war and the commitment of medics, it is also a harrowing read.

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

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Book Review: Hard Pushed

Hard Pushed: A Midwife’s Story, by Leah Hazard, provides a timely reminder of how valuable the NHS is, and of the appalling demands currently being made of front-line staff. The author is a working midwife and shares stories of cases she has dealt with, and the conflicts regularly faced due to the spectre of rules and a lack of resources. It is not, however, polemic. Written with grace and generosity, this candid memoir presents the business of birth with clear-eyed understanding of expectations and reality. There may be a great many bodily fluids to contend with but bringing a baby into the world remains an emotional event.

The births described are those that were memorable, mostly due to complications, many unforeseen. These include: the young mother who is still a child herself; the woman who became pregnant thanks to IVF and whose partner now has cancer; the rape victim; the prospective mother suffering a serious illness. Between each case study are notes in which the author muses on such subjects as: thwarted assumptions; being human; the many challenges of the job. She has to deal courteously with colleagues who have contentious opinions. When mistakes are made they can have far reaching consequences.

The author writes of a new mother whose own mother undermines her confidence with well-meaning suggestions, and how a midwife must support but never interfere. She writes of: birth plans, birthing pools, FGM and death. She describes the mind-numbing exhaustion faced by staff working lengthy shifts in over-crowded wards where medical emergencies leave labouring women unattended. The professional script she must follow is designed to both minimise patient concern and protect the midwife.

The intense and unpredictable daily demands lead to regular burn-outs, something to which the author is not immune. The job takes a physical and mental toll that can be a challenge to sustain.

This is a fluently structured and fascinating account of a job that, even as a mother of three, I had not fully appreciated. I feel angry on behalf of these hard working professionals for the way our healthcare system is being managed and funded.

Yet the warmth and compassion with which this book is written provides a beguiling and entertaining read. The balance achieved is impressive – recommended for all.

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

Book Review: Under the Rock

In celebration of the paperback publication of this beautifully written and produced book, I am reposting my review.

This is not a book to be rushed. Over the course of the days I spent reading I kept setting it down to step outside and appreciate my surroundings – the small things it is easy to pass by, unregarded, on my walks through local fields and woodland.

The author is curious and unafraid of straying beyond marked paths. He views man as a part of nature, a shaper of landscape albeit for short term, selfish gain. There are no gushing superlatives about the beauty of our natural world – however that may be defined given man’s tinkering – but rather an exploration of a microcosm through the changing seasons and from a variety of perspectives. There is recognition and appreciation of the cycle of life, that death is not an end.

“Nature does not stop. It never shies away from the task at hand: perpetual growth and death, growth and death. Survival – that is all. Of plant species and creature alike. Feeding, mating, birthing. Dying. On and on it goes.”

“Only humans reach further, filling their time with false desires, delusion and distraction from the self. Turning away from news media, I find myself instead considering the wider environment, at a deeper level.”

Ben moved out of London with his partner a decade ago. He left the noise and bustle of the city for a village in the Upper Calder Valley, West Yorkshire. Within Mytholmroyd is a fenced off area containing the looming mass of Scout Rock. The site has been quarried, was once the town dump in which asbestos from a nearby factory was buried. It is a place of:

“toxic soil and bottomless mineshafts and cliff-diving suicides and unexpected landslides in the night”

Having been abandoned by man, the flora and fauna thrived. This is the story of the place, its history and surrounds, the impact a sometimes desolate environment has had on the author.

Ben and his wife purchased a property in the shadow of the rock. Each day he would take their dog and walk through the fenced off area, scrambling around the rock, making his way to the moorland above. He came to understand the personal changes wrought by the seasons, to endure the persistent rainfall, to accept the mud splatter, the minor injuries from slips and falls. He would swim in the nearby pools and at a reservoir, seeking to immerse himself physically in the place. Gradually he learned its history from libraries and conversations with locals, some of whose families had lived there for generations.

Divided into four main sections – Wood, Earth, Water and Rock – each is completed by field notes, poetry, and photographs. The chapters in Water detail the devastating floods that affected the area at the close of 2015. There is acceptance that this was not a unique event in the valley’s long history. It did, however, bring change.

“The Scout Rock I have known for the past decade is no more. It is something else now.”

When the workmen, drafted in to supposedly make the area safer, finally leave, this fresh molestation will be recolonised, reclaimed. The author may then explore the place anew, recreate the paths he chooses to take.

Ben’s walks and swims lift his mood but the dank darkness of winter, the heavy rainfall of the area, are oppressive. He mentions the financial difficulties of surviving as a writer. He acknowledges both the challenges and benefits of modern living. Woven into these deeply personal musings are the layers of discovery from his daily perambulations.

He writes:

“My goal in life is
to walk the
hills unheard.”

Within these pages we hear his voice, and it sings.

Under the Rock is published by Elliot & Thompson and is available to buy now.

Book Review: Constellations

This review was written for and first published by Bookmunch.

Constellations is a collection of fourteen essays written by an eloquent storyteller. Each celebrates the imperfect body – its workings and failings. There are musings on wider attitudes to ownership and behaviour. The stories told are incisive and highly personal. They cover a variety of the author’s lived experiences including: bone disease, cancer treatment, pregnancy, motherhood, and death. As a woman growing up in Ireland she has shouldered a burden of expectation against which she quietly rebels.

Alongside periods of incapacitation, the aloneness of illness, are many joyous moments of freedom and adventure. The author writes of: music, dancing, travel, relationships. There is an underlying generosity in her attitude to the world she inhabits, “making wounds the source of inspiration, not the end of it.”

She expresses a wish that her children, especially her daughter, may live their lives to the full and not be curtailed by

 “Those who go out of their way to avoid your good news,
who flash facsimile smiles when the world smiles on you,
The people who are too afraid to try to do
what you will one day do.”

The essay titled ‘Hair’ explores society’s attitude to women who choose to grow or shave off their tresses:

“Every time I’ve shaved my head, or sported a suedehead of regrowth, there is always a response, especially from men. They are mostly horrified or bemused; some declared it attractive: but I was always asked to justify myself.”

These unasked for responses to changed looks, or to actions deemed unfeminine and therefore unacceptable, are recounted in many of the essays. Too many people appear to believe that women require guidance, that they cannot be expected to know what is best for them.

In 60,000 Miles of Blood’, the author explores attitudes to this vital liquid when it leaves a host’s body. A soldier shedding their blood in battle is regarded as heroic. A woman’s monthly menstruation is shameful. An artist using blood in their work is berated. There are always opinions on what may be done with the one’s own body and its constituents.

“Art is about interpreting our own experience. Upon entering hospitals, or haematology wards, our identity changes. We move from artist or parent or sibling to patient, one of the sick. We hand over the liquid in our veins to have it microscoped and pipetted. Beneš used his art as tenancy. If hospital tubes could house his blood, so could his own work. Beneš knew that if his blood had to be anywhere other than in his veins, he might as well use it as an aesthetic agenda; a declaration of possession.”

Moving on to the subject of parenthood, the author writes of how this has brought with it both joy and pain. As children grow they travel ever further away, carrying their parents’ intense love for them lightly.

There is a thread on feminism running through many of the essays. A woman’s pain is not always taken seriously by medical professionals. A mother is expected to put her children’s needs before her own. ‘Twelve Stories of Bodily Autonomy’ looks at abortion in Ireland and the 2018 referendum on the issue. It wonders at the mindsets of those who oppose a woman’s right to choose a termination.

“Ireland is scornful of its girl children. The state can and does oppose what a family/a woman/a pregnant person believes is in their best interest. A born girl has no more rights than an unborn foetal one.”

“A writer friend overhears a group of twenty-something men talking on a train. One, full of swagger, says he doesn’t ‘want to give them that’, insinuating that women are uppity and asking for too much wanting to control their bodies.”

‘Second Mother’ tells of a beloved aunt who suffered from Alzheimer’s and how the family could only watch as the person they had known and valued faded away, mind before body.

‘Our Mutual Friend’ is a reminder of the precariousness of life and the pain of grief. It is an intensely moving tribute to a young man whose life ended unexpectedly.

The writing throughout is percipient and exquisitely rendered, arguments expressed with clarity and compassion. Although important and at times emotive, vital issues are presented with grace.

Any Cop?: Every entry in this collection was a pleasure to read.

 

Jackie Law

Book Review: Built on Sand

Built on Sand, by Paul Scraton, is centred on Berlin. It explores the varied effects of an ever evolving place on those who call it home for a time. Told through events in the lives of the author’s friends and acquaintances while he was living there, it looks at, amongst other things: shifting borders and beliefs, dispossession, those who leave and return across generations. It is a story of individuals, their relationships and psychogeography. It portrays the transience of people and what defines them, as much as the place.

The first chapter introduces Annika, a mapmaker whose products are sold in a small number of bookstores and galleries. Her maps are themed to well known historical figures who have links to Berlin, providing details on significant locations during their stays there. Many of the buildings they would have frequented have gone but the street layout remains largely the same. Annika walks the city to gain a feel for what she is attempting to recreate.

“Bad news. Her maps, as a whole, told the story of the city, from its medieval origins on a malarial swamp to fifteenth-century riots, reformation and industrialisation, militarism and nationalism, National Socialism and communism, the Marshall Plan and the European Union.”

This sense of history permeates the city – its numerous destructions and endless rebuilding. The author is interested in the ghosts of the past that linger and how they affect those who pass through today.

The second chapter introduces a trio of men who met as boys living in the GDR and remained friends despite taking very different political paths as men. The author’s girlfriend retains her disdain for Markus in particular as he worked for the Stasi. The author is more interested in learning why Markus chose this path and how what he was required to do has affected him long term.

Other key characters in the narrative include the two young men the author shared a flat with when he first moved to Berlin. Their’s is a story of a close friendship when young that does not survive the changes wrought by passing years. At its heart is a tragedy and its repercussions.

Interesting additions to the cast are young people who were raised outside Germany, whose forebears told them stories of the country as it was then, including the lives and lands lost when they fled as refugees. The children or grandchildren visit and find themselves connected to the place despite it bearing little resemblance to the shared memories.

These personal anecdotes offer a vision of a city that exists only in such memories. Each of the people passing through are creating their own version which they will then carry and polish.

Over time borders are moved, walls built and knocked down, housing provided for workers and subsequently renovated for incomers. Reminders of conflict exist in memorials or the scarring of buildings by bullets or shrapnel. The people who come and go follow changing social and political beliefs. They may fight for what they think is right but this too changes with hindsight.

People are shaped by the stories they grow up with and how they interpret them when exposed to wider thinking. Some will embrace new developments but many hanker after what drew them to settle, even if only for a short while, in any given place. They value its history and the ghosts of their past selves, echoes existing in the shadows of recollection.

The writing has a melancholy edge which befits the many horrors Berlin has witnessed. The diverse reactions to events offer a variety of perspectives to consider. Although a very personal account the narrative offers broad insights, not least the folly of trying to cling to what has already passed by. It is a compelling, humane and intelligent portrayal of a city, its residents and inevitable change.

My copy of this book was provided gratis by the publisher, Influx Press.

Book Review: A Chill in the Air

Iris Origo is perhaps best known as the author of her previous diary, War in Val d’Orcia, which she published to acclaim in 1947. It was praised for the positive effect it had on Anglo-Italian relations as it detailed the risks taken in the German occupied region of southern Italy, where Origo lived with her husband and daughter, to assist partisans, fugitives and refugees. A Chill in the Air is another of Origo’s diaries covering the years 1939/40, when Italy was looking to Mussolini to keep them out of a war slowly spreading across Europe. It details the rumours and propaganda of the time – the struggle to sift truth from a variety of news sources and the debates these sparked.

Origo was born to wealth and privilege. She had high placed connections in the arts as well as diplomatic circles. In 1924, aged twenty-two, she married Antonio Origo and they purchased an estate in southern Tuscany. Despite having a child (who died, aged 7) she continued to travel abroad periodically, indulging in occasional love affairs. She would return to her husband who was taking advantage of Mussolini’s ‘Battle of the Wheat’ to turn their arid land into productive farms worked by peasants.

The book offers a first hand account of a strange time written by a woman largely raised in Italy but not fully belonging due to her British and American parentage. As well as providing insight into the thinking of her peers and the local population, it offers thoughts on wider attitudes to the growing threat of conflict. Early on Origo recognises that governments must manipulate popular opinion by whatever means necessary if they are to get their way.

“It is now clear what form propaganda, in case of war, will take. The whole problem will be presented as an economic one. The “democratic countries”, i.e. the “haves”, will be presented as permanently blocking the way of the “have-nots” to economic expansion.”

There is resentment from wives and mothers as their husbands and sons are conscripted. They question the point of raising boys, of working hard for a better life, if the men they nurture can simply be taken away.

There are predictable prejudices and blind spots recounted, depending on who the author is talking to. Despite differences of opinion, few have any appetite for the coming war.

“A still, lovely summer’s evening; the grapes ripening, the oxen ploughing. Only man is mad.”

Nevertheless, as Hitler continues his expansion this mood must be changed – governments control through fear and suppression of resistance.

“Day after day, year after year, every paper gives us the same news, preaches the same doctrine. Plenty of people say, ‘We don’t believe what’s in the papers: it’s all a pack of lies!’ But all the same, something sinks in.”

Horrific tales of atrocities abroad are discussed. The German army, high on cocaine to retain energy, are reported as baiting and killing the ordinary Polish people they come into contact with. Businessmen make money from stolen property and commerce.

“The capitulation of Holland is announced with considerable Schadenfreude. On the same day a grocer in Florence receives a letter from a German firm – already offering him Dutch cheeses!”

More countries fall to Hitler’s occupying forces and freedoms are curtailed. News from abroad becomes harder to obtain. Attention focuses on what Italy’s future role will be.

“we hardly pay any attention to the news that Russia is occupying Lithuania, Estonia and Latvia. Japan is menacing Indo China. Banditry spreads fast.”

When Italy joins the war there is a feeling of inevitability. Within the new order, power is shifting.

“the contempt of the new world for the old, of the self-made man for those who have attained with ease what he has achieved with effort.”

It is interesting to read this Italian view of other nations, especially of England – regarded as corrupt and sterile – and of Churchill whose speeches are considered:

“vain boasts, based on no foundation of fact – a cynical last attempt to bolster up the English people to meet their inevitable destruction.”

The diaries cease abruptly when Origo goes into labour – her pregnancy had not been mentioned until she travelled to Rome for the birth.

In an Afterword, written by her granddaughter, we are offered a glimpse of the author’s later years.

These diaries offer a first person account reported with immediacy rather than hindsight. I did not find the entries entirely compelling but they challenged the history taught to me in school. For this I am glad to have read the book even if my interest did at times wane. The politics and loyalties of Italy under Mussolini are portrayed in an alternative and therefore thought provoking light.

My copy of this book was provided gratis by the publisher, Pushkin Press.

Book Review: Tempest

Tempest: An Anthology, edited by Anna Vaught and Anna Johnson, contains a wide variety of speculative fiction, poetry and essays that explore our tempestuous times. Subjects covered include politics, climate change, equality and the possibilities offered from the development of artificial intelligence. Donald Trump appears as himself or in caricature. Dystopias are created to portray imagined post-Brexit worlds or ecological Armaggedon. Although sometimes lacking depth, the collection’s strength is its spread of opinions.

Anna Vaught writes in her introduction:

“I would desist, if I could, from political and social involvement – I know plenty of people who have entirely stopped following the news and/or placed severe limits or careful muting on their social media diet. I understand this, but it is not an option for me or, really, for this press, with its philanthropic bent, passionate sense of questing after social justice and being involved in politics.”

This passion is evident in many of the entries. What is refreshing is the lack of shouting despite the frequent despair so clearly expressed. The issues raise awareness. When there is anger it is controlled and measured.

The opening article, The man who would be Christ, was written in 1988 and is a study of Donald Trump, the property developer. This is aptly followed by a story, The Wall, which I enjoyed until its unlikely ending.

Women must act now looks at the development of robots – artificial intelligence.

“Women must act now, or male-designed robots will take over our lives”

“There are great benefits in the use of AI and we should cherish them. However, the issue is not innovation, or the pace of technological improvement. The real problem is the governance of AI, the ethics underpinning it, the boundaries we give it and, within that, who is going to define all those.”

Whilst finding this subject interesting, I remained unconvinced by the author’s arguments that most low paid, replaceable jobs are held by women because they cannot access anything better. I would have liked references to verifiable studies on this premise, to make the piece appear less opinion. If the only jobs remaining in the future will be in STEM, women are as capable as men.

Some Start Fires is a poem around climate change offering a picture but no solution. Of course, there may not be one as man appears bent on destroying his life support system.

This is Earth is a similarly depressing depiction of man’s selfish tendencies, this time written from the point of view of aliens. Although offering a clear message, its development felt somewhat simplistic.

I enjoyed The cowboy with the calcium spur, a poem that I read as having another dig at Trump.

The Walking Stick imagined a post-Brexit Britain, although I considered the ending another ultimately pointless protest.

Save me from the dogs was a more straightforward story about uncared for children living underground and groomed as criminals. Between the lines lies the question of what options society offers those it rejects.

One of the headline contributors is Sam Jordison and it was no surprise that his article, Rage, had Brexit as its subject. He suggested that those who voted to leave the EU did so out of a desire to return to times they remembered as better.

“I’m pretty sure a lot of the Leave Vote was inspired by misplaced yearning for the years when Baby-Boomer voters didn’t have such bad backs, still had flowing locks and something more to look forward to than nights in watching repeats of Mrs Browns’ Boys. They imagined that everything was better before we joined the EU, because that was when they personally felt better.”

Populists are on the rise… is a cogent essay, first published in the Guardian in 2018, that appears to offer more balance than is normally apparent in newspapers writing for their loyal readers. Perhaps it was simply good to consider some alternative opinion.

Nature and culture provides a discussion on the damage to ecosystems from globalisation.

“We have come to believe that harm to the world is inconsequential, or at the very least if something is lost then it can be replaced.”

The essays around nature and ecological collapse put many of society’s current political preoccupations in perspective.

I readily admit that there were certain pieces throughout the collection that I didn’t get. Neither can I comment on subjects I know little about, such as Palestine. It is good that the publisher offers space to such potentially divisive subjects and divergent opinions. Refreshingly, the authors make their cases without getting shouty or insulting.

The Job takes an interesting idea – a future where most people do not work – and weaves a story of coercion. Although sometimes lightweight, I enjoyed many aspects of this tale, including its ending.

A narrow escape for the Chelsea Hotel takes another dig at Trump, exploring what is valued in life other than money. I couldn’t help thinking its conclusion was reprieve more than escape but the Russian angle was a neat addition.

We should own the stars is an fascinating essay on AI and equality with reference to Bladerunner. This entry was a particular favourite of mine.

Tempest on Tyneside offers a vision of the region as a sought after destination offering beer and football while southern England disappears under water. Ironic as this turnaround is to consider I thought the apparent interest men had in female footballers a stretch too far. It says much about the reader what imaginative aspects of a story can be accepted.

As with any collection of opinions there will be favoured and disregarded contributions. What I enjoyed in the reading was that disparate voices were included. Projects such as this, which take us outside our carefully curated echo chambers, are always worthwhile.

My copy of this book was provided gratis by the publisher, Patrician Press.