Gig Review: Sam Guglani and Katy Mahood in Bath

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

Book Review: Histories

“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

And so?

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.