With the Wellcome Book Prize on hiatus this year, an unofficial Not the Wellcome Prize is being run (with permission) to showcase some of the best health-themed literature of 2019. This has been organised by Rebecca Foster (@BookishBeck) who invited me to participate. My avoidance of blog tours was overcome by my fondness for the Wellcome Prize.
To find out how the winner of the Not the Wellcome Prize 2020 will be decided, read Rebecca’s post here.
Today, I am reposting my reviews of two fabulous books that are in contention.
Constellations by Sinéad Gleeson
(published by Picador)
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 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.
Every entry in this collection was a pleasure to read.
War Doctor by David Nott
(published by Picador)
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.