The following review appeared in the Scotsman on 1st November 2017. Follow this link for the original article. Thanks again to the Scotsman and the Wellcome Trust.
There’s a line of non-fiction books which advance their subjects as having changed the world. Recent examples include cod, salt, cooked food, potatoes, tea, sugar and coffee. Given that sleep occupies a third of our lives and a lack of it kills within weeks, neuroscientist Matthew Walker’s claims for its central importance in Why We Sleep stand as good a chance as any of bearing scrutiny. Early on he sets out his stall with the following: “What if the real question is: why did life even bother to wake up? Considering how biologically damaging the state of wakefulness can often be, that is the true evolutionary puzzle here, not sleep.” So there we have it: consciousness itself could be no more than a risky afterthought. Cogito ergo sum? More like somnio ergo sum.
Walker’s book begins as an enjoyable tour through the history of sleep science. We hear of Kleitman and Richardson’s six week stay inside Mammoth Cave in Kentucky, where it was first demonstrated that the body’s internal clock ran in circadian (nearly 24-hour) cycles. He goes on to describe the discovery of REM and NREM sleep, before moving on to sleep’s myriad benefits: “Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed, and less anxious. Are you interested?” I have a feeling all these benefits have been claimed for exercise and a healthy weight and diet, but still: it’s a pretty impressive list.
Most compelling are his arguments against early school start times (particularly in the US), where teenage brains are being systematically sleep-deprived, and his description of the effects of sleep deprivation on the body are excellent, and should be required reading for anyone who thinks they can get by with less of it.
The book does have its flaws, however. There are instances where Walker cites poor quality or low-powered studies, or extrapolates freely from their conclusions. For instance, referring to a trial of elderly people woken up by alarm clocks, he states they “will suffer a spike in blood pressure and a shock acceleration in heart rate.” Following this he suggests: “Think of the multiplicative abuse your heart and nervous system will suffer across a life span.” And yet the trial as presented showed absolutely no evidence for this. Then the central question: how many hours of sleep are optimal? Of the observed rise in mortality rate beyond nine hours Walker states: “the causes of death in individuals sleeping nine hours or longer include infection (eg. pneumonia) and immune-activating cancers… It is simply that some illnesses, such as cancer, can be too powerful for the mighty force of sleep to overcome.” Yet this is not backed up by reviews of the evidence, which have concluded that lack of sleep and excess sleep are independent risk factors in themselves: that even after individuals with major co-morbidities were excluded, there was still a rising mortality rate at the extremes.
I would have liked to see more description of Walker’s day to day work in the sleep laboratory, and the clinical conditions are rather skimmed over. He discusses the use of Prazosin for the treatment of nightmares in PTSD (post-traumatic stress disorder), and I understand he has a personal interest in this because it fits with his neurobiological model of REM sleep as overnight therapy. Nevertheless, this blood pressure medication is not licensed for the condition in the UK, and he should perhaps have mentioned the far greater evidence and efficacy overall for using SSRIs (anti-depressant medication).
He contends that the functions of REM sleep lie in procedural memory, creativity and emotional wellbeing, and these arguments are well presented. Within this Walker includes his own theory: that REM was part of a “re-engineering of sleep... that rocketed homo sapiens to the top of evolution’s lofty pyramid.” This is an interesting idea, but with its inclusion I would have liked some of the other competing theories for REM function (eg. predawn warming of the brain, threat rehearsal) to have had an airing as well. A little more discussion of the culture and history of sleep, and especially of dreams, would have brightened up what is sometimes a rather dry factual account. However, the book contains some fascinating ideas, and Walker’s suggestions for how society and government and educational establishments might change their attitude to sleep are laudable. And yes: he left me more convinced than ever of sleep’s importance.
The following review appeared in the Scotsman on the 30th August 2017 (follow this link for the original article). Thanks once again to the Scotsman and The Wellcome Trust.
The Less You Know The Sounder You Sleep tells the life story of Dasha and Masha Krivoshlyapova, Russian conjoined twins who were born in 1950 and who died in 2003. Juliet Butler interviewed them many times while she worked as a translator in Russia, and has previously published a biography of their lives – which, she informs us, was “heavily edited by Masha,” the dominant twin. This novelisation, then, is an attempt to tell Dasha’s story, and what a magnificent achievement it is.
The book begins in 1956, at the Paediatric institute in Moscow, when the twins are six. They are living in a box – a glass box, cot-sized – and are bored. They want to go home for the weekend with a member of staff they’ve become attached too, who they call mummy. “She’s not your mummy,” a cleaner barks at them soon afterwards. “Your mummy probably went mad as soon as she saw you two freaks.”
The girls, we learn, were taken from their real mother at birth and subjected to barbaric experiments: “We both get all crunched into the corner of the cot to hide when we see it’s Dr Alexeyeva come in, and we start crying, because it means it’s time for our procedures.”
The exact nature of these “procedures” is revealed only later on in the book, and they make for disturbing reading. So far so grim-sounding, but in fact this book is anything but. The Less You Know... is a searingly frank and sympathetic portrayal of two very different women: Dasha, our narrator, who’s smart, sensitive, honest and loving; and her sister Masha who is quite the opposite: vicious, foul-mouthed and psychopathic – and outrageously funny with it. While receiving a lecture Dasha recounts: “(He) starts going on about Equality and Justice and Doing No Wrong. It’s a bit awkward, as we’re standing next to the little kid Masha tried to stuff down the rubbish chute the other day.”
There was a risk that Masha could turn into a figure of hate – especially given her incessant casual cruelties to Dasha – but we stay onside because we sense she’s a survivor, and because her sister obviously loves her. Dasha’s voice as narrator is a wonderful achievement, and there’s much to be moved by here as she recounts her life, not least the moment the twins see themselves in the mirror for the first time: “...we saw this lumbering, ugly thing with bits sticking out everywhere rocking towards us... like nothing we’d ever seen before. It was me and Masha. It was how everyone sees us. I won’t even think about it now, it makes me sick.” Of the girls’ first time outside, she recalls: “My head’s spinning like it does when we do loads of somersaults. There grass is mushy, not hard like the floor, and there are no walls anywhere to keep us upright... It’s too big, there’s too much space, there’s nothing keeping us in!”
The girls grow up and move to a school for invalids in Novocherkassk, where they make friends, including Slava, who Dasha falls in love with. Then after a grading which condemns the girls to invalidity and lifelong state support they move back to Moscow, where the new administrator, on warning them against self-harm, tells them icily: “Our statistics for suicide are the best in Moscow. So if you intend to die, we shall ensure it’s of natural causes.”
The girls spend their lives struggling against the oppression of the system and the ignorance of “healthies”: “Ugh... you should’ve been drowned at birth,” is a fairly typical reaction from people who encounter them.Set against this, though, are those who treat them with love and humanity, most memorably Aunty Nadya, who battles Kafkaesque soviet bureaucracy to get two passports rather than one, and who is there (unforgettably) for them in the final hours of their life.
This novel, while always being an accessible read, offers profound insights into the effects of early deprivation on two very different people, and into the daydreams we nurture in order to survive; it tells us about love in impossible circumstances, and about the loneliness of never actually being alone. And the importance of having something to hope for. “Olessya always used to say that happiness lies in three things,” Dasha tells us. “Having someone to love, something to do and something to hope for. At least I’ve got the first and last.” For the second: do yourself a favour and read this wonderful book.
The following review appeared in the Scotsman on the 28th of June 2017 (follow this link for the original article). Thanks once again to the Scotsman and The Wellcome Trust.
Swedish poet and author Tom Malmquist’s In Every Moment We Are Still Alive is a work of autofiction – that is, a fictionalised autobiography. It tells his own story, though in the style of a novel, and it begins when his wife Karin is admitted to hospital in Stockholm with what at first appears to be pneumonia. She also happens to be 33 weeks pregnant. Very rapidly her condition deteriorates and it becomes clear that she is suffering from a recurrence of her leukaemia. She is moved to the Central Intensive Care Unit at the Karolinska University Hospital, and there her baby is delivered by emergency Caesarean Section.
Sadly it seems that Karin never woke up to hold her baby, or even see the picture of newborn Livia that Tom taped above her bed – though she may well have done. With memoir-as-fiction you never quite know where you stand, which could perhaps be seen as its chief drawback.
I began reading In Every Moment We Are Still Alive cold, as a work of fiction, not scanning the blurb or press release and knowing nothing of its background. Being slow on the uptake what struck me first was the research Malmquist had put in, and all of it meticulously incorporated and ringing true on some fundamental level. Surely the author had to work in intensive care? Was he a nurse, or a physician? Eventually though (still slow on the uptake) I Googled Malmquist’s name to find out he’d lived it. At one point Tom even describes himself, the main character, sitting in ITU, writing in his notebook – caught in the act, as it were.
Tom’s experience is described first-person and present tense; dialogue is free of speech marks and isn’t always paragraphed or attributed, which enhances the story’s immediacy and adds to the overall air of confusion, the sense that the protagonist just-about-understands what’s going on. The narrative is highly restricted, confining itself in the opening third to snatched conversations in and fleeting impressions of a large, busy hospital. We see Tom jealously guarding access to Karin, even from her mother and father. There’s a poet’s eye for small details and significant words: in a waiting area Tom sees “chewing gum pressed into the leaf of a yucca plant,” and Karin is not to be moved to an intensive care bed, but “installed”. The overall effect, disconnected from any thoughts of past or future, adds to the sense of this person not really grasping what’s going on; to an air of claustrophobic disconnection. “I feel as if I’m wearing a diving helmet,” Tom says at one point, and the reader does too.
After Karin’s death, the pace of the book changes. Tom has to deal with the bureaucracy of becoming sole guardian to Livia, then with his father’s own death from cancer. The present-day is intercut with the past, and this works well: it is arresting to have Karin alive then gone in everyday moments, just as she would be in Tom’s own thoughts. As the book progressed, however, I began to find its autofictional cloak distracting. What was real and what wasn’t? I wondered if I would have accepted all the everyday details and medical abbreviations in an unambiguous work of fiction, and began to wish that Malmquist had just set out his stall on the biographical side of the market. For my money, fiction reaches highest in creating realities which could exist, but likely haven’t or even couldn’t: you admire how far up the garden path the author has led you, while still suspending (or even subverting) your disbelief.
As for the translation, Henning Koch has done a fine job, though in my proof copy on the very first page BP (Blood Pressure) was rendered as “BT (Blod Tryck)” and “...it’s just a dry retching” should perhaps have been “...I just dry-retch.”
Whichever way you read it, In Every Moment We Are Still Alive is both a poignant memoir and a fine first novel. I just wish I could have switched off the part of my brain that wanted to know where the best-told truths and best-told lies were.
Book review: The Enlightened Mr Parkinson: The Pioneering Life of a Forgotten English Surgeon, by Cherry Lewis
This review appeared in the Scotsman on 3rd May 2017 (follow this link for the original article). Thanks once again to the Scotsman and The Wellcome Trust.
Parkinson’s disease is a neurodegenerative condition which affects millions of people worldwide, and yet surprisingly this is the first popular scientific account of the life of James Parkinson (1755-1824), who first described the illness in his classic treatise, ‘An Essay on the Shaking Palsy’, published in 1817. Still more surprising because Parkinson himself was a fascinating figure, a veritable enlightenment polymath: surgeon-apothecary, geologist, palaeontologist and political radical, as Cherry Lewis’s excellent new book The Enlightened Mr Parkinson: The Pioneering Life of a Forgotten English Surgeon makes clear.
Parkinson was 62 when his treatise was published, towards the end of a rich professional life and a turbulent private one. Lewis, an honorary research fellow at the University of Bristol, is a geologist by training, and has written about Parkinson before with respect to his work in this field and in palaeontology (known then as oryctology).
The book begins by describing Parkinson’s upbringing in Hoxton, then a village about to be engulfed by London’s urban sprawl at the time of the industrial revolution, and within a few pages we’re grounded nicely in the sights, smells and social changes of the time. During a seven-year apprenticeship Parkinson trained to become an apothecary like his father: learning to grind and mix his own medicines, how to diagnose minor ailments, let blood and purge and blister his patients (medical practitioners of the 18th century still believed in the Hippocratic notion of bodily humors, and tried by these means to rebalance them.) After this he trained as a dresser (surgeon’s assistant) on his way to later becoming a surgeon. Parkinson would generally have treated poor and lower middle-class patients; if he attended to the servants of the wealthy he would be admitted via the back door (while the physicians, arriving in a chaise at the front door, administered to the family themselves.)
Around this time Parkinson worked in a receiving house, where “bedraggled bodies, most of them pulled from London’s waterways, could be taken for treatment.” Enlightenment society appeared to share the later Victorian dread of being buried (or dissected) alive, and it seems the roots of resuscitation were as much about proving death as preserving life. I was surprised to learn attempts were being made even then to “defibrillate” the heart – in fact Parkinson may have been one of the first to carry out such a procedure, using a “portable electrical machine” he kept in his pocket.
During the late 18th century, the Age of Revolution, Parkinson turned into something of a political radical, perhaps inspired by the poverty and inequality he had witnessed during his rounds. In 1792 he joined the London Corresponding Society, whose main objective was parliamentary reform – particularly universal male suffrage (only 2 per cent of the population were eligible to vote). Parkinson began writing for the anti-government fortnightly Hog’s Wash, writing (dreadful) poems under the pseudonym “Old Hubert.” Then in 1794 he was caught up in the Pop Gun Plot, an alleged conspiracy to assassinate the “Mad King” George III, which reads like a precursor of McCarthy-era American paranoia. He most comes to life during an account of his interrogation by the Privy Council, including no less a figure than Prime Minister William Pitt the Younger. Parkinson’s tart replies reveal a proud man who risks serious consequences by admitting his authorship of “seditious” pamphlets.
His later career demonstrates a wealth of talent and interests. In 1799 he published no fewer than five books, including his Magnum Opus, Medical Admonitions, a medical advice guide for families. He was an advocate of social reform and made recommendations for the regulation of child labour and asylums, and was a supporter of smallpox vaccination; he designed a hernia truss the poor could make cheaply for themselves, and wrote about gout (which he himself suffered); and he wrote foundation works in Geology and Palaeontology. And of course there was his ‘Essay on the Shaking Palsy’, in which he described the cardinal symptoms of Parkinson’s disease for the first time: a seminal work which led Jean-Martin Charcot 50 years later to propose the illness be named after him.
Lewis writes in an enjoyably digressive style: her descriptions of medical practice at the end of the 18th century, and of changing life in east London, are particularly engaging. My only quibble would be the last chapter, which traces Parkinson’s descendants to New Zealand and the present day; this reveals nothing about the man himself. This aside, Lewis’s book shines a light on Parkinson, and gives something of the name back to the person: a man whose interests ranged far beyond medicine, and whose social engagement, and engagement with his time, sings from the page.
This review appeared in the Scotsman on 25th February 2017 (follow this link for the original article). Thanks to the Scotsman and The Wellcome Trust.
Making vaccines is difficult. Or more precisely, making safe vaccines is difficult. In 1942 around 330,000 US servicemen were exposed to the Hepatitis B virus after being given a yellow fever vaccine contaminated with donor plasma; nearly 150 of them subsequently died. Then in 1955 a polio vaccine with live (not attenuated) virus paralysed almost 200 people, and killed 10. So at the start of 1960s the race was on to create vaccines that were not only effective, but also safe.
Viruses grow and replicate inside cells. Therefore in order to create viral vaccines in bulk, ready supplies of cells are a prerequisite. Ideally, these cells should, to paraphrase the American anatomy professor Leonard Hayflick, be clean, safe, normal and noncancerous. This would necessarily rule out the famed HeLa cells (everlasting cancer cells taken from Henrietta Lacks, and described in Rebecca Skloot’s book The Immortal Life of Henrietta Lacks); but what cells to use instead?
This is the focus of Meredith Wadman’s excellent new book, The Vaccine Race: Science, Politics and the Human Costs of Defeating Disease. Hayflick’s research into cell lines, described in the book, was pivotal in the creation of a critical rubella vaccine, at a time when major epidemics of the illness caused terrible birth defects. At the outset of Hayflick’s career in the late 1950s, there was growing awareness that cell cultures derived from animals might contain unrevealed viruses which could cause illness, or even trigger cancers. His goal was to find (and mass-produce) the safest human cells for vaccine production. This he eventually achieved by using lung cells from the aborted fetus of a Swedish woman, identified in the book only as Mrs X.
Her permission was never sought for this: one of many dubious ethical decisions which Wadman’s book explores. She also describes how orphans held in institutions and infants born to women in prison were used to test the experimental vaccines utilising Hayflick’s cells and then, perhaps most contentious of all, Hayflick’s decision in 1968 to take all of his cell cultures (catchily named WI-38s) with him to his new professorship at Stanford University, when in fact he had agreed to leave some behind at the Wistar Institute in Pennsylvania. This would lead to a long-running legal battle which almost ended Hayflick’s career – though ultimately it was also the catalyst for proper legislation regarding the ownership of cells and the process of vaccine creation.
Rubella, or German measles, was at that time one of the main targets for vaccine research. Major outbreaks were occurring every six years or so. The illness in children and adults is generally mild; but for women contracting rubella during early pregnancy it’s a different matter entirely. The virus targets growing cells at a specific phase of fetal development, causing Congenital Rubella: heart defects, hearing loss and eye defects, in a clinical syndrome first described by Dr Norman Gregg, an Australian ophthalmologist. In the US alone, 20,000 babies were born with Congenital Rubella during the 1964 outbreak, and in the aftermath there was a desperate need for safe, mass-produced vaccines before the next major outbreak, anticipated to be in 1970.
Wadman makes fascinating comparisons between rubella and the currently newsworthy Zika virus: both viruses causing mild illness in the mother, but major birth defects in the fetus. But her book really hits its stride is in part two, where it focuses on rubella, and horrifyingly, rabies – the case descriptions of children affected by this illness are heartbreaking. Despite the title, however, it’s a slow starter, possibly too detailed in places, and I must admit to glazing over at mentions of biotech shareholder dividends and US government legislation. Also, I would have liked more about the MMR scandal of the late 1990s and early 2000s, described elsewhere as “Perhaps the most damaging medical hoax of the last 100 years,” if only to show how much mass vaccination is taken for granted today.
Hayflick’s WI-38 cells – shared widely around the world – have helped to provide vaccines against (among others) polio, measles, rabies, chicken pox, and hepatitis A. To date billions of people have been vaccinated. The Vaccine Race takes in all of this, plus cell death, human ageing and the ethical dilemmas of owning living tissue, and is in the end an important story, well told.
*The Vaccine Race, by Meredith Wadman, Doubleday, 448pp, £20
Here's The Persistence of memory, which got 3rd place in the Costa Short Story competition this year.
The Persistence of Memory
A comet strikes the moon on our way to the pantomime, and nobody reacts.
My husband Ben goes on driving in his clunk-click, hard-by-the-rules way; our two children remain sprawled on the back seat, going about their business of dishing out dead legs and back-and-forth bickering as on any other drive.
Singular feeling, that: bearing witness alone to the end of the moon. A melting, meandering fireball of ice crept across my passenger-side window and ploughed with unimaginable force into its nearly-new face. Our little satellite wept flame, flared briefly as bright as the sun, then disappeared behind some wintergone trees.
I blink, sit up sharp. There's no new sound of calamity: just the car droning over tarmac as before, the heater set on four, some radio 4 show rounding up the year. Iris, behind me, hissing to my youngest Jack: Do that again and I'll smash you, pizza-face. Jack growling back: Like ah'm bothered brace-face. Ben telling the both of them to pack it in, then his hand on mine (he must’ve seen the impact too?) and a quick glance at me as he checks the mirror on my side.
'Everything okay?' he asks.
‘Was I – did I say something?’
‘You made a noise. You alright?’
I gawp out at the passenger-side sky. Over a frosty stubble-field the moon is there, back, doing its thing: tailing us, dodging clouds, counting its spots like my teenage son, suspended in place exactly as before.
I look to the windscreen and see at once my mistake: little rafts of sleet, melting, meandering, pushed and pulled along by the airflows outside.
Just sleet. Of course. That's all. The moon’s unharmed.
I sink into my seat, close my eyes, wanting to put off any other mistruths the world will tell tonight.
We make the panto with ten minutes to spare. The kids look embarrassed by my infirmity, and to be honest, I'm doubting my own obstinate demands that they come along. I must be soft in the head. Morna, my old dear friend, laughed when I told her. 'You're not serious!' she said. 'Which one?' 'Aladdin,' I'd replied. 'Want to come?' 'Ha! You're pulling my leg! You're not serious!' 'I am serious. What's so damned funny about wanting, no, needing to have a little bit of fun?' Here her smile faded. 'You are serious,' she said. Then: 'Ignore me. Have a good time.'
So. A pantomime, because pantomimes are happy things, forget-yourself entertainment, and I could do with a little of that right now.
There's a service lift which gets us into the theatre, just large enough for Ben and me. He pulls me inside until the wheelchair sits snug against the grille doors. Honestly, I'm glad to be slipping past the box office and all those sympathetic titled heads. Ben, holding my bag, leans in over my right shoulder.
'Still keen?' he asks.
'Yes, yes,' I say, irritated by any hint of backtracking.
The lift jolts, rises a few feet – and then stalls. The lights flicker off, on, off.
Ben presses the first floor button: nothing. He presses again, then again. Nothing doing. No movement. He presses the red alarm button and I laugh, exasperated.
'Typical,' he says. He slaps the sheet metal wall.
'Looks like it's broken,' I say.
'Your luck is one of the wonders of this world.'
'Speak for yourself.'
Ben kneels down beside me, rubbing at his eyes. To keep me amused, I suppose, he morphs into his younger self. It's 1978. Summer loving. Grease at the picturehouse, that hippy-coloured-ink-blobs screen before the film, blue loops of fag smoke rising along with lustful thinkings, dirty floors, tatty seats, screeching girls: me among them. Ben and I are punks, but we've forgotten to be snot-hurling and world-weary for the afternoon and instead we're just filmgoing teens. We're the twin rejects in a cross-eyed double-date. Our original date partners—loud and beautiful, you know the type—paired off quick together, then shrugged off going to the film with us. Last seen heading for the parklands beyond the high flats and an unwanted baby nine months later. Ben, beside me, is wearing faded denim, 24-hole Doc Martens, studded belt, spiked hair. (His Mohican is still a year off.) I'm in tie-dyes, leather snog-me skirt, 18-hole Docs, laddered tights. My foundation might be putty and coal dust, and maybe I fancy myself as a punk Cleopatra, but I look more like Francis Bacon's leering pope. Ben sticks his tongue in my ear. I tell him that this tickles my right bumcheek and he spits popcorn in mirth.
I try his ear, but the tickle is mine alone.
Afterwards we walk home, arms around each other's necks, stopping for brazen punk-snogs wherever there's a chance that someone might be there to see us. We both agree that the film was dire and that John Travolta was an utter arsehole, Olivia Newton-John pure cat's piss. In fact, the film was so bad we talk about it the whole way home... A safe distance from my street we stop to kiss in a reeking underpass where I suppose my spots might be less obvious. I sit up on a zzzrrrnnng-ing electricity box, away from the streetlamps, looking down on Ben, who looks up, his face hairless, his own angry rash of acne obvious, looks so young when I see him now--
older when I see him now. That young punk: now careworn, silver in his beard, his father's crow-lined eyes and hairline going the way of the glaciers. We're back in the lift.
'You were gone for a moment there,' he says. Then haltingly: 'You, eh, tried to stick your tongue into my ear.'
'Yes. Yes you did.'
I don’t like his disappointed, scared, tired face. 'Relax,' I say, patting the stubble-island of his forehead. 'A little ear-tonguing before the theatre never did anyone any harm.'
'You'll give me swimmer's ear.'
'Ach you never bothered about that when you were a punk.'
He's silent. Reaching in under my cardigan, he takes out my morphine pump. 'How much of this did you have in the car?'
I tell him not nearly enough. 'I felt all the bumps in the road. I think I hit it every three minutes, or as soon as the lock-out would allow. How? You think I've had too much? You think I need to go easier?'
'Maybe.' Ben looks away to the floor. 'No, of course, press it if you're sore. Don't worry about that. Don't worry about getting too much. Just as long as you're not in pain.'
I put the pump back in out of reach.
In my case, cancer has been about pain. My right breast and a job lot of lymph glands were removed five years ago. The cancer returned a year and a half later. A second round of chemotherapy dusted off the recurrence, but six months later this recurrence—well, recurred. I am now officially beyond remission—in the terminal lounge, so to speak. And I am in pain. Bad pain. Burning, burrowing, unmanageable pain. Let's call it commanding: a neat euphemism I learnt while on the oncology ward. This is pain light years beyond the nudges and scratches of a good punk-kicking; pain that has you wishing, pleading, praying, even as an atheist, for god.
My little pump keeps me sane. And insane, of course, depending on your viewpoint / bias. Before cancer I used to be scared of losing my mind; now cold sanity is the bogey man. After a minute or two at the surface I'm done, and ready for reverie. Sometimes I get an odd notion of myself as human Morse Code: dots and dashes of real life with long gaps for nostalgia in-between. Sometimes it gets me the guilt: to be woolgathering while everyone else worries. The same guilt—and fear—that roots me in stopped horror in the supermarket, gawping at the sell-by dates: will I be gone by then? I need to sleep less, live more. What about this date? Will I still be here? And then? And then?
'Someone on the other side,' Ben's saying. 'We might catch the start yet.'
I swim back up to now. 'Where are our kids?'
'Waiting. I can hear Iris. She's asking if they couldn’t just leave us be.'
'Very droll. A punitive slashing of her allowance, then.'
'Ten o'clock curfew.'
'Removal of sleepover privileges.'
'No art school for her.'
'Oh… wouldn’t go as far as to say that.'
Iris, my bonny Iris, plans to follow in the footsteps of her mother. It's 1985. Glasgow School of Art. My spots have gone. I'm a self-styled Caledonian Dadaist, in thrall to Salvador Dali, doing for surrealism in Scotland what Hitler did for little square moustaches in Austria. I make kilts for dead rats; elegant evening dress for dogs; deface my own early watercolours with moustaches and pubic hair; beseech pigeons teetering on the sides of tall buildings with a loudhailer – DON'T DO IT; draw a comic strip series where all the main characters turn into elephants, then eggs, then back to elephants, before someone thinks to say: 'Oh, screw this for a laugh.' And in the midst of all this self-indulgent creative hubris, I fall pregnant with Iris. My first lesson in real life art: there is nothing more surreal than trying to complete your final year thesis while vomiting twenty shades of green into a bucket. Now here am I, Ben's hand on my shoulder, his hand fine, young, slender. He's pulling my hair back out of the way as I throw up. I'm retching so hard, in fact, that I see stars. When I look up again, my forehead slick with sweat, there's a cup of sweet tea by my left hand.
And a ring.
Advice, ladies. Test your man. Vomit endlessly into a bucket, or trial a mysterious flu or five-day migraine which keeps you incapacitated in bed, then wait and see what he does. The good ones will be there to hold back your hair, wipe the sick from your mouth. The bad ones will make good their exit.
Ben cranes in, nearly falling into my lap. 'They're forcing the doors,' he says. 'Let me lie over you for a sec.' Sure enough, some sort of metal pole—a marlinspike, or is that the morphine talking again—is being forced between the lift doors above our heads. We're mid-floor—three feet of concrete, three feet of busy foyer. Not quite six feet under—an apt metaphor for my life! Above us, the box office, two flustered ushers, our mortified kids, and horror of horrors—a crowd hanging back, greedily waiting to eyeball the sick lady in the chair.
'So much for slipping in past the box office,' I say.
A cheer goes up as I'm wheeled past the stage. I could do without Widow Twankey's not very subtle aside, 'Three cheers for our lady of the lift! Isn't she a brave sweetheart!', and the sentimental furore of clapping and foot-stomping that follows. Ben pushes me left of centre, where I huddle inside my jacket, sitting between our kids, staring at my knees. The panto goes on. I squirt morphine until the colours wash with the sound which washes with time. The stage and auditorium empty and it's just me, Jack, Iris.
My eyes slip shut and they turn toddler beside me. They're wearing pyjamas with blue stripes and pink butterflies: four and six, the bowl-cuts I gave them yesterday, Jack's gappy grin, Iris throttling her manky toy rabbit. I show them how to put a knitting needle through a balloon, how to yank a tablecloth leaving all the crockery in place (we fail.) Then we're on holiday in Wales and Jack is asking me, 'Are there spacemen in space, mummy?' to which I reply, 'Of course. Else how would we find them?' He puzzles over the false logic of this, then: 'Are you scared of ghosts, mummy?' And I answer: 'No, I'm more scared of there being no ghosts.'
It’s only now that I understand what this means.
We retreat to the barn adjacent our holiday cottage, where I subject them to the long-winded ghost story which begins It was a dark, dark night…, while holding a torch, uplighting my face for sinister effect--
torch shining in my face. One of the usherettes is asking, 'You feeling alright, ma'am?' I scowl up at her. I mean, who calls anyone ma'am these days? I seem to have slumped a little. Ben says everything's fine, and rights me back in my chair. Iris, on my left, dabs at her eyes. 'Knew this was too much,' she says. 'You're exhausted. But you would insist.'
'I'm fine,' I snap. 'The goose is about to lay the golden egg. Leave me alone.'
There's a pause. Ben squeezes my arm. 'Wrong panto,' he whispers.
What will I become? Dust on a window ledge? A distracted moment on a vulnerable day? A saltwater memory, photos thumbed and yellowed?
I believe in no god: so can only hope to persist in the minds of those I will leave behind. The occasional thought in my direction would be enough.
On the oncology ward all we talk of is hope. The living know nothing of this language: our terminal code. There are days where I wake up feeling optimistic—it still happens—and on those days I talk of a bridge to a bridge to a bridge. Perhaps the next treatment will take me up to the next breakthrough which will buy me six months, a year, two years, who knows. And then, in that future remove, things might be very different: gene therapy, nanotechnology, some miracle cure for all forms of cancer discovered in an as yet unshorn Amazonian glade: an über-cure, extracted, distilled, crystallised and available in pill form for me to take just in time for Jack's twenty-first birthday.
This is the way you get. This is what hope does. This is where perhaps and maybe and who knows gets you; to the edge of forever. But no further. This is my drop, my festering consciousness, my dance of death. This is hope.
Ben's hand on my shoulder. He's smiling, and so are the kids. It seems I've been screeching along with all the other children at the villains. Oh my. The auditorium crackling with applause. So I missed the end. Too bad. To be honest the costumes were a little disappointing this year: washed out sepia, the colour of old underpants. But maybe that's the morphine talking again.
I am back inside the car's bone-snug, air-con closeness.
On our return home I notice three things. One: Ben's hand drifting to mine as he says, 'I haven’t enjoyed the theatre so much since we went to see Grease together. Do you remember? That was a good film. You cried at the end. And the middle. And the beginning. You were the soppiest punk in the world as I recall.'
I categorically reject this version of events.
Two. Our children behind us going on about Christmas like it's not some doomed pageant or Shakespearean tragedy, but an event to be enjoyed.
Three. Our little satellite moon, surviving another cometary collision. At the last I move my head and the colliding fireball of ice veers from its path, melting on harmlessly.
I'll leave off the pump for a while longer.
Really pleased to be able to announce I've been shortlisted for the Costa Short Story prize, along with Jess Kidd and Billy O'Callaghan. Here's a link to the Costa website where all three stories are available to read and listen to.
Below, an article I wrote for Pulse Online: 'How I became a GP novelist.' (link here)
I started writing while still at university: short stories, crap poetry, and a couple of (even crapper) novels. Medicine for me at that point was all about taking in vast amounts of knowledge, so it was good to be doing something that felt completely different.
I’ve never been on a writing course, so learnt through failure (lots of it). I reckon courses are a good way to speed things up – though I also reckon you have to learn the 10,000 ways of writing a bad novel as well as the 20 bullet-pointed ways to write a good one – and the only way to do that is through practice, failure, then more practice.
Several years ago I got a short story published in Granta’s New Writing; at the launch for that I met my agent. Two years ago when I completed my third novel, The Last of Us, she pitched it to several publishers, and Borough Press bought it. Sounds simple – but getting to that point involved one shelved novel and took ten years!
Being a GP it’s always been challenging finding time to write. Now I work six sessions, so there are two mornings and a lunchtime per week where I can get some words down. The rest is stolen half-hours, which forces me to be efficient.
Little details of the professional make their way into the stories. For example, The Last of Us has a young girl called Elizabeth who’s the daughter of rural GPs who job-share on a Scottish island (my wife and I job-shared on the Hebridean island of Barra). The novel I’m currently writing is based around a GP practice in Glasgow, set just after the financial crisis.
The writing and editing involved in creating a novel feels substantially different to anything I do as a GP, which helps me switch off and stay sane. Reading, I think, is the key: is there not some research which suggests that reading fiction can make a person more empathetic? (Although if you Google ‘reading fiction’ the first result you get is ‘waste of time’).
If any other GPs wanted to become novelists my advice would be start by writing short stories; they help you discover the voice and viewpoint you’re good at. Reading and writing poetry helps you appreciate the cleanest, simplest, sweetest language. And by all means go on a writing course, but also be prepared to learn by failure. As Samuel Beckett wrote: ‘Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better.’
Here's a link to a Q&A I did for the Caledonia Novel award.
It's an Edinburgh-based, international award for unpublished and self-published novelists, now in its third year. (Thanks for asking me Wendy.)
This article appeared in the Guardian Review, 16th July 2016.
Before Zika reached the Americas, casting a shadow over this summer’s Olympics in Rio, it was little heard of. And yet it was there: present in the human population at least since 1952, and considered a rather innocuous virus until the amplifying effect of a large outbreak in Brazil revealed its devastating association with the rare birth defect, microcephaly (continue to rest of Guardian article.)
My novel The Last of us was published by The Borough Press in April 2016.