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Tales of life, death and brain surgery – Holiday reading 2015

The heading for this post is the sub-title of ‘Do no Harm’ by Henry Marsh, which I chose as the first of my holiday books this year.   It’s a fair description for the book – a memoir from a senior neurosurgeon, now close to retirement, but coincidentally it just about sums up all my summer reading.  I hadn’t appreciated when I was packing, that one of my other choices – ‘Saturday’ by Ian McEwan, was also about a brain surgeon, although this time of course a fictional one.   And the other books certainly covered plenty of life and death, if no more brain surgery.

Do No harm

I’d heard Henry Marsh talking on the radio before reading his book, and heard the book described more than once as remarkably honest.  It is, in the sense that he talks openly about his failures as well as his successes.  That means not only the occasional death on the operating table, but coming across others, years later, who had been left in a permanent vegetative state as a result of his failures.  And he’s open, although perhaps not to his patients, that mistakes, even with terrible consequences, are almost a necessary part of the learning process, if we’re to end up with experienced consultants.

He’s also candid about the arrogance and feelings of being a Master of the Universe, that the job can tend to cultivate.  That may apply, with less cause, even beyond brain surgery, to other surgeons who can hold our lives in their hands.  At least in his case though, the arrogance doesn’t entirely prevent the feelings of self-doubt or the necessary humanity and understanding of what patients must be feeling.   He recognises that he’d much prefer to be carrying out a difficult operation than having a difficult conversation with patients – a failing he suggests is common amongst surgeons, to the extent that many unnecessary or even damaging operations are performed.   Consultants prefer to offer patients the hope that an operation may succeed, rather than be honest with them that at best the result is likely to be a painfully extended death rather than a swifter less painful one.

The book’s a great read, although quite an emotional one and a fascinating insight into a little known world, at least to me, as someone who’s spent little time in hospital and even less watching medical dramas.  I always imagined that brain surgeons were cutting into the brain and attempting to influence in some way the way it worked.  It seems instead that their bread and butter is the more humdrum business of cutting out tumours, while trying to avoid as much as possible of the brain itself.

Saturday

Fortunately there are few glaring inconsistencies between the fictional neurosurgeon in ‘Saturday’ and the real one in ‘Do no harm’.   Ian McEwan has done his background research well (I went straight to the acknowledgements to check whether Henry Marsh had been consulted, but it’s another of his colleagues who provided the advice).  The arrogance and self-satisfaction is still there, and although it starts to unravel in a ‘Bonfire of the Vanities’ style moment, McEwan spares us the full descent into Hell and is satisfied with a brief look over the edge into the abyss.  It builds up to an action-packed and gripping finale, but the real strength of the book is in its slower, more descriptive sections, with extended riffs on a game of squash or the preparation of a fish stew.   I’ve enjoyed all of the McEwan books I’ve read and will be searching out more.

Elizabeth is missing

I also enjoyed ‘Elizabeth is missing’, a first novel by Emma Healey, an unusual combination of murder mystery and literary exploration of dementia, another theme that I’ve seen tackled elsewhere recently.   The action shifts constantly between past and present, as our heroine Maud, who can hardly remember what happened a minute ago, solves a 70 year-old mystery.  It’s in some ways a similar structure to the one that A.S. Byatt used so well in ‘Possession’ and then Tom Stoppard in ‘Arcadia’, and it’s well suited to the subject of dementia.  On the whole, the episodes of flashback to her youth work better than the passages in the present, which are a bit predictable and repetitive, but it’s a great read.

Albatross 159 The ABC murders

As of course is Agatha Christie.   I’ve worked my way through quite a few of her classic mysteries in recent years, several of them from the Albatross Crime Club editions. ‘The ABC mysteries’ definitely feels rather dated now, but so carefully plotted that it still keeps you on the edge of your seat, pitting your wits against the great Hercule Poirot.

The Father at Theatre Royal, Bath

Spoiler alert – this review contains significant plot and production details, which you might prefer not to know until after you’ve seen the play.   If you have a chance though, do go to see it.

The father poster

This is not at all a comfortable play.  You simply never know quite what’s going on.  Almost all the basic details of the situation laid out in the opening scene, are contradicted in later scenes and many of the contradictions are never resolved.  We don’t know whose flat we’re in, whether the daughter is in London or in Paris, whether she’s married or divorced, whether her husband / partner is sympathetic or menacing, what has happened to a second daughter, and so on.  The same roles are played by different actors in different scenes. so we don’t even fully get a grip on who’s who.   Time is a fairly slippery concept too as scenes are interrupted or replayed, so we never really have a full grasp of time, place or person – fairly basic concepts in theatre.   The music between scenes becomes increasingly fractured and the furnishings gradually disappear from the set.

The aim of all this disorientation is to show life from the point of view of the father, who is gradually slipping into dementia and reverting to childhood.   He’s not sure who his daughter is, who the carer is, or where he is.  Everything keeps changing to the point that he questions everyone else’s sanity as much as his own.   It’s a convincing performance from Kenneth Cranham as the father, who wanders around the stage in pyjamas a lot of the time, making little sense of what’s going on, before ending up in a hospital bed, desperately calling out for his mummy.   Claire Skinnner plays his daughter (for most of the play!), which inevitably brought to mind the same actress trying to deal with both an ageing father and young children in ‘Outnumbered’, as well as some of the parallels with ‘King Lear’.

The father Claire Skinner Kenneth Cranham

In a Question and Answer session with the cast after the performance, one audience member suggested that absence of love was the tragedy of the play, but that didn’t feel right to me.  There was little doubting the love that Claire Skinner showed in her portrayal of the daughter, but love isn’t always enough in the tragedy of old age.   As I’ve seen with my own parents and others, the role of carer can be particularly thankless and another questioner almost broke down as she thanked the cast for their sympathetic portrayal of this.   But in the end that wasn’t really the point either.   This was about the tragedy of the parent, through whose eyes we were being asked to experience it, rather than that of the carer.   It succeeded brilliantly in portraying that, leaving all of us just a little bit more nervous about what might be to come, particularly those of us who are maybe closer to the high risk age than we might like to imagine.