Review: Intensive Care by Gavin Francis
I finally finished a book in 2021! And it’s one with undeniable ongoing relevance. The subtitle is “A GP, a Community & COVID-19.” Francis, a physician who is based at an Edinburgh practice and frequently travels to the Orkney Islands for healthcare work, reflects on what he calls “the most intense months I have known in my twenty-year career.” He draws all of his chapter epigraphs from Daniel Defoe’s A Journal of the Plague Year and journeys back through most of 2020, from the day in January when he and his colleagues received a bulletin about a “novel Wuhan coronavirus” to November, when he was finalizing the book and learned of promising vaccine trials but also a rumored third wave and winter lockdown.
In February, no one knew whether precautions would end up being an overreaction, so Francis continued normal life: attending a conference, traveling to New York City, and going to a concert, pub, and restaurant. By March he was seeing more and more suspected cases, but symptoms were variable and the criteria for getting tested and quarantining changed all the time. The UK at least seemed better off than Italy, where his in-laws were isolating. Initially it was like flu outbreaks he’d dealt with before, with the main differences being a shift to telephone consultations and the “Great Faff” of donning full PPE for home visits and trips to care homes. The new “digital first” model left him feeling detached from his patients. He had his own Covid scare in May, but a test was negative and the 48-hour bug passed.
Through his involvement in the community, Francis saw the many ways in which coronavirus was affecting different groups of people. He laments the return of mental health crises that had been under control until lockdown. Edinburgh’s homeless, many in a perilous immigration situation thanks to Brexit, were housed in vacant luxury hotels. He visited several makeshift hostels, where some residents were going through drug withdrawal, and also met longtime patients whose self-harm and suicidal ideation were worsening.
Children and the elderly were also suffering. In June, he co-authored a letter begging the Scottish education secretary to allow children to return to school. Perhaps the image that will stick with me most, though, is of the confused dementia patients he met at care homes: “there was a crushing atmosphere of sadness among the residents … [they were] not able to understand why their families no longer came to visit. How do you explain social distancing to someone who doesn’t remember where they are, sometimes even who they are?”
Francis incorporates brief histories of vaccination and the discovery of herd immunity, and visits a hospital where a vaccine trial is underway. I learned some things about COVID-19 specifically: it can be called a “viral pneumonia”; it has two phases, virological (the virus makes you unwell) and immunological (the immune system misdirects messages and the lungs get worse); and it affects the blood vessels as well as the lungs, with one in five presenting with a rash and some developing chilblains in the summer. Amazingly, as the year waned, Francis only knew three patients who had died of Covid, with many more recovered. But in August, a city that should have been bustling with festival tourists was nearly empty.
Necessarily, the book ends in the middle of things; Francis has clear eyes but a hopeful heart. While this is not the first COVID-19 book I’ve encountered (that was Duty of Care by Dominic Pimenta) and will be far from the last – next up for me will be Rachel Clarke’s Breathtaking, out at the end of this month – it is an absorbing first-hand account of a medical crisis as well as a valuable memorial of a time like no other in recent history. A favorite line was “One of the few consolations of this pandemic is its grim camaraderie, a new fellowship among the fear.” Another consolation for me is reading books by medical professionals who can compassionately bridge the gap between expert opinion and everyday experience.
Intensive Care was published by the Wellcome Collection/Profile Books on January 7th. My thanks to the publisher for the free copy for review.
Gavin Francis’s other work includes:
Previously reviewed: Shapeshifters
Also owned: Adventures in Human Being
I’m keen to read: Empire Antarctica, about being the medical officer at the British research centre in Antarctica – ironically, this was during the first SARS pandemic. (In July 2020, conducting medical examinations on the next batch of scientists to ship out there, he envied them the chance to escape: “By the time they came home it would be 2022. Surely we’d have the virus under control by then?”)
The Not the Wellcome Prize Blog Tour: Francesca Segal and Ian Williams
It’s my stop on the “Not the Wellcome Prize” blog tour. With two dozen reviews of health-themed 2019 books to choose from, I decided to nominate these two for the longlist because they’re under the radar compared to some other medical releases, plus they showcase the breadth of the books that the Prize recognizes: from a heartfelt memoir of a mother welcoming premature babies to a laugh-out-loud graphic novel about a doctor practicing in a small town in Wales. (The Prize website says “picture-led books are not eligible,” so in fact it is likely that graphic novels have never been considered, but we’ve been flexible with the rules for this unofficial blog tour.)
Mother Ship by Francesca Segal
This first work of nonfiction from the author of the exquisite The Innocents is a visceral diary of the first eight weeks in the lives of her twin daughters, who were born by Caesarean section at 29 weeks in October 2015 and spent the next two months in the NICU, “an extremely well-funded prison or perhaps more accurately a high-tech zoo.” In Mother Ship, she strives to come to terms with this unnatural start to motherhood. “Taking my unready daughters from within me felt not like a birth but an evisceration,” she writes. “My children do not appear to require mothering. Instead they need sophisticated medical intervention.”
Segal describes with tender precision the feeling of being torn: between the second novel she’d been in the middle of writing and the all-consuming nature of early parenthood; and between her two girls (known for much of the book as “A-lette” and “B-lette”), who are at one point separated in different hospitals. Her attitude towards the NHS is pure gratitude.
As well as portraying her own state of mind, she crafts twinkly pen portraits of the others she encountered in the NICU, including the staff but especially her fellow preemie mums, who met in a “milking shed” where they pumped breast milk for the babies they were so afraid of losing that they resisted naming. (Though it was touch and go for a while, A-lette and B-lette finally earned the names Raffaella and Celeste and came home safely.) Female friendship is thus a subsidiary theme in this exploration of desperate love and helplessness.
The Lady Doctor by Ian Williams
This sequel to 2014’s The Bad Doctor returns to a medical practice in small-town Wales. This time, though, the focus is on Iwan James’s colleague, Dr. Lois Pritchard, who also puts in two days a week treating embarrassing ailments at the local hospital’s genitourinary medicine clinic. At nearly 40, Lois is a divorcee with no children; just a dog. She enjoys her nights out drinking with her best friend, Geeta, but her carefree life is soon beset by various complications: she has to decide whether she wants to join the health centre as a full partner, a tryst with her new fella goes horribly wrong, and her estranged mother suddenly reappears in her life, hoping that Lois will give her a liver transplant. And that’s not to mention all the drug addicts and VD-ridden lotharios hanging about.
Williams was a GP in North Wales for 20 years, and no doubt his experiences have inspired his comics. His tone is wonderfully balanced: there are plenty of hilarious, somewhat raunchy scenes, but also touching moments where Lois learns that a doctor is never completely off duty and has no idea what medical or personal challenge will crop up next. The drawing style reminded me most of Alison Bechdel’s or Posy Simmonds’, with single shades from rose to olive alternating as the background. I especially loved the pages where each panel depicts a different patient to show the range of people and complaints a doctor might see in a day. Myriad Editions have a whole “Graphic Medicine” series that I’m keen to explore.
See below for details of the blogs where other reviews have appeared or will be appearing soon.
The shadow panel will choose a shortlist of six titles to be announced on 4 May. We will then vote to choose a winner, with the results of a Twitter poll serving as one additional vote. The Not the Wellcome Prize winner will be announced on 11 May.