January’s Nonfiction Releases: Clarke, Heminsley and Lalkhen
Three new books with medical themes (no surprise there), including the first Covid wave in the UK; fertility and body issues in a new queer family; and pain management strategies.
Breathtaking: Inside the NHS in a Time of Pandemic by Rachel Clarke
Clarke is a palliative care doctor based in Oxfordshire. She runs the Katharine House hospice but during the coronavirus pandemic has also been on active duty in the Oxford University Hospitals system. If you’re on social media you have likely come across some of her postings as she has been equally vocal in her praise of the NHS and her criticism of Boris Johnson’s faltering policies, which are often of the too little, too late variety. So I was eager to read her insider’s account of hospital treatment of the first wave of Covid in the UK, especially because her previous book, Dear Life, was one of my top two nonfiction releases of last year.
The focus is on the first four full months of 2020, and the book originated in Clarke’s insomniac diaries and notes made when, even after manically busy shifts, she couldn’t rest her thoughts. Her pilot husband was flying to China even as increasingly alarming reports started coming in from Wuhan. She weaves in the latest news from China and Italy as well as what she hears from colleagues and disease experts in London. But the priority is given to stories: of the first doctor to die in China; of a Yorkshire ICU nurse’s father, who comes down with Covid and is on a ventilator in an Oxford hospital; and of her patients there and in the hospice. She is touched that so many are making great sacrifices, such as by deciding not to visit loved ones at the end of their lives so as not to risk spreading infection.
A shortage of PPE remained a major issue, though Dominic Pimenta (whose Duty of Care was my first COVID-19 book) pulled through for her with an emergency shipment for the hospice – without which it would have had to close. Clarke marvels at the NHS’s ability to create an extra 33,000 beds within a month, but knows that this comes at a cost of other services, including cancer care, being stripped back or cancelled, meaning that many are not receiving the necessary treatment or are pushing inescapable problems further down the road.
A comparison with Gavin Francis’s Intensive Care, published earlier in the month, is inevitable. Both doctors bounce between headlines and everyday stories, government advice and the situation on the ground. Both had their own Covid scare – Clarke didn’t meet the criteria to be tested so simply went back to work two weeks later, when she felt well enough – and had connections to regions that foreshadowed what would soon happen in the UK. Both give a sense of the scope of the crisis and both lament that, just when patients need compassion most, full PPE leads to their doctors feeling more detached from them than ever.
However, within the same page count, Francis manages to convey more of the science behind the virus and its transmission, and helpfully explores the range of effects Covid is having for different groups. He also brings the story more up to the minute with a look back from November, whereas Clarke ends in April and follows up with an epilogue set in August. A book has to end somewhere, yes, but with this crisis ongoing, the later and more relevant its contents can be, the better. And in any book that involves a lot of death, mawkishness is a risk; Clarke so carefully avoided this in Dear Life, but sometimes succumbs here, with an insistence on how the pandemic has brought out the best in people (clapping and rainbows and all that). Her writing is as strong as ever, but I would have appreciated a sharper, more sombre look at the situation a few months later. Perhaps there will be a sequel.
With thanks to Little, Brown UK for the free copy for review.
Some Body to Love: A Family Story by Alexandra Heminsley
From Heminsley’s previous book, Leap In, I knew about her getting married and undergoing IVF. It was also a book about outdoor swimming; I appreciated her words on acquiring a new skill as an adult and overcoming body issues. This memoir continues the story: in 2017, after a gruelling journey through infertility treatment, Heminsley finally got the baby she wanted. But not before a couple more heart-wrenching moments: the lab made an error and notified her that she shared no DNA with this last embryo, and while heavily pregnant she was assaulted by a drunk man on a train. Both incidents left her feeling a loss of agency. “Why was I consistently being deemed the least reliable witness of my own reality?” she asks.
As they adjusted to new life with a baby, Heminsley started to notice that she wasn’t connecting with her husband, D, like she used to. She felt emotionally unsupported and, in fact, jealous of D’s relationship with their son, L. And while they’d never been the most conventional couple, D’s changes of appearance and wardrobe seemed like a sign of something bigger. Indeed, when L was six months old, D told Heminsley, “this body doesn’t represent who I am” and announced a decision to begin transitioning.
As D moved towards having a body that fit their identity, Heminsley, too, needed to get back in touch with her body. After books like Running Like a Girl, she was considered an exercise guru, but she didn’t see herself in the new obsession with Instagram-ready images of fitness perfection. This is not, then, primarily a memoir of queer family-making, because D’s transitioning was not Heminsley’s story to tell and mostly occurs in the background. Instead she focuses on what she does know and can control: her relationship to her own body.
However, this entails what can feel like irrelevant flashbacks to her teenage years of undergoing rehab at a military clinic in Germany for hypermobility, trips to Trinidad and Italy, and the genesis of her two sporting memoirs. Much as I applaud the sensitivity to trans and body issues, the book ends up feeling scattered. Still, the writing is so candid and the narrative so eventful that you’ll race through this even if you don’t normally pick up nonfiction. (For a bit more information, see my short write-up of the virtual book launch.)
With thanks to Chatto & Windus for the free copy for review.
Pain: The Science of the Feeling Brain by Abdul-Ghaaliq Lalkhen
Originally from South Africa, Dr Lalkhen is an anaesthesiology and pain specialist based in Manchester. In a nutshell, his approach is “biopsychosocial,” meaning that he seeks to understand pain not just as a physical phenomenon resulting from acute injury or damage but as an ongoing process that is affected by emotional and psychological factors. Particularly in the context of chronic syndromes, he acknowledges that pain can continue even when its immediate cause has been repaired. Mental preparation can come into the equation: if a patient assumes they’ll wake up from surgery healed, they may be alarmed if pain persists. Lalkhen talks about managing patient expectations, perhaps with something as simple as the promise, “we’ll aim to get your pain down to a 4 after surgery.” In part, he blames Western society’s Cartesian philosophy for treating mind and body as separate rather than a system.
There are genetic and psychological reasons people might be predisposed to chronic pain. Pain itself can then change the brain chemistry, making the body more alert to pain signals. People can choose one of three paths, Lalkhen observes: “You can spend your time agitating about the alarm going off, you can try to ignore it (but the ignoring of it actually takes up more energy), or the final alternative is to learn to live with this deeply unpleasant situation.” Those who opt for pharmacological solutions can become addicted to opiates, which are less effective over time. Non-drug-related therapies involve the desensitization of nerves, the injection of anaesthetics or steroids, or the implanting of spinal cord stimulators. But all of these strategies have their limitations, and can diminish in efficacy. The patients he sees in his pain clinics may be disappointed that, rather than offering a panacea, he wants to wean them off their current pain relief and help them develop a new way of thinking about pain.
I felt I learned a lot from reading this. Lalkhen is careful to state that he is only referring to non-cancer pain (cancer pain in terminal patients will take all the morphine you can throw at it). Like many physicians, he worries about the modern epidemic of overtreatment and our obsession with wellness. I especially enjoyed the discussion of the understanding of pain and its treatment from the ancient world onward, and in particular the history of opiates. The prose is not literary, but this is an accessible and informational read if the subject matter draws you.
With thanks to Atlantic Books for the free copy for review.