dovegreyreader scribbles

¶ Pilcrow ~ Adam Mars - Jones

¶ Well I don't really know where to start with Pilcrow by Adam Mars-Jones, so I will settle for the very beginning and my apologies... this is a very long post because it is a very long book and I have been a very long time reading it.

¶ It was 7am and I was idly sitting up in bed looking at Twitter. Linda Grant had sent out a tweet that she was reading Pilcrow by Adam Mars-Jones and it was really good and she thought, being a nurse, I would like it, though I'm sure she said it much more eloquently and persuasively in 140 characters than that, because she is a writer after all.

¶ Now to be truthful I have never really wanted to read anything by Adam Mars-Jones. I'm a bit ashamed of this because it isn't very grown up, but a year of subscribing to the London Review of Books and reading his rather waspish reviews on books that I had really enjoyed sent me spiralling along the narrow road of judgement... the I Know I Won't Like Anything That You Write Even Though I Haven't Read It...that sort of thing. A bit like the decision I made when I was about five... about prunes, that I would be a lifelong prune refusenik despite never having eaten one.

I mean why would you eat something that looks so revolting??

¶ So anyway, I reluctantly downloaded a sample of Pilcrow to my Kindle, because I do often like the books that Linda recommends.

By this time it is about 7.04am.

By 7.10am I have read the sample and bought ...yes bought the book.

By 9.30am I decide that it really is time I got out of bed because I am supposed to be at my desk working, but in that time I have made a good enough dent in the kindle percentage-read to know that I am enjoying it tremendously, and have eaten a large slice of humble pie about that Adam Mars-Jones thing.

I even panic and start to hyperventilate when I eventually switch on my Kindle later in the day to find that the book has disappeared, not even a pilcrow to show for it, and I feel bereft. It transpires that there has been a huge KindleMuddle about the e mail addresses for my account and I am on the live chat facility to KindleHelp in a flash to sort it because I can't wait a minute longer than I need to to read Pilcrow.

¶ The first thing to sort is this pilcrow business.

This is a pilcrow ¶ and I have imported and liberally scattered a few around today (and at great technical expense) so that you can get used to it if it seems a little strange. A pilcrow is the name for the typographical mark signifying the indent of a new paragraph and John Cromer deides that this is the sign that best describes him...

'I am not sure that I can claim to have taken my place in the human alphabet, even as its honorary twenty-seventh letter. I'm more like a specialised piece of punctuation, a cedilla, umlaut or pilcrow, hard to trak dwon on the keyboard of a computer or a typewriter. Pilcrow is the prettiest of the bunch, assessed purely as a word. And at least it stands on its own. It doesn't perch or dangle. Pilcrow it is.'

The only problem, if I can call it one, is that the book at 525 pages (because Faber very kindly sent me a real one too) seems to have been by my side for a very long time indeed while I have followed the early first-person narrative life of John Cromer born and growing up in 1950s England.

Diagnosed at the age of about two with rheumatic fever John is placed on complete bedrest. Except it isn't rheumatic fever, it is Still's Disease, juvenile arthritis and by the time the misdiagnosis is discovered it is too late, John's joints which should have been kept mobile have locked permanently in a fog of excruciating pain. If there is a silver lining to the cloud of his doctor's inadequacy it is that he also refuses to prescribe John long-term steroids, this after taking fright at the near-miraculous complete remission induced by a trial dose. Though John is again rapidly returned to his bed-ridden state the decision in fact saves him from the fate of many other children who suffer arrested mental development and premature death because the doses are dangerously high...all in the days before the side-effects of steroid use in children were understood.

So the paediatric nurse in me is now wide awake and on the case, I spot that John's mother doses him with relentless amounts of aspirin and wonder if A.M-J has Reyes Syndrome up his sleeve too. That would be really ironic, that John's doting and at times suffocating mother (though can you blame her) might be responsible for his illness. That doesn't happen but I am really enjoying this intensely detailed style. If you are a nurse too this book is a must, and though the potential for boredom to set in seems huge, I wasn't, and this chunkster of a book is all made even more bearable by short chapters which carried me along and allowed me to stop when I needed to. "I'm a bit Pilcrow-ed out" became a familiar term chez dovegrey for a few weeks. You see what an odd book it is...you absolutely have to put it down...but you can't wait to pick it up again, and when you do within three or four lines you are right back into the novel.

¶ This is ...sorry I was missing the old pilcrow there...a post-war nation trying to find its feet and John Cromer, who seems unlikely ever to find his; a nation still living off the glories of a war victory and receiving regular top-up doses of courage and derring-do as the conflict is relived at cinemas and on the small screen via all those war films we would watch every Sunday afternoon. A people in thrall to the gutsy courage of the legless Douglas Bader has little sympathy for those who don't 'try'. Fussed over by his mother who is be-devilled by class and the family's place in the system, chivvied and largely untouched by his ex-RAF father, and aided and abetted by his able-bodied brother Philip, John eventually moves from home and the confines of his bedroom, to the Nancy Astor-funded Canadian Red Cross Hospital at Taplow, before heading off as an adolescent to the Vulcan School (named after a bomber plane) in Berkshire.

Not a lot happens in the grand scheme as events and characters pass through John's life and are double-filtered, because this is an adult John narrating his childhood self, and not trying to disguise the fact. But the strength of the book is the focus on the minutiae as John's life shrinks to the world visible from his prone position lying on his Tan-Sad. The irony not lost in that Tan-Sad, whilst being the makers of many activity toys for children, and thus a by-word for fun and escape (I would travel miles on my scooter...on the days I took my roller skates off) were also the manufacturers of the pram-like contraption that John is confined to and wheeled around in for much of his childhood.

This is a childhood overlaid with adult intellect, and I have to take my hat off to AM-J, never boring and much of it very funny if it wasn't so dreadful. It was hard not to sneak a wry smile as my pre-conceptions were continually challenged and as I cringed at the innate cruelty.

'WHY AM I ENJOYING THIS SO MUCH??' I wrote very upper-casely at one point in the book, and because I regularly couldn't quite believe I was.

I was bound to love all the 1950s childhood references. Adam Mars-Jones is just a year younger than me so he too knows the power of...

... Uncle Mac and Children's Favourites and that my favourite song was Sparky's Magic Piano too

... and the Etch-a-Sketch that we all coveted,

... and the game shinty ('hockey for hooligans') that we all played at school

... and Professor Branestawm and chemistry sets

... and this has to be the very first book that ever mentions the PDSA Busy Bees and our leader Enid Blyton. John Cromer and I probably both collected 'honey for the hive', the milk bottle tops, rags, bandages and amalgam all to the best of our respective abilities.

Here's my proof... I expect John Cromer has one of these too..

More irony given that we were all working diligently to be kind to animals and wearing our badges 'constantly' and with pride, whilst kindness and appropriate care for disabled children remained very much in its infancy.

There is a great deal of very intelligent stuff written about Pilcrow out there which I would hate you to miss whilst I am displaying my Busy Bees certificate and wittering on about prams, so you might want to check out a few links to other bloggers who have enjoyed this one too...

An interview with Adam Mars-Jones over on John Self's Asylum

KevinFromCanada's review here

If you grew up in this era the book really holds good, reading at times for me like a trip down nostalgia alley, but it comes with timely reminders about differing standards and the cruelty that was meted out to many children in schools. I was frequently educated by fear as an able-bodied child at a state primary school, it is even more chilling to read about John's care...at least I could race off across the playground. Were it not for his indomitable spirit and stoic personality, this would read like a manual of how best to abuse a crippled child... hard to believe that words like that even existed now isn't it, let alone that they were everyday parlance for defining disability. The sadists who found their métier in the caring and teaching professions seem incomprehensible these days, and I find it ethically fascinating and complex that some of them are now being judged by today's very different benchmark and being called to account if they are still alive.

I have Cedilla, the sequel ready and waiting to read and I am mighty keen to follow John Cromer into young adulthood. He has started to explore his sexuality as best he can so what on earth will he take into maturity from a childhood like this ? I suspect a cast-iron resilience to hardship, but it is to Adam Mars-Jones's credit that John Cromer has leapt (would that he could) off the page and into that odd world of fictional reality for me, a character who seems knowable and known and of whom I have to know what happens next.

But I am definitely feeling a bit Pilcrow-ed out for now so I will gather myself before embarking on the next 733-page phase of John's life.

And mainly because I don't have clue where on earth to find a cedilla on my keyboard either.

 

 

 

 

 

Edith Cavell ~ Diana Souhami

'The hospital bedspreads at the London were blue-and-white check. Probationers were taught to ensure that precisely nine squares hung over the end of each bed they were making. When the squares did not align, Ethel Hope Beecher...Sister of Mellish Ward from May 1897 to December 1899, would strip the covers off the beds to humiliate the recalcitrant bedmaker.'

Sounds not unlike my humiliation at the hands of a ward sister some seventy years later, but that was the London circa 1898.
I wrote a great deal about the inspirational trails that Diana Souhami's book on Edith Cavell had led me down as I read it, though not about the book itself, but I think we may have already ascertained that I knew as much about Edith Cavell as could be gleaned from the 1939 film starring Anna Neagle coupled my 1970's sojourn at the London Hospital, so I was keen to find out more in that way that nurses always like to know much more about other nurses, and indeed the book is very simply dedicated 'to nurses'.

Born in the Norfolk village of Swardeston on 4th December 1865, Edith was the oldest child of the Reverend Frederick Cavell (to rhyme with travel), forty years old and married to twenty-six year old Louisa. Also born in that year Rudyard Kipling and W.B Yeats who would both go on to play pivotal literary roles through the years of the Great War, and who could have imagined that this baby, born into an ordinary family, would likewise become a name synonymous with that conflict too.

Brought up in an atmosphere of devout and rigid religious observance, Edith Cavell had little alternative but to embrace a life of piety, and one steeped in expectations of duty and service to others, though it would seem she did so with a glad heart. Working initially as a governess and proving herself to be a competent artist as well, in 1895 Edith decided to follow in her younger sisters' footsteps and train as a nurse, eventually applying and being accepted to train at the London Hospital in Whitechapel in 1896 under the legendary tutelage of  matron Eva Luckes.

If you watched the TV series Casualty 1909 based around actual historical events at the London - a hospital sufficiently diligent about its record-keeping that a wealth of important research material now exists along with a fascinating hospital museum, then you may recall Cherie Lunghi playing the part of Miss Luckes. A year before Edith Cavell's arrival, the London had been the first hospital to establish what many of us in the 1970s still knew as PTS, Preliminary Training School, a period of induction that supposedly broke you into the ways of hospital life and nurse training gently before throwing you in the deep end.

'A pause on the threshold would give eager beginners time and opportunity to realise the importance of the new life and work on which they were about to enter, work that is taken up far too lightly at the present time by many sadly lacking the necessary vocation.'

(Miss Luckes quoted in Ministering Angels by Stella Bingham)

Eager beginners we were in 1972 too, though I think we had all thought it through quite carefully before sacrificing our feet and lumbar discs, to say nothing of quickly gaining hands that resembled those of a seventy-year old, and all for £12 a week.

Dedicated nurse and friend of Florence Nightingale, Eva Luckes ran her school of nursing as a centre of excellence setting the very higest standards. Standards that it may well have been nigh on impossible to match, and it initially came as quite a surprise to me to discover that Edith Cavell was not the bright star in Eva Luckes's nursing firmament. Ward reports are often highly critical and lukewarm with but rare glimmers of a hint of praise, frequently disparaging and uncomplementary, Miss Luckes clearly subjective and highly judgemental, a very hard task master and quite intolerant of any hint of a dedication any less than her own.

Well we've all been there, even student nurses as late as the 1970s were subject to that, so how much more severe was it likely to have been in 1896 at the birth of a recognised nurse training slowly being rescued from the clutches of a poor and disreputable level of disorganisation. I'm thinking back to Helen Rappaport's wonderful book No Place for Ladies about the nurses of the Crimean War, only fifty years earlier. Except perhaps, just perhaps, Eva Luckes viewed a nurse as self-contained and quietly confident and capable as Edith Cavell, and a woman not that much younger than herself, to be a slight threat? Not unheard of in any profession for someone in power to use that power as they choose. My own suppositions not Diana Souhami's and that's why she's the biographer and I am not, but those thoughts did occur to me as I read on. It seems Miss Luckes was often lukewarm in the references she gave Edith in her search for employment after her training, and it was that lack of a fulfilling post to which Edith felt sufficiently committed that seems to have been instrumental in her acceptance of the post in Belgium in 1907.

Edith Cavell's success at establishing a nurse training school in Brussels is exemplary, and as I read on I became increasingly aware of how I knew this book must end... and I couldn't quite believe that it would end as it surely does.

How could this kind, serious, gentle woman be led out on the morning of October 15th 1915, to be tied to a stake, blindfolded and shot as a traitor? Well, no more detail from me because it is that detail and the aftermath that makes for much more fascinating reading, but I will tell you this much... when I reached that point, the night before the execution, as Edith is left alone in her cell with the light burning so that she can be checked to ensure she doesn't commit suicide before she meets the firing squad, I had to put the book down and walk away for a few hours.

I was genuinely upset at the mere thought.
I walked in to see Bookhound,
'They are going to shoot her and I can't bear it...'
and he went and made me a cup of tea.
That's how upset I was and not a little angry at the inertia of the powers that be who clearly failed to intervene effectively on Edith's behalf and seemed to let it happen.

So a book that engaged me at every level. Diana Souhami carefully avoids many of the biographer's pitfalls as I see them, one of which must be that of constantly assuming you know what your subject 'perhaps might have done or thought' and the temptation must have been great. Edith Cavell was incredibly self-effacing, any letters that do exist seem to deflect the focus from herself onto others as she worries about them and asks after their welfare. And whilst copious quantities of Miss Luckes's written records and correspondence survive, very little remains of Edith Cavell's. For example all her hospital records, reports and diaries meticulously written about her work in Belgium were destroyed for fear of falling into enemy hands, so it cannot have been an easy task to build up a picture of a woman who consistently deflected the attention away from herself.

There are some wonderful little moments of discovery...the diary fragments found many years later stitched into a cushion belonging to Edith. Edith's faithful dog Jack who saw out his life with friends and is now stuffed and on display in the Imperial War Museum in London... I shall go and visit him next time. But above all I will, for all the arguments and mayhem over its construction, go and pay quiet homage at Edith Cavell's statue near Trafalgar Square too, because I have emerged from this book with a deepened respect and heartfelt admiration for a very courageous and dedicated woman.

I'm not sure you can ask for much more than that from any book.

101 Things to Do Before You Are Five ~ Sally Norton

Over the years I have understandably gathered quite a large selection of baby and child care related books and during my time as a caseload health visitor I would keep a shelf of Books for Loan in my office, for beleagured parents who needed to know they were not on their own with this little rascal, and that was how a few real favourite books emerged. This wasn't about what I thought parents might find useful, no indeed because it was all very professionally evidence-based i.e. which books, once loaned, never came back. Then I'd take my 'evidence' to the surgery's Patient's Association and ask if they'd buy me more. I could guarantee that six copies of just a few books would always be out and very hard to retrieve 'oh please could I just keep it a few more weeks' ... Raising Boys by Steve Biddulph was one, The Social Baby by Lynne Murray and Liz Andrews was another.

However the most popular and in demand book, and the first amusing one I can recall arriving on the scene after the serious years of Hugh Jolly and Penelope Leach, was Toddler Taming by Christopher Green. I could never have enough copies and we all cried allelulia that at last someone had got it... could look at all this with a sense of humour and perhaps parents stood a chance of feeling less haunted by the lasting damage they were supposedly doing their children, and may be more inclined to view the whole process, replete with all its challenging moments, as at least halfway enjoyable and on many occasions downright funny.

I used to tell parents to store up those moments that seemed so dreadful at the time for future use... after all we now lovingly recall the day the Kayaker played barbers and cut the hair of all Offspringette's friends,  solemnly bringing the cuttings, ranging from fair to dark to curly and little ponytails, to me in a box in the kitchen. It was such a memorable day I can almost recall how many hyperventilations per minute I was doing.

Writers sensibly jumped on the hilarity bandwagon and the books all became much more light-hearted but lately we've been back in a serious phase with books about contented babies and baby whispering and continuum concept parenting and what mothers do when it looks like nothing and no-cry sleep solutions, so when 101 Things to Do Before You Are Five by Sally Norton arrived from Penguin last week I was prepared for a wry smile, but perhaps not much more. I wasn't prepared for a little book that has had me laughing out loud every time I pick it up and which I now think should be issued free to every new parent in the country when they apply for Child Benefit or something...

'Congratulations, you've been born! But don't just lie there gurgling. You've got lots to do before you turn five and are packed off to school.

You're only little now but in the blink of an eye you'll be walking through the gates of academia. You'll be someone who has redefined the word 'holiday' for their parents, and a highly evolved human being who can win an argument simply by saying three words - 'no', 'no' and 'no'.'

The book is packed with sage advice for the new arrival...

' You'll start your first year unable to support your own head or tell the difference between daddy and a hat stand. But that's no excuse for just lazing around blowing milky bubbles. If you don't get on with things, you'll find you're one year old and full of regrets for what might have been...so come on, you've got to get through twelve clean babygros a day, regurgitate at least a dozen feeds a week...'

and then the 101 suggestions start...

Here's an extract from 5 ~ Sleep Like a Baby Stay Up All Night

Lull your parents into a false sense of security in the first three days after you you're born by sleeping soundly 99 per cent of the time...clearly you're a very very easy baby.
Once the friends have drifted away and granny's gone home safe in the knowledge she's not needed, it's time to wake up and stay awake.

It'll now take you around six months to work out the difference between night and day. But don't worry because there's loads you can do. Why not stay up all night...

• Crying because you're hungry?
• Crying because you've got wind?
• Crying because you don't want to be picked up?
• Crying because you want to be picked up?
• Crying because you're tired?

or what about 16 ~ Eat Out of the Dog's Bowl

The world really opens up once you start crawling. It gives you the chance to check out hitherto unseen areas of the house. You'll soon discover that chicken-flavoured dog food's nice...once you get started there are plenty of other ways to tickle your tastebuds and enhance the weaning experience...

• Lick the railings at the zoo?
• Suck the edge of a greasy tablecloth in a cafe?
• Swap dummies with that runny-nosed baby in the doctor's surgery?
• Suck the bristles of the big brush that's kept by the toilet?

Which reminded me that all toilet brushes become brushes non gratae the day that I found a little Offspringette brushing a baby Kayaker's hair with one.

I could quote from this little book all day and can't recommend it highly enough as a gift for yourself if you have small children or know anyone who has just had a baby, or for those of you who are grandparents to chuckle over first and then pass on down the line.... oh alright then one more...

46 ~ Like the Rabbits Best at the Zoo

Mummy and Daddy love the idea of exposing you to nature. And nothing makes them laugh more after spending £36 on tickets to the zoo than your favourite animal being something you could see in next door's hutch...

    Them: But didn't you like the cheetahs? They can run at 70mph

    You: Rabbits

    Them: What about the elephants? They weigh 8 tonnes.

    You: Rabbits

    Them: You must have liked giraffes? They can be 22ft tall.

    You: Rabbits

 

The Immortal Life of Henrietta Lacks ~ Rebecca Skloot

'On October 4th 1951, a young woman from Baltimore died of cancer.
Her death changed medical science for ever.'

Perhaps the first thing I have to do, as someone who works daily with those either battling cancer or caring for those who are, is to issue a health warning. Only you can decide whether you want to read a book that dwells in some part on the virulence of cancer.
Everyone reacts differently to knowledge like this and the first half of The Immortal Life of Henrietta Lacks by science writer Rebecca Skloot may make for grueling reading if you, or someone you love, is fighting cancer.
Or perhaps think carefully if reading a book like this is likely to raise your own anxieties.

In January 1951 Henrietta Lacks was diagnosed with advanced cervical cancer.

A black American woman, born and raised among the tobacco plantations of Virginia, the thirty-one year old wife of David (her first cousin) and mother of their five children, (the eldest born when Henrietta was just fourteen,)  The treatment was surgery followed by local application of a very rudimentary form of radium and before the year was out, fifty-nine years ago today, on October 4th 1951, Henrietta Lacks died.

I will spare the details but again, this makes for very painful reading as does the fate of her children especially little Elsie, sent as a child to a Hospital for the Negro Insane.

During the period of diagnosis and surgery cells were collected from Henrietta's tumour for culture in the lab. Cell growth under laboratory conditions had thus far been a complete failure, no one had been able to replicate the growth of human cells in a test tube, so it was with a resigned air that lab assistant Mary Kubicek set to work when the cells arrived.
Within a week Henrietta's cells had started to multiply with a 'mythological intensity', doubling every twenty four hours, filling as much space as they could be given, growing twenty times faster than Henrietta's normal cells which quickly died, and the 'first immortal human cells' had been discovered.
Hard to imagine that those same cells are still alive today.
HeLa cells (pronounced hee-lah) have been the foundation of a vast amount of medical research and drug development ever since; the 'standard laboratory workhorse' for a wide range of diseases, leukaemia, influenza, haemophilia, Parkinson's disease, the development of the polio vaccine and countless others. Instrumental in advances in in-vitro fertilisation and gene mapping, HeLa cells are still likely to be found in their billions in just about every cell culture laboratory in the world, which makes the story behind the cells even more fascinating and often deeply disturbing.
Not only does this bring ethical issues regarding ownership and consent to the fore, but central to Rebecca Skloot's story are the Lacks family who have lived in near-poverty, and endured years of mental anguish over their misunderstanding surrounding the immortality of the HeLa cells. It is this fascinating human story that has been uncovered with some fairly strenuous and demanding research, much of it conducted with an understandably suspicious, fearful and at times aggressive family. Little had been explained to them about the exact nature of the cell replication thus wild assumptions had been made about cloning and Henrietta still being alive in some form, fears that had led to a great deal of hurt and in some cases serious mental illness as various family members grappled with the impossibility of the science, and all tangled up with ideas of immortality and fundamental religious beliefs.
Alongside this was a sense among family members that they had been duped; the cells were taken from Henrietta without her express knowledge and much seemed to have been done since without the family's permission. Though the now familiar notion of informed consent was unknown in the 1950s, there are some hair-raising episodes concerning breach of confidentiality, and further very dubious research amongst members of the family that was only very 'lightly' explained to them beforehand.
But perhaps even more disturbing than the racism that also emerges, is an issue that has caused the family further devastation. The irony of a situation where they have received no financial benefit from the HeLa cells, and could afford little or no health insurance to cover the cost of any life-saving treatment that Henrietta's cells alone have made possible.
Little wonder they were confused and angry over the duplicity of a system, one that has grown from the benevolent deception of the 1950s into a law declaring the possession of human tissue is not a right once it has left the body, but one that allows a vial of HeLa cells to retail at $167 a time. That's very rough justice indeed and Rebecca Skloots outlines the family's distress in their own words throughout the book which makes this a highly compelling read.
Rebecca Skloot's journey with Deborah, to trace details about Deborah's sister Elsie who had died in the Hospital for the Negro Insane at the age of sixteen, is unbearably moving. None of the younger family members had known she was there and Elsie saw no one again after Henrietta's death, it's hard to imagine what she went through.
The research whilst deep and at times highly scientific is essential to the whole and thankfully largely understandable, I think I only got lost once in the clinical depths of cell division, but that all serves to emphasise the complexities and confusion that this held for Henrietta's family. Once Deborah, Henrietta's daughter, had mastered the detail (and mastered it to a very high level) a calmness seemed to descend for the first time in her life, and when someone finally had the courage to apologise for past wrongs the family were largely at peace with themselves, their history and each other, allowing many restless ghosts to finally be laid to rest.
Reparation can sometimes consist of such a simple action.
That those apologies were finally forthcoming seems thanks in large part to Rebecca Skloots's tireless efforts and courage in pursuing this story so tenaciously in the face of frequent setbacks, and over many years, with both the family and the medical authorities.
So as aforementioned, if you can cope with the early part of the book, The Immortal Life of Henrietta Lacks is indeed a brilliant read and yes, as the blurb suggests, it was impossible for this reader to put down. Finally a fitting tribute exists to the contribution that this poor Southern tobacco farmer, buried in an unmarked grave, (though a memorial has recently been placed in the vicinity) has unwittingly made to the quality of all our lives.
May Henrietta Lacks never be forgotten.

Always the Children ~ Anne Watts

Having trained in paediatric nursing and at a hospital where the motto was Children First and Always, the title of this book was always going to resonate deeply with me.
Then the cover...and this cover has entranced me throughout, though I suspect its traditional image is more about ensuring that Always the Children - A Nurse's Story of Home and War by Anne Watts take its rightful place amongst the plethora of nursing memoirs hitting the shelves at the moment.
The cover perhaps also slightly misleading when you delve into the content because Anne Watts is no traditional nurse following the path of starch and hospital hierarchy, charting instead a very different route for herself and I have thoroughly enjoyed reading about her diverse and fascinating career.
Anne's childhood blighted by a terrible tragedy and ensuing sadness and it was much against her father's wishes that she entered nurse training in October 1958, and for some reason the month is always important in the old nurse training calendar. I have always been part of the Oct 72 set at Gt Ormond Street, Anne doubtless the Oct 58 set at Manchester Royal Infirmary. Nurse training hadn't changed that much twixt her day and mine so I identified with many of Anne's experiences in the School of Nursing and on the wards.
In 1967, and with some experience under her belt, Anne applies and is selected to work for the Save the Children Fund and posted to Qui Nhon in South Vietnam, 360k north of Saigon and a war zone comparable with the very worst the world could offer.
I was immediately interested because the family of one of my student nurse flatmates back in the early 1970s had adopted Vietnamese twin girls, deserted by their mother in a Saigon orphanage in 1969. Setting aside any ethical issues and controversy about the principles of adoption outside a home country, these two little girls (who are now in their forties) were rescued from certain death and raised in a family that loved them dearly and gave them a fantastic start in life. I knew them as very bouncy four year olds who were the delight of the little Yorkshire village they grew up in and yet somehow Vietnamese to their core.
As I read Always the Children I realised I could actually squeak it into this month's Endsleigh Salon theme of Plague and Pestilence. I'd been scouring the shelves for a good disease to catch my attention...Journal of a Plague Year or the History of Polio/ Cholera and nothing seemed to be working its contagion on me; but what bigger source of plague and pestilence if not the scourge, the stupidity and the futility of war and its associated viral spin-offs, genocide, massacre, displacement and the torture of innocent victims to name but a few.
On her travels Anne certainly meets plenty of disease...Malaria, Bubonic Plague (nearly)  Hansen's Disease (formerly known as Leprosy) and in the latter years AIDS, as well as the devastating injuries to be expected in the war zones in which she works. After Vietnam, Cambodia under Pol Pot and the Khmer Rouge and then Lebanon during the Israeli occupation.
There are some incredible photos too, several very moving and one in particular which relates to some school desks made for local Vietnamese children by the US Navy 'SeaBees'.
There's a little girl seated at one, a look of complete concentration on her face as she does a puzzle...you can see the words 'all interlocking' on the box on the desk and it's a beautiful little desk, no botch cowboy job this, and I looked at this little girl's face for ages until eventually I scanned the picture as a whole and my eyes caught the space beneath the desk where two little legs should have been dangling, and they were not.
But as I pondered the plague and pestilence theme in relation to Always the Children, so much more emerged too and often in the most surprising places.
A stint in between overseas placements spent working in an elderly care home in Wandsworth revealed shockingly low levels of care.
For all its wealth Saudi Arabian attitudes to women and their oppression seemed as pestilential and insidious as the worst outbreaks of any disease likely to be found in a war zone. As did the brutality of female circumcision in the Sudan, the results of which Anne witnessed, and over which I most definitely wanted to cry.
It seems like lazy recourse to a series of corny cliches on my part to say that Anne's indomitable spirit shines through the most appalling experiences of man's inhumanity to man, but they do, and all alongside her darker moments of doubt and fear mixed with anger, compassion and grief at what she witnesses. But there's black humour too, always in evidence in most nursing environments and essential when you've been there. So expect some refreshingly light-hearted moments, much laughter, a wonderful encounter with Bob Hope and a few high-risk mischievous adventures too.
And yes, Anne might have thrown up on the floor with fear but I was almost incontinent as she described the footsteps crashing and circling the hut in the middle of the night suspecting it to be...when actually it was... who'd have thought it!
Faced with overwhelming distress and sadness Anne's pragmatism also comes to the fore.
In my own experience you're completely scuppered without this capability in most nursing situations; there may be things happening around you that you detest with a passion, yet you cannot change them and to try, or to lose sleep over it all, is to waste precious emotional energy needed elsewhere and thus risk becoming increasingly ineffective. It's the quick road to burn out. Other things that perhaps you can change a little, and that little may actually become a lot in the bigger scheme and it's that old wisdom adage about knowing the difference.
Always the Children a truly worthy addition to those nursing memoirs currently so popular, Nurse on Call by Edith Cotterill ... Call the Midwife by Jennifer Worth and who knows perhaps one day dovegreyreader's as you all keep urging me to do, though doubtless I'll miss the moment and find the publishing world is sated with them by the time I do. A few of mine own memories are on here, but the big ones, the majority are stored up for a future date (perhaps) because I think there is a right time in a nursing life to share them and mine are still too recent, the people far too local and far too alive and we still live here. I see most of them at the checkout in Morrison's for starters and no matter how deeply I buried the details, some of those really hair-raising moments out in the community are so one-off that everyone would recognise themselves. I'd be in terrible trouble with the NMC over confidentiality and probably be struck off or de-aproned or whatever is done to nurses these days.
If I'm still compus heapus at 70 I'll have another think about it.
Meanwhile I'm delighted for Anne Watts, she has a warm and sensitive voice and has found exactly the right moment for her book, and thank goodness her sister Joan motivated her to write it.

On memory...

It was fascinating on my recent trip to London to see behind the scenes at some of the publishing houses and talk about how I read and how I write dovegreyreader, and interesting to try and explain all my own systems which I tend to take for granted because they just happen. Can I also confirm that I do it, in the inimitable words of a two year old I once met, 'by my own', someone recently had felt sure it had to be a conglomeration of people, no, just me...while Bookhound does the cooking and cleaning and shopping and... and...
But who knows the wealth of differing skills that we all bring to our reading?
I have quite surprised myself in that analysis because whilst talking to people various it became clear that the old working life, the one which I am so relieved to have moved sideways from, has given me many skills, one of which is that ability to read several books at a time and visualise, perhaps even take some mental video footage to keep something in my memory.
I'm sure everyone has their own methods and I'd be interested to know yours, it's basic memory skills after all, and I wouldn't go so far as to say I have a photographic memory because if I have I'd like to know where to buy new films, but a skill I had to learn in health visiting seems to be standing me in good stead with reading.
If I did four home visits in a morning I would have to settle down after those and write up the records, and I think you can see the potential for chaos if there was no method for separating out each visit and the vast amount of information that each one generated. Unwittingly I perfected the art of mental video and replay/rewind technology and storage of information that could be retrieved at will.
Of course it all comes to the fore when you are called to give evidence in court which hopefully won't happen as result of reading a book or writing a blog, but frequently happens as the result of being a health visitor. A subpoena to appear in court was definitely capable of spoiling my day and the weeks and months that followed until you got there.
My most memorable appearance was, as they always are, born of sad circumstances and a case of child abuse that I won't detail beyond an early indication of problems ahead when I had been the first to spot large and livid bruising on the leg of a nine month-old baby.
It's not a good moment let me tell you because the real 'inner you' feels momentarily sick to the core before it allows the 'professional you' to take over, but what I did next proved to be crucial when the case eventually came to court two years later.
I turned to the parents, pointed out the bruising and asked very simply how it had happened.
I knew them well, they had both had a poor experience of being parented themselves and were struggling with basic childcare but we had a good rapport, they were both very open about the difficulties and there was a lot of support in place.
As I turned around they were both looking at the floor.
Neither of them could make their usual eye contact with me and as they spoke to the floor offering an explanation my every instinct told me in an instant that it was untrue and this baby was at risk.
Unfortunately the paediatrician accepted their explanation later that day, and a great deal more happened with that family before  the case went to court, but it was that single moment of memory amongst others about which I was questioned most intensely and by five different barristers.
Each time I replayed the footage in my memory of that moment and I was able to answer and share those misgivings and eventually, as the case progressed over the next few days, the awful truth emerged. I had been very right to be worried on that day two years previously.
Sorry that's all taken us off the reading track but the book I had picked up to try and recapture the mood it left me with, to reframe again a week or more, a trip to London and two theatre trips since I had finished it, was My Father's Places by Aeronwy Thomas . A book itself about memory, who knows what video-footage Aeronwy Thomas had re-played as she wrote of her childhood, but her account would need to offer me clear pictures if I was going to do it justice as I wrote about it here.
I opened it and read a bit to remind myself...

'After a few days, gradually my parents began to speak to each other again in cold, subdued tones, the atmosphere chilly like the deteriorating weather. Autumn was on its way. Now my parents quarrel had filtered down to me and I felt the lack of warmth,
    'The trouble is you look  so much like your father, ' Mother said when I asked of an explanation.'The harder I pull your curls the better I feel.'

I think that gave me enough to be getting on with, but I'd love to know what eases a book into your memory...

Legend of a Suicide by David Vann

Legend of a Suicide by David Vann arrived from Penguin with plaudits months ago and I shelved it but I knew I would have to read it.
David Vann admits in his acknowledgments that he was writing about an uncomfortable topic, his father's suicide during his own childhood and confiding that

'there's exposure in these stories. They're fictional but based on a lot that's true.'

To my mind that's a high risk personal strategy involving courage and emotional maturity, a confidence in your own ability to be able to take it all out and look at it again, probably recall some of the most traumatic events in your life, because the suicide of a close relative forces those left behind to traverse a lifelong territory they had no intention of crossing.
That journey can be a minefield and, whilst reading Legend of a Suicide as fiction, I inevitably spent a great deal of time wondering where those mines had been laid for David Vann. If something like this happens in childhood the problem is compounded, that loss has to be re-experienced again and again through each stage into adulthood and beyond, each time it surfaces it may be as raw and excruciating as it the day it happened, so I don't underestimate the difficulties David Vann may have encountered.
Phyllis Silverman has written one of the best books I have come across on the subject of bereaved children, those young but 'fully-fledged mourners', A Parent's Guide to Raising Grieving Children. I refer to it constantly in my day to day work and she talks of her book as a 'road map for a long journey'. I know the 'journey' word is becoming a bit of a cliche these days (from X Factor to Strictly via I'm a Celeb) but in the context of mourning I cannot think of a better one, and David Vann's book feels like an integral part of his own journey and that need to make sense of what had happened, perhaps to understand.
Whilst it may be stating the obvious to issue a health warning I'd be negligent not to, Legend of a Suicide may inevitably make for traumatic reading if you have any experience of such a tragedy and
brace yourself for a massive shock about half way through too, quite a devastatingly bizarre and unexpected twist that threw me off course completely. I was settling in and expecting one story when quite suddenly it was as if I'd been turfed out of a slightly uncomfortable hammock, but one I was just about managing to keep balanced and on an even keel.
I metaphorically spent the rest of the book lying on a hard cushionless floor.
The title seemed to be offering me first clues with the various interpretations of that word 'legend', both as an event acquiring mythical status, but also in twenty-first century speak as a hero.
Roy and his father Jim are both legend and hero to each other, but that realisation comes in various ways and at differing times in the book as perceptions are shattered and reshaped constantly between them. Legend of a Suicide consists of five novellas of varying length and narrative perspective and to approach it as a novel makes for interesting reading because it becomes almost impossible to get a sense of reading continuity between them. Each one positions reader and characters slightly differently and perhaps that is the point, the disjointed, jarring moments that don't quite seem to fit and are quite unsettling, once I'd been turned out of that hammock my confusion perhaps mirrored that of the characters in the book.
I haven't told you much about the plot and I don't really want to focus on that for fear of giving anything away but it is Sukkwan Island the backwoods Alaskan survival experience shared by Jim and a thirteen-year old Roy that forms the backbone of the book. Roy becomes father to the man, disturbed by, yet sensitive and perceptive to the needs of his father, whilst Jim is completely unable to 'send his life into another's' and understand his son.
I suspect that like me you will tell no one the details of that shock moment if you read the book.
We have to keep the faith about it as we have kept it over Kevin in Lionel Shriver's book. If someone tries to tell you before you read this, just block your ears and la-la your way through it.
Carol Staudacher in another really excellent book, Beyond Grief, suggests,

' It is vital to understand that suicide is not solely the result of some sudden-bizarre impulse; nor is it one single act which can be isolated and analyzed without examining the whole life context in which it occurred.'

And to some extent that is what David Vann has explored in Legend of a Suicide.
I rarely read what the review pages have to say while I'm reading a book, a bit like I won't ask for directions if I'm lost, I just have to figure these things out for myself and it may take me some time, but once I'd drafted out my thoughts I did have a skate around and this book is getting some really good and well-deserved coverage,
I just can't better Tom Bissell's splendid observation in the New York Times Review so I have to share it here

'The central event of "Sukkwan Island," shocking for several reasons, appears to take place in a parallel universe. The Roy and the father of the other stories cannot be the Roy and the father of this story. Vann does not choose to explain this, and he should not have to. But it is strange, like encountering Borges, in waders, within "A River Runs Through It." 

and I was quite relieved to see that Observer reviewer Alexander Linklater and I are of like mind

'Then there is the third thing you need to know which is, rather, something you must not know. As this book reimagines its central death, an event occurs that utterly transforms the encounter between protagonist, father, author and reader. Do not let anyone tell you what this event is before you start. To know what happens in advance would be to spoil not just a narrative surprise in a heart-thumping tale, but the entire apparatus Vann has constructed to wrench out the dreadful and meaningless facts of existence, to master them, and, in a violent act of fictional transmogrification, to reconfigure them as something not less, but more real.'

It wasn't just me that fell out of my hammock and took a vow of silence then.
So I hope I've given you the essence, an emotionally charged and challenging book but one that is echoing and reverberating in mind still, moments when I really thought I might suffocate as I read, but having fought my way to the surface and the final page, a book I am actually glad to have read.
Now it has me searching my shelves for more father and son books and I seem to have a dearth beyond Turgenev's Fathers and Sons and Joseph Roth's Zipper and His Father, so all suggestions welcome.
Meanwhile, if you decide to read Legend of a Suicide I'd love to know your thoughts.

The Yellow Wallpaper by Charlotte Perkins Gilman

The arrival of a new edition of The Yellow Wallpaper and Selected Writings by Charlotte Perkins Gilman before Christmas had me eager to read that familiar story once more and plenty more of interest in this volume too.
I lose count of the number of times I have read The Yellow Wallpaper but every time the effect is the same, it's magnificent, it's utterly tragic and I am left inwardly crying with rage.
For those who may not have read it, and if you haven't it's very short, twenty pages is all it takes to get you to boiling point. The nameless young wife accompanied by her doctor husband John, arrives at a house in the country  for some rest and recuperation from what is clearly a case of post-natal depression and minus the baby who is being cared for elsewhere,
This time round I thought I'd try and read with a difference, suppress the rage and look at the actual condition of Wife of John because post-natal depression is in the news again this week
Nowadays the NICE guidelines require that all women are asked specific questions post-natally in the hope of identifying post-natal depression and  we'd then usually ask anyone who expressed an inkling to complete the Edinburgh Post - Natal Depression scale.
The EPDS is one of those helpful tools made available which, as well as offering a means of quantifiable assessment, also enabled professionals to bring the whole subject of post-natal depression out into the open, permission to express feelings without fear of being judged to have somehow failed at motherhood. Ten questions, three possible answers to each and a maximum score of three for each question, a score higher than thirteen indicating depression and the higher the score out of thirty the more profound that depression.
It has had its critics and needs to be used with care.
There's no point in offering the EPDS without support systems in place to take referrals...a score of 30/30 and you need to move very fast, scores in the twenties and you need to be ensuring adequate services are available as necessary. If you are asking staff to provide regular counselling support then you must provide supervision for them and so it goes on.
Years ago we never really knew what to say or how best to treat post-natal depression and many women suffered in silence thinking they were alone. Today we should be identifying and talking about it openly and honestly and with appropriate follow-up assessment and carefully managed treatment, outcomes are very good. To have a measurable means of initial assessment is invaluable as a starting point and I have used it effectively in the workplace for many years.
I wondered if it was possible to score Wife of John on the EPDS.
If you can bear to do it try reading The Yellow Wallpaper as I did with a copy of the EPDS questions and answers alongside and see for yourself how Wife of John scores even in those first few pages of the story.
I've read the story through very very slowly at least six times now and have been very careful not to take quotes out of context to try and make them fit the questions. It's still a textbook case, Charlotte Perkins Gilman unwittingly answers all the questions and even amid the confusion of John's controlling influence over his wife's thinking it's still possible to pick out the evidence,

1. I have been able to laugh and see the funny side of things
"It does weigh on me so not to do my duty in any way!"

2. I have looked forward with enjoyment to things
" We have been here two weeks, and I haven't felt like writing before, since that first day."

3. I have blamed myself unnecessarily when things went wrong
" I meant to be such a help to John, such a real rest and comfort, and here I am a comparitive burden already"

4.I have been anxious or worried for no good reason
" You see he does not believe I am sick!
And what can one do?"

5. I have felt scared or panicky for no very good reason
"I get unreasonably angry with John sometimes. I'm sure I never used to be so sensitive. I think it is due to this nervous condition"

6. Things have been getting on top of me
"I don't feel as if it was worth my while to turn my hand over for anything, and I am getting dreadfully fretful and querulous"

7.I have been so unhappy, I have had difficulty sleeping
"He thought I was asleep first but I wasn't, and I lay there for hours"

8. I have felt sad and miserable
"These nervous troubles are dreadfully depressing"

9. I have been so unhappy that I have been crying
"I cry at nothing and cry most of the time"

10. The thought of harming myself has occurred to me
"I am getting angry enough to do something desperate. To jump out of the window would be admirable exercise, but the bars are too strong even to try."

Separated from her baby and effectively imprisoned by the constraints of the ghastly rest cure, in the end  Wife of John's condition can only get worse, it's that old battle with the wallpaper because that's all there is to look at. Lonely and isolated from virtually all human contact in an attic room as she yearns for the pretty little chintzy room downstairs, the inconsolable madness is inevitable and utterly tragic to read.
I suspect Wife of John moves from an initial score of 23/30 towards 30/30 in the space of about six pages.
This new reading of The Yellow Wallpaper did however have one interesting outcome.
Feminist readings condition a harsh response to John but I think I have managed to read him slightly differently, not a lot but I've given a bit of ground this time round. Whilst acknowledging that his treatment of his wife undoubtedly made her far worse and many's the time I have wished much evil to befall him, we do only have Wife of John's side to the story...reliable narrator?
Unreliable narrator?
Reliable unreliable narrator?
Whilst the Woman in the Attic has been given a voice how can we possibly interpret that voice accurately?
Wife of John is very unwell, eventually psychotic, at which point I did have to acknowledge that for husbands and partners the whole post-natal depression scenario can be very frightening and very difficult to handle.
But in the end it was only a partial attack of sympathy, my rage over The Yellow Wallpaper still burns strong especially given the very personal context within which Charlotte Perkins Gilman wrote it.
To make comparisons with how we aim to handle post-natal depression these days, a non-stigmatised non-judgemental approach, with compassion, empathy, reassurance, drug treatments as necessary, listening and supportive therapies, a containment of anxiety and above all else keeping and building that essential bond between mother and baby, whatever it takes, and  The Yellow Wallpaper then becomes a book that you realise must never be allowed to go out of print.
Just in case we ever need reminding, heaven forbid but just in case.
(If reading this has raised any issues surrounding post-natal depression or you want any further information start here)

Deadly Companions : How Microbes Shaped Our History by Dorothy Crawford and a prize draw.

Now where were we?
Ah yes, rats (three fleas on the average black rat) and bubonic plague so perhaps first I'd better issue a health warning.
If you happen to be one of those people ( and there is no shame in this, there are many of you) who read about a disease over breakfast, by lunchtime are convinced that you have it and by dinner you can't face food because it's obvious you won't live much longer, then this might not be the best book for you.
Even if a bout of bubonic plague is seeming most unlikely, no Xenopsylla cheopsis (rat flea) to your certain knowledge has regurgitated its stomach contents containing 25,000 bacteria into your bloodstream, and you have no excruciatingly painful buboes ready to rupture (hope you're not eating porridge) that you are aware of, really no amount of reassurance from Dorothy Crawford or I is going to help if you are that way inclined, just don't read Deadly Companions, How Microbes Shaped Our History.
Meanwhile the rest of us can just plunge headlong into this fascinating cauldron of disease and putrefaction and emerge so well-informed that you'll wonder how you've managed this long without knowing it all.
If it crawls, flies, wriggles, squirms or just plain magics itself through the air the whole disease trail is mapped out down the ages, and though I'll admit I got slightly bogged down in the early epidemiology sections( but plenty of you will eat all that up easily) I soldiered on because I knew there would be glorious treats in store and I wasn't disappointed as you can tell already.
I am now a bulging buboe of  disease information, stick a needle in me and I could give you the lot.
In those days when I worked (now seeming like many light years ago) I had within reach of my right hand something called The Spotty Book. This was a real face-saver, a sort of vade mecum to cope with the myriad phone calls I would get about florid rashes and incubation times and can you get shingles from someone with chickenpox (no) and might this be scabies(possibly) and waaaaaahhhhhh we've found head lice. I might have sounded like I was reeling it off out of my head but in fact I would be frantically rummaging for the disease in my Spotty Book for fear of muddling my Parvovirus B 19 with my Coxsackie or my Impetigo with my Erysipelas.
Dorothy Crawford moves in a much bigger world than rural Devon and chapters like Microbes Go Global, explaining as it did quite what happened when crowd disease microbes hit the Americas, made for a succession of 'did you know' moments.
Did you know for example that most microbes jumped from domestic animals to humans but the Americans were such efficient hunter-gatherers that very few animals remained to be domesticated, just the odd turkey, couple of guinea pigs, few llamas, one or two alpacas, none of which transmit too much of note.They were reasonably disease free until the Europeans arrived and shared so generously causing a 90% decrease in Native American population over the next 120 years.
That's staggering because there had been 100 million of them to start with.
The background to the history of disease transmission should by rights be quite deadly boring but not in the hands of Dorothy Crawford with this informative quote from 1547,

' The cause of these impediments or infyrmytes doth come many ways, it maye come by lyenge in the sheets or bedded there where a pocky person hath the night before lyenin, it maye come with lyenge with a pocky person, it may come by syttenge on a draught or sege where as a pocky person did lately syt, it may come by drynkynge oft with a pocky person, but specially it is taken when one pocky person doth synne in lechery the one with another.'

Don't say you haven't been warned.
Our anaesthetist friend John Snow gets a mention for tracing the 1854 London cholera outbreak to the Broad Street pump which is probably a good time to mention that a prize copy of both Deadly Companions by Dorothy H. Crawford and Blessed Days of Anaesthesia by Stephanie J.Snow up for grabs today from Oxford University Press. Names on the operating list in comments and we'll lance the boil choose the two winners once it's come to a head eventually.

Blessed Days of Anaesthesia: How Anaesthetics Changed the World by Stephanie J. Snow

Funny how now that I no longer work in a GP's surgery all things medical and bookish, whether it be in the news or on my shelves are holding a fascinating appeal. I hope that's not my sub-conscious clinging onto a previous life for fear of letting it go, it would have to be my sub-conscious because the rest of me is fair bursting with joy and happiness at all this t----i-----m----e which stretches out each day and which like most people I have no trouble filling.
Perhaps it's just good to read something I know a little bit about, and in the case of anaesthetics it really is a very little bit, but Stephanie Snow's book, Blessed Days of Anaesthesia : How Anaesthetics Changed the World published by Oxford University Press, would be of interest and entirely readable even if you knew absolutely zilch.
However you do know that any book about the history of anaesthesia and early surgery is duty-bound, somewhere between the front cover and the end, to detail the terrible account of Fanny Burney's anaesthetic-less mastectomy and to Stephanie Snow's credit she sorts all that on the first page.
For me this was a wise move because if I know it's coming in a book I start to feel sick with apprehension.
Just need to get it over with.
So I was fine once past page three and then deeply interested to find out exactly how nitrous oxide was discovered and had no idea that we have Sir Humphrey Davy to thank for that. Early in the book and throughout it becomes clear that most gaseous investigators experimented on themselves and their close friends, so dinner at Humphrey's was always quite a laugh and there was probably a queue at the door. Davy himself 

' utterly absorbed by nitrous oxide..just seeing the bag caused Davy to desire the gas'

so I assumed a level of addiction must have been the price he paid for his discovery.
But it was the work of a Soho general practitioner John Snow (Stephanie is married to his great great great nephew) in the mid 1800s which really advanced the whole idea of painless surgical intervention and also unleashed a huge moral dilemma over the whole issue of pain and the unconscious state which all seems impossible to even entertain these days.
Pain had always been considered an essential facet of life, whether character building, spiritually improving or otherwise so there were challenges a-plenty but there is no doubt that advances were assisted by endorsements from Queen Victoria. She who famously utilised pain relief in the shape of chloroform administered by John Snow whilst she was in labour. Patrick Bronte was another early convert to anaesthesia for his cataract surgery and Charlotte even considered having her front teeth 'extracted and rearranged' if there was ether involved.
It is against this Victorian social backdrop that Stephanie Snow locates the development of anaesthetics as a bona fide medical entity. The pages turned rapidly in this book because it's all fascinating and whilst I may wince at Fanny Burney's dilemma I couldn't help but smile at John Hoare's.
Unsuccessful surgical intervention without anaesthetic in the search for a fistula in his nether regions (and I won't recount, it would make your eyes water) was borne heroically and just left John complaining lightly of 'smarting in the parts' (that is 'parts' not 'pants' but it was probably both).
Clearly pain thresholds were an issue as much then as now.
But the discovery of pain relief caused a seismic and far-reaching shift in social attitudes and created religious schisms of mammoth proportions,

'The new generation of Victorians who knew anaesthesia to be a routine blessing of modern society could no longer stomach physical suffering in any form'

The change in society's attitudes was noted by William James to be 'a strange moral transformation' and there is much to explore in the light of this new approach to pain which had never really struck me quite so forcefully before. Palliative care will follow as a natural progression, by 1868 public hanging and thereby a public infliction of pain will become unacceptable while prevention of cruelty to animals will come to the forefront of the political agenda.
Stephanie Snow steers her impeccable research through into the 20th century, pursuing the growth and establishment of anaesthetics as a regulated medical discipline and yet the research seems to sit lightly and readably on the whole and we love that here. I emerged from this engrossing book a good deal wiser and clutching an excitingly new and informed foundation with which to read around the nineteenth century.
It's also a book full of those useful 'did you know' epithets.
Did you know that Fanny Longfellow, wife of poet Henry, was the first mother to use ether in childbirth in the USA?
Anyway, now that I've really got the medical history bit between my teeth I've moved onto Deadly Companions How Microbes Shaped Our History by Dorothy Crawford, so brace for an in-depth look at bubonic plague which I know you'll enjoy over breakfast, and just wait until you hear how many fleas (Xenopsylla cheopis) there are on the average black rat (Rattus rattus as opposed to Rattus norvegicus)...go on guess.

Don't miss this...

...in today's Spectator

Just wanted to say that...

You'll be pleased to know that I have no intention of becoming a regular commentator on news items on here but today I just can't stop myself.
If ever I sought vindication for making this soul searching decision it is this and there but for the grace of God etc.
Single-handedly managing a sprawling rural caseload of 350 children under the age of 5 on just 3 days a week (many health visitors have far greater numbers) it felt like it was only a matter of time before I missed something or made a wrong decision that would haunt me for the rest of my life.
I got out and have taken my 30 years of health visiting experience and expertise with me and probably a good 5 years sooner than I needed to and the relief here is palpable.
I don't know the details of Baby P's case but my heart goes out to the health visitor involved. Who can know what was expected of her in an average day?
Well I can guess.
I had an interesting discussion with one of the GPs I worked with before I left about the current state of  the health visiting profession and we agreed several things

• there would be a big incident
• there would be a big outcry
• there would be a big investigation
• heads would roll
• someone might just spot what has really happened to the health visiting service in this country
• health visiting would have to be resurrected somehow because this country absolutely needs it doing what it's best at

Given that this conversation was only two weeks ago today and we reckoned this might happen within the next ten years, it all feels scarily prophetic.

Friday's Child by Ben Palmer - update

Oh no...the new typepad composing page has finally reached dovegreyreader scribbles, I wondered when that would happen. I know it had a few teething troubles and this is not the post to lark about with it so perhaps I'll just opt for a short post to trial the font and the colour, not helped by being clueless about which ones I've been using for the last two and a half years so apologies while I tweak.
You may remember back in the summer (yes those few days of it) when I was doing all the pre-Dartington reading in the run up to the Ways With Words festival that I had quite a big moment of reading synchronicity. I read Rebecca Abrams' book  Touching Distance, a fictional account of the discovery of the causes of childbed fever in the late 1700s and as I turned the final page and quite by coincidence there was an article in the Guardian about a book by Ben Palmer called Friday's Child.
Ben's wife Jessica died of childbed fever following the birth of their daughter Emily in 2004.
The book remains one of the most moving that I have read all year.
Ben recently spoke about his experiences at the The Sixth National Conference on Current Issues in Midwifery organised by the British Journal of Midwifery. I asked if he would put his talk up on the Jessica's Trust website because I'd heard it had a huge impact and he has very kindly done just that. You can read it here and also more about Ben's amazingly diligent and heartfelt yet entirely practical campaign to raise awareness about a condition we thought we'd cracked with the advent of antibiotics, but clearly hadn't.
It's the saddest of tragedies but I think Ben's talk makes for important reading and how brave of him to stand and do it.

Small Stones - Fiona Robyn

I wanted to follow yesterday's post with something useful for anyone who may have been affected in any way by the difficult subject matter. There's no substitute for professional help of course but sometimes along comes a book that can be safely added in to the mix.
I haven't rushed to share my thoughts on Fiona Robyn's book small stones : a year of moments because rushing is exactly what Fiona discourages. I wanted to give the book time, to use it in the way that I think Fiona intends.
I also think I know what Fiona intends because her first book A Year of Questions sets it all out very clearly.
A book about slowing down and seeing.
I'll be honest and own up to a minor aversion to self-help therapy books. They really are not me and that's not because I am arrogant enough to think I don't need them but much more about the sort of person I am. However sometimes along comes a book that really impresses.
A Year of Questions is thankfully a different sort of self-help book because it's one that talks good basic common sense. There are some beautiful quotes too, this one from Pema Chodron really appealed,

'A further sign of health is that we don't become undone by fear and trembling, but we take it as a message that it's time to stop struggling and look directly at what's threatening us.'

What better way to think about facing up to the demons?
Everyone needs to develop their own strategies and Fiona has plenty of suggestions. I  know that for me the most effective way to harness the bit of me that is easily buried is to tap into my creativity, start eyeing the fabrics, browse the quilt design books, check out the wool situation (always healthy here) set up the swift for some skein winding and cast on some socks.
One thing writing this blog and sharing a small piece of the world I live in has taught me is that it remains possible on a daily basis to reflect on the familiar through new eyes and see it all in a new and vibrant light. Just walking down the lane with my camera month by month has been a revelation of observation, seeing things I would usually pass by or, even worse, drive over and squash.
small stones a year of moments is something very similar.
Almost haiku-like in their brevity and often with an open-endedness that leaves the thought ebbing and flowing around your mind through the day, brief daily observations of the ordinary things in life, one for every day, and quite soon you will start noticing small stones of your own. It might not be meant but there's space enough in the book to write them down too.
The book has sat propped on my desk and I have turned to it most days, it focuses you on the minutiae of life and hasn't disappointed me once because I have quickly learnt to appreciate that the simplest things can harbour so much meaning.
We dismiss them too readily but the next time you overhear a conversation think small stone and see what happens,

'The lady is so pleased to be asked how she is by the cashier (someone, anyone) that she tells her about her husband in the hospital, who has Alzheimer's. It is a kind of bereavement, but not.'

or spot something as you are driving,

'dog daisies on the roundabout: standing room only'

or how often does this happen?

'A muscle underneath the lower lashes of my right eye has mutinied. It vibrates in the mirror: the wings of a bird trapped in the corner of a room.'

Suddenly the notebook becomes essential and wordsmithing within everyone's capabilities. Fiona will welcome your small stones to a new blog starting here in September and Snowbooks will be publishing her three novels in 2009.
A great discovery.

Feather Man by Rhyll McMaster

'But I couldn't get past the first chapter,' I whined.
'Persevere, it's really worth it' publisher Marion Boyars replied.
'Do I have to?'
'Maureen Freely liked it...Catherine O'Flynn loved it'
So never let it be said I chicken out on a challenge and that first chapter about suspect neighbours chopping the heads off er...chickens and doing very unpleasant things to small children.
But it's only fiction, right?
I sat down gritted my teeth, read the first chapter again through half-closed eyes and proceeded to rejoice as I read on, indeed Marion Boyars was quite right. So right that I (wrongly) added Feather Man to my list of Booker predictions.
Can anyone confirm, are there any pure fictional children's voices on the longlist this year?
The setting is Brisbane, Australia, Sookie is the child in question and there is no denying the abuse is terrible but what follows is the story of a young girl who has to piece her life back together, rebuilding it on wobbly, virtually non-existent emotional foundations as she tries to work out the rules of the game where men are concerned.
Rhyll McMaster has created a memorable character in Sookie but also somehow maintained an emotional distance which feels like reader safety. First person narrative defines thought processes with pinpoint accuracy, not only Sookie as a child but as teenager and young woman too. The burden of her past translates into difficulties all along the way and as readers we can always step back and see why; sadly Sookie can't, and we look on helplessly as she falls into every single knowable trap that a childhood of abuse may leave set and ready to snare.
The fragility, the insecurities, the low self-esteem, the self-loathing and the unwitting submission to power and control wherever it may come from.
Feather Man is a simultaneous dissection of Sookie's life and a reconstruction for the reader of just how totally abuse disempowers at every turn, and alongside it a feature anyone who works with survivors of abuse will recognise; the inability to change those deeply ingrained patterns as successive relationships frustratingly seem to follow the same disastrous trajectory.

' I wish to find the mate for my soul. I will settle for someone with a bigger problem than I have. I am ripe for a tormented rebel or a drug-addicted recalcitrant...Anyone practical or easygoing, uncomplicated or friendly does not interest me. Gloom, ambivalence, the unresolved : that's what I want.'

Pattern-Changing Courses run by Women's Aid are now a valuable resource for reversing this trend here in Devon. Overcoming the fear of facing up to the realities, engaging in the hard emotional work involved and then emerging with new insights and radiating renewed confidence and assurance, women are experiencing life-changing possibilities. Sookie instigates a pattern-changing of her own and you keep your fingers crossed for her every single step of the way as bit by bit she strives to claim back her soul.
Does she manage it?
Well Rhyll McMaster will keep you guessing until the very last line and even then leave you wondering. But you will also be left with a deep sense of understanding.
Yet Feather Man never pitches into a depressing read and that's important because I hate reading books about abuse, I really do, probably because I listen to a great deal of it by day, but then I may be mixing up those autobiographical misery memoirs with the fiction, so I'm grateful to Hilary Mantel for shedding some light in The Guardian this weekend,

'A novelist spends a lifetime in the business of presenting what's life-like, but not like life. It's a sobering thought - life won't actually do. Verisimilitude and the truth are conjoined twins, one often flourishing at the expense of the other.'

Yes it is a subtle point worth remembering, and I may have whipped it right out of Hilary's writerly context to fit my own as a reader, but this is fiction, 'a process of falsification' and Rhyll McMaster has performed that great sleight of pen, 'the conjuring trick' as Hilary Mantel calls it, the one that allowed me to read Feather Man in a state of trusting belief in the fictional reality whilst emerging unscathed and a good deal wiser from this fine novel.
So now I'm rewarding your tenacity for reading this far and offering that spare copy in a prize draw.
Names in comments and we'll post worldwide as always.

The Squire by Enid Bagnold

So I'm going to join the Whingers' Bagnold Revival and apart from National Velvet this is the only other book I have, The Squire, published in 1938 and I had  immediately been drawn to Dame Margaret Drabble's suggestion,

'Imagine To the Lighthouse written by Mrs Ramsay expecting her fifth child and you get something of the spirit of this intense and passionate novel.'

It is certainly one of the most deeply moving books I've read on the subject of pregnancy, birth and motherhood, almost existential in its thinking as a woman known as the 'squire', prepares for the birth of her fifth child whilst her husband is away on business. The house also has the luxury of staff,

'Ah this old feudal nonsense in a toppling world,'

and as the midwife arrives, she and the squire are able to escape into a mutual world of time-honoured ritual and tradition as the labour progresses and the baby is born.
I'm not sure why I might assume that perceptions surrounding childbirth and motherhood should be any less insightful in 1938 than they are in 2008, but I would be profoundly misguided if I did.
The role of the midwife as curator of the mother and baby, lionishly protective, fierce and involved but equally able to walk away when her job is done, is uniquely described by Enid Bagnold, and I fancy we could learn much from the way that this allowed the mother-baby attachment to develop. Given protected time and space away from her older children, the squire wallows in the languid, soporific stress-free post-natal environment created by the midwife and meditates on life, love, children, ageing and so much more as she feeds and gets to know her newborn. This is about utilising that special and unrepeatable period of time to the full, nature facilitates this but the environment needs to be quiet and still enough for it to be heard.
The lying-in period as was, has all but been swallowed up in early hospital discharge and off to the supermarket shopping on Day Three, and we have high expectations of a baby's ability to withstand the bright lights and the hustle and bustle after so long as a snugly well-wrapped and insulated little traveller.
Enid Bagnold's midwife knows this too,

'I should say that as your baby is now so he will be in old age, that the perfection of his introduction to life will reassert itself again and again in all his crises.'

Here's me with my mum, September 1953, I'm a day old, yes, yes I know and beautiful too, so blessed. But I'll bet we stayed put here for weeks. No wonder I now take to my armchair when it all gets too much.

The midwife has a dream ,

'Some day, ' said the squire, 'you will be helped to your dream. A convent-clinic, where nuns abet the mothers. And birth is worshipped. What a mother-superior you would make.! ...
'How seldom I can care for a mother and her baby in the peace I want for my work, away from the household and its surroundings! My clinic would be a palisaded place, far in the country.'

Enid Bagnold knew what she was talking about. Old style Maternity Homes have all but disappeared from the face of the earth in the UK, designated an unaffordable luxury service but I'm grateful to have benefited from ours x 3 and for ten days each time. I know it all set me up to succeed, after ten days I was raring to get home and get on, after three I was most certainly not.
Enid Bagnold's midwife, childless herself, is a strange, single-minded, ethereally goddess-like being; almost other-worldly with a touch of the wise but stern Fairy Godmother about her,

'I have seen so many bad mothers, poor indifferent mothers.Yet often the babies do well with them...There is something between the mother and the baby.Not only love, not only milk. Some sort of closeness. A baby, when it has been so close to her, needs to be close again after it is born.'

And here's a very modern concern, I'm almost comforted to know it was a problem then too,

'The book of instinct has long, long been closed, ' said the midwife
'But what do we get instead?' said the squire. ' The science-guided baby! Labelled, its tears and stools in bottles, its measurements on a chart, its food weighed like a prescription!'

So much more I could write about this book, it has been a read which has made me consider deeply at every level, both personal and professional, and hopefully that's enough to encourage you in the direction of The Squire if you feel so inclined. If you then find you are in the mood for more childbirth reading don't miss Winter's Child by Dea Trier Morch, and excellent to see one of my favourites, Call the Midwife by Jennifer Worth, (where the midwives are actually nuns) up there amongst the best-sellers at the moment.

Friday's Child by Ben Palmer

It was inevitable that I would have to read  Friday's Child by Ben Palmer after my post about Touching Distance by Rebecca Abrams last week. It had all been one of those strangely-meant serendipitous connections as I read in the Guardian about the tragic death of Ben's wife Jessica from puerperal sepsis just six days after giving birth to baby Emily, at the same time as I was reading Rebecca Abrams fictional account of the 1790's epidemic of Childbed Fever.
I knew this would be a tough emotional read and I suspect, like many people, I studiously avoid books like this because I don't want to be upset, but also because I work for the organisation that was culpable. As an employee it gives books like this a There But For the Grace of God factor and wouldn't it be nice to just bury my head in the sand?
Be warned this book will make you cry (seem to have had a few of those lately) and even tough-as-old-boots me spent half the book reading through eyes blurred with tears. The book leapt clean across all of my carefully placed professional boundaries and right into my heart.
The impact cannot be overstated and I think it's all down to the way Ben has written Friday's Child. It's searingly honest and he writes in an amenable, down to earth style and intersperses e mails throughout which give the book an intimate personal quality. There is ample opportunity to get to know Jessica well too, she had a vibrant and bubbly personality, loved motherhood and she and Ben made a great team. This all makes the reality even more shocking and palpable, that in this day and age of knowledge and advanced medical science Jessica died of an entirely treatable infection.
But as her death proves, time and observation is of the essence.
The window of opportunity for effective treatment between diagnosis and complete organ shutdown in puerperal sepsis is frighteningly narrow, it's one of the reasons midwives used to visit twice a day for ten days and do old fashioned things like check pulse and temperature. In Jessica's case had she received treatment just eight hours sooner her chances of survival would have been far greater.
But Friday's Child feels like a book that should be read by all health professionals and not just those of us involved with childbirth.You can't be a registered health professional of any description without carrying some burden of responsibility for assessment and decision-making and thereby accountability. A book like this is a stringent reminder that there is no room for complacency or short cuts, even given fewer staff and increasing workloads, you can't afford to take your eye off the ball for a second. This involves being at the top of your game every single working day, nothing less will do and most certainly not second best.
I think I'd like health service managers to read this book too.
The people who in times of financial constraint have to juggle budgets and yes, I know they all tell us it's difficult and we don't understand how difficult, but in my experience we do understand all too clearly. It is staffing levels and staff training and updating that are the first casualties when budget deficits are on the agenda and more often than not the buck stops with the person with the NMC registration. Plenty of you will know that there's nothing quite like that to really define and focus your thinking and coincidentally I've just written the £76 cheque for mine this weekend for the coming year. After reading this book my hand didn't feel quite so light as I wrote.
I wasn't entirely sure whether there was a manager standing shoulder to shoulder alongside (alongside, not behind) Jessica's named midwife who I think very bravely and honourably took responsibility for her mistakes in court, but if not there should have been.
This must have happened on someone's watch and they are equally accountable.
There were a disastrous chain of errors and lapses in communication but amongst them all it will not have been the community midwife's preference to have had to prioritise the workload as she was forced to on that fateful day. Many lives have been changed tragically and irrevocably as a result of Jessica's death and hers will be one of them.
The legal battle that ensued makes for very uncomfortable reading indeed. Ben delineates his struggles with a transparent honesty and openess as he copes with life as a single parent to Harry and Emily. Whilst Emily is a developing little person Harry knows a great deal more and some of his 3 year old out-of-the-mouths-of-babes observations will have you biting your lip and fighting back the tears.
Ben's resources are tested to the very limits of human endurance as the grief and anger rage and he descends into depression and alcoholism and then, depleted and exhausted, has to take on the mighty and seemingly heartless behemoth that is the NHS. I was overwhelmingly relieved to see the name Havers in Family Palmer's excellent legal team.
I emerged from this book and encountered an unexpected whirlpool, a swirling mass of disturbing and uncomfortable emotions. Firstly because few books make me really cry, to the point where my voice falters if I talk about them, but also because I of all people could see this tragic situation from both sides, but what happened was indefensible and by admitting liability the NHS clearly agreed.
So why read a book that's likely to have such a profound impact?
Isn't life upsetting enough sometimes without adding to the grief ?
Well that's a decision you will have to make for yourselves. I am so glad that I've read it, I was deeply moved and humbled by Ben's experiences and as a health professional it makes you consider some very unpalatable evidence.
Clearly the time has come to admit that we can no longer afford to be complacent about puerperal sepsis and it is an illusion to consider it a problem consigned to history. Ben is now campaigning widely via Jessica's Trust to raise awareness. If you decide not to read the book at least follow the link to Ben's website and familiarise yourself with the symptoms. Like many Ben had no idea but assumed that the health professionals would, and that fact has caused him undeniable anguish and heartache since. I sense a subtle irony to that title given that Jessica's trust was placed wholly in the care she thought she would receive from the NHS.
Ben and Jessica's children depended on his survival, he has survived and Friday's Child and Jessica's Trust are a magnificent testament to that.
Emily will be four years old tomorrow, and the memories will doubtless return through this coming week for Ben, and having read Friday's Child I can assure him hand on heart that Jessica would have been rightly very proud of her lovely family.

Touching Distance and touching hearts.

A Ways With Words pre-read and the health warning today is that this post might make difficult reading if you are either pregnant yourself or by proxy as it were, perhaps with grandchildren imminent, but on the other hand to be informed is to be aware and in this case, as you will realise, awareness is everything.
Here's also yet another fine example of that synchronicity in reading. I bet I'm not the only one who does this, spreads out an old newspaper for something and then starts reading it, but I did a double take this week  when I glanced at the front page of the Guardian Family section from Saturday June 7th.
The feature is headlined After Jessica and shows a smiling couple, in the snow, a chubby rosy-cheeked babe-in-arms and altogether a happy family scene, but the headline quickly dissipates the happiness,
'Jessica Palmer had an easy labour and a healthy child. Five days later she died from a treatable infection. Her husband Ben talks about anger,guilt and life alone with two children.'
Surely this can't be what I think it could be?
Puerperal Sepsis?
I'd just finished reading Touching Distance by Rebecca Abrams and so I now have an excellent fictional account of the devastating impact of Childbed Fever before anyone had the first clue as to its cause.The book is based on the actual outbreak that occurred in 1790 in Aberdeen and I knew something of this already.
It being one of my 'subjects as it were, I have quite a collection of books ancient and modern on childbirth and one of the most fascinating is The History of Childbirth by Jacques Gelis. Again, don't stray within a mile of this if there is a baby imminent, but for a fascinating look at 'the system of practices, belief and taboos which surrounded conception, pregnancy and birth in early modern Europe' this book cannot be bettered.
With something now so well accepted it seems nigh on impossible to imagine that the theory of contagion had yet to be recognised in 1790, and when Alexander Gordon finally realised that the doctors and midwives were largely responsible for the spread of infection it was obvious he was dealing with one very hot potato.

'I have evident proofs that every person who had been with a patient in puerperal fever, became charged with an atmosphere of infection, which was communicated to every pregnant woman, who happened to come within its sphere.'

Thus spake Gordon's Treatise and for his discovery he was villified and rejected, his marriage broke down and he returned to sea as a ship's doctor while his work went largely unrecognised almost to the middle of the nineteenth century.
I love fictional medical history and in Touching Distance Rebecca Abrams has woven a fascinating and highly readable story around her factual foundation with added undercurrents of what I felt sure rippled towards  Jean Rhys' Wide Sargasso Sea, if I'm underlining by page six this bodes well. The sights, sounds and smells of the unpalatable are essential to the story and Rebecca Abrams graphically conveys it all, the ignorance of the 1790's compounded by an unwillingness to listen, enmities and rivalries between the professions and all in the midst of the agonisingly painful deaths endured by the women some five to seven days post delivery. The research feels thorough and impeccable yet rests lightly on the book, facilitating a good page-turner of a read rather than a slog through a thesis. There's no doubt it's shocking but somehow you tell yourself this is history so you feel one step removed, surely it's unheard of in these days of antibiotics?
Except that in areas of the world where hygeine and access to medicine are seriously compromised, up to 250,000 woman a year may still be dying from puerperal sepsis...but not here surely?
Then I read that Guardian article, and it all hits home. As Rebecca Abrams elaborates, childbirth remains one of the riskiest events in a woman's life and as Ben Palmer says

'I don't want to scare people by adding to their worries, but as part of a normal pregnancy, mums are aware of a lot of things that can go wrong, but not this.'

and he's right.
I haven't read it but I suspect Ben's book, Friday's Child : The Heartbreaking Story of a Mother's Love and a Family's Loss may well make for very emotional and uncomfortable reading. From the moment Jessica's labour began (while she was sitting on the sofa reading Daphne du Maurier's Frenchman's Creek) to the the quick and normal delivery of daughter Emily and early discharge home, followed by the fulminating course of the unrecognised but lethal streptococcal infection. It sounds like a catalogue of terrible errors, the stuff of nightmares, overworked medical staff, an acute lack of awareness, the faceless anonymous bureaucracy as Ben fought for compensation, the tough climb back from the mire of grief which engulfed him. But one comment from Ben unwittingly encompassed not only his own experience and Rebecca Abrams' book, but also the centuries, and the silence that greeted Alexander Gordon's discovery, suddenly you wonder whether we've actually learnt that much since 1790,

'Childbed fever is not a new illness, it's as old as the hills, but nobody seems able or willing to say it still happens.'

Final word to Jean Giraudoux,

"Education makes us more stupid than the brutes. A thousand voices call to us on every hand, but our ears are stopped with wisdom."

Don't Let Them Tell You How To Grieve

Down the years I've done my fair share of training in bereavement counselling, both year long and short courses, and in the process you listen to a lot of talking, do a great deal of role play, read a whole heap of books and you learn a great deal, but sometimes a book comes along that imparts far far more than any course ever could.
Grief and loss isn't just about death of course, life's replete with loss at many levels and anything which leads to that whirlpool of reaction can have far-reaching effects. The seven stages of grief often identified as shock, denial, anger, guilt, bargaining, depression and acceptance and the possibilities for getting stuck on any one of these after a significant loss are ever-present. The stages may be experienced as a complete chaos of emotions hence the whirlpool imagery and often people make great leaps across them but when people are sucked down and hindered in the process it can be hugely debilitating.
I was delighted to meet Gina Claye, one of the Oxford Writers over the lunch at The Trout, who kindly gave me a copy of her book Don't Let Them Tell You How To Grieve . Overcome with the excitement of such a lovely gathering I promptly left the book on the windowsill in the pub and didn't realise until I arrived home. If you're looking at which stage I was stuck on over this loss it was the kicking myself stage and I just hope whoever picked the book up has found it useful.
Gina kindly sent me another copy and when you learn about the circumstances that led Gina to write this quietly amazing little book you will realize that she is extremely well-qualified to do so and to give it such a direct but telling title.
In 1987 Gina's elder daughter Nikki, aged nineteen took her own life, just over a year later Gina's husband left. The stresses of a bereavement are profound on any family, a suicide even more so and the losses for Gina started to stack up. Her son Robin went off to university and Gina had to return to work to support the family and trained as a teacher. Once her youngest daughter Rachael had headed off to university there was a house to be sold. More upheaval, more loss.
Then in 2003 Robin, on a trip to Singapore, fell ill and died of encephalitis.
In the two years that followed Gina wrote this book of poems. Previously she had written poems for children published in anthologies by Scholastic and Oxford University Press.
I can only say thank heavens Gina decided to share both the circumstances of her grief and her poetry because she has done something remarkable here. Each poem is accompanied by a brief personal explanatory note from Gina which places it in context and these are all contexts that a bereaved person will recognise with ease.There is nothing mawkish or sentimental about any of it, it's a book that gives anyone permission and the courage to do the agonising but essential work of grieving however they may choose.
Crying over the clothes of the deceased person long after they've died, the full house suddenly empty, the right words from a friend at the right time,

'One foot in front of the other and don't forget to breathe.'

The feeling that the ground may be about to give way beneath your feet, others living a normal life while you think yours may never be so again, the letters that keep arriving addressed to the dead person, the hours of sitting and staring into space and many more.
The profound comfort to be gained from knowing this is all normal and part of the process cannot be over-stated and this book, with its short pieces, is perfect for that brief attention span so often experienced after a bereavement, making it ideal to have alongside.
I would have no hesitation in recommending this book to anyone whether grieving or not, everything within speaks to the many facets of grief and loss, and there are startling moments of such acute and simple revelation making it a book that offers both an understanding of grief as well as endless compassion. I will return to it many times over.
Here's one extract and if anyone would like to make contact with Gina you can e mail her here.

'This photograph of Robin and me stood near the television in the sitting room which I had to go through to get to the kitchen, so I could hardly avoid seeing it. There were other photographs around of course, but it was this particular one, taken not long ago, that seemed to be a focus for my loss.'

The Photograph

At first I almost took the photograph
down. It showed the two of us
together, walking in the Chiltern hills.

We had stopped for a rest. I leant
against you, your arm around me,
my head on your shoulder.

The pain I felt each time I saw it
was so acute, it made me feel
again my overwhelming loss.

But to stare at the space it would
leave would be worse. So it
stayed. And gradually as time

passed, I made a friend of pain.
And now in moments of anxiety,
I stand and look at the photograph.

I lean on you still and will all
my life. Your arm around me.
My head on your shoulder.

Gina Claye
Don't Let Them Tell You How To Grieve
Published by WritersPrintShop
ISBN 1904623441

Sunday Salon - Halfway to Venus

'My mother closed the door and turned towards me, and without saying anything, she made a chopping motion with her right hand above her left elbow. I thought my world had come to an end.'

So I'm wittering on about knitting and quilting on the same day that I am reading Sarah Anderson's truly remarkable book Halfway to Venus , A One-Armed Journey and wham, it hits you right between the eyes, my two-handed and much loved craft activities may be nigh on impossible for Sarah.
How does that make Sarah feel?
How does that make me feel?
How does that make you feel?
However this is not a book about making you feel guilty for having two arms. Thus far it is a book about grief, loss and awareness and much more besides.
In 1957 at the age of ten, Sarah was diagnosed with a synovial sarcoma and admitted to Great Ormond Street for the amputation of her left arm.The surgery was performed by Mr Denis Browne, an orthopaedic surgeon whose name was legend in the corridors of the hospital when I arrived to become a 'nurse in pink' some fifteen years later, so I was immediately fascinated by Sarah's experiences. Even more so because my first, and therefore most memorable, ward placement as a student nurse straight out of Preliminary Training School was twelve weeks on the seventh floor Private Patients where Sarah was treated. I can smell the smell (antiseptic mixed with polish, milk, rubber and gravy) and visualise the rooms and the ward as I type and of course the whereabouts of every single item in the sluice and the linen cupboards where I spent a great deal of those twelve weeks.
That said, nothing but nothing will prepare you adequately for this book other than a personal experience of amputation and to say I've had my eyes opened would be understating the effects of today's reading of the first 100 pages or so.
What Sarah makes clear in her exceptionally well-written book is that if we were to meet, she would be the one to bear the burden of my embarrassment if I said something insensitive, and that's often how it is for  people as they apologise for making the rest of us feel slightly awkward and uncomfortable,

' The burden always seems to lie with the disabled or bereaved person: again and again it is the way the person with the disability reacts that paves the way for other people's reactions...there is a very strong urge to apologise and somehow to take the blame.'

then this and how true it is

'Society certainly does have a way of categorising people and there is an assumption that to be a full member of society there is a 'normal' way to be.'

In my day job, meeting as many different people as it can be possible to meet, I've often pondered who made the decisions about what constitutes 'normal' and who makes that final decision on what 'normal' is ?
Sarah invests with new meaning and clarity that saying we all use when there's something we really want or need...I'd give my right arm to...and suddenly you realise the significance and importance of two arms and hands in ways that may never have occurred. Crossing arms as a way of defending and protecting yourself, thumbs up to signal success, expressive sign language with hands as we speak, I can guarantee this book will make you think and reflect in ways you may never have thought before.
Coming up on the blog this week a couple of  books on grief and loss which have moved me greatly; tomorrow my thoughts on a simple but profoundly thought-provoking book of poems by Gina Claye, Don't Let Them Tell You How To Grieve. Sarah's careful examination of that huge loss in her life at the age of ten and how she has coped with it at the various stages of her life is adding greatly to my thinking in that relay-baton way of reading that I mentioned here recently,

'The reality is that the loss of a body part is equivalent to the death of that part, and grief, depression and anxiety are the universal responses to that death. Denial is one recognised way of dealing with the bereavement; prolonged depression is another.'

Much more on Sarah's book soon but don't even wait that long, add this one to the list because it is a truly astonishing and unmissable read, and here's an article in yesterday's Telegraph confirming it. Whilst she may not wish to become a standard-bearer for people with disabilities because she is completely able, from what I've read so far, I suspect Sarah's book will become a blessing for those who identify any grief and loss in their lives and strive to find ways around the obstacles that it can place in their path.
There is much in here that translates with relevance across the whole broad spectrum that is life.

RIP Dr G

I will be at a memorial service today for a retired G.P. colleague who died recently.
The very first G.P. I worked with when I emerged naive and blinking into the bright, exciting and promising new world that was the Primary Health Care Team back in July 1978 and I rolled up at his surgery to start being a real health visitor.
Look at my first ID card, not a wrinkle to be seen. I'm too embarrassed to show you the latest one taken a few weeks ago. When I said I didn't like the picture they refused to take eighty-eight more until I was happy and wouldn't let me revert to this one for some reason.
But 1978, it was high summer, it was sunny, I'd learnt to drive and passed my test in three months because I absolutely had to (Dartmoor on a bike didn't appeal) and just passed a heap of written exams and vivas at the end of the most intensive year of study I'd ever done and I was oddly terrified.
What was I doing here?
Suddenly I was in a strange and surreal heaven, this couldn't be right.
After the hierarchical cauldron that had been hospital nursing for me, to find myself out in the community, free to organise my own work, and drive across some of the most exquisitely beautiful countryside while I did it, seemed like a privilege not to be sniffed at. Indeed as I drove onto high and deserted Dartmoor this week I drank in the space and that freedom in huge gulps.
I always do.
But my first encounter with a GP as a working colleague was going to be an important one and thankfully it was with Dr G who was kindness personified. In retrospect I see that he must have looked at me 30 years ago much as I look at doctors and policeman now; young health visitors were very unusual, most in their forties or fifties then (plus ca change) and all called Betty and Shirley (and now called Lynne).
But Dr G and I hit it off and many's the time he offered guidance and advice that has stood me in very good stead ever since. He was a New Zealander, a family man of deep religious conviction and a real listener, beloved by his patients in that old-fashioned rural way and always inundated with gifts of salmon, fresh eggs, a bunch of rhubarb, half a sheep and more and surrounded by a dedicated team of staff.
Remember the old-style 1970's doctor's receptionists? Full and quietly attentive waiting room, mega-decibels as they answer the phone,
Mrs Smith?
Is that Mrs Smith of Back of Beyond Farm?
You want to see a doctor Mrs Smith ? 
Why?
Is it really necessary?
What's wrong with you?
(Increase in decibels) PILES?
But we let you see the doctor about that last week.
The nurse who would quickly shove her cigarette in a Bovril jar when I went in the room, realise it was me and get it out again.
I've mentioned her before, the Jamaican district nurse - midwife who took me out on my first day to show me the MOST important place I needed to know about. I was mystified as we pulled into a car park, deserted but for a lone ice-cream van and with far reaching views right over the moors and across to Plymouth Sound.
99 or Raspberry Mivvi she said to me and went and bought accordingly (99 for me, never did like Mivvis) and we sat in silence and looked at the view. I was still mystified and asked where the house was that we surely must be visiting.
No no she said, never forget because they won't have taught you this bit. This is where you come and park up when it all gets too much and you need a breather.
Duly never forgotten and my car knows its own way there now.
That was the surgery and the job I left to go off and have babies and I cried a river because it was such a perfect time (not without its moments of course but ideal working conditions) and I somehow knew that it would never be repeated (I was very right) . When I left I bought them a huge teapot because Dr G was always complaining the teapot was too small. That surgery, which I did eventually return to nineteen years later and for eight years until last summer, still has afternoon tea and cake behind reception as instigated by Dr G.
Dr G in fact convinced back in 1981 that I needn't leave, childcare non-existent, we all gave up work. We could put a cot in the corner of the office and you could carry on, we'll look after the baby while you're out he said.
Those of us still around have had little gatherings this week to help the giver of the eulogy, another retired partner, and many laughs ensued as we recalled some of the very funny moments.
Dr G memorably the recipient of what would now be considered a very non-pc April Fool letter actually from us, but on council - headed notepaper (probably illegal to do that now too)  informing him that planning permission had been granted for the establishment of a traveller camp on wasteland right next door to the surgery, in fact right outside his window, and would he accept "this happy band of people " as patients and allow them to use the toilet and washing facilities in the building.
When he dialled the phone number and found it was Dial-a-Recipe he laughed like the proverbial drain but doubtless had it been true he'd have willingly added them all to his list.

Dream Babies

Following on from yesterday's veiled threat to read a book on parenting here it is.
I have long subscribed to the school of thought that cites (or it might be my own school entirely) that parenting has become increasingly difficult over the last few years with so much information and advice out there about everything that can go wrong, plus an emphasis on the myriad potential pitfalls seemingly lying in wait for the unsuspecting. Add to that the new and different pressures on parents in 2008 to those of years ago plus the plethora of childcare books and it's all a recipe for confusion.
Tom and Ann, in Novel About My Wife, were certainly in uncharted territory and blatantly nervous about what parenting would involve and how it would change them, and for them the consequences were ultimately tragic.
Therefore it is incumbent upon me to finally check out Dream Babies Childcare Advice from John Locke to Gina Ford by Christina Hardyment. I bought this one at The Oxford Literary Festival and here's yet another great review of several events there by Sarah Laurence.
As I occasional allude to, but try not to dwell on here, change is rife in the UK health visiting profession at the moment and I'm certainly beginning to feel positively palaeolithic, or at least as if I have been around since 1693 when John Locke's book Some Thoughts Concerning Education first appeared. I'm too nervous even to mention Gina Ford's The Contented Little Baby Book on here because that got netmums into serious trouble, suffice to say it's horses for courses and plenty of families I know are devoted to Gina and have had great success with her methods. Every childcare book has its advocates and beneficiaries and its detractors and victims so I have to know their contents and remain open-minded about them all bar the obviously and patently dangerous.
From where I stand it's more about assessing a situation and advising on the right book for the circumstances if requested.Then I add a caveat, there might be plenty in there of no relevance but you might just find the one bit of advice that helps.
However where Dream Babies is concerned, I do seem to have been offering childcare advice contemporaneously alongside a hefty chunk of Christina Hardyment's through-the-ages guide.
It leads me to ponder at a tangent why in some professions a lifetime of experience at something equates to being seen as old-fashioned and out-dated whereas in others it is venerated ?
Or is that just me getting older and my perspective changing?
But it's my own fault, I certainly was around in the good old days advising the Neanderthals on Feet to Foot and Back to Sleep cot death prevention advice as applied to their woolly mammoth fur-lined cots...no sorry, perhaps I might respectfully suggest, best not to use woolly mammoth fur because the baby will overheat. Thankfully woolly mammoths now extinct before I get into trouble for even suggesting such a heinous crime as to kill one for its fur.
Think on it, if only the Neanderthals had heeded my advice we'd be enjoying woolly mammoths even now.
If however you should come across a stray woolly mammoth and you do skin it please don't lay your baby on the fur, think of the germs.
If however you decide to wash the fur first please don't use biological soap powder, think of the allergies. Fabric softener may also give your baby a rash.
If having washed the fur you then lay your baby on it please ensure there are no loose tufts that your baby could ingest.
If your baby does ingest a tuft of woolly mammoth fur please ring NHS Direct where you will be advised on the best course of action...I shouldn't jest, I know it's all become very serious and worrying, but the caveat list has become endless.
I'll be very interested to read Dream Babies and examine Christine Hardyment's overview of it all. My hope is that in the end the outcome will be generally to let common sense and instinct prevail, and with it a confidence in parents' own abilities to do what feels right for their family.
But I'll let you know about this one and isn't that cover, in a slightly deeper shade of what is now called Daphne Red here, quite perfect?

The Air We Breathe by Andrea Barrett

I missed reading Andrea Barrett's The Voyage of the Narwhal when it was published years ago. I think it arrived in one of those cumbersome, stiff, spine-creaking paperback book club editions and I just never got around to it.
Then Andrea Barrett disappeared here until a copy of her latest book The Air We Breathe to be published by Hutchinson and in a nice soft, floppy, proof copy fell into my hands and begged to be read.
Autumn 1916 and an isolated TB sanatorium in the Adirondacks.
I rolled up my sleeves and prepared to get stuck in, there were sure to be blankets on balconies and they'd need a nurse.
Isolation hospitals I surmised might provide the same device as snow for suffocating action and all the more intense here as breathing is the biggest difficulty for many of the patients.
The war and social unrest might be in progress in the trenches of the Somme and in Russia but nowhere is impenetrable and the outside world soon starts to filter in around the edges of the sanatorium and in many ways the war is played out, in a mini-version within Tamarack Lake.The outcomes are just as cataclysmic and there are some passages that really do leave you gasping for air as events unfold.
The imagery of transparency struck me constantly as the experimental work of the radiographer comes into focus. Irene literally can see right through her patients, no secrets can be hidden in a place like Tamarack Lake where all the patients have been disempowered by their diagnosis and treatment. A weekly discussion group takes off and with it emerge all the thoughts and feelings suppressed by so much resting and gradually the inpatients rediscover their voices.
I had never really appreciated the thinking behind the TB rest cure.
TB was a disease of the past when I did my nurse training so I knew very little about it beyond the usual symptoms, associations with the consumptive in literature and the risk of fulminating and horrific haemorrhagic death, but why exactly the rest cure?
Call myself a nurse? Honestly, I'll be stripped of my letters next.
Thankfully I now know because Andrea Barrett weaves all this in and more as she recounts her story and I was quickly impressed with her peopling of this book. I'm not a writer of fiction but I imagine populating your book can be a tricky process because your reader has to be able to meet and greet and keep track of everyone quickly and decisively.
Here you've got a whole hospital full of patients, all on the same balcony as it were, to choose from, to try and make into individuals.The system has worked slavishly to depersonalise them and conceal them under identical blankets and somehow the reader has to be able to tell them apart. I took it for granted that I'd be able to and I could but it must be a huge challenge for a writer to sort it
There is a very clever little manoeuvre at the end of the book, an extensive family tree.
These are usually at the beginning surely? There to be constantly referred to?
Not this one. Take my advice, don't give it second glance until you turn the final page when you are then meant to look at it and the penny drops. Then you have a lovely surprise because you will carry on telling Andrea Barrett's story for quite some time after you have finished the book.Then I dig around and discover that many of these characters started life in a previous book Ship Fever and now I really do want to know more.
I don't think it's a spoiler to tell you but as I was reading I was gradually thinking 'who is telling me this story', it will rightly puzzle you mysteriously throughout the book.
No quotes from The Air We Breathe because it says I mustn't as it's not out until March here in the UK  (you already have it in the US I think) but all very clever indeed, a good read to watch out for and meanwhile it might be worth catching up on more Andrea Barrett if like me you've missed any or all of her five previous novels or two collections of short stories.

The return of the blog doc

Three very great big cheers and I don't care a fig that I'll never catch him in the Technoranki charts now, let's hear it for NHS Blog Doctor because he's back. I'd given up looking at Technoranki anyway because this great big Shaolin Tiger thing leapt out of nowhere and petiteanglaise had a bit of a surge and I thought oh, just let them fight it out amongst themselves.
NHS Blog Doc a very mysterious re-disappearance back in October, not a whisper of a word out there in the corridors of General Practice.
Be advised that, in my thirty years of stalking their corridors and hanging around outside their doors to annoy them with a question inbetween patients, I have never known a GP to disappear.They just don't, they have great big retirement parties and afternoon tea so all their patients can come and say thankyou and goodbye and they get gifts.
For weeks beforehand there will have been an envelope going around the building for staff contributions, then we all sign a card and write impolite things on it and give them a glass bowl or a lawn mower depending on how nice they've been to us when we interrupt them to ask questions inbetween patients.The new Senior Partner gives an embarrassing tribute speech and as the Old Senior Partner is ushered out of the back door the chap's round the front unscrewing the brass plaque and moving all the others up a space.
In return the Old Senior Partner gives the surgery a picture to hang on the wall.
Have a look next time you go in.
Most surgeries have a picture spot behind the front desk for the most recent hanging gift.When the next one retires the previous one gets demoted to the corridor, often near the eye-testing card, then it may be moved to the staircase.Five GP retirements on, the wall space is filled and it's in the attic along with the surgery Christmas tree and Friends of the Surgery summer fete bunting.
I had seen no sign of this over at NHS Blog Doc.
Was he in the Tower?
Had he been gagged, stuffed, embalmed or all three?
Perhaps he'd crossed the divide and Gordon had dragged him into Number Ten to offer a helping hand, along the lines of well you think you're so clever, you sort the mess out then.
It was a very big mystery but NHS Blog Doc has returned, probably from a debilitating bout of hypercynicismitis along with the rest of us and possibly only just in the nick of time.
I shall be a regular visitor.

Reading on Prescription

Susan Hill has already flagged it up but I'm going to follow because there was a piece by Blake Morrison in The Guardian Review this morning which gladdened my heart, Are books the new Prozac? The Reading Cure.
The papers arrived courtesy of Bookhound, along with a pot of tea and off they all went out beating the bounds for the day.There is a certain joy to an empty house when you know it will be filled again about seven hours later and with thanks to Mary Azarian , woodcut artist extraordinaire, who kindly gave permission for me to use this picture occasionally.
One of the delicate little cats arrived and curled up as always (Rocky not great at jumping on beds) and I headed straight for the Guardian Review and cheered.
When you love reading and realise how much it adds to your life you can get quite evangelical about it. Preaching to the converted here but I can't tell you how frustrating it is to work in an environment like the NHS and watch people struggling with all manner of mental and physical illness and wonder if they read.
Or have they been offered some suggestions for reading?
Has anyone offered to help them with those choices? If you've been signed off work with stress and depression that's a lot of time on your hands to fill inbetween appointments with the practice counsellor.
Might a reading group help?
Not self-help manuals about eating tofu and how to get the best out of Choose and Book (don't get me started on what that has cost the NHS) and what to ask at your consultant's appointment, but fiction, poetry, letters, biographies, all sitting there waiting to be explored for the good.
I've long held a simplistic, intuitive feeling that the anti-depressant prescribing budget could be substantially reduced in general practice if surgeries ran reading groups and referred patients to them.
There is a skill to running a group of any description and I think it's one of the things health visitors actually do well, though far less these days because...well let's not go there.Making everyone feel included, at ease and valued is a pre-requisite skill that goes hand in hand with our ability to relate non-judgementally to people right across the social spectrum.We have walked up enough garden paths or climbed flights of stairs in blocks of flats and knocked on enough doors down the years to have learnt about that.
But there's the problem, simplistic, intuitive feeling no good these days, has to be evidence-based before we even think about it.
I corresponded with Jane Davis some time ago after she wrote extensively about her work in this sphere in The Reader magazine and I shared my thoughts on bibliotherapy here. Jane has initiated a brilliant scheme in and around Merseyside and it would seem the evidence is starting to gather. We can but hope that people in high places listen and it does all fit neatly into current campaigns for libraries along with the realization that children aren't the only ones who need some encouragement and confidence building around reading and how it can be used as a lifelong tool.
Congratulations to Jane for all her hard work and for having the determination to bang on all those closed doors.

Hello, can you hear me...

Mandatory Training day is imminent next week and I hear I am to be there from 9am to 5pm.That's one heck of a long time to sit and stay awake, so to cheer us all up I must redress the balance because resuscitation training day, done separately, is always good for a bit of tension and acute concentration. I mean this is serious, people could die in front of you for want of listening properly so we do make quite an effort.
Years ago we used to have do a practical exam for resus.
Into a room with two examiners and a mock-up of a "terrible event" with a Resusci-Anne lying on the floor looking very unwell.
For some reason, where in real life we'd probably definitely just get on with it, this whole mock-up thing used to work us up into a feverish, adrenalin-soaked, nervous heap of terror. Heaven knows why, we'd all been watching Casualty for weeks for some revision.
One colleague bravely entered the bear pit first and emerged some considerable time later looking ashen. She had confused the numbers of compressions to breaths and after two quick chest lunges had moved in swiftly and efficiently to do fifteen breaths (or was it twelve...or fourteen?) on the Resusci-Anne. After about ten breaths she was seeing stars, feeling decidedly light of head and the Resusci-Anne was now looking more like the Resusci-Hindenberg and at similar risk of explosion. Through the mists of a fast approaching self-inflicted Glasgow Coma Scale of two she saw smug grins mixed with grimaces of impending doom on the faces of the examiners and realised the error of her ways.
Bless her, she managed to gasp out her mistake as a warning to the rest of us before slumping in the corner a demoralised and breathless failure, ready to rip up a lifetime of nursing certificates and scrub out the letters after her name. So armed with the numbers now drilled into my head I dashed in for my turn.
I immediately resisted the natural urge to say 'Sorry, no can do, someone's made off with the legs, this one's a no hoper' because that's not funny and it was not the moment for such frivolity.
I spotted the fallen ladder but was more excited about the electric cable lying under the torso.
Aha, trying to catch me out eh? Clear case of electrocution.
I did my verbal assessment and talk through of the situation.It was calm, composed and, eat your heart out Casualty and Charlie Fairhead, it was masterful. Switched off the plugs, made the area safe, summoned help from thin air, called 'Hello, can you hear me?' to half a doll and proceeded to perform, though I say so myself, a perfectly executed resuscitation when the doll didn't reply.
Feeling quite pleased with myself I awaited my Distinction with Honours.
There was a lengthy silence.It was patently obvious the examiners were completely overwhelmed by my stunning expertise and at this point thinking to themselves, let's hope this woman's around when the big whopper strikes because we're sure to live to thank her.
Could you carefully examine the back of the half a doll's casualty's head?
Ah, right, yes, quite a great big head injury there, er, goodness, a hole even, quite a lot of blood too, oh my word and clear fluid, where did that come from? Yeeeees...hmmmm... probably a skull fracture.
Mind you, these things do often look worse than they are.
Dirty trick I thought as I went and joined my colleague, huddled and demoralised in the corner, and divested myself of any pretensions I may have had that I could ever save a life.
In the immortal words of Henry James, who I'm reading and loving all over again right now,

'...the very stuff that human life is made of. What is it but the discovery by each of us that we are at the best but a rather ridiculous fifth wheel to the coach, after we have sat cracking the whip and believing that we are at least the coachman in person.'

Mandatory Training Day

Like most people who work for a large organisation I have to attend something called Mandatory Training.
It takes up a whole week day and will include subjects such as Fire Training, Manual Lifting and Handling, Human Rights, Data Protection, Health & Safety et al et blah et groan etc.
A selection of dates are usually given to us early in the year and we quickly plan ahead so that we are unavailable.
I know this may possibly shatter your image of me as a dedicated NHS employee, but that can't be helped, it's not my favourite day in the year and I might as well be honest.
Even changing the name to Corporate Catch Up Day hasn't fooled me.
I was given an early December date back in January and despite my protests that I knew for sure that on that exact day I would, with absolute certainty, be doing the developmental assessments on the babies born in May in the morning and be visiting the babies born at the end of November in the afternoon, I was informed I had to be there.
Somehow the date has loomed like a very big blot in my consciousness ever since.
None of the drama of  resuscitation training in store, that's done on a separate day but the last time I did Manual Lifting and Handling Training we did drive the hapless instructor rapidly towards a nervous breakdown, the tricky scenario to be sorted was as follows,
"The weekly consignment of fifty large boxes of toilet rolls have been delivered to the wrong door of the hospital, how would you resolve this problem safely?"
We split up into small groups with a flip chart and big coloured pens and, after debating the reasons why a tiny cottage hospital was using so many toilet rolls and that perhaps the menus needed to be revised, we settled on an excellent solution which we bullet pointed on our flip chart.
In essence, we'd contact the delivery company and advise them of the error of their ways requesting that they return forthwith and deliver the toilet rolls to the correct door. If it rained in the meantime and the toilet rolls got wet we would not be paying the bill and trusted that the company would feel suitably riven with conscience over all the patients now severely compromised by the lack of toilet tissue.
We quite liked this robust approach which seemed commensurate with our role as Band Six employees (via Agenda for Change banding has replaced grading ) but apparently it was the wrong answer and we expressed our collective dismay that the correct one just hadn't occurred to us.
We were supposed to divide the boxes down into liftable sized packages, keep our backs straight, bend at the knees to pick them up and then, holding them at waist level and close to the body, walk them around to the correct door. If there were enough staff available we could set up a line and pass them one to another for increased efficiency.
I can't wait for this year.

The Family That Couldn't Sleep - Portobello Books

Ever the one to be pleased to hear from independent publishers with an interesting list, I was delighted to get my hands on some titles from PortobelloBooks.
The list looks wide-ranging and already I'm two books into the three that arrived and have a few more on request.
The one that I really have to tell you about first to get it off my mind is The Family That Couldn't Sleep Unravelling a Venetian Medical Mystery by D.T.Max.
I have to get it done and dusted because to be honest it's terrifying.
I was glued to this on the morning it arrived and though I haven't read every single word, I've read most of it and what I have read quite unnerved me.
You get immune when you work in a doctor's surgery.Not blase but you need some defence mechanisms in place.Terrible things happen daily and you quickly learn not to think that the unusual patient's symptoms, resulting in a rare and unpleasant diagnosis and discussed incredulously over coffee, actually seem to mirror a whole host of your own that you've just been ignoring or keeping quiet about.
It would be quite easy to have self-diagnosed something rare/fatal by lunchtime every day, imagine it will likely fulminate through the afternoon and you'll doubtless be dead by teatime and with a whole load of records not written up.Trust me, they'd call you back from the dead to write up records.
So I'm quite good at coping with it all in a book, but the unthinkable tragedy of this one just chilled me to the bone,

"The first symptoms begin after just a few nights without sleep, with shaking, sweating and overwhelming anxiety. Several weeks on the insomniac is unsteady on his feet, wracked by fevers, and drifting in an out of delirium as the body's vital organs begin to fail. Finally, after months of agonising open-eyed deterioration, the victim falls into a state of exhaustion resembling a coma and mercifully dies."

Fatal Familial Insomnia and no, I'd never heard of it either.
Now don't panic, it's an incredibly rare, inherited disease which has afflicted one noble Venetian family since the eighteenth century and only a handful of other families worldwide.The cruelty is the fact that it strikes at random once child-bearing years are over, and as an autosomal dominant mutation there is a 50% chance of a child getting it too.
The family agreed to undergo testing to aid the research and though the names of family members who will succumb is known in the laboratories the family agreed they didn't want to be told.
So this all feels quite far and distant from the rest of us until Max reveals that the research has also identified that this is all caused by a rogue protein known as a prion and then suddenly you think it's right on the doorstep because so was CJD or Mad Cow Disease a few years ago.
Having read in tragic detail the implications for the Venetian family, it's therefore tricky to hold your nerve when you read Max's investigation into that whole sorry saga here in the UK. We all remember it well, the incredulity as more and more was revealed and Max can barely disguise his scorn for what went on.
It does not make for comfortable reading and I'll own up I had to skip bits and when I finally reached the end and the hope of some comfort there wasn't a great deal to be had. Max himself suffers from an undiagnosed neurological disease and recounts his own story.
All in all there is not a lot of joy in a book like this, but the truth is there to be told and someone has to tell it so that someone else can read it. The research looks impressive enough and you have to applaud D.T.Max for taking on a subject so close to his personal situation, it can't have been easy.
Thankfully another book from that pile, The Visible World by Mark Slouka was waiting to effect a rescue and I was quickly and gratefully esconced in wartime Prague, but many thanks to Portobello Books for a highly challenging read.

Hospital by Toby Litt.

Right I'm posting this and by the time you read it I'll hopefully have left the country which is probably wise.
I'm completely bamboozled again, this time over Hospital by Toby Litt as Jess over at The Book Bar warned me I might be and I've taken a vote with myself and elected to stop reading it at p298 because sad cliche though it is, life really is too short and I think I'm just too long in the tooth for this book, even given the fact mine is a very broad-minded nursing tooth.
You bright young twenty-thirty somethings can embrace this one but I'm out.
Unfinished, therefore whatever I write can't offend anyone, because they can now say that things take a different turn on p299 and I'm the loser.
What a strange, bizarre surreal book and I can't decide whether it's a case of emperor's new clothes or cutting edge contemporary literary fiction?
A work of staggering genius or a complete load of old rubbish?
The product of a tortured mind or someone who has bizarre dreams?
Whatever I'm definitely in need of treatment myself because I was worryingly transfixed by it in that rubber-necking way that has you shamedly watching gruesome events unfold. I think it was the nurse in me that kept me reading on and on through ghastly scenes of slightly unreal medical mayhem blended with satanic ritual, headless babies, voodoo in the basement and a touch of Mills & Boon thrown in. It's relentlessy ghastly and vile, there are no other words for it and I hesitate to call it literature but I fully expect others will be fulsome in their praise.
It was all compounded by the presence of senior surgeon Sir Reginald St Hellier.
I had my appendix out in St Helier hospital in Carshalton back in 1970, a week after my O Levels had finished. I thought I'd eaten too many strawberries actually but I was wrong and fortunately for me my mum also disagreed with my self-diagnosis.Every time I heard the name Sir Reginald St Hellier I was reminded of sitting up in bed feeling wretched, listening to Wimbledon on hospital headphones and trying to figure out who'd just hit the ball because radio commentary used to be sparse...clunk - clunk - grunt - clunkclunkclunk- CLUUUUNCK - great smash there from John Newcombe.
I wouldn't even like to try and second guess possible hidden meanings or be so daft as to gush intelligently on what Hospital is really about and I'm not even sure whether to recommend it to you as a readable book or not.
I didn't actually hate it but in the end hated myself for reading it and by just over halfway I'd had enough especially as it looked like more of the same to come.
If you do decide to read it you'll need a strong and preferably empty stomach, though after a while you'll be fine to raid the fridge and eat raw liver sandwiches with grated pancreas and a drizzle of bile.You become so immune to the horrors, because it so cannot be real, that the next time a pickled specimen comes to life or another body gets sawn into pieces or heads get chopped off you start to accept it all as completely normal for this particular hospital.
All very worrying if only for the realisation at how easy constant exposure to horrors can make you immune to them.
But it wasn't real was it? So it doesn't really matter does it?
Do also bear in mind that if you enjoy hospital drama this is nothing like One Pair of Feet by Monica Dickens.
Do you ever wish you'd never read a book? Could somehow unread the horrors that you've read no matter how tongue in cheek or spoof they may be? It may be some time before I'll be ready for another Toby Litt, but when I am I think I'll probably approach it all with an open mind and not hold Hospital against him.
I've suddenly had a very worrying thought; the Booker long list will be out soon...surely not...no they wouldn't...
Meanwhile I think I deserve a medal for reading 298 pages or at least a complimentary session with a counsellor....or perhaps a holiday will suffice, see you all soon.
It's all yours Offspringette!

In Search of Adam

Perhaps its a subject you think you understand, perhaps it's a subject you just don't want to read about, perhaps it's all a bit too painful to read? That's fine, nothing's compulsory here and I realise this book may be just more than many people can cope with.
In fact I have a feeling that In Search of Adam is going to be one of those books that readers will either heart or hate and there may be no middle ground.
I'm going to declare forthwith that I'm in the heart department and that's very unusual because it's a book about my pet- hate- subject- to- read- about- for- pleasure, child abuse. After all these years of working in child protection I'm more of an expert on it than I'd ever choose to be.
Next time round I'm going to be a librarian.
Jude Williams at six years four months and two days old finds her mother dead in bed from an overdose and by her body a note
"jude, I have gone in search of Adam, I love you baby"
You can hazard a guess at this point that Jude's problems are only just beginning and what unfolds makes truly harrowing reading because it could be argued that Caroline Smailes has done for child abuse what Mark Haddon did for autism.Through the limits of Jude's childlike understanding things happen over which she has no control and no understanding and it's all very very real.If you didn't understand the impact of all this on an innocent child beforehand you most certainly will by the time you have finished In Search of Adam. Don't be put off by ideas of a misery memoir, this is subtly different and there is a powerful redemption of sorts that for some reason should but doesn't leave you in the depths of despair.Just sad.
If nothing else the book clearly shows how childhood abuse can lead insidiously to patterns of obsessive compulsive behaviour, self-harming, isolation, low self-esteem, bulimia and worse.
For Jude these are rooted in the events of her childhood and that is when the problems start; you clearly understand exactly why she does what she does even at such a young age.
There were some telling moments of huge importance for me,
Jude's silent pleas to her teacher

"The summer came and went. The summer when I left primary school. I left the watching eyes. Miss Waters was getting nearer to the truth. I was leaving her little clues, She was clever. She was picking up the clues.But. I left.I left before she figured it all out"

Her explanation for her bulimia

"They were right. I wasn't normal. A reet strange bairn. I'm not normal. But they never asked the questions. They never allowed the words to escape from me. They never realised that I was trying to communicate. Sicking up the words that I couldn't voice. Trying in the only way that I could find. Trying to tell them all the things that were eating away inside of me"

The writing style is unusual and often cleverly limited by an authentic age-appropriateness for Jude's thoughts and language, but I quickly got used to that and it worked well as an additional means to emphasise what was happening to her.
Dust jackets important as always to me and the design of this one would seem to be the result of a collaboration between The Friday Project and Snowbooks.You can look at a dust jacket and think "oh yes very nice" and barely notice it for the rest of the read or you can have a dust jacket like this one that somehow carries you through the entire book. As I was pondering what I'd read this dust jacket became a really important focal point as did the endpapers, but I'll let you discover those for yourselves.
A word about the words, often strangely laid out on the page.
This could easily be dismissed as a gimmick but I understood it as something else. If obsession is about repetition and patterns of behaviour and often a means of gaining control in uncontrollable situations then the order  that Jude aches to find in her life is being cleverly reflected visually in the unusual use and placing of words on the page.
I feel I have barely scratched the surface of this book's significance but I have emerged feeling suitably reminded that there is always more to learn on a subject I thought I understood quite well.
Books like this must be agonizing to write and equally difficult to promote and sell but for starters I'd love to prescribe it as compulsory reading for all those professionals like me who find themselves on expensive multi-agency child protection courses, teachers, social workers, police, health visitors, child and mental health workers etc.
There's always a session on the effects of abuse on the child, bit of a powerpoint intro, off into groups, groan, talk about the lunch, flip charts, felt pens, last five minute rush to have something intelligent to feedback to the group.Plenary.No one ever wants to do the feeding back.Usual story.
We could all have the day off instead to quietly read this book, save a fortune and learn far more, and for that reason, amongst many others, it gets 5* from me.

The Law of Bound Hearts

A little bird called Adele pointed me in the direction of Anne LeClaire, a U.S.based writer who also has the distinction of being related to Emily Dickinson. I hold my hands up, I'd never heard of her (Anne not Emily) so I just plumped for the first and easiest book to get hold of and so The Law of Bound Hearts it was.
I say it time and again, why are US paperbacks so much nicer to have and to hold than ours here in the UK? They are soft and floppy and forgiving, the pages drape across your hands and lie flat as you hold the book, the matte covers don't go sweaty. None of this stiff, upright spine-cracking stuff with disobedient and intransigent pages that we have to battle with.
I'm sure I'll be told.
Any book that has its epigraph as a quote from a poem by Anna Akhmatova has my immediate attention.
"So much to do today:
kill memory, kill pain,
turn heart into stone,
and yet..."
The book has cleverly already been invested with depth for me and in fact doesn't disappoint.
It's almost a complete conglomeration of so many other themes that have unwittingly permeated my reading lately.
Reaching a crossroads in life when you can longer take your health for granted and the huge losses that mount up when Libby finds herself in renal failure and on the dialysis/ transplant trail.
Even the loss of food,

"Food was no longer about pleasure or nourishment, celebration or diversion, or even denial.Now it was about chemistry. A precise monitoring of sodium and potassium, of phosphorous and protein."

Anne LeClaire goes for the broadest of canvases painting in families, childhood, sisters, infidelity, illness, loss of trust, reconciliation and some of the thornier issues of renal transplantation and organ donation all with huge sensitivity and surprising ease.
It should make for the sort of book that has you depressively thinking "no thank you" at first glance, but not so.This was a thoroughly enjoyable read and I emerged the other end not only having read a good book but having done a lot of thinking along the way.The characters are real and believable, flawed and utterly human and I warmed to them all.
Keeping up with the trend for author interviews at the end of the book which I enjoy and also a List of Questions for Reading Groups which for some reason I don't, it was useful to find out more about this author. As a child Anne LeClaire's imagination was so enormous she spent her time not only making up stories but blurring those boundaries and "telling huge and involved lies".
That set me thinking that in a way that's what fiction is, one great big lie.You had all probably realised that light years ago but I'd never thought of it quite so intently.
It was but a small step to attempting to figure out what's the truth then? Because I often enjoy a book for its believability and thereby what I see as its truth and honesty.
That all made my head hurt because for my next trick I was going to have to figure out the meaning of life, so it was clearly time to return to earth and go and wash the kitchen floor, because, no word of a lie, it was a disgrace.
Good read, the buzz of a new find for me and so I shall be on the lookout for more Anne LeClaire.

Dartmoor Book Fair

Into Tavistock for the Dartmoor Book Fair last Sunday and the Town Hall full of book sellers all reading the papers and drinking coffee while the good people of the town browsed and bought.There is always a hushed, reverential atmosphere at these gatherings in these superb surroundings on a Sunday morning.
I always vaguely feel, on Easter Sunday of all days, that really I should be across the Square and sitting in the choir stalls of the Parish Church singing the anthem.I sang in the choir there for years but finally decided to leave the ranks when we moved out of town and into rural isolation.
My book purchasing down to an addition to the collection of old nursing and childcare manuals. I always keep an eye out for these and this one an 1879 edition of Hints to Mothers for the Management of Health During the Period of Pregnancy and in the Lying -In Room.
Books like this are often full of a surprising amount of wisdom but all combined with suggestions and advice which make your hair curl in 2007.
First browse and I learn that deafness in a nurse is an evil to be avoided, she won't hear when you call for her at night.
I now have the job description and person specifications for employing a wet nurse.
Age 21-30, vigorous, well-formed and of robust constitution with no taint of consumption, must have amiable disposition etc etc.
The wet-nurse "also has the propensity to derange the order of the nursery" so care must be taken to assign her place and duties whilst not looking on her as a "living dairy".
There's a helpful recipe for purgative biscuits but first go pick your jalap.
The formulary of over the counter medicines for babies would now be locked in the controlled drugs cabinet, accounted for daily by two people and an official record signed to that effect with witnesses.The truth was however starting to dawn and there are dire warnings.
Syrup of Poppies is "nothing more than a decoction of poppy-heads"
Mrs Winslow's Soothing Syrup (trade name Quietness)
Godfrey's Cordial - a mixture of infusion of sassafras, treacle and tincture of opium (56 deaths recorded)
One druggist in Manchester states "I sell in retail about 5 gallons per week of Quietness and half a gallon of Godfrey, the former preparation so strong as to contain 100 drops of laudanum in an ounce".
Some handy advice on leeches, when, where and how, and I think I could sort out a poultice too. If properly made "you might throw it up to the ceiling and it would come down again without falling in pieces"

Nightingale Nurses

I've always felt duty-bound to keep an eye out for books on the history of nursing and so my recent bout of hyper-Crimea-itis has had me scurrying back to them with a greater interest than usual.
I seem to have inadvertently strayed into the world of medical reading of late and I have to say I do usually try to avoid anything that connects with my working day when it comes to reading for pleasure.
After so many years I feel as if I've given the profession my bone marrow and I need a bit of space from it in my "other" life.
But try as you may it's inevitable, in the end one life informs the other and you can never quite take off that metaphorical starched cap and apron when you analyse something.
Here's the Staff Nurse pic again for those who missed it last time round...no laughing at the hat.
I was probably one of the last generation of nurses to be trained along Nightingale lines with a formality and discipline that has long since disappeared. Preliminary Training School (PTS) felt like an initiation, a rite of passage into this strange world that you were going to live and breath day and night for the next four years and you felt honoured to be part of it.
We were broken in gently and all 40 of us were billeted together in a large house, Rosslyn Lodge in Belsize Park, and travelled into the Gt Ormond St School of Nursing daily for those first 6 weeks.The object was for us to bond as a group and make friendships which would become our support networks and we did. 35 year reunion coming up this year.
You did have to polish your shoes, your hair did have to be off your collar and you did wash your hands so many times a day that they really were raw.Thermometers had mercury in them, babies all wore towelling nappies and bottles were sterilised in Milton.
Reading about the nurses in the Crimea you realise that drunkeness and debauchery were the biggest problems that Flo faced in disciplining her staff and despite chronic shortages she regularly dismissed and sent home the women who fell short of the mark. No wonder draconian training measures were required and I think they were still in place in 1972 though we'd probably learnt how to keep our drunkeness and debauchery a secret.
Ward Sisters were fearsome and you were terrified of them, as for Night Sisters...well I'm sure I've mentioned The Big Bruiser here before.Great Ormond Street counted many of the Nightingale school among its number, yet all of them were utterly dedicated to the profession, the hospital, the children and ultimately to their student nurses.
They knew exactly how to get the highest standard of nursing care out of us and sloppy habits (how we loved our sloppy habits) were just driven out of existence; humiliation worked a treat and it became pointless not to do a job properly first time.Always the first thing that was pointed out to you was that you had somehow endangered a child's life in the process. Even down to touching a swing door to open it, never touch a swing door, you push it with your backside...

"Gather round everyone, this nurse will now list the bacteria she may have left on that door with her hands?"

"Thank you Nurse...now would you like to spell them for us?

We learnt to work to the highest of standards and it has stuck through years out in the community, though I have trained myself not to reverse through every door I go through.I can also spell staphylococcus aureus on a good day and pseudomonas aeruginosa when I want to show off.
The moment of truth was when you had to go in to Sister and collect your report at the end of each 12 week ward placement. My worst ever ward, 12 weeks of pure, unadulterated misery, day and night and a harridan of a Sister who I thought hated my very being.I was expecting a drubbing.
How wrong can you be? She gave me an A and actually asked me to go back and be her Staff Nurse.I was so flattered and taken aback I almost accepted, then I saw sense...er that's very kind but no thank you.

The Ides of March

A giant post for the Ides of March and this is a strange week for me to choose to read a book about cancer and then write about it, but in a way I think it chose me.
This time of year, and today especially, my thoughts always return to my only brother who died of leukaemia at the age of 24 on Saturday March 15th 1975 at The Royal Marsden Hospital at Sutton in Surrey. He'd only been married 3 weeks when he was diagnosed and his death was the saddest time imaginable for us as a family after living through his 18 months of hugely experimental treatments.
I was just 21 and also a student nurse but I learnt some enormous lessons about cancer at an age when it was going to affect me for life one way or another. I had to find positives and one of those was that the big C word and death itself would hold no taboos.
This book arrived, I opened it and I couldn't stop reading, then I went back to the beginning and read the first few chapters again. Dina Rabinovitch has written a very,very different book about breast cancer and despite the fact that she was told the book world was flooded with breast cancer memoirs, I'm not sure it's flooded with memoirs quite like Take Off Your Party Dress..
Most of the books on the subject feel duty bound to offer the complete ending...
I've been in remission for 5 years, I've had the all-clear, perhaps I'm cured and we all feel happy and relieved to read that.
Someone needed to write that this is not always what happens.
Dina hasn't been able to offer quite such an upbeat conclusion because she has had a recurrence and is still in mid-treatment but she has learnt and shares much wisdom.In her own words "Living with cancer as opposed to dying from it".
Yes, cancer can mean death before you really fancied the idea, but so too can heart disease and countless other ailments, often more so, but somehow they don't hold the same fear and terror that cancer does.
We need to redefine our interpretation and our assumptions about a disease that is responding with ever-better outcomes, may never be cured, but is now becoming increasingly manageable and controllable.
Life goes on for Dina and her family, albeit differently (lots of takeaways) but it goes on whilst she undergoes chemotherapy, surgery, school assemblies, radiotherapy, interviews with Madonna, drug trials with Herceptin, and much more besides.You hit the highs and the lows alongside her but somehow this exceptionally readable book never drags you down or leaves you feeling depressed.
There is an indomitable spirit addressing the seemingly ordinary but actually the things that would matter to me too, important issues, how on earth do you find the clothes, what about the hair, the prosthesis, the swimsuit but there's also an underlying loss that anyone who has ever been seriously ill will readily identify with.
That insidious depletion of your own carefully gathered inner resources, the rational baselines from which you assess your own health; basically you lose the health plot and a strange and disease-induced state of hypochondria beckons, an inability to rationalise even the most innocent symptoms because often they could actually be quite serious symptoms.That balance is something that most of us take for granted and you don't realise you have it until it is taken away.
It's very difficult to get that back.
Plenty of salutory reminders in this book for all health professionals, the throw-away remark that can cause untold anxiety, the rushed consultation, the tone of voice, the mis-timed facial expression, the unreturned phone call.I keep saying it, I've worked with GP's for 30 years or more now and I think it never does them or us an ounce of harm to be reminded of just how wrong we can get it and we would be stupidly arrogant not to take note.It is indefensible to misuse the power that being on the prescribing side of the desk gives you.
Dina is now part of a trial for a new and as yet unlicensed drug here in the UK and therefore at the forefront of evidence-based medical research without which we go nowhere these days.
If you read this book, and I hope plenty of people do and whether this subject affects you directly or not, you will come away from it with a true and honest account of what it means to be diagnosed and treated for breast cancer right now and with that knowledge comes understanding. For starters you will know exactly what and what not to say to the next woman you meet who has it and that has to be a good thing.
I'm also completely behind someone who fundraises without putting on running shoes and doing a marathon (though hats off to those of you that do it, I'm just a lover of the armchair and a good book as you know so you all make me feel terribly guilty) and you can see just how Dina's doing it here.

Ion, Alan, the diaries and Brentor

It was my great pleasure to meet Ion Trewin at the Long Barn Books editorial board meeting last week and also of course to do my usual and ask in the politest possible way " who are you?".
When you've lived down in the back-end of Devon for 30 years or so you circulate in rather narrow circles even if they are in the nation's most unspoiled market town (though according to this the dog walkers have a problem) so this new world is all very exciting but I do have to ask the most obvious of questions.
Susan has done a wonderful resume of Ion's publishing background over on her blog but I was particularly interested to discover that he also edited Alan Clark's diaries.
I do at least know who Alan Clark was.
Son of historian Kenneth Clark, eminent politician, MP for Plymouth (Sutton) from 1974-1992, frequently a Minister of State and of course a keeper of a diary for almost 45 years.
How many times have I passed these diaries by?
But now with good reason to explore them Volume 3 arrived first, so it's been Alan - A Life Backwards as I've started with his ending.This volume The Last Diaries : In and Out of the Wilderness makes for poignant reading,especially with my nurse's hat on and an honours degree in hindsight. Alan, famous hypochondriac that he was, yet clear as a text book, catalogues the gradual onset of all the signs and symptoms of his final diagnosis, a massive brain tumour.All this long before it is detected and then amazingly only 3 months before he died.
Perhaps a man who presented so many symptoms and ailments to his doctors it was all like that radar chaff that diverts the attention from the target.He must have been a difficult patient to assess thoroughly and objectively.
I had been unaware that Alan Clark lived for some time at Bratton Clovelly, what is it about Bratton?  James Hewitt, notorious "friend" of the late Diana, Princess of Wales lived there.
It's also regular health visiting territory for my team so we all drive those lanes a great deal.
The diary reveals that Alan Clark would often stop at Brentor Church on his way there. Another surprise was that he was a devout and god-fearing man who actually stopped here to pray.
Brentor Church is one of those striking, rocky-outcrop landmarks you take completely for granted when you live here. I drive past it several times a week.
Years ago it was one of our great places to take three energetic children togged up in puddle suits and a collie dog in tow on a wet and windy afternoon in that dread hour before tea, bath and bed.Nice steep but safe enough climbing, wind to take your breath away and this exquisite miniature church at the top to go into and dry off and probably annoy people like Alan Clark.

Stunning views across to Plymouth Sound and Whitsand Bay in the distance.
St Michael de Rupe is still a "working" church for the summer months.
We'll venture up to the top any day soon and take some pictures of the 4th smallest parish church in England, a mere 37ft long by 14ft 6" wide.There's a churchyard and graves up there and it is still used for the occasional wedding.
Meanwhile I've made grand progress with Alan, a Life Backwards.Volume Two Into Politics has just arrived, and I will now eagerly anticipate Ion Trewin's biography of this unusual and fascinating man hopefully for publication in 2008.
Read the diaries and you definitely want to know more.

Made for Laughter -Reading the Doctor's writing

Leading the "Reading the Doctor's Writing" trail, it's been quite a few years since I read Dr Sheila Cassidy's books Audacity to Believe and Sharing the Darkness but I was inspired so to do after hearing her speak at several study days and courses.
So I was delighted when some off-blog correspondence with Philippa (who often comments here and on the Hill Blog) came up with an offer of Sheila's latest book Made For Laughter.
We agreed on one of those lovely book swaps and Philippa requested On Being ill by Virginia Woolf which seemed like an appropriate exchange.
Sheila Cassidy is best known as the young doctor who was imprisoned and tortured under the Pinochet regime in Chile for treating a wounded revolutionary and all this is recounted in gripping detail in this book.
On her return to the UK Sheila eventually settled in Plymouth, here in the West Country, and has since spear-headed the development and continuation of the hospice and palliative care services for this area.
Just how much I was quite unaware until I read this book which once opened I couldn't put down.
I'm not a great lover of autobiography, always that uncertainty about whether I'm really reading a warts and all account.
You instantly know this one is different.
I get the feeling that Sheila Cassidy tells it exactly like it was and this book is just riven with a transparent honesty laced with genuine humility about problems,personal failings and struggles and plenty of mea culpa as she recounts her life to date.
As the blurb says, this book is "a story of grace under pressure" and much that speaks from the heart and to the heart of anyone who reads it.Sheila's journey of faith is well documented and there's something quite uplifting about hearing that she has eschewed organised religion and all its trappings in favour of her own daily and constant acknowledgement of her beliefs.
For many years unknowingly on the run from the post-traumatic effects of her harrowing torture in Chile,  Sheila eventually had to sit down and face up to it all.It's that old millstone round the neck thing.The suitcase with contents bulging out of the sides and the traveller sitting on the lid trying desperately and to no avail to close it, eventually it becomes a pointless exercise.Suddenly the time is right and the whole lot can be taken out, washed, repaired, ironed, folded and put back in neatly.
Amazingly the lid will often then shut quite easily and stay shut.
Now in her late 60's, retired from front-line medical practice but maintaining her role as a psycho-therapist, Sheila now finds herself in new and richly deserved territory
"I don't remember being so well or so happy for a very long time...happy and peaceful in my heart"
this after her own recent and very ironic encounter with breast cancer.
I'm pleased to report that she rates knitting amongst her relaxing occupations alongside watching The Bill and Casualty.I do hope she's turned a heel.
All I can say is read this one for the story of a unique and very remarkable woman who has unstintingly left a large and very generous footprint on life for which many people, both knowingly and unknowingly, will be extremely thankful for many years to come.

Interlude

I think I've mentioned before that, on my working days, I share a large office with the local District Nursing team.There are four of them and one of me and they are now called Community Nurses and there is a clear demarcation boundary in the room.
My side is the happy health visitor side and, apart from my work station and drawers of records, it's full of toyboxes and nice pictures of Bob the Builder and Balamory, Charlie and Lola books and my baby changing area and scales.Mobiles for babies to look at, a nice clock with a bee that buzzes around, Bookstart packs and little table and chairs and all the toys I use for developmental checks and things.
It's lovely, a sort of warm welcoming, relaxing child-friendly zone.
The other side of the room is terrible, there's no getting away from it.
Therein rest unwelcome daily reminders of what may be in store,as if you needed reminding but I'm going to tell you anyway.Incontinence pads prevail, then there's catheters and leg bandages and dressings and ...no, enough, I can't go on.
As if the visuals weren't enough, marginally more taxing are the nurse's phone conversations because there's no getting away from it, the elderly are rightly very exercised about their bowels.
They are usually hard of hearing too so the conversations are high decible and inescapable.
It would seem that if you put the Hogwarts sorting hat on these poor patients they fall between two stools  houses, they've either got the slytherins or the hufflepuffs and it all causes a great deal of distress.(on reflection, JKR might not like that comparison, please don't tell)
Today it was all enough to bring on a bout of the voldemorts and so I took my lunch up to a very young and sprightly 81 year old Tinker, we got out some old photos, fell about laughing at pictures of me in a mini-skirt and didn't talk about bowels once that I can recall.

Cancer Vixen- Marisa Acocella Marchetto

I can't wait a minute longer to tell you about this book and you don't even know I've bought it until tomorrow's confessions.
Cancer Vixen by Marisa Acocella Marchetto has arrived in Devon and was the next book of the year to become an open and don't shut until finished case.Like all graphic novels it will bear a zillion re-reads because there is so much to miss each time and so many new things to notice.
Marisa is the self-confessed fashionista and cartoonist with The New Yorker and it must have been almost instinctive for her to record events as a cancer vixen rather than victim through her pen. The result is one of the best books you could ever wish to read on the subject of breast cancer but probably holds principles that could apply to any form of the disease.
This was never meant to happen to Marisa especially as she had let her health insurance lapse.The discovery of the lump comes just three weeks before her wedding to Silvano Marchetto owner of DaSilvano's which sounds like New York's answer to The Ivy in London, probably and not that I'd know.
On the subject of cost, continue to light a candle at every opportunity for the parlous state of health and wellbeing of our beleagured NHS because Marisa's final bill, eventually mostly covered on Silvano's insurance after they married, was $192,720.04
But what this book gives you is one of the most unique rides through this disease that you are ever likely to find. A serious subject dealt with in comic book format.Marisa took a tape recorder and a camera along to all her appointments translating the results into her distinctive cartoon style.
The outcome is an emotional as well as a factual account of what to expect, but it's all done with wondrous honesty and humour.
I always thought I was probably the only woman who had stood in the squashogram machine wondering why on earth men didn't have this done to bits of their anatomy? Well I'm not because Marisa thinks just the same and I suspect that throughout this book there will be moments for any woman to identify with.
Underlying it all is Silvano's love for Marisa and some very funny episodes when the 'it' girls make a play for him in the restaurant; he feeds their calling cards to the dog so they probably had vet's bills to pay too.
Another key player is Marisa's mother Violetta "the New Jersey version of Sophia Loren" and always plagued by her own ills but when the chips are down Violetta comes good, sitting through all the chemo sessions with Marisa and letting the world and its mother know the day the IV needle threatens to damage her daughter's drawing hand.
What follows is one of the many and frequent "best" moments in the book.
"Mom...?"
"Yes, Hon"
"YOU HAVE A SAY-IT-BEFORE-YOU-THINK-IT-TACTLESS-UNDIPLOMATIC
-BIG-FAT-SAGITTARIAN-MOUTH"
...and I love it"

Marisa, I love it all too and you can all perhaps see why when you read some extracts from the book here.
I was fortunate in the early days of my health visiting career to attend a course on palliative care run by the remarkable Dr Sheila Cassidy.The sessions opened quite dramatically with Sheila's own hand drawn cartoons depicting a woman discovering she had a breast lump.The impact of those pictures remains with me.
This book now joins those images.
I'm tempted to go into the surgery on Monday and quietly dump all those breast cancer "Help Yourself" books from the patient's library (eat tofu and feel better) and put copies of Cancer Vixen out instead, far more helpful and life-affirming.

Medical Humanities

I belong to several Medical Humanities mailing lists which is a lesser known subject that makes for a potentially useful though little used combination of those rather daft letters after my name, RGN (Registered General Nurse) RSCN (Registered Sick Children's Nurse) RHV (Registered Health Visitor)These earn the money to enjoy the pure unadulterated pleasure I have had from the BA (Hons) Literature.
Usually the list messages just induce a state of envy about a conference in the US that I'd love to go to but can't. Calls for papers come in and occasionally something of real interest.
With the current state of finances in the NHS Medical Humanities would seem to be struggling to maintain its profile as a discipline and there's a few thousand words here attempting to defend it.Must all surely be coming under microscopic funding scrutiny right now. Lose it I suspect at our peril if we focus entirely on medicine as a clinical discipline that neglects the simple fact that we are all thinking, feeling people with a narrative of our own that deserves to be listened to and can really have a huge impact when illness comes along.
There's a highly recommended book on that subject, The Wounded Storyteller by Arthur Frank I've heard him speak and he is a remarkable man.
This call for papers is for a conference this year in Pennsylvania. I'll never write the paper and doubt I'll be able to put a trip to the US on my monthly mileage sheet (33.5p per mile if I could drive it) but often these ideas can really wake up my reading and this one has done just that, it gets a bit techno-academic towards the end but the gist has really got the antennae waving.
This panel will explore representations of the nurse in literature, film,
and/or television and the relation of those representations to the status
of nurses professionally and socially.  Papers might contextualize classic
images of the nurse such as found in Edith Wharton's *The Fruit of the
Tree* or Milos Forman's *One Flew Over the Cuckoo's Nest* or they might
address representations that challenge existing stereotypes, such as the
male nurses found in *Magnolia* and *Angels in America*; they could address
nineteenth-century ideologies of nursing evolving in the writing of
Dickens, Nightingale, or Alcott, or they might discuss contemporary
representations of nursing as found on television programs like *ER* and
*Scrubs*.  All papers should work toward unpacking the ideologies of
nursing, interwoven with broader gender issues and constructs, as a means
of informing current concerns about the profession, such as nurses'
continued subordination in the medical hierarchy, the shortage of nurses,
and issues around nursing and immigration, all related to the conference's
theme of "health, medicine, and inequality."  Proposals are welcome from
those with a clinical background as well as training in literary studies.
Buried in there is a message to me about an author I've been meaning to revisit for ages and as Louisa May Alcott obviously had something to say on the subject she must be added to yesterday's list of US women writers I shall be reading in 2007.

Bugs are us

You'd think there might be obvious advantages to working in a doctor's surgery.
Appointments at your behest, flu jabs for all your family and friends plus dogs and cats, quick ECG when you feel a bit of a palpitation, blood test when you feel a bit anaemic, consultant referrals in a nano second, diagnosis of your ailment and a prescription over coffee but of course none of this happens.We are not allowed to register with the General Practice we work with so despite knowing you could have the best doctors in the town sorting you out, you actually have to go and queue up like everyone else somewhere else.No preferential treatment for this NHS worker.
So in fact there are often more disadvantages to working in this germ and bacteria-laden environment. You tend to build up a cast iron immune system, but just occasionally draw breath through a packed spluttering and coughing waiting room and that droplet infection is yours for the asking.
So this week I am not good news.
I take the line I wish many others would in the crowded workplace wherever that may be and STAY AT HOME if at all possible.Doesn't your heart sink when the martyr walks into the office to tell you they've been up all night being sick? Or sits there dripping throughout the day with the tissues to hand?
If you need permission to be kind to yourself here's one good reason.It's now increasingly recognized that to ignore the call of the duvet when ill could be tantamount to requesting a bout of post-viral syndrome if you are susceptible.Your brain is actually giving your body some very sage advice which it wants you to heed.
I decided no one would want to share my bugs in the week before Christmas and I do have the added incentive of having to be especially considerate to my newborn population.
So dosed up and warm I shall sit it out through the throat, onto the nose (that's today) and then the cough in all its glory.
The dosing has proved difficult, like most well organised nurses the medicine cabinet was bare but for some Beechams Flu Powders which looked suspiciously like a wrapped packet of a controlled substance, but one that went out of date about 2 years ago.I spent a while deciding whether it may have bio-degraded into Polonium 210 and eventually decided probably not.

Charlie and Lola very really absolutely do rule OK?

Very occasionally I write about work but rest assured, you can be sure it'll involve a book eventually.
I now find myself rather worryingly in my 30th year as a trained Health Visitor having entered the profession precociously early at the age of 8 you understand.
It's even longer since we were The Ladies Sanitary Inspectors and in fact I've had cause to fail in recognizing a picture of a head louse this week because it's so long since I've met one.
30 years is a long time to be doing developmental checks on children and this week was no different with battalions of two year olds. I love two year olds especially other people's.
It will come as no surprise either to know that I use books extensively.
I hand out the free Bookstart packs which the children love and which are about encouraging parents and children to share books, join the library and generally be at ease with books pre-school.They have also proved very succesful in getting stroppy toddlers out of the office without a tantrum about leaving the toys behind, little faces light up with glee as they proudly carry out their book bags.
Incidentally, great to see that Wendy Cooling has just won The Eleanor Farjeon award for establishing Bookstart, amongst her other excellent contributions to the world of children's literature.
I also keep a ready heap of children's books on my desk. Apart from the fact that they cheer me up on a dismal day, these are good  to flick through when an inquisitive child finally sidles up and starts to interact with me on their own terms, I am a stranger to them after all.
Books give us something to talk to and I quickly get a good idea about language and comprehension from a child who would invariably have stayed mute had I actually asked them to talk to me.
Also, is this a child who is familiar with books? They will need to be when they go into school and many families need a lot of gentle, tactful and careful help accessing books per se. For some people this is not confident territory at all but you can be sure that most children will have watched TV.
Every so often I have to up my game and replenish my stock with more up to the minute childen's fare. I don't get to watch children's TV much but I do follow the crazes and Offspringette (until now)has always kept me in touch with the latest series she is editing or tech reviewing or dubbing into Gaelic.Dotted around my room is old evidence of Teletubbies, Bob The Builder, Balamory,The Tweenies et al but it's an ever-changing world and now I have new friends, Charlie and Lola really very absolutely do rule.
Most of the fads I go along with out of the necessity of finding common and familiar ground but I can't say I actually adored Bob the Builder .But I do love Charlie and Lola, there is something adorable and endearing about patient Charlie and fiesty Lola who knows her own mind and has no problem saying so. How can you not love a little person who lives in the realms of the superlative and declares "I will never not ever eat a tomato" or who insists "I absolutely must do colouring-in now" and with an imaginary friend called Soren Lorenson?

Babies in libraries

One of the many messages to follow up when I got back to my desk last week was one to phone Radio Devon who wanted to interview me about the Baby Massage classes which I do in the local library.
I keep a bit quiet about those on here now because there seems to be so much flak in the air about libraries becoming community centres and creches and branches of specsavers and not all about books and of course I'm a culprit.
The problem is we have nowhere else fit for the purpose in the town that the NHS would advance me the money to rent.I'm in "use it or lose it" territory and the library have saved the day in terms of helping me keep my 'free and open to all' classes going.
So perhaps I'm contributing to the demise of libraries as we know them but all I know is that I have queues of people waiting to join.Nor do we spoil the look or sound of the place for any other users because we're off in a side room and, as it was pointed out to me, we have as much right to use that room as a writer's group or a children's after school club.The classes bring in more new members to the library and help young families access a facility in a roundabout way when they may just not have bothered and the library staff love having us there.
We are starting our library users off very young here in Devon and what's wrong with that?
I pushed the message to the bottom of the tray but I got another one, and another one and so finally today I phoned them so the radio moment will happen.

A day in the life of...

Time to go out and spread joy and happiness so back to my health visitor's desk after 3 weeks holiday and clinging on for dear life to the wonderful literary time I've had and hoping not to see it all dissipate in the first hour.
I thought it all through as I drove the ten miles down into the valley.The radio news was cranking up the annual flu vaccine debacle (wrong stuff on wrong eggs or something) into a crisis and we're all going to die of flu before Christmas and yes the chaos was predictably in full swing as I walked into the surgery.
I'm covering an extra caseload at the minute, GP surgeries far flung and responsibility all told for about 400 children under the age of 5, which is a lot of names and histories to remember.
As I drove I anticipated the things that might spoil my day and determined not to be phased by any of it

• my in tray approaching the ceiling
• my message book running to 10 pages
• my colleague who has been covering for me ringing to tell me of disasters
• messages from social workers
• messages from the police (especially the WPC for Domestic Violence)
• messages from GP's
• first person in to see me has insurmountable problems

Anyway,all of my anticipated's happened in full measure and though the biggest disaster recounted by my colleague was shocking and sickening it is not mine to worry about (this time) but it will mean pressure,turmoil and sleepless nights for others.
What I hadn't anticipated was an office full of books, yes that's right, well Bookstart packs to be exact.This is a government initiative, free books for all children and I have the pleasure of handing out the packs except something has gone seriously amiss with the order. If every woman in the parish were to give birth to quads I would still have spare Bookstart packs.I tripped over and round them all day so I felt quite at home.
I also have a new employer from today.The South West is back where it started 30 or more years ago in terms of NHS organisation but please don't ask me to recall how many changes we have had in that time or how many new central office suites have been set up.I have no idea where mission control is now but doubtless someone will tell me eventually. Meanwhile first instruction, please use Tippex on your photo ID badge to erase the name of the old trust, good positive savings on Day One.
I still have my old name badge from 30 years ago so perhaps I'll just use that, I'm sure I haven't changed a bit.

Babies and Books

A bewildering mountain of books out there on child rearing in all its forms and I do try and keep my finger on the pulse of what's available as I know they are hugely influential in people's lives.
I keep a shelf of books in my office to lend out and also have a bevvy of reading mums and dads who will read and feedback on a book for me and tell me how relevant it feels to their situation. There's little point in me recommending Elizabeth Pantley's The No Cry Sleep Solution when I have just emerged blinking into the new dawn that is getting your offspring to the other side of teenage-dom. I'm still looking for the Should They Be In the Recovery Position Because They are Drunk? Sleep Solution and as I haven't found it yet I may have to write it myself.
There are just a few books that I feel should come with the baby and I know have survived the test of many loans. These are the ones I have to track down and beg to have back, here's the first and the 6 copies of this are rarely back on my shelves
The Social Baby - Understanding Babies' Communication From Birth Lynne Murray and Liz Andrews (ISBN 1903275016)
I love everything about this book, in fact I think it makes a lovely gift for a new baby and a change from the obligatory expensive outfit that fits for about a month.Why do we always buy babies designer outfits? The whole thing is so stressful, babies are being dressed 6 times a day to get them all worn in rotation.
This book remains one of the least judgemental, least guilt inducing baby books that I have read. There are no right and wrong ways of approaching this baby lark and a clear and beautifully illustrated message that all babies are different.It's all about watching your baby and deciphering which traits your little person has, seeing what those are telling you, and being amazed at just how much they can tell you in the first few months.
There is a great website too www.socialbaby.com
It's a book that is accessible across the range of families that I work with and is loved by the young mums and dads as much as the older ones (no I'm not going to say elderly primips) everyone is able to glean something special from its pages.

Treasure Basket Tuesday.

Baby Massage ends and I set up for a session on Treasure Baskets for the 5-7month old babies and their parents.
Treasure Baskets were the brainchild of Elinor Goldschmied, a child psychologist who researched what we have all known for years.The excitement and learning potential for toys has melted away with the advent of modern materials, rigid safety standards that require a toy to be safe for a baby to be left alone with, and a general fear about letting anything remotely unusual near a baby's mouth.
In the process we have lost sight of one very important detail; a  6 month old baby has gargantuan concentration skills all cleverly bound by the limitations of their development.Once they can sit, reach out, pick up and put things in their mouths and swap from one hand to the other, that is what they love to do to the exclusion of much else.They are not yet ready to explore their surroundings, what's in front of them is interesting enough.
Now here's an experiment for you, the next time you see a baby playing with a plastic toy, pull rank and take it off them.If they are only 6 months old they won't mind, now suck it and see...revolting eh? What does the plastic taste of ? What does it smell like ? Is it hot or cold or neither ? Is it heavy or light ? What does it tell your senses ? Does it make noises without needing a battery ? The chances are it cost a lot of money and a baby will tire of it quickly.Now act your age and give it back.

A Treasure Basket in contrast is a stable, low rimmed cornucopia of inexpensive delights and easily accumulated at virtually no cost from around the home. Brushes, silk scarves, large pebbles, fir cones, shells, sponges, lemons, an egg whisk, some bells, a ball, boxes that rattle, metal dishes, wooden spoons, heavy things, light things, cold things, smelly things, the list is endless and as long as I can't swallow it and it's not sharp or deadly poisonous, in it goes.
I give the parents the chance to take out anything that really would set their teeth on edge and we then seat 4 babies around each basket and sit back and watch them make the choices.
Everything happens in unreal,slow and ponderous time.Their grasp is not mature enough for speed nor are they strong enough to do damage. Better still, nor at this age have they acquired the warlike fighting skills of the toddler so they will happily allow another baby to reach out and take something off them.There is always a little hunter-gatherer in the mix who will accumulate and we just gently slide some things back in the basket but the chances are we will all still be sitting watching the completely engrossed babies 45 minutes later. Soon the world will be a much bigger place and they will be off , but for those few months between sitting and crawling there is much to discover and a little window of time too precious to waste.
Of course a baby must never be left alone with a Treasure Basket and actually the whole point is that you sit and watch them exploring and developing all their five senses, I know we all grew up beating nine bells out of saucepans with wooden spoons but that's a lost art these days.
Thinking about it, what a wonderful and unusual gift a Treasure Basket would make for a baby near you.Better still if you know someone with twins, triplets or quads I should think they would bless the day you walked in the door with it.

I love Tuesdays

Right now I love Tuesdays. This has probably not always been the case but at the moment and hopefully for the foreseeable future I will wake up on a Tuesday and think "Oh good, I have to go to work today".
There are pros and cons to every job and health visiting is often weighted in the 'cons' department with a daily desperate search for some 'pros' to balance it all out.
On Tuesdays however it is the best job in the world. I get dressed in comfortable, cool clothes (as in not too hot, not necessarily cool as in Boden catalogue, I need to be very washable) because I will spend the morning sitting on the floor.
Tuesday is Baby Massage and Treasure Basket Day.Better still, as if it wasn't good enough, I do the classes in the library.
I trained and qualified as an Infant Massage teacher 4 years ago and must have seen hundreds of parents and babies through my classes since. I've managed to argue successfully and from an evidence-based research point of view (don't try doing anything innovative in the NHS today without hoping that someone has researched it first) that these free classes should be an intrinsic part of my day to day work and it's not difficult to see why. The list of benefits is endless.         

Even the tetchiest of babies and the most stressed parents settle into the calm, relaxing atmosphere of a class.A clean, warm, carpeted room, comfortable bean bags, cool drinks and low lighting and then the simplest thing, you tell them it doesn't matter if their baby cries, in fact they probably will and the room visibly sags with relief and off we go. A gentle mix of Indian and Swedish massage and some reflexology and the babies positively purr.I have a favourite moment in the proceedings, if you stroke the sole of a baby's foot from the toes to the heel, you elicit a primitive reflex called the Babinski, it's pure magic to watch a room full of  perfect little toes perk up.
Too much excitement for one blog, I'll save Treasure Baskets for next Tuesday.

 

Visit to Nova Scotia: The Birth House by Ami McKay

Well I've spent a glorious weekend in the garden Canadian Maritime Provinces and grateful thanks to British Airways Ami McKay for the privilege of becoming so well acquainted with North Mountain and Scots Bay, Nova Scotia.
I have read The Birth House from start to finish and loved every word.

Set in an isolated and closeknit seafaring community on the Bay of Fundy and against the backdrop of a remote and distant Great War, Dora Rare finds herself the only daughter born to five generations of the Rare family and apprenticed to Miss Babineau the local midwife.Miss B's methods are steeped in folk lore and herbal remedies and a vast amount of innate sensitivity to the needs of the women who seek her help as they give birth. Modernisation and exact medical science is around the corner in the shape of the rather worrying Dr Thomas with his collection of  forceps, scissors, needles, bottles of ether and interesting battery powered remedies for women with neurasthenia.Needless to say the two cultures collide and the women have to decide whether to hand over their care to medical science or remain confident in their own abilities to birth naturally.It's tricky as clearly some of Dr Thomas's aids are more helpful than others!
Ami McKay writes beautifully haunting and evocative descriptions of location; sentences that you read two, three times because they are just full of magical prose and creates a cast of memorable characters who give credence to the sense of value of a quietly powerful and close knit community of women.It's also a foregone conclusion that I'm going to bond with any book that comes up with the idea of The Occasional Knitting Society where the women knit what else but socks.Perhaps you feel more at one with a book that is so in tune with your own thinking and the world you have worked in for so long, but that apart for me this book had everything.
Much as Annie Proulx's The Shipping News had me almost booking a passage to Newfoundland so this book draws you to Nova Scotia with of course the promise of a quick hop to Prince Edward Island and the chance to check out Green Gables.
For publication here in the UK in August, this book is likely to gently rekindle the debate about reconnecting and being confident with the innate ability of women to give birth, home births and choices and empowerment for women in childbirth, and at what point should birth become a medical event and that is always to be welcomed. We like to think we are getting it right but so often we don't and it does us no harm to be reminded of the fact.
As a health visitor I often have to pick up the pieces of a frighteningly technical hospital birth experience.Sometimes these are inevitable and essential in an emergency but precious early months with the joy of a new baby can be lost as women try to work through the equivalent of full blown post-traumatic stress disorder.
On a note of great blogendipity my trawl around to shamelessly flog my blog put me back in contact with another student nurse friend from the Great Ormond Street set of October 72. Mary Who (forever so called because then she had a delightful double barreled name that you never quite remembered first time round) e mailed me from her home in Vancouver and check out what she's up to now at her website Cowichan Birthwise.

Sunday Confessions

Such a sin free book buying week it's hardly worth getting down on my knees to confess to it.
Medical Women and Victorian Fiction was too tempting to resist and Good Girls Make Good Wives: Guidance for Girls in Victorian Fiction a charity shop find.
All sitting on my lifesaving writing slope. The bookhound bought me this after it was clear that my recent six month bout of excruciatingly eye wateringly painful brachial plexus neuritis was going to leave me with an ongoing "looking down whilst holding my arms out" problem.
If you write a lot or even a little and haven't tried one of these don't wait for the BPN, get one anyway, your neck will thank you.
I will blog about all this eventually but it has been an eye opener to find myself sampling the authentic NHS patient experience when I'm usually on the other side of the couch. I have some tips for you all and am tempted to say cut to the chase and head for the vets but that would be disloyal and I go back to work on Tuesday so I shall be one of them again.
My first word of advice is for any health professional who drops by here.
When faced with a whimpering, sleep deprived, clearly distressed patient never ever shrug and say "let's gIve it another week or so".