debut Posts

Sarah Moon’s “Sparrow”

And then there it is, our new, terrible silent routine. And to top it off, I have no birds and the world feels like a different kind of dark than it felt before. Mom isn’t perfect, but I miss her. I miss her picky neatness, I miss her bothering me about taking my nose out of a book and making a friend for once, I miss her getting on my case about my hair. I miss telling her about what I’m reading, what I’m thinking, asking her about work, listening to her carry on about Aunt Joan and whatever drama she’s gotten into. I miss her. There is a sadness I can’t shake, that’s not just from breakfast. There are no birds by the feeder. There aren’t pigeons cluttering the sidewalk as I go to school. I know, now, that last night’s dream was the last flight I’ll take. 

Sarah Moon‘s debut novel for young adults Sparrow is about a teenager of the same name who has a nervous breakdown. Sparrow is fourteen. She was whisked away to hospital from school after being discovered on the roof. Sparrow maintains she was bird watching as she has always been fascinated them fly. Sparrow lives with her mother, who is a single parent. Sparrow is named after the bird by her mother because she was “so small and brown, almost breakable, but so strong. Tiny but mighty…”. Few weeks later Sparrow is released in her mother’s care with the stipulation she takes her prescribed medication and visits a therapist regularly. So it is fixed that Sparrow attends regular sessions with Dr. Katz which are protected by doctor-patient confidentiality and even Sparrow’s mother cannot sit in upon the hour-long meetings. At first Sparrow refuses to speak to Dr. Katz but after weeks of therapy Sparrow begins to come around. It is probably listening to Dr. Katz playlist which begins to break the barriers for Sparrow. So much so she orders the very same songs/bands she heard during therapy for her listening pleasure at home. All through months of treatment and close questioning by her mother Sparrow is adamant that she was not trying to kill herself but just wanted to be with the birds. Probable reason for her being found alone on the roof ledge was she was devastated upon hearing of the tragic death of her favourite librarian, Mrs Wexler, in a traffic accident. Mrs. Wexler had been warm and welcoming to the shy and reserved Sparrow, encouraging the little girl to sit in the library any time she felt like it, read, participate in the book club etc. Mrs. Wexler offered the fragile little Sparrow a refuge from a world which constantly overwhelmed her.

Sparrow begins from the moment Sparrow is released from the hospital. She is portrayed as a very lonely girl who slowly opens out under Dr Katz’s patient guidance. By the end of the novel Sparrow finds the smallest steps like conversing with other girls of her age still a daunting task but at least she is doing it! It suddenly dawns upon her during the finale when she is running away from her responsibility that the feeling of being ready will never come. She has to muster courage. “I am not going to be ready. I’m going  to have to do this without being ready.” The ultimate epiphany is that the very same music that helped her in therapy is where she finally gets what she has been craving for — to fly away, for her limbs to go light. In fact Sarah Moon created her playlist for Sparrow on Spotify. In it are listed all the pieces of music referenced in the story.

Depression comes in many shades. With the recent suicides of two prominent people Kate Spade and Anthony Bourdain within a week of each other has suddenly put the spotlight on mental health. These issues were always there and always discussed but the magnitude of this problem is unthinkable. To quote Dr Anirudh Kala, Clinical Director, Mind Plus:

Clinical depression is the commonest mental illness and it is true that life time prevalence of depression(which means how many people at one time or the other during their life time will suffer from it) is about 18-20% and many times it just comes out of the blue without any stress like any medical illness which Clinical Depression  actually is a medical illness. Both drugs and psychological treatment methods help and these help the best when used together.
However many well meaning but ill informed persons and some pop psychologists keep telling the person that the key to getting matter is to feel positive implying that the patient can if he willed to feel positive and get better, which is not true. You cannot will away your depression like you cannot will away your fever or your thyroid problem. And it makes the person worse because because he is told he can and he cant’. That is why the quip,’ Positivity is a scam.’
( In fact Dr Kala is also a debut author with his forthcoming collection of short stories The Unsafe Asylum: Stories of Partition and Madness)

In Longreads essay “Surviving Depression” by Danielle Tcholakian written after the deaths of the Bourdain and Spade one of the sanest pieces of advice shared for those who battle depression every day as well as those around them is:

…the biggest lesson I’ve learned in wrestling with this illness for nearly 20 years. You can’t get out of it alone. It is also, confusingly, true that no one can save you — you’re always the one who has to do the work, who has to slog through the muddy darkness — but the eminently human kindnesses of friends and family along the way are what make the slog even remotely possible. And the truth is, you don’t have to do much of anything most of the time. Just be there. . . . Depression is a beast that swallows you whole and forces you to live inside it until you fight your way out — always with help, always with the others safely outside the beast who can pull you back. 

Writing about a teenager whose mental health is being questioned by everyone around her even though the teenager herself is under the impression that her reality makes perfect sense is probably not easy. Yet Sarah Moon’s undeniable wizardry is evident in her sensitive storytelling. Sparrow can be challenging even for an experienced author to create as it is a potential minefield if not handled well. It can fall apart easily. After Nathan Filer’s The Shock of Fall this is another great young adult novel to add to a school reading list. Perhaps to be read in conjunction with Matt Haig’s Reasons to Stay Alive which is not a young adult novel, nevertheless an excellent memoir about coming-to-terms with depression and easily accessible to readers of all ages.

Do read Sparrow. It is not always easy to read for it can be a challenge to read but it is time well spent.

Sarah Moon Sparrow Arthur A. Levine Books, An imprint of Scholastic Inc., New York, 2017. Hb. pp. 270 

21 June 2018

 

 

 

Siddhesh Inamdar’s “The Story of a Long-Distance Marriage”

Instead of muddling up so many things in your head, why can’t you simply be with me? Here. In the moment. 

Siddhesh Inamdar’s debut novel The Story of a Long-Distance Marriage is about a young couple, Rohan and Ira. They have been married for a while but have known each other since they were students. Now they are feeling the strain of living apart from each other as Ira is studying in New York and Rohan continues to work in Delhi.

The Story of a Long-Distance Marriage is light fiction where the anxiety felt by the lonely husband about his marriage is compassionately presented. The wife’s point of view is equally sharply sketched even though the reader inhabits Rohan’s mind more than that of Ira. Despite being physically absent from Delhi for large parts of the story it is Ira’s character that comes across far more strongly than Rohan.

It is a simple, often to-be-found tale among young Indian middle class couples and yet there is something rather lovely in the way The Story of a Long-Distance Marriage casts its magic spell. It will be a joy to read what Siddhesh Inamdar spins out next.

Siddhesh Inamdar The Story of a Long-Distance Marriage HarperCollins Publishers, Noida, India, 2018. Pb. pp. 180 Rs 199

19 June 2018 

#Horror

#Horror ( Amazon and Flipkart)  is an anthology of horror stories for middle grade.  It consists of various young writers most of whom debut with their stories. Journalist and writer Siddhartha Sarma is the only writer who has previously won a literary prize too — Crossword Prize for his powerful young adult novel The Grasshopper’s Run. It is a pleasure to see his comeback story “Hive” as the opening short story. It sets the right tenor for the volume with its mildly comic plot and an unexpected twist.

The stories are original with familiar themes of zombies, ghosts, school scenarios etc. ( Vampires are missing!) Some of the writers who stand out are Satadru Mukherjee with his magnificently creepy “Wives’ Tale”. It is going to be a while before I can look at a lizard again without freaking out about the ghosts the reptiles may harbour! Anuj Gupta with his freaky “The Smiling Portrait” nudges the perfectly ordinary into a dark, disturbingly sinister space — its very unsettling! Anukta Ghosh ‘s “The Night Bus” may seem to be a predictable ghost story but in her quietly restrained, elegant writing style, she makes the story magical.

#Horror is undoubtedly a sparkling set of stories with a few experiments in formats too — unusual offering in an otherwise predominantly prose collection. For instance C G Salamander and Upamanyu Bhattacharyya’s short story in graphic format “The Textbook” is unforgettable particularly the last frame. “Eterni-tree”, the long poem in rhyming couplets by Kairavi Bharat Ram is astonishing for how it operates at two levels — one of telling a story pleasantly but at another level, the existence of the chilling undercurrent, is fairly mature storytelling for one so young. Kairavi Bharat Ram is a gap-year student with another publication written while she was still in school — Ramayana in Rhyme.

The well-thought out arrangement of the stories is just as it should be. Beginning with the seasoned writer Siddhartha Sarma and slowly introducing new and strong voices, with the subjects ranging from the familiar to the unusual. Thereby ensuring the young readers are not too taken aback by completely unfamiliar themes. An equal amount of care seems to have been taken with the layout and design. There is a crispness with the speckled look for the double page spread between stories, with an illustration to hint at what is to come.

Many of these stories beg to be read over and over again. The stories have the charming, old-fashioned, languid style of storytelling that absorb one completely from the word go. Adults will love the book too!

#Horror is the perfect introduction to horror stories for middle graders. It is also the launch of a fine new generation of young writers who are going to make their mark in years to come.

Grab #Horror asap!

#Horror Scholastic India, Gurgaon, India. Pb. pp. 120 Rs 299

Reading level: 10+ to young adults 

 

29 May 2018 

“Pashmina” by Nidhi Chanani

Pashmina by Nidhi  Chanani is a graphic novel about a young Indian-American teenager Priyanka, growing up in America, where she lives alone with her mother.  She has plenty of questions about India and her father. Her mother gives her information as and when she feels it necessary otherwise manages to evade them. One day at home she discovers a Pashmina shawl, beautifully embroidered. It falls out of the cupboard. Priyanka is enthralled by its beauty and wraps it around herself. When she does her world transforms and she is transported magically to a different world, represented colourfully in the plates which are otherwise black and white. These magical interludes in her life only strengthen Priyanka’s resolve to visit India and find out more about her roots. Despite her mother’s resistance she is able to book a flight to India by using the prize money she won at an art competition. While in India she discovers the truth about her identity, her mother’s decision to migrate and the history behind the shawl.

Pashmina is a beautiful coming-of-age story much like the desilit of nearly two decades that had suddenly become popular except in this case the format is graphic, a generally more acceptable form of storytelling nowadays. Having said that there is a statement on the glossary page saying “Traditionally, the term ‘pashmina’ is associated with shawls that are made from very fine Kashmiri wool. However, in this book, pashmina refers to the embroidered silk shawls that are woven in Nagpur, Maharashtra. ” Even though this clarification has been printed in the book it is misleading to have an entire story which is ostensibly set in America and western Indian state of Maharashtra to have the shawl and its title taken from the state of Kashmir, which is in the north.  It may not be confusing for those unfamiliar with India, for whom the exoticism of this story will be appealing rather than the details but it is unfair to stretch the creative license of storytelling to transplant the handloom unique to a state to a different region. Handlooms and handicrafts are unique to every region and representative of the cultural identity of the state. It is also an identity that the artisans and others working in this sector for the preservation of handicrafts strive for — particularly in registering Geographical Indicators (GIs)under the TRIPS Act. So books like Pashmina while creating awareness indirectly about the beautiful shawls also cause damage by blurring regional identities in the minds of people who will ultimately be counted upon preserving handlooms.  While writing for children and young adults, of impressionable minds, it is imperative that facts are checked, even if the story is purely fictional.

This book has been whispered about and discussed for a while now and its production quality has not disappointed one at all. In fact there is a lovely essay available online by the cover designer on the many avatars his designing underwent before the team selected the final layout.

Be that as it may despite the reservations about the mixed regional identity of the handloom, Pashmina is a lovely introduction to the community of  Indian-Americans and the possible questions of identity that plague the younger generations. It is wonderfully represented in the storyline and the artwork. Well worth reading!

Nidhi Chanani Pashmina HarperCollins Children’s Books, an imprint of HarperCollins Publishers, Noida, 2018. Pb. pp. 170 Rs 399

5 May 2018  

*Note: All images are off the Internet. If you own the copyright to them please let me know and I will acknowledge it.

 

“Sight” by Jessie Greengrass

…the framing of a  radical scientific discovery in ordinary language, the ability to impart understanding without first having to construct a language in which to do so. Rontgen’s description of his work comes like the unravelling of a magician’s illusion which, explained quickens rather than diminishing, the understanding of its working conferring the illusion of complicity …

Jessie Greengrass’s debut novel Sight is about an unnamed narrator pondering whether to have a child or not.

I wanted a child fiercely but couldn’t imagine myself pregnant, or a mother, seeing only how I was now or how I thought I was: singular, centreless, afraid. 

It is a long reflection by the narrator split into three parts like a play with a short interlude.  Every section itself is structured with the long self-reflecting passages about by the narrator interspersed with interludes with factual historical content. The first section involves the Lumière brothers, Auguste and Louis, and Wilhelm Conrad Röntgen’s discovery of X-rays; the second section is about psycho analyst Sigmud Freud and the final section is about Scottish surgeon John Hunter who was exceptionally well known for his knowledge of the anatomy, both human and animal. In fact John Hunter’s fine collection of over 14,000 specimens was acquired by the British government and even today exists at the Hunterian Museum at the Royal College of Surgeons in London. Interestingly every section while the narrator reflects it corresponds with a particular moment in her life. The first section while she tussles whether to get pregnant or not she also contemplates upon Röntgen’s discovery of X-rays whose experiments in the laboratory resulted in a big impact on medical science and society too. It was the intensely subjective moment that led to greater objectivity:

For seven weeks and three days Röntgen existed in a private world transformed for him and him alone, and perhaps this too was a part of his later bitterness: that despite this experience of revelation, the conferral on him of a scientific grace, afterward nothing was different at all, and although he had seen through metal and seen through flesh to what was hidden, and although he had known, or thought that he had known, its nature, what had been left afterwards was only so much quibbling on the bill. 

Similarly mothering her firstborn, remembering the death of her mother due to cancer while the narrator herself was in her early twenties leaving her an orphan,  sharing her fears with her partner Johannes whether to have the second baby or not, while wondering if she is capable of the responsibility — these are intensely personal experiences for any woman more so for the narrator. Pregnancy is a very female experience that is repeated number of times over with every mother-to-be and yet remains an intensely intimate and subjective experience. Towards the end of this section she realises she has “outdistanced her anxiety” and wants the second child.

In the second section the narrator introduces her grandmother, Doctor K, and Sigmund Freud — both psychoanalysts.  Her childhood memories of spending holidays with her grandmother who worked as a professional psychoanalyst while caring for her granddaughter and on those rare occasions for her own daughter. The narrator recalls her mother telling her how when she was a five year old girl her mother, Doctor K, would insist upon analyzing her dreams. Result was the little girl stopped dreaming! It is a jumble of memories shared by the narrator that are at once intimate and intertwined and yet involving distinct individuals and personalities, much as in the way the network of blood vessels connect the unborn baby in the womb to its mother. Similarly Sigmund Freud’s biography and analysis of his patients including daughter Anne are interspersed with that of the personal narrative.

…the past is as prosaic as the future and the facts about it only so much stuff. To pick through dusty boxes, to sift through memories which fray and tear like ageing paper in an effort to find out who we are, is to avoid the responsibility of choice, since when it comes to it we have only ourselves, now, and the ever-narrowing come of what we might enact. Growing up, I said, is a solitary process of disentanglement from those who made us and the reality of it cannot be avoided but only, perhaps, deferred … . 

Plate VI of “The Anatomy of the Human Gravid Uterus” (1774) by William Hunter, engraving by Jan van Rymsdyk.

In the third section the narrator is pregnant and waiting to give birth so a lot of time is spent in hospital waiting rooms awaiting tests. She intersperses her reflections with that of the eighteenth century Scottish surgeon John Hunter who was also known for his phenomenal collection of specimens. He was very keen to know about anatomies and would pay gravediggers to get him bodies from fresh graves so that he could dissect them and study the anatomy.  He worked closely with his brother William Hunter who had in fact introduced him to the medical sciences. The dissections were conducted in the basement of William Hunter’s Convent Garden house where the brothers were inevitably accompanied by the artist Jan van Rymsdyk who rapidly sketched as evident in the illustration on the right.

The Oxford English Dictionary definition of “Sight n. the faculty or power of seeing”. Jessie Greengrass studied philosophy in Cambridge and London. Her novel Sight is a literary example of psycho-geography — a combination of personal reminiscences and factual historical content. It is also an attempt to get at a further truth which is about how we see one another and we see ourselves especially the female experience which is most often taken away from human experience. ( Interview with BBC Radio 4, February 2018) It is a constantly evolving process of the individual’s subjectivity vs objectivity. It was first discussed in a similar meditative fashion by the Romantic poet Samuel Taylor Coleridge in Biographia Literaria. It is unsurprising given that Coleridge  too like Jessie Greengrass was inspired by John Hunter’s work and its focus on the distinctions between life and matter. As Jessie Greengrass remarks in her BBC interview “having a subjective self is something which allows us privacy but also separates us even from the people we are closest to” and this is the angle she explores as a novelist in her powerful debut Sight.

Sight has been shortlisted for the Women’s Prize for Fiction 2018 and the winner will be announced on 6 June 2018. This will be a close finish since the other contenders for the prize are equally strong and experienced women writers.
Jessie Greengrass Sight John Murray ( Publishers), an Hachette UK Company, Edinburgh, 2018. Pb. pp. 
30 April 2018 
* All pictures are off the Internet.

Lindsey Fitzharris “The Butchering Art”

Lister came to the vital realization that he couldn’t prevent a wound from having contact with germs in the atmosphere. So he turned his attention to finding a means of destroying microorganisms within the wound itself, before infection could set in. Pasteur had conducted a number of experiments that demonstrated that germs could be destroyed in three ways: by heat, by filtration, or by antiseptics. Lister ruled out the first two because neither were applicable to the treatment of wounds. Instead, he focused on finding the most effective antiseptic for killing germs without causing injury: When I read Pasteur’s article, I said to myself: just as we can destroy lice on the nit-filled head of a child by applying a poison that causes a lesion to the scalp, so I believe that we can apply to a patient’s wounds toxic products that will destroy the bacteria without harming the soft parts of this tissue.” 

British surgeon Joseph Lister ( 5 April 1827 – 10 February 1912) was a pioneer of antiseptic surgery. He was born in a devout Quaker family. Simplicity was the Quaker way of life. Lister was not allowed to hunt, participate in sports, or attend the theater. “Life was a gift to be employed in honoring God and helping one’s neighbor, not in the pursuit of frivolities. Because of this, many Quakers turned to scientific endeavors, one of the few past times allowed by their faith.” His father, Joseph Jackson Lister, managed the centuries old family business of being wine merchants  but it was his discovery of the achromatic lens to eliminate the distracting halo in the compound microscope that earned him worldwide fame. This lens was showcased in 1830. His son, Joseph Lister, grew up in such a home where the spirit of inquiry was encouraged as was exploring miniature worlds with the microscope.

The very first time he looked down the barrel of a microscope, Lister marveled at the intricate world that had previously been hidden from his sight. He delighted in the fact that the objects he could observe under the magnifying lens were seemingly infinite. Once, he plucked a shrimp from the sea and watched in awe at “the heart beating very rapidly” and “the aorta pulsating.” He noticed how the blood slowly circulated through the surface of the limbs and over the back of the heart as the creature wriggled under his gaze. 

Yet Lister’s decision to become a surgeon was met with surprise by his family as it was a job that involved physically intervening in God’s handiwork.

And surgery, in particular, carried with a certain social stigma even for those outside the Quaker community. The surgeon was very much viewed as a manual laborer who used his hands to make his living, much like a key cutter or plumber of today. Nothing better demonstrated the inferiority of surgeons than their relative poverty. Before 1848, no major hospital had a salaried surgeon on its staff, and most surgeons ( with the exception of a notable few) made very little money from their private practices. 

Lister had an insatiable curiosity about the world and was forever creating slides to view under his microscope. Later in Edinburgh he would convert a portion of his study at home into a laboratory where there were always perched tubes filled with different materials, plugged with balls of cotton. Next to it would be his microscope and slides he made. He was also a proficient artist — a skill that would help him document in startling detail his observations made during his medical career. Yet all through his life Lister also battled depression, a “garment of darkness”, which would often descend upon him. Despite these odds he would work in the hospital and later return home to do his research. Many would marvel at his dedication and diligence.

The early training to use a microscope was to stand Joseph Lister in good stead throughout his career as he pondered over the crucial question as to why wounds that were open inevitably festered and proved fatal for the patient whereas internal injuries such as broken bones healed and the patient recovered normally. Years later his supervisor would recall that while working together at the University College Hospital in 1851, Lister “had a better microscope than any man in college”. It was the microscope that would eventually help Lister unlock the medical mystery that had been plaguing his profession for centuries. This was at a time in the nineteenth century when surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis, so most deaths were due to postoperative infections. Operation theaters were gateways to death. Infections were frequent in hospitals. They were filthy institutions as exemplified by an anecdote where a patient lay on a hospital bed completely unaware that the mushrooms growing on his damp bed sheet was not normal. The four major infections to plague hospitals in the nineteenth century were erysipelas or St. Anthony’s Fire ( an acute skin infection which turned the skin bright red and shiny), hospital gangrene ( ulcers that lead to decay of flesh, muscle, and bone), septicemia ( blood poisoning), and pyemia ( development of pus-filled abscesses). the increase in infection and suppuration brought on by the “big four” later became known as hospitalism.

The best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher” — whose job it was to rid the mattresses of lice—was paid more than its surgeons. 

Nineteenth century doctors had multiple theories for why infections occurred although they were clueless about how infectious diseases spread. Many surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Another theory was that patients were infected by miasma arising from corrupt wounds. Between the 1850s and 1860s there was a shift from miasma being the root cause of infections towards contagion theories. Some doctors believed that contagious diseases were transmitted via a chemical or even small “invisible bullets”. Others thought it might be transmitted via an “animalcule”, a catchall term for small organisms.

The Butchering Art’s  graphic descriptions of surgical procedures in nineteenth century are horrific. They were a spectacle with the surgery taking place in a theatre packed to the gills mostly with students, physicians and few curious onlookers. Most surgeries before the discovery of choloroform were conducted with the patient wide awake through the painful procedure. The crude surgical instruments used were by today’s standards basic such as a saw. ( See image) Unfortunately most patients died in post-operative care inevitable due to infection setting in. Popular belief held it was due to the bad air in the vicinity of patient resulting in infection and ultimately death.

With the discovery of chloroform by the Scottish obstetrician James Y. Simpson and advent of anesthesia in 1846 the number of operations increased as surgeons were more comfortable operating knowing that their patients would no longer feel the pain of the knife cutting through them.  Although hospitals in Victorian England were being rebuilt with more wards the high rate of mortality continued to grow as number of patients also increased and it became near impossible to keep hospitals clean and contain the infections. Primarily also because infection control was unheard of and hospitals were known by the public as “Houses of Death”. In Victorian England population also grew dramatically from one million to over six million with at times more than thirty people living in one room. There was dirt and filth with absolute no sense of public hygiene; infections were bound to spread.

Completing his education in London, Lister moved to Edinburgh, the city which had established itself as the city of surgery. He went to work with Professor James Syme, surgeon at Edinburgh’s Royal Infirmary. Syme’s colleagues called him “the Napoleon of Surgery”. He was lightning fast as was his equally legendary cousin in London, Robert Liston, whose surgeries too Lister had witnessed. In fact Liston designed an amputation knife with a blade fourteen inches long and and a quarter inches wide. The dagger’s point, the last two inches of which were razor-sharp, was created to cut through the skin, thick muscles, tendons, and tissues of the thigh with a single slice. The “Liston knife” was Jack the Ripper’s weapon of choice for gutting his victims when he went on his killing spree in 1888.

While working in Edinburgh Lister realized his patients continued to die due to hospitalism. Frustrated Lister began taking tissue samples of his patients to study under the lens of his microscope so he could better understand what was happening at the cellular level. He was determined to understand the mechanisms behind inflammation trying to figure out the connection between inflammation and hospital gangrene. He and other surgeons tried many “solutions” such as using vellum to cover the wound to control inflammation and “water dressings” or wet bandages which they believed counteracted the heat of inflammation by keeping the wound cool. But there was no consensus as to why this occurred in the first place.

In the 1860s Lister was convinced cleanliness would help reduce mortality rates in hospitals due to hospitalism. Prior to this three doctors — Scotsman Alexander Gordon ( 1789), American essayist Oliver Wendell Holmes ( 1843) and Ignaz Semmelweis in Vienna (1847) — had tried making a similar connection between transmission of morbid substances from doctor to patient. Lister was so obsessed by this puzzle that his house surgeon said of him that a “divine discontent” possessed him.

His mind, he said, “worked ceaselessly in an effort to see clearly the nature of the problem to be solved.” Lister’s exasperation spilled over into the classroom, where he turned to his students with the question that had been haunting him for some time: “It is a common observation that, when some injury is received without the skin being broken, the patient inevitably recovers and that without any severe illness. On the other hand trouble of the gravest kind is always apt to follow, even in trivial injuries, when a wound of the skin is present. How is this? The man who is able to explain this problem will gain undying fame.” 

It was the behest of his colleague and chemistry professor, Thomas Anderson, that Lister became familiar with the research on fermentation and putrefaction  of French microbiologist and chemist Louis Pasteur. Upon reading Pasteur’s publications on the decomposition of organic material Lister began replicating the French scientist’s experiments in his laboratory at home. Pasteur’s experiments confirmed that fermentation was a biological process and that the yeast that helped produce wine was a living organism. His experiments established what is now considered a cornerstone of biology: Only life begets life. Soon the word “germ” was being used to describe these protean microbes. Pasteur began making the connection between putrefaction and fermentation as he was convinced both processes were caused by the growth of minute microorganisms. Lister too was now of the opinion that it was not the air as such but its constituent of microbial life that was the source of hospital infection.

Lister came to the vital realization that he couldn’t prevent a wound from having contact with germs in the atmosphere. So he turned his attention to finding a means of destroying microorganisms within the wound itself, before infection could set in. Pasteur had conducted a number of experiments that demonstrated that germs could be destroyed in three ways: by heat, by filtration, or by antiseptics. Lister ruled out the first two since neither were applicable to the treatment of wounds. Instead he focused on finding the most effective antiseptic for killing germs without causing further injury. 

Many substances considered to be antiseptic such as wine, quinine, iodine and turpentine, had proved ineffective or caused further damage to the tissue, making the wound vulnerable to infection. Lister tried many solutions including the popular Condy’s fluid or potassium permanganate. None worked. Then Lister remembered reading that engineers at a sewage works in Carlisle had used carbolic acid to counteract the smell of rotting garbage and to render odorless nearby pastures that were irrigated with liquid waste. An unexpected benefit of the carbolic acid was that it also killed the protozoan parasites that had caused outbreaks of cattle plague in the livestock that grazed in these fields.  Carbolic acid, also known as phenol, is a derivative of coal tar and was first discovered in 1834. Lister obtained samples of crude acid and observed its properties under the microscope. Soon he began experimenting with it on his patients but realized he needed to be a little more disciplined and methodical in his approach. So after a few trials he suspended using carbolic acid as a disinfectant for wounds in hospitals and waited for a patient with a compound fracture to show up.

…compound fractures [are] injuries in which splintered bone lacerated the skin. This particular kind of break had a high rate of infection and frequently led to amputation. From an ethical standpoint, testing carbolic acid on compound fractures was sound. If the antiseptic failed, the leg could still be amputated — something that would have likely occurred anyway. But if the carbolic acid worked, then the parent’s limb would be saved. 

In early August 1865 Lister had the opportunity to work upon the compound fracture of eleven-year-old James Greenlees whose leg had been crushed by a the metal-rimmed wheels of a cart. Lister tended to the wound by creating a space in the putty cast in to which he poured carbolic acid. He looked after the boy himself for the next few days. After the initial few days inflammation began to set in and no amount of diluted carbolic acid could stem the redness. It was then Lister created a new solution of carbolic acid with olive oil. It worked. Six weeks and two days after the cart had shattered his lower leg, James Greenlees walked out of the Royal Infirmary.

Although Lister was evangelical about antiseptic methods there were few adopters of this method. In fact his critics were greater in number and began to write even in respected medical journals like The Lancet. For a while Lister was caught in a terrible wrangle with his contemporaries about the benefits of using antiseptics and it was proving impossible for hospitals to consider using carbolic acid despite statistics proving the dramatic fall of mortality rates in which Lister had enforced antiseptics be used. That is until 4 September 1871 when Lister was summoned to Balmoral Castle to attend to Queen Victoria who was gravelly ill with an abscess in her armpit that had grown to the size of an orange. Lister chose to lance the boil and used carbolic spray to disinfect the room. The next day when he came to dress the wound he realized that pus was forming once more. He needed to quickly stem the spread of infection. Spotting the atomizer he removed the rubber tubing of the apparatus, soaked it overnight in carbolic acid, and inserted it into the wound the following morning in order to drain the pus. It worked. Queen Victoria recovered.

With the royal stamp of approval to Lister’s antiseptic system the surgeon’s fame spread far and wide. His methods were accepted as far as in London. In 1876 Joseph Lister was invited to defend his methods at the International Medical Congress in Philadelphia. The American tour was a success. It also resulted in spreading awareness as well as popularizing personal hygiene products. One of these was  Listerine invented by Dr. Joseph Joshua Lawrence in 1879 who had attended Lister’s lecture in Philadelphia, “which inspired him to begin manufacturing his own antiseptic concoction in the back of an old cigar factory in St. Louis shortly thereafter. ” Other products that sprang up were carbolic soap and toothpaste. Astonishingly one of the most surprising offshoots of this tour was the establishment of a corporation recognizable even today — Johnson & Johnson. Robert Wood Johnson upon hearing Lister speak joined forces with his two brothers, James and Edward, and founded a company to manufacture the first sterile surgical dressings and sutures mass-produced according to Lister’s methods. Lister died in 1912 after having been knighted by Queen Victoria and winning many other awards and recognition for his work.

Dr. Lindsay Fitzharris who received her doctorate in the history of medicine, science and technology from the University of Oxford embarked upon educating and engaging with the public during her post-doctoral research. She was fatigued by academia and tenure-track and was far more keen to maintain her blog The Chirurgeons Apprentice and later her videos — Under the Knife .

The Butchering Art is a fantastic history of surgery in the Victorian Age. It is a perfect balance between facts and storytelling without making the subject dull. Dr Fitzharris’s love for the subject shines through. She uses the methodology and discipline of writing academic works in presenting a highly technical subject for the lay reader. The text is well annotated with end notes for every single chapter but not disturbing the design of every page. In fact she has been accused of “bastardizing” the discipline.  To which she replies:

I think there is a misconception that writing popular history is easier than writing academic history. Both have their challenges, and just because a person can write one doesn’t necessarily mean that same person can write the other. I’m a storyteller first and foremost, and an historian second. I don’t apologize for this. Unfortunately, some academics don’t see a value in what I do. But the past doesn’t belong to scholars alone. It belongs to everyone. My hope is that I can bridge the gap between academia and popular history, and open up new and interesting subjects to a curious public.

( History of Science Society @Work interview with Dr Lindsey Fitzharris, April 2018)

 

Even though some of the academics may be disapproving of her style of making the history of medicine available, Dr. Fitzharris has won the 2018 PEN/E.O. Wilson Prize for Literary Science Writing and has been shortlisted for the 2018 Wellcome Book Prize. The Butchering Art was also featured in the Top 10 Science Book of Fall 2017, Publishers Weekly and the Best History Book of 2017, The Guardian.

Undoubtedly The Butchering Art is not for the faint-hearted for its gory descriptions of Victorian hospitals, operation theatres and death houses. Nevertheless it is an unusual page-turner for it is purely about scientific progress in Victorian England  and the remarkable discovery of Joseph Lister.

Lindsey Fitzharris The Butchering Art Allen Lane, an imprint of Penguin Books, Penguin Random  House, UK, 2017. Hb. pp. 

25 April 2018 

Ruth Jones, “Never Greener”

Welsh actress and writer Ruth Jones debut novel Never Greener is about an affair between a television actress Kate with a school teacher, Callum, seventeen years older to her. They first meet when Kate is nineteen in the mid-80s’ and then nearly two decades later. Result of their cheating on their spouses is the inevitable fallout of their respective marriages breaking up. Chiklit with a traditional plot. Mills & Boon plot for a modern reader with a supposedly pacy plot punctuated at regular intervals with sex scenes between Kate and Callum. Prior to this Jones’ writing credits include co-writing TV hit “Gavin and Stacey”, in which she also co-starred as “Nessa” alongside James Corden. She has also acted in BBC dramas “Tess of the D’Urbervilles”, “Little Dorrit” and “Hattie”, playing Hattie Jacques.

Despite this manuscript having been in a fierce 10-publisher auction in 2016 eventually won by Transworld for a two-book deal, this debut novel is rightly termed by the Guardian as a “soggy squib“. Although popular writer Jojo Moyes endorsed the book saying ‘Ruth Jones is excellent on human nature and why we make the mistakes we do. I felt for every character. Unputdownable.’ Having said that Never Greener by Ruth Jones reached number 1 in the UK adult fiction chart within days of its 5 April 2018 release.

Never Greener is fine as an airport novel and will probably be adapted for film or television fairly soon given that it has all the elements of a soap opera and most definitely features of what is deemed as “adult entertainment” on cable television. This book will soon be sold for adaptation if it has not already been done so.

Ruth Jones Never Greener Transworld Publishers, Bantam Press, Penguin Random House UK, London, 2018. Pb. pp. 416 Rs 599 

19 April 2018 

A.J. Finn’s “The Woman in the Window”

  A. J. Finn’s debut psychological thriller The Woman in the Window is about child psychologist Anna Fox who has a bad case of agoraphobia. Confined to her refurbished brownstone in Harlem she uses her Nikon to take photographs of her neighbours. It is very reminiscent of Alfred Hitchcock’s storytelling particularly Rear Window. The resemblance is probably intentional as Dr Fox is addicted to watching black and white films of the past, many of the classic Hitchcock films are her perennial favourites. She suffers from depression as well so is constantly on a cocktail of prescription chemicals that are constantly being titrated by her doctor. He has to constantly advise her not take alcohol as she is fond of drinking Merlot. ( To her delight she has discovered that for an agoraphobic person like her it is convenient to order cartons of Merlot online and it will be delivered at home.) Otherwise she whiles away her time participating in online group chats with other agarophobic patients and playing chess.

The Woman in the Window is about Anna Fox who is confined at home out of choice and the supposed murder she witnesses across the street. Unfortunately she has a hard time persuading neighbours and the police that it is true and not a hallucination under the deadly influence of medicines and alcohol. The story takes a while to build up though the details are fascinating. It is only about 100 pages into the story that it zips along. It is being promoted to be a thriller in the same vein as Gone Girl and Girl on the Train. The chapters are short, sometimes only a few paragraphs, a form of writing apparently influenced by James Patterson’s writing.

A. J. Finn’s debut is being much talked about as it was sold in a hotly contested auction only to be won by William Morrow in a deal worth seven figures. The movie rights have been sold to Fox 2000 to Hollywood producer Scott Rudin who won an Oscar in 2008 for the adaptation of Tom McCarthy’s No Country for Old Men. It is rumoured that Kate Winslet is in the running for the lead role. So far the book has already been sold in 38 book markets. A.J. Finn is the nom de plume for publishing executive Daniel Mallory who used to work at William Morrow but after the runaway success of his manuscript he has quit his day job. Instead he is focussing on writing his next novel. he is being represented by Felicity Blunt, Curtis Brown Literary Agency, sister to actress Emily Blunt who acted in the film version of Girl on a Train.

The Woman in the Window is also the first debut novel to have made it immediately to the NYT Bestseller List in nearly 12 years. Undoubtedly the influence of Hitchcock exists in the story not necessarily due to the constant references to his films. Though the story is a story that has been told many times before and there are sufficient hints in this novel itself to old films to how the plot is going to develop, yet there it rings true for the character sketch of Anna Fox. Apparently Daniel Mallory suffers from bipolar disorder and had been misdiagnosed for a very long time. So the descriptions of Anna and her breakdown are to a large extent “authentic”. Otherwise the plot itself is very thin and relies heavily on many details being shielded from the reader until the explosive conclusion. A very old fashioned trick. Be that as it may it is a book that will be read, watched on screen and talked about for a long time for the richness of detail and the pitch perfect suspense.

A. J. Finn The Woman in the Window HarperCollins Publishers, London, 2018. Pb. pp. 430 Rs 399 

12 March 2018 

“With the End in Mind: Dying, Death and Wisdom in an Age of Denial” by Kathryn Mannix

Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, ofen need to tell their story repeatedly, and that is an important part of transfering the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it. 

And those of us who look after very sick people sometimes need to debrief too. It keeps us well, and able to go back to the workplace to be reqounded in the line of duty. 

….

Cognitive therapist and palliative medicine pioneer Kathryn Mannix’s With the End In Mind is a collection of medico-narrative stories which focus on the stages of dying. Usually the stories focus on terminally ill patients as it is in such scenarios the patients and their families are anxious and fearful of impending death. The stories are based on decades of her experience with the NHS in UK. They are stories which work equally well as case studies and for the benefit of getting the point across well at times Dr Mannix has clubbed together experiences of more than one patient in one narrative. These are grouped in sections such as “Patterns”, “My Way”, “Naming Death”, “Looking Beyond the Now”, “Legacy” and “Transcendance”.

The stories included in the volume are extraordinary. It is not only the magical quality to the storytelling of experiences while sitting by a patient’s deathbed but it is the calm sense of peace and kindness that pervades every single story. Undoubtedly the crippling anxiety that grips every patient and their families as death approaches has its impact on the families. Every one has a different response mechanism in managing the situation. These may be defined by an individual’s choice of the cultural codes of behaviour they have learned to adopt while processing the dastardly news. The stories are about the experiences of all ages of patients including those who have died in hospitals or those who have died at home surrounded by family. It is always the conversations about dying with every person and their caregivers that may never be easy but has to be conducted.

Notice how often you hear euphemisms like ‘passed’, ‘passed away’, ‘lost’, in conversations and in the media. How can we talk about dying, plan our care or support those we love during dying, theirs or ours, if we are not prepared to name death?

There are many conversations recounted that are memorable for demonstrating to a lay person and the medical professional that certain bedside manners with a large dose of humility, patience, honesty, level headedness, cultural sensitivity, and empathy are required when on a death watch whether offering solace to keening mothers who have lost their babies or even the elderly.  There is one particularly straightforward conversation the “leader” ( head of the hospice where Dr Mannix worked as a young physician) had with a WWII French resistance woman called Sabine who wears her Resistance Medal and who withstood the terror of war and yet was afraid of death. She was an elegant eighty-year-old inmate who was always well mannered and well turned out. Kathryn Mannix was a young trainee in the new speciality of palliative medicine. Her trainer was the consultant in charge of the hospice who had a good rapport with Sabine as he was bilingual and would at times converse with her in French. So when he decided to have the conversation about dying with her in the presence of the nurse to whom she had confided her fears and the young physician Kathryn Mannix, no one was prepared for how the conversation would develop. For the young Kathryn Mannix this particular episode was transformative and has lived with her throughout her career as if on a cinema reel. It formed the basis of her future practice, teaching her to be calm in the face of other people’s storms of fear and “to be confident that the more we understand about the way dying proceeds, the better we will manage it”. She realised over decades of clinical practice that:

The process of dying is recognisable. There are clear stages, a predictable sequence of events. In the generations of humanity before dying was hijacked into hospitals, the process was common knowledge and had been seen many times by anyone who lived into their thirties or forties. Most communities relied on local wise women to support patient and family during and after a death, much as they did ( and still do) during and after a birth. The art of dying has become a forgotten wisdom, but every deathbed is an opportunity to restore that wisdom to those who will live, to benefit from it as they face other deaths in the future, including their own. 

It is curious that Dr Mannix refers to the “art of dying being a forgotten wisdom” as coincidentally historian and chronicler of Delhi and accomplished Urdu translator Rana Safvi mentioned that she has read an account of daily life within the Red Fort during Mughal times where existed a category of women called khair salla waaliyan. They were employed in the Red Fort presumably by the noble families. Their job was to look after well being of the family. They weren’t necessarily nurses or care givers but who could make people feel good.  She thinks their job was to look after the emotional well being of the people being left behind the dying person. None exist now. It is only the professional mourners like the rudalis who continue to exist in Indian society.

Preparation for death is culturally specific too as with the Swedish ‘Döstädning’, or ‘death cleaning’ which is the focus of Margareta Magnusson’s The Gentle Art of Swedish Death Cleaning discussed beautifully in Christina Patterson’s essay “The ‘new hygge’: downshifting for death“. Journalist Arifa Akbar in her interview with Dr Mannix asked a pertinent question noticeable by its absence in the book itself:

AA: The people whose stories you tell in the book do not ever talk about God or an afterlife. Did you edit out these discussions? (You have said that you didn’t want to discuss religion in the context of end-of-life as it can be polarising and unhelpful.) Could you say if some patients do talk about this aspect and if it is helpful to them?

KM: People’s spirituality manifests in different ways. Where this is a religious faith, then people do discuss God and their hopes, anxieties and desires for an afterlife, as well as measuring their personal worth against the constructs of their faith. I’ve met people hopeful for heaven, fearful of hell, anticipating reincarnation, angry with God, or leaving their fate entirely in Divine hands; I’ve met people with no belief and at peace with the idea of oblivion, and others feeling sad at the ending of self-awareness; I’ve met people who have lost their longstanding faith in the face of the perceived injustice of illness; I’ve met people who discover a faith amidst the emotional storms of terminal decline.

Dr Mannix offers some thought provoking options to initiate conversations about dying as well as a way for the mourners to come to terms with their grief such as death cafes where people in similar situations could gather and share their experiences. She also provides template of a letter with possible points to consider for having a conversation about dying. She shares a list of resources that can be considered to prepare for this ultimate stage of life and recommends watching Australian intensive care specialist Dr Peter Saul’s TED Talk “Let’s Talk about Dying” ( Nov 2011). She also acknowledges Dr Atul Gawande’s books too.

With the End in Mind is a devastatingly powerful book of which extracts must be made available freely. It is certainly a book to be read cover to cover and take its learnings to heart, make them your own.  Persuade those who are anxious about the deteriorating health of their loved ones to read it. It is going to be a near-impossible task, but try nevertheless.  It is unsurprising that this book is on the Wellcome Book Prize 2018 longlist. Well deserved recognition!

Kathryn Mannix With the End in Mind: Dying, Death and Wisdom in an Age of Denial ( William Collins, an imprint of HarperCollins Publishers, London, 2017. Pb. pp.340 Rs 599 

12 March 2018