Africa, Atlantic Books, Author, Book review, Damon Galgut, Fiction, literary fiction, Publisher, Setting, South Africa

‘The Good Doctor’ by Damon Galgut

The-Good-Doctor

Fiction – Kindle edition; Atlantic Books; 216 pages; 2011.

The end of the year might be four months off, but The Good Doctor by Damon Galgut is certainly going to be on my list of favourite reads for 2015. I read it over the course of a couple of days, but every time I put the book down, I kept thinking about it, and now, a fortnight later, the characters and the story still remain with me — the sign of an exceptionally good novel.

Two doctors, two room-mates

First published in 2003, The Good Doctor is set in the “new” post-apartheid South Africa. It tells the story of Frank Eloff, a staff doctor working in a deserted rural hospital, who is forced to share his room with a blow-in: a younger doctor, Laurence Waters, who is newly qualified, green behind the years and brimming with energy and new ideas.

From the very start, Frank, who narrates the story in a cool yet forthright manner, is unhappy about Laurence’s arrival:

When he said, ‘I would never do that to you,’ he was telling me that he was a true friend. I think he felt that way almost from the first day. Yet the feeling wasn’t mutual. He was a room-mate to me, a temporary presence who was disturbing my life.

But despite Frank’s best efforts not to become too close to his new colleague, he finds himself drawn into Laurence’s orbit. Yet Frank has secrets he wishes to keep — an affair with a black woman living outside the village, for instance, and a troubled past in the army — which makes it difficult for him to truly open up to the man everyone thinks is his best friend. This creates a narrative tension, a kind of suspenseful atmosphere, that builds throughout the story.

This is aided by the sudden arrival in the village of a group of soldiers and an Army General — from Frank’s dark past — who are on the trail of a self-made dictator from the apartheid era rumoured to be living nearby.

Compelling portrait

But, to be honest, there’s not much of a plot. The book works on the basis of simple yet effortless writing, which makes for an effortless, almost dream-like read — the closest thing to floating on clouds — and a compelling portrait of two men and the friendship that develops between them over time.

It’s also an intriguing look at what happens to people living in isolated communities, where relationships between people can become strained and oppressive because they are living in such close proximity to one another: privacy is non-existent, which might go some way to explaining Frank’s fierce protection of what little private life he does have.

Essentially, the two doctors could be seen to be a metaphor for “old” and “new” South Africa: Frank is set in his ways, a loner, comfortable in his own skin, who resents change; while Laurence is idealistic, passionate and eager to take on new responsibilities in order to prove himself. Neither is unlikable but they are poles apart — in so many different ways.

I looked at him, but I didn’t see him. I was seeing something else. A picture had come to me, and it was of Laurence and me as two strands in a rope. We were twined together in a tension that united us; we were different to each other, though it was in our nature to be joined and woven in this way. As for the points that we were spanned between — a rope doesn’t know what its own purpose is.

This is a dramatic story about guilt and honour, loyalty and friendship, politics and fear — and probably the best book I’ve read all summer.

The Good Doctor won the 2004 Commonwealth Writers’ Prize for Best Book from the Africa region and was shortlisted for both the 2003 Man Booker Prize and the 2005 International IMPAC Dublin Literary Award.

Author, Book review, Canada, Eric Rill, Fiction, general, Lake Union Publishing, literary fiction, Publisher, Setting

‘An Absent Mind’ by Eric Rill

An-absent-mind

Fiction – Kindle edition; Lake Union Publishing; 207 pages; 2015.

It might sound odd, but I’ve been thinking about Alzheimer’s disease a lot recently. Initially it was because I found out that someone I went to school with in Australia died of it a week or two ago. She was just 44 and was one of those active, sporty types who seemed invincible. Then British writer Sir Terry Pratchett succumbed and it was all over the news and social media.

I made a small donation to Alzheimer’s Research UK in honour of them both, and then I decided to read Eric Gill’s An Absent Mind, which I’d had on my wish list for a while, though, ironically, I can’t recall how I found out about it or where I saw it mentioned first. (If you’ve reviewed it, please let me know in the comments, because it may well have been your review that sparked my interest.)

The book is a  fictionalised account of a man living with Alzheimer’s disease. In the author’s afterword, he said he was inspired to write it after his father had the condition for eight years, which might explain why it seems so realistic — and heartbreaking.

Charting a patient’s progress

An Absent Mind is set in Montreal, Canada, but it could be any place on Earth: this is a disease that afflicts more than 44 million people worldwide, regardless of geography or income per capita.

It charts Saul Reimer’s illness from initial diagnosis, aged 71, until his death more than five years later.  Through Saul’s ramblings we get to know his feelings, his fears and his coping mechanisms. We also get to hear from his loved ones because his wife, Monique, and two adult children, Florence and Joey, take it in turns to narrate their version of events. What emerges is a fully rounded, sometimes conflicting, view of the way in which this disease cruelly robs the patient of his faculties and his family of their loved one through a steady, often frightening, decline.

From this we learn that Saul, an “Anglo” and a Jew, has always been a strong and rather controlling person, so his slide into dementia is not, at first, taken seriously by his family, least of all himself — “I sometimes forget where I park my car when I go to the mall. Florence always kids me that I have Mallzheimer’s” —  but when tests reveal he’s in the early stages of the disease and that his memory loss and other cognitive functions will get worse over time, there’s no denying it and everyone has to readjust their outlook and attitude.

The impact of his illness on his long-suffering wife — a Catholic who converted to Judaism — is particularly upsetting. She refuses to accept any home help and won’t attend counselling, thinking she can cope alone, but as Saul’s behaviour worsens her own safety gets put at risk.

Florence, the upstanding, stoical and dependable daughter, does all she can, but she’s got her own husband and children to worry about. And then there’s self-absorbed Joey, a 35-year-old bachelor, who’s forever chasing the next business idea and taking on more debt than he can handle. Or, as his father so eloquently puts it:

I swear, if there was a way to get rich from marketing the sweat that drips from my armpits after I wake up from one of those dreadful nightmares of falling into a never-ending black hole, he would be the one to do it.

As you might be able to tell from the above quote, there’s a little bit of humour in the narrative to lighten the load — and there would want to be, because this is a rather depressing narrative that takes us through the three stages of Saul’s disease, including his admittance to a care home for Alzheimer’s patients in the final years of his life.

Easy to read novel about a difficult subject

An Absent Mind is written in quite a straightforward prose style. The language is plain and to-the-point. The chapters are short, too (some are only a page long), which makes it especially quick and easy to read.

I liked the author’s non-sentimental approach on how one family copes with life post diagnosis. But one of its real strengths is the way it educates its readers about the disease. This is done through the voice of Dr Tremblay, an Alzheimer’s expert, who treats Saul and narrates a couple of chapters. He explains aspects of the disease, including the fact that it can take six to 10 years to run its course, that I found particularly interesting. Until recently, I couldn’t quite comprehend how dementia could kill someone. Now I know that it can impair brain function so badly that the body no longer knows how to breathe:

Alzheimer’s is characterised by the formation of cellular debris in the form of plaques and tangles. The plaques float between the neurons, while the tangles attack the neurons from inside the cell membranes. But regardless of how they go about their destruction, they achieve the same result, preventing the neurons from communicating with one another. As clumps of neurons die, specific functions such as short-term memory, spatial relationships, reasoning, and eventually things like muscle coordination, and even swallowing, are affected. The result is always death.

No doubt as this disease becomes more prevalent in our society more novels will be written about Alzheimer’s. An Absent Mind is a good one to add to the canon.

For another take on Alzheimer’s, I thoroughly recommend Samantha Harvey’s extraordinary debut novel The Wilderness, which is written entirely from the perspective of a 60-year-old man diagnosed with the disease. For non-fiction, Annie Ernaux’s A Woman’s Story is a deeply affecting memoir about the author’s mother who dies from Alzheimer’s. If you know of any others, please do leave a comment below.

UPDATE: The Reading Agency has a list of Books on Prescription for Dementia as part of its Reading Well programme. You can read the list in full here. Hat tip to Susan Osborne, who wrote about the iniative on her blog here.

Author, Book review, Fiction, Gabriel Weston, Jonathan Cape, literary fiction, London, Publisher, Setting

‘Dirty Work’ by Gabriel Weston

Dirty-work

Fiction – hardcover; Jonathan Cape; 192 pages; 2013. Review copy courtesy of the publisher.

Gabriel Weston is a practising surgeon. Many of you may be familiar with her first book, Direct Red, which explored what it is like to be a surgeon, and went on to win the PEN/Ackerley Prize for autobiography in 2010. She sticks with the medical theme in her first novel, Dirty Work, which is a dark, oppressive tale about a doctor who makes a terrible mistake and then must face the consequences.

The kind of surgery no one talks about

From the opening line — “I have never seen so much blood” — this novel transports you directly into the fascinating world of surgery, where every decision (and incision) can make the difference between life and death.

But this is not the kind of surgery we normally talk about, for Nancy, the narrator of this story, is an “abortion provider” — she never calls herself an “abortionist” — and her career is not something she can freely mention in company without being shunned or condemned. Even fellow surgeons look down on her line of surgery, which is viewed as “dirty work”.

When she makes an error during a procedure, her world is turned upside down. She is investigated by a tribunal appointed by the General Medical Council to explain herself. If she is found to be negligent she will be struck off the register and unable to practise as a doctor again.

A novel in four parts

The book is structured around the four sessions of the tribunal (one a week for a month) — what happened in theatre; a psychiatric assessment; her recent performance as a doctor; and the verdict — but the narrative does not follow the cut and dried Q&A to which she is subjected. Instead, it ebbs and flows around Nancy’s memories — her childhood split between the USA and England, how she got into medicine, why she began providing abortions, the support she receives from her sister — which occur to her before, during and after each session.

This is a successful technique, because not only do you come to know Nancy very well and empathise with her predicament (it’s clear she is an excellent surgeon), you keep turning the pages because you want to know the verdict, which is delivered in the final pages of this short novel.

Compelling and claustrophobic read

I read this book on a four-hour plane journey and I have to say I was hooked from the start. It’s not a light or fun read though, because it covers such dark territory and there’s an oppressive atmosphere which resonates off the page.

While Dirty Work is told in a cold, detached manner, the author manages to make it incredibly moving in places. It’s an extraordinarily powerful novel for those prepared to read about a topic told in such a frank, forthright and often unnerving way.

But it’s real strength is the way in which it explores lots of issues and medical ethics and is able to show that nothing is black and white. This is not a book that examines the arguments for and against abortion; instead it looks at the mindset of those carrying them out. For instance, what makes a doctor want to become an abortionist? How do you rationalising saving life with terminating the unborn? And what kind of psychological impact, if any, does this kind of surgery have on those providing it?

For another take on this novel, please visit Jackie’s review at Farm Lane Books.

Author, Book review, Carol Topolski, crime/thriller, Fiction, Fig Tree, London, Publisher, Setting

‘Do No Harm’ by Carol Topolski

Do-No-Harm

Fiction – paperback; Fig Tree; 336 pages; 2011. Review copy courtesy of the publisher.

A couple of years ago I read Carol Topolski’s Monster Love and found it one of the most disturbing novels I’d ever come across. When I discovered that Topolski had a new novel out, I was anxious to see whether she would up the ante. I think it’s safe to say she has.

Do No Harm is billed as a psychological thriller, but it’s not your typical page-turner. For a start it’s structured in an odd way, interleaving several different story strands, told occasionally in the first person and at other times in the third person. The tenses are sometimes present and sometimes past. And yet, despite what could be described as a piecemeal, bitty approach, there’s a narrative tension that builds and builds as you get closer to the climax. I read it with a sense of mounting horror, but the denouement, when it comes, is brilliant.

The story builds on our worst fears: that doctors, with whom we trust our lives, are capable of doing unimaginable things to their patients.

Dr Virginia Denham is a consultant in obstetrics and gynaecology working in one of London’s top hospitals. She’s held in high regard by her patients (for her genuinely caring manner) and her colleagues (for her brilliant mind, surgical prowess and management skills). But Virginia is a bit of an odd ball. While her staff are used to her somewhat unkempt, mannish appearance, no one knows the secret life Virginia leads when she leaves the hospital and goes home to her empty house at night.

In this secret life, Virginia has an odd system of eating in which she stuffs herself silly for three days in a row (which she calls “trips”), then starves herself for the following four (which she calls “quads”).

Choosing to eat like this put me in absolute control and I never had to depend on Mother for food. I never went hungry for attention or felt full of her bile. On trip days I stuff myself with the most desirable foods I can imagine — way, way beyond my appetite’s outer reaches. Quad days starve me into submission. During the three days of the trips, I can believe myself the most loved woman on earth. The austerity of the following four stops me wanting more.

Virginia also gets her thrills by self-harming while wearing lots of rubber. Her imaginary friend Ruby is often close by, encouraging her to do bad things.

The story is told in chunks and moves backwards and forwards in time, from 1974-79, in which we follow Virginia’s adult life, and 1938-1945, when we hear of Virginia’s childhood and her mother’s extra-marital affair.

Interleaved into this narrative are two other stories: that of Dr Faisal Usman, one of Virginia’s colleagues, who was sent to England, from Pakistan, to be educated as a child, but has never been brave enough to return to his homeland; and that of Gilda, one of Virginia’s patients, who has escaped the clutches of a cult and given birth to a son she doesn’t want.

This probably sounds very confusing, and I admit there were times when I wondered where the story was going. But if you hold all the elements in your head, you will be rewarded, because the ending draws all the threads together in one neat, and genuinely surprising, conclusion.

Topolski, who is a practising psychoanalytical psychotherapist, has created an amazingly complex character in Virginia, a woman who is outwardly successful and incredibly intelligent but who is deeply troubled and cruelly flawed. But be warned: female readers, particularly those who are pregnant or having difficulty conceiving, might find Virginia’s exploits too traumatic to stomach…

Australia, Author, Book review, Canongate, Fiction, Helen Garner, literary fiction, Publisher, Setting

‘The Spare Room’ by Helen Garner

TheSpareRoom

Fiction – hardcover; Canongate; 180 pages; 2008.

Even before I started reading Helen Garner‘s The Spare Room I knew I was going to like it. It was the design of the book that convinced me, because surely a publisher wouldn’t go to all this trouble to make it look so beautiful if the content was rubbish? The cover image grabbed me initially when I ordered it online, but once I had it in my possession I loved the whole package: the gorgeous cover image (tulips are my favourite flowers); the dust jacket with its luxurious matt sheen; the pretty endpapers (tulip petals interspersed with green leaves); and a green bound bookmark.

But putting the sheer physical beauty of the book aside, The Spare Room is also rather special because it is Garner’s first novel in 16 years. Her last novel, Cosmo Comolino, was shortlisted for the Miles Franklin Award in 1992, but she then took a different writing path, concentrating on short stories and journalism. The first (and only) Garner I have read was The First Stone, a non-fiction account of a sexual harassment scandal at a residential college at the University of Melbourne, which caused much controversy upon publication in 1995. I ate that book up in the course of a day and closed the last page feeling dazed, slightly dirty and not quite sure whether the author was a genius or a traitor. Having now read The Spare Room my opinion lies toward the former rather than the latter.

That other great Australian author Peter Carey endorses Garner’s talent by describing her new book as a “perfect novel”.  Of course this is an oft overused trite phrase but, in this specific case, it’s a wholly appropriate one. In fact, I’d go so far as to describe it as a sublime novel, and one that works its way into your subconscious so that you find yourself thinking about it when you are doing other things.

Reviewing the book is difficult though, because the synopsis sounds terribly dull and depressing. A 60-something woman offers her spare room to a cancer-stricken friend of the same age and then finds their relationship tested to the core, doesn’t really grab you by the throat, does it? And yet, in Garner’s careful hands this story becomes a thoroughly engrossing one. The carefully measured prose, stripped of unnecessary clutter, serves to remove the claustrophobia of such a dark storyline, imbuing it with a light-hearted touch. Indeed, there were many times when I laughed out loud, not the least of when Nicola, the cancer sufferer, asks Helen, the friend caring for her, to buy some organic coffee for an enema.

When I saw her brewing the organic coffee in the kitchen after dinner, I said tentatively, ‘Do you need a hand to set it up? I can…
She shook her head, too busy to listen.
‘I wonder, though,’ I said, as she forged off to the bathroom with the equipment. ‘Is it a good idea to have a coffee enema at bedtime? You don’t think the caffeine might keep you awake?’
‘Why on earth would it do that, darling?’ she said breezily. ‘I won’t be drinking it — I’ll only be putting it up my bum.’

Supposedly based on Garner’s own experience of caring for a dying friend, The Spare Room has a genuine ring of authenticity about it. You can understand Helen’s anger, her fear, her inability to look after her dying friend, even if it is for just three weeks, because you know to be in a similar situation you’d probably feel the same way. Why should a friend do what a family member should be doing? And what happens if this friend dies in your spare room?

This is a novel about death and friendship, about drawing lines and crossing them, about facing up to hard truths and shying away from things we’d rather not confront. But it also embraces other uncomfortable issues, including whether it is permissible to believe in alternative therapies if Western medicine does not have a solution, but all the while it never preaches, never comes across as heavy or patronising.

The Spare Room is one of those books that throws you in at the deep end and, to completely mix my metaphors, you either run with it or you don’t. I’m pleased to say I ran with it… and only wished it was longer than its brief 180 pages.

Author, Book review, Druin Burch, England, History, Non-fiction, Publisher, Setting, Vintage

‘Digging Up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon’ by Druin Burch

DiggingUpDead

Non-fiction – paperback; Vintage; 276 pages; 2008. Review copy courtesy of the publisher.

I have read some interesting and unusual books in my time, but Druin Burch’s Digging Up the Dead must be the most interesting and unusual book I have ever read. Indeed, when I was offered it for review, I had initially been drawn to the dark, Gothic nature of the subject, but hadn’t quite clocked the fact it was a non-fiction title. So when it popped through my door I was slightly taken aback to discover that it was actually a biography. But what a biography it turned out to be!

Digging Up the Dead looks at the life and times of arguably the world’s first famous surgeon, Astley Cooper (1768-1841), whom Burch — himself a medical doctor — describes as vain, egotistical, nepotistic and “rather wonderful”.

Astley was born into a highly educated family — his father was an Oxford-educated vicar, his uncle was senior surgeon at Guy’s Hospital in London — but he showed little interest in books or study but specialised in pranks and adventures. When the family moved to Yarmouth he began training under a local apothecary, who also doubled as a surgeon, in the hope that he might learn enough to follow his older brothers into university and perhaps a physicianship, or his uncle to a hospital and career as a surgeon. He did well and moved on to become an apprentice to a surgeon at the Norfolk and Norwich Hospital.

When he was fourteen-and-a-half he witnessed a problematic, but successful, operation to remove a stone from a man’s bladder. This was to have a profound influence on him, because it was not long after that he decided to embark on surgical training in London, much to the delight of his family.

In London, his early career got off to a shaky start. He boarded with one of his uncle’s colleagues, Henry Cline, in a “a grand detached residence with stables and outbuildings” at 12 St Mary Axe in the heart of the City of London, and spent much of his newfound freedom running wild instead of knuckling down to his studies. His superiors regarded him as lazy.

Cline, sick to the back teeth of his charge’s reckless nature, came home one evening with a human arm and challenged Astley to dissect it then and there.

The skill and industry with which Astley dissected the arm astonished both the apprentice and the teacher. Astley was transformed. The fraudulent military uniform was gone, and in its place was the dress of a surgeon. For the first time in his life he found himself taking an interest in work.

From then on Astley became rather enamoured with dissection, working long hours in St Thomas’s hospital, hunching over stinking corpses, learning everything he could about human anatomy. Because the study of anatomy was in its infancy at the time, there was no other way for surgeons to learn their trade and so this is where Druin’s book delves into the gruesome nature of body-snatching, that peculiar illegal practice of stealing freshly buried bodies or — worse still — murdering people to satisfy the medical profession’s need for corpses to study.

Indeed, Astley is often so desperate for fresh corpses he steals neighbourhood pets and dissects them at home while they are still alive, something that turns the stomach today but which, at the time, taught him much that was not known by the surgeons of the day. (Readers with weak stomachs will find much to disgust them in this book, not least the descriptions of vivisection but also the many and varied operations that are performed without anesthesia. But it would not be fair to say they have been included merely for their shock factor; they are necessary for the reader to put Astley’s life into context.)

Eventually, of course, Astley becomes a hugely successful surgeon and lecturer, has studies published in The Lancet, wins the Royal Society’s highest prize and tends to the Prince Regent and Queen Victoria. All the while, he manages to travel abroad (he gets caught up in the French Revolution), marry, have children and teach surgeon-soon-to-be-turned-poet John Keats (yes, that John Keats).

The picture of Astley that emerges from this rather in-depth but beautifully written biography is an enormously complicated man, arrogant but caring by turns, who loved to take risks but made sure to cover his tracks when it counted most. Living at at time of great political, social and scientific change, he seems to be one of the leading lights in almost every field, not just medicine, and was loathed and loved in equal measure.

Digging Up the Dead is a truly fascinating account of a fascinating man who lived in fascinating times.  Druin Birch has done much to bring him to life by not only capturing the man so vividly but by illuminating the narrative with his own experiences as a medical doctor working more than two centuries after Astley first trod the London cobblestones. It’s a slow-burn of a read, one that requires concentration and diligence, but it’s well worth the effort, especially if you are fascinated by science, medicine or history.

Author, Book review, Chang-Rae Lee, Fiction, Japan, literary fiction, Penguin, Publisher, Setting, USA

‘A Gesture Life’ by Chang-Rae Lee

AGestureLife

Fiction – paperback; Penguin Putnam Inc USA; 356 pages; 2000.

Every so often you come across a book that makes you rejoice in the sheer beauty of the English language and the power of the novel to change your perspective on so many different things.

In A Gesture Life Chang-Rae Lee has delivered one of the most elegantly restrained pieces of fiction I have ever read and yet, despite the unhurried prose, it brims with suspense, so much so I was reluctant to put the book down and read it within a matter of days.

It’s a rare, almost perfect novel that provides such an eloquent insight into the nature of human relationships that I don’t honestly know how to condense the magic of this profoundly moving and deeply unsettling story into one short review that will do A Gesture Life any kind of justice.

In fact, I’d argue that the blurb on my Penguin edition, doesn’t even come close to explaining what this story is about, and I suspect that most people would overlook the book entirely should they stumble upon it in a bookstore or library. Personally, I can’t even remember why I bought it, other than the ringing one-word endorsements — “Stunning,” New York Times Book Review; “Unforgettable,” USA Today; “Mesmerising,” San Francisco Chronicle Book Review — on the front cover must have spoken to me on some deeply unconscious level. Even so, this book lay unread in my bedside cabinet for nine months before I decided to pick it up.

Once I picked it up, I was taken on a sagacious journey that allowed me to walk in another man’s shoes. The fact that that man was an elderly Japanese-American speaks volumes for Chang-rae Lee’s abilities as a story teller.

Weaving dual narratives, set a generation apart, Lee is able to build up a rounded portrait of a man, Franklin ‘Doc’ Hata, who spends his life adapting to a new culture by behaving with abject politeness in order to be accepted, first, as an orphaned Korean boy adopted by a Japanese family, and then as an immigrant in America where he runs a medical supply store in a well-to-do suburb of New York.

Here in Bedley Run ‘Doc’ leads a quiet, tranquil and commercially successful existence. He buys an expensive house, adopts a Korean girl, Sunny, and becomes romantically involved with a local widow.

But ‘Doc’s life, his passivity, his politeness, covers a much deeper malaise that is revealed through a series of seamless flashbacks. These reveal the horrors he confronted while a medical officer with the Imperial Army during the Second World War. While interned in a Burmese camp he oversaw the health of a group of ‘comfort girls’, young Korean women held captive to’service’ the soldiers, which deeply disturbed him.

I don’t think it is an exaggeration to say that it is these expertly written flashbacks that make this novel what it is. They are superbly paced and enrich the present story by giving the reader little nuggets of information that help illuminate Doc’s modern-day behaviour: the shaky rapport he has with his daughter, why he values his standing in the Bedley Run community, how he cannot allow himself to be emotionally frank with his lover – or anyone else for that matter.

The impact of the flashbacks is heightened by the horror of the narrative which focuses on some astonishingly brutal, gruesome and obscene scenes, some of which reduced me to tears. This is in stark contrast to the suburban melancholia that characterises the rest of the book.

A Gesture Life is a beautifully moving novel that weaves the past with the present. The longing, regret and sadness resonate off the page. But it’s not without hope – friendship, forgiveness, redemption and atonement are all explored. And by the last page you can’t help thinking that Doc’s pain might have been worth it in the end…