13 Mar, 09 | by BMJ Group
Elizabeth Bryan, Singing the Life – The Story of a Family in the Shadow of Cancer. London: Vermilion, 2007, ISBN 9780091917159, GBP12.99 hb
Book review by Richard Ashcroft
Dr Elizabeth Bryan is a distinguished paediatrician and founder of the Multiple Births Foundation. She is also someone affected by familial breast cancer. In this fascinating autobiography she gives a detailed and affecting narrative of her and her family’s experience of being first at risk of, and then suffering from cancer. Her training and work as a doctor gives her a deep insight into the medical and genetic aspects of the inherited cancers, and this book will be very useful as a guide to familial cancer for sufferers, their families and others interested in this area. But the main value of the book is in its description of the impact of the shadow of the disease, and the disease itself, on affected individuals and their families.
Many similar books offering illness narratives, and much of the ethical and sociological literature concentrate on the ways the illness and its treatment affect individuals medically but also can be destructive to family bonds, undermining of faith in the medical profession, and hence creative of a series of “ethical issues”. Ethical issues in this sense are issues which arise out of or create points of conflict and suffering. A book I and colleagues edited, Case Analysis in Clinical Ethics, arguably takes this approach.(1) Dr Bryan’s book, on the other hand, while not denying the family difficulties which can arise, illustrates the ways personal courage, good clinical care, and strong family and friendship bonds can facilitate survival. In this sense, Dr Bryan offers a moral narrative of cancer, but it is a moral success narrative rather than a moral conflict narrative. But this is not a sentimental book, and throughout the tone is of a clear-eyed pragmatism and determination to face problems as they are found, rather than to over-emote. I found this very attractive, although occasionally the plain style of the writing jarred with my expectations of this sort of literature. These stylistic and attitudinal matters noted, the story neither skates over tragedy and disappointment nor presumes a happy conclusion to the author’s illness.
This book will be helpful to cancer sufferers, their families and friends, especially where there is the suspicion or knowledge that the cancer is inherited. For doctors and ethicists, the value of the book is in the way it illustrates the experience of “being at risk”, the experience of treatment, and the possibility of a moral narrative of illness that is both pragmatic and set against a background of an unusually strong and supportive family and friend network and a high level of understanding of the disease and its genetics. For instance, the author illustrates very well how an almost ideally autonomous and informed patient can nonetheless require support and care, and the kinds of support and care that may be needed. And it also illustrates something of the nature of a life lived well in the face of serious illness. Students of the notion of the “virtuous patient” will find this particularly valuable, in allowing us to explore the ways in which being virtuous while being imperfect and vulnerable human beings are possible.
(1) Ashcroft RE, Parker MJ, Verkerk M, Widdershoven G, Lucassen AM (eds.) Case Analysis in Clinical Ethics Cambridge: Cambridge University Press, 2005