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medical humanities

Book review: The Heart

21 Jul, 16 | by cquigley

heart

Maylis de Kerangal, The Heart. Translated by Sam Taylor. Farrar, Strauss and Giroux, US.

In the UK it is titled Mend the Living, translated by Jessica French, and published by MacLehose Press.

 

Reviewed by Elizabeth Glass, PhD student in Comparative Humanities, University of Louisville.

 

The Heart by Maylis de Kerangal tells the story of 24 hours in the life, and death, of twenty-year-old Simon Limbeau. The narrative includes snippets from the brief hours before a car wreck that ultimately takes Simon’s life, moving through to the aftermath of his death when his heart is transplanted into the recipient Claire Méjan.

At the beginning of The Heart, Simon goes on a surfing trip with friends. On the way home, they are involved in a car accident. The other two young men escape with minor injuries, but Simon is critically injured. Once it has been determined that Simon’s injuries are fatal, and that his brain has ceased functioning, the doctor, Pierre Révol, approaches Simon’s parents to discuss organ donation. Initially reluctant, particularly about donating Simon’s heart which they believe holds his dreams, love and life, they eventually agree. Thereafter we follow the journey of Simon’s heart.

The Heart spends more time with Révol than any other character as we observe him negotiating with different aspects of the organ donation process. We also see Simon’s mom, Marianne, arrive at the hospital, her trauma heightened by being unable initially to get hold of her estranged husband, Sean, Simon’s dad. We then follow the interaction between the parents throughout the horrendous process of losing their adult son. We watch the hospital staff work with and around Simon. We are there when Révol asks Marianne and Sean to donate Simon’s organs. The most painful part of the novel involves witnessing Marianne’s reactions to learning new information about Simon as he is dying. Though we spend more time with Révol, we know Marianne better–we can feel her emotions. We meet Claire, who receives Simon’s heart. We also meet the transplant team and witness both operations: the organ removal surgery and the heart transplantation.

The novel is not about Simon’s life, and it is also not entirely about his death. Instead, it focuses on the donation and transplantation of Simon’s organs, and his heart in particular which we follow to Claire. We care about Simon’s organs as he is being kept alive awaiting surgery, and then it our own hearts that quicken as his is removed. The surgical scenes are the most tense in the novel overall. They allow the reader to alternate between a distance of watching from afar and that of being almost so near to hand that we could imagine ourselves passing the sponge to the surgeon. This is when we are closest to feeling and understanding what the characters experiencing. While the surgery and the donation process are both simplified, for someone who is only peripherally acquainted with such processes, the medical procedures were described in a detailed and interesting manner without becoming overly technical.

The Heart is told from an omniscient narrator’s point of view with a distance that gave me the feeling of being outside a glass door, or looking down from above in an operating theatre, an onlooker on unfolding scenarios. The narrator is not only all-knowing but is also an I who addresses the reader as you on occasion. This had the effect of taking me out of the moment of the action and of detaching me from the story. It caused me to wonder who I actually was, but the answer to this is never revealed and the identity of I remained hidden throughout. At one point the narrator writes, “You undoubtedly remember the description of the books on Révol’s metal shelf, mentioning a copy of an issue of that magazine from 1959, so you will have already guessed that the article appeared in that very issue” (p. 32). Instead of drawing me into the story, this aside had the opposite effect. Such asides were infrequent, but when they did occur I found them distracting. The narrator was not a presence that I was aware of all the time; the opposite in fact, as most of the time the narrator was in the background. Thus, when he or she appeared, it felt strange and distanced me from the ongoing story.

This distancing, which creates the illusion of watching what is happening, of being an onlooker instead of being directly involved, means that as readers we can only access the characters’ thoughts tangentially. The things we know are told to us, but with the impassivity of overhearing a stranger’s order at a restaurant. As a result, it is hard to care about the characters to the extent that the subject matter deserves. However, if one did become very involved with the serious content, The Heart would surely become a challenging and potentially harrowing read. Thus, the sense of clinical detachment evoked probably serves a useful purpose, and will, I suspect, ensure a wider readership.

Each sentence in The Heart tends to be a paragraph in length, containing many phrases separated by commas. This makes the novel a difficult read at times and is potentially distracting; yet it also encourages a sense of urgency. The reading experience felt halting initially, but this sensation ceased as I progressed through the book. At the outset I found myself stumbling and searching for parts of speech to make sense of some of the sentences, but there came a point later in the book when I found myself unable to put it down.

There are two versions of the novel translated into English from the original French: for the United States it is titled The Heart, and for the United Kingdom Mend the Living, which is a more direct translation of Maylis de Kerangal’s original French title Réparer les vivants. Mend the Living was nominated for the Man Booker Prize. The US reader will have difficulty with Mend the Living, however. For example, in Mend the Living, as Simon and his friends are getting ready to surf, they are said to have “liquid rhinitis, sleep with your clothes on.” In The Heart, it says they have, “runny noses, slept-in clothes.” This type of difference exists between the two translations throughout. The end of Mend the Living is as exciting as The Heart, but elements of the writing will limit its appeal to the American reader. Thus, for this reader, Sam Taylor’s translation was a more satisfactory read.

In terms of the Medical Humanities, The Heart is an illustrative example of the arts interacting with medicine. The reader witnesses doctors wrestling with complex ethical issues such as how far to push the parents to donate Simon’s organs, decisions around to whom his organs will be donated, as well as the reality of the organ removal surgery that ends his life. The reader also observes Claire’s Méjan’s difficulty coping with the fact of receiving the heart of someone who has died, as well as her transplant surgery. All these issues render The Heart a compelling read.

Overall, The Heart is a gripping novel. Although we know at the outset that Simon will die, this fact does not detract from the extent to wish it engages the reader. The book is not without its faults. The reading experience may indeed have benefitted from a shorter sentence structure, and from a more in depth delving into the characters’ minds and thoughts. Notwithstanding, the narrative that underpins the novel remains intriguing and engaging. The Heart is particularly recommended to readers of Medical Humanities.

 

 

 

Related reading

M Shildrick, P McKeever, S Abbey, J Poole and H Ross. Troubling dimensions of heart transplantation. Med Humanities 2009;35:1 3538

TA Faunce. Book review: Cutting for Stone. Med Humanities 2009;35:2 123124

‘I am Book’ – Clare Best

1 Jul, 16 | by cquigley

Illustrated talk for University of Kent symposium

on Artists’ Books and the Medical Humanities, on 21 April 2016

http://www.kent.ac.uk/english/research/conferences/artistsbooks.html

I had been so looking forward to this wonderful symposium devised, designed and immaculately planned by Stella Bolaki, and to seeing the exhibition of Martha Hall’s and other book artists’ work  – which is still on until 14 August  (Prescriptions Beaney House of Art & Knowledge, 21 April-14 August 2016). Then I went down with a virus the day before the symposium and lost my voice overnight. Stella very kindly delivered my talk for me and showed the images that went with the words. Here is a potted version of my talk. See some of the images at https://selfportraitwithoutbreasts.wordpress.com/2016/05/26/illustrated-talk-for-university-of-kent-symposium-on-artists-books-and-the-medical-humanities-on-21st-april-2016/

As well as being a writer, I have worked as a fine bookbinder, a bookseller, an editor and a Creative Writing teacher. Throughout my life, making books has provided me with metaphorical and physical structures within which to reconstruct versions of my self, and body.

I am Book. A bold statement, but a pragmatic one. To a great extent we are all Book. We have our narratives, we talk of turning the page, or of starting a new chapter in our lives. We shelter, disguise or hide ourselves between covers. But I think I’ve always been particularly absorbed in the idea of books, of Bookness, and today I’m going to talk about why that is so, and perhaps my sense of Bookness might suggest things about artistic identity in general.

My father was a papermaker for his entire working life. As children, my brothers and I spent our Saturday afternoons at Dartford Paper Mill, where my father was then Manager. Our lives were full of paper samples and offcuts. I wrote on them, folded them into pamphlets and made childish books out of them from my earliest years. And I was an obsessive reader. It all began with the illustrated Golden Treasury of Poetry I was given for my 6th birthday. It’s still one of my most precious belongings. I feel a primal thrill when I open it. Most of the time, growing up, I had my nose in a book.

I went on to read English Literature at Cambridge, gathering along the way a passion for print and fine books, and after university I decided to become a book maker and book doctor – I trained as a Fine Bookbinder and loved working with fine papers, cloths, marbled papers, leather, vellum, gold leaf. But after nearly wrecking my eyesight with close work (gold tooling) I was obliged to change professional direction. I went to work for Tim Waterstone in the early 1980s when his bookshops were taking London by storm. In time I moved across from the art book department at the High Street Kensington store to working with Waterstones Publishing Division, first as a researcher, then as an editor. Later I was an editor for ten years with the French publisher Gallimard Jeunesse and their English language partner Moonlight Publishing.

I can see now that up to this point I was wanting more and more to inhabit Bookness – to read, to make and bind, to edit and publish and sell – but had not yet dared to jump into the very stuff of my identity, or identities – the writing itself. And, through the writing, to uncover the reasons for my Bookness in the first place.

So I see these stages of my life, up to my early 40s, as serial constructions, deconstructions and reconstructions of different versions of myself in the world, in efforts to find out what I was and where I belonged. I was creating and exploring a kind of library showing different aspects of my identity, or indeed different identities.

Since then, the past twenty years have represented a deeper and infinitely more satisfying deconstruction and reconstruction of my self, my selves, through writing and making Books that I inhabit from the inside, outwards.

I had always written, but the pressure to ‘come out’ as a writer built up through the 1990s and beyond. The latter part of this period then coincided with another pressure in my life, that of facing head-on my high risk of contracting the genetic breast cancer in my mother’s family. The result of this confluence was my first full collection of poetry, Excisions, which has at its core the autobiographical cycle Self-portrait without Breasts.

(Here I would have read a few of these poems, alongside showing some of Laura Stevens’ photographs which were taken in two shoots, the first a few weeks before, and the second some 18 months after, my risk-reducing double mastectomy.)

 

Self-portrait without Breasts

 

Tangled hair, charcoal-socket eyes,

mouth slack after one more long night

restless on my back. This body’s fenscape,

manscaped, hills removed – the meaty joins

still livid, tight shut mouths

where distant territories were stitched

 

in touch. Blood seeps in deltas over ribs,

yellow and purple track to the waist.

You’re even more beautiful now, you say

and I believe, for though I never was, I am

explorer, seeker – I’ve travelled

and I have an ear for truth.

 

Memento

 

When you cast me, I held my breath

as the plaster set. You kept your focus,

capturing the contours of my breasts.

 

Remember that awkward fold by the clavicle,

air trapped between layers, remember

my fear – that flesh could not be cast

 

to look like flesh. But now, when I touch

the rough white woven skin, I want to quit

my body, let the twin chalk rind

 

contain my breath, while I recall a lover’s kiss,

the heat of milk-tight flesh, my newborn

trying to focus as I held him.

 

How will I remember this?

Numb flesh stapled over ribs,

my breath snagged within.

 

Making the Self-portrait poems provided me not only with a way of working through and revisioning my experience of this trauma and its many repercussions, but also with a way of reconstructing my changed body into a body of work – and, metaphorically and literally, into a Book. Excisions has proved to be a key book in my development as a writer and in my personal growth – a milestone on my artistic journey. At the level of line and stanza, as well as at the level of physical object, I used poetic form to bring new order to my altered identity and to my sense of belonging both in terms of family history and artistic inheritance.

I later put together that very solo experience of writing the Self-portrait without Breasts poems with Laura Stevens’ before and after photos (in book/pamphlet form, as Breastless).

Since then I have returned several times to the Bookish concept of collaboration – through a site-specific theatre piece called Vacant Possession co-written with Sara Clifford in summer 2015, through a multimedia project Take Me With You: the museum of friendship, remembrance and loss, with the film-maker Tim Andrews, which was launched at BSMS in February 2016, through Springlines, a project with the painter Mary Anne Aytoun-Ellis in which we are exploring hidden and mysterious bodies of water across the South of England – and through a three-way collaboration to make CELL, involving my own long poem in twelve parts, Michaela Ridgway’s drawings and Katy Mawhood’s design.

This last project, CELL, had been many years in gestation before being published in its unusual ‘almost-pamphlet’ state in 2015, and in some respects it is – of all the books I have made – the one that most closely represents, in its themes and emotional content and in its form, my own earliest sense of identity.

The poem is a retelling of the story of Christine Carpenter, a girl of fourteen who was enclosed in an anchorite cell in 1329. She requested release after more than a thousand days of living in the cell, and did come out, only to be forcibly re-enclosed when the Bishop heard of her release.

I myself was sexually abused, and emotionally ‘locked away’ as a young child. I underwent many years of isolation, silence, shame and suffering before finding my way out of the cell and into healing.

(I would then have read out parts of an interview about CELL with Kay Syrad for the most recent edition of The Frogmore Papers.)

 

Kay Syrad in dialogue with Clare Best about CELL (Frogmore Press, 2015)

 

‘KS: Getting ready to read CELL, I found myself acting rather ritualistically: I cleared the table, placed the pamphlet parallel to the edge of it, carefully removed the wrapper, studied the cover and the printed burgundy paper sleeve, eased off the sleeve and finally held the pamphlet in my two hands. Standing up throughout, I read the poem until I came to the point where, following the diagram, I was to unfold the pages in a way that creates a paper ‘cell’. There could be no rush.

 

I think this is the closest I have come to genuinely embodied poetry: knowing there is a potential space within the form, waiting for it, creating it, reading the poetry within that confined space, unfolding the structure to a flat sheet and then refolding it into its pamphlet form – these experiences seem to me quite as emotionally significant as reading the poem. Would you agree?

 

CB: With CELL, I wanted the reader’s experience of content and physical form to be especially closely bound.

 

To write the poem, I’d researched what happens to the body and mind in situations of extreme privation such as enclosure in a basic cell over this kind of period. I wanted to emphasise the changes Christine would have lived through by achieving a physical form for the work which is several different things at once (pamphlet, paper sculpture, flat printed sheet) and which suggests alternations between different states.

 

The object’s form is designed to mirror the unfolding drama described in the poetry and the drawings. Early sections of the poem can be read by turning the pages, so far so relatively normal. Then the reader discovers the ‘cell’. Next they must open the entire sheet – making the ‘cell’ vanish and freeing its imagined prisoner – in order to find and read the last section of the poem. Finally, refolding the sheet into a pamphlet is like re-enclosing Christine or even burying her. Throughout, the reader is in some way complicit in the events of the poem simply by carrying out the act of reading.

 

KS: Your crystal clear, unflinching poem lives and breathes not only the pain of its subject, Christine Carpenter, but her heart-breaking effort to justify her pain – and in this way the poem speaks to every woman who knows the cultural and mortal price of imagined or projected ‘sin’. Clare, what precipitated the writing of CELL?

 

CB: I’d started thinking about the themes in CELL when I spent some intense weeks working with male life prisoners, witnessing the damage that separation and isolation can do to a person. And I know a lot, personally, about the damage inflicted on the self by shame. Finding and retelling Christine’s story presented an opportunity to write in a focused way about the double prison of isolation and shame.

 

CELL evolved slowly over a number of years when I was working on other poems and sequences and also on a prose memoir which explores relationships between daughter and father, daughter and mother. Christine’s mother plays an important role in CELL, although we never hear her voice. There are also male figures in the poem – the priest/father figure whom Christine watches through her cell window, the real or remembered or imagined Lucifer/rapist, and the Bishop. The mother’s absence, together with the ambiguous overlapping presences of these males, points to some essential but unspoken truth about Christine’s vulnerability. Today we would probably say that she was acting out a traumatic past. I am interested in how the ‘choice’ of extreme deprivation (still) can be framed as religious cleansing.

 

But in some ways I wrote CELL blind and it wasn’t until the poem was almost complete that I realised fully what it was about.

 

KS: The pen and charcoal drawings by Michaela Ridgway (who is herself a poet) also embody a claustrophobic intensity in the way they refuse to stay within their borders, at once hiding and exposing a female body that is tender and fierce, layered, smudged (almost erased), dark or clear. Can you tell us how this extremely effective collaboration began and how it developed into what we see here?

 

CB: I was finishing the umpteenth draft of CELL and beginning to think about how to send it out into the world, when I saw Michaela’s powerful and enigmatic drawings of female nudes which she was posting on Facebook. We met and talked at length. Michaela completely ‘got’ the poem and the layers of it, plus she agreed with my aim of wanting poem and art to work independently and together – this was no illustration task.

 

We talked about how we wanted words and images to complement each other, moods and feelings to bounce around between them. From this point, our work was to whittle down the choice of drawings, discover how to sit the images within or across the confines of rectangular spaces, and figure out where to place them in relation to the poetry in order to imply both incarceration and breakout, confinement and rebellion. We also wanted some significant blank space – with only a single folding sheet this was challenging, but we managed it!

At the same time that Michaela and I were thinking about all this, we were consulting the designer Katy Mawhood, whom I had commissioned. Katy had excellent ideas for placing Michaela’s art and my words in the context of the particular pamphlet form we had decided on. For instance, Katy’s suggestion for the lettering on the cover, where the C of CELL appears like a cap over the neck of a headless female figure, was daring. Michaela loved it and so did I. In fact, that C and the entire cover design encapsulate the power of word and image working in close harness.’

To finish, I’d say that for me and for my evolving identities, the idea of Bookness carries sacramental meaning.

Books, in all their forms and in all their manifestations in my life, have been my saving and my making, my containment and my freedom, my focus, my work and my relaxation.

I made my first books with my father’s discarded paper. Later – in training to be a bookbinder – I was preparing to rescue, restore and protect my own damaged and vulnerable yet resilient substance, my own Bookness. I was drawn to bookselling and publishing because they kept me in close contact with my life blood. But writing and imagining my own Books into being has been and is for me the most faithful and true expression of my identity/ies.

I like to think of my bookbinding skills, tools and materials as interchangeable with elements of my life and creativity. I start with flat sheets, I fold and sew and cut them into books, press them in presses, cover them, decorate them, leave them under weights. Like the surgeon or the tailor – as a writer, artist and maker of books, I keep my knives sharp, my eyes clear, my needles and tape measure close to me.

As a child I reached for what was closest and I made of the materials what I could, what I had to. I have continued to do this and I will do it all my life.

 

The bookbinder

 

Pare the leather, thin the skin

where it must stretch and crease.

Then paste: the tanned flesh darkens,

 

wet and chill, fingers working

over spine and cords, into joints,

mitreing corners neat and flat.

 

Bandage the book in paper, let it

settle under weights, day after day

until the leather’s dry and tight.

 

When the time is right for finishing,

black the room, clamp the book

spine up in the beech-wood press,

 

the lamp pointing where to begin.

Hot brass letters and a vigilant hand –

an accurate blind impression.

 

Paint in glair with a fine brush,

lay on gold leaf, with level breath.

Tilt the light, shadows will reveal

 

the place to press the tool again.

Now, strike the gold – feel the title

word by word, bright in the grain.

 

Clare Best is a poet and writer with particular interests in writing body and landscape. Her poems are widely published in magazines including The Rialto, The London Magazine, Magma, Resurgence, Agenda and The Warwick Review. A chapbook, Treasure Ground (HappenStance 2009), resulted from her residency at Woodlands Organic Farm on the Lincolnshire fens. Breastless – poems from the sequence Self-portrait without Breasts with photographs by Laura Stevens – came out with Pighog in 2011, and Clare’s first full collection, Excisions (Waterloo Press 2011) was shortlisted for the Seamus Heaney Centre Award. She teaches Creative Writing for Brighton University and the Open University, and lives in Lewes, Sussex.

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

Kay Syrad’s website: www.kaysyrad.co.uk

 

The Reading Room: The Violet Hour – Great Writers at the End

10 Jun, 16 | by cquigley

 

the violet hour

Katie Roiphe. The Violet Hour: Great Writers at the End. Virago, 2016

 

Reviewed by Professor Robert C Abrams, Professor of Psychiatry, Weill Cornell Medical College, New York

 

A central premise of Katie Roiphe’s The Violet Hour is that the awareness of approaching death is a milestone we all will face at some time and in some form. From there, Roiphe explores how the moment of awareness, the awful prognosis, was confronted by each member of an august selection of writers and thinkers. But it is not only that first acute glimmer of understanding that Roiphe examines, since dealing with death more often than not involves a lengthy, even a lifelong, prodrome, an unwelcome perception that appears slowly and gathers to invade consciousness.

Roiphe’s subjects are persons of uniquely substantial depth, creative visionaries in their own fields—Susan Sontag, Sigmund Freud, John Updike, Dylan Thomas, Maurice Sendak. An interesting aspect of the book is that, when the subject is death, these luminaries are just as avoidant and vexing as the rest of us. One is at first tempted, naively, to believe that what these individuals have accomplished in their lives ought to ease the pain of anticipated death, or enable them to articulate the experience in a way that leads us to greater insight. However, intellectual or artistic stature does little to soften the impact or illuminate the journey—at least for this select group. Instead, Roiphe shows how the nearness of death strikes with terror at one’s narcissistic heart and can derail the psychological homeostasis of almost everyone.

What can be derived from the accounts of these great thinkers is therefore not clarity, but an analysis of how they actually felt as death loomed. In a way, Roiphe’s writers coped with death much as they had lived, in all their contradictory ways. Like strands of spaghetti Bolognese, each story line branches out and swirls around in so many messy directions that the themes can be difficult to untangle and trace. (In fact, compared with their highly variable, tortured pre-death processes, the actual moment of death for these writers seems to have been uniformly anticlimactic; all the complicated action has taken place earlier). So it is that we are shown how Dylan Thomas dreaded death but died in a self-destructive orgy of alcohol and Benzedrine, the culmination of years of punishing abuse of his health. John Updike, on hearing his dire prognosis, turned immediately to poetry, for him a reliable source of consolation, and he kept at it, creating what some have considered his finest work, for as long as his strength allowed.  Susan Sontag did something similar, finding solace under the cover of the intellectual constructs that were her hallmark, except that she fiercely refused to give in or let go; she marshalled all the intellectual force at her command to master her illness and survive it­­, until she simply fell away. Freud was magnificently inconsistent: Freud, the ultra-rational doctor who once famously insisted that “a cigar is just a cigar” could never give up what he knew was rooted in primitive oral gratification and thus knowingly died of smoking-related cancer. Maurice Sendak, who seemed to have imbibed angst prenatally, was completely preoccupied with death and had been preparing for it nearly all of his life.

But thinking about death when it is not proximal is very different from grappling with it in the moment. Death is something for other people, never for oneself, until it isn’t. But up to that moment, it is safe enough to wish for death, romanticize it, flirt with it. When death actually does arrive, it is presented as a full-stop but not necessarily a resolution; one dies, not after living but during it, leaving everything that is unsolved, unsolved. Again, these observations would be unremarkable were it not for Roiphe’s notion that the deaths of such hyper-articulate individuals should be exceptionally revelatory. That in the end her characters are merely ordinary humans contending with the direst possible threat to their existence may be in fact the point.

If The Violet Hour can be a dark, depressing read, it is also a brilliant one, framed in stunning, exquisite prose by an artist-of-a-writer.  Roiphe’s introductory synthesis of thoughts about death could easily stand alone as a splendid thought-piece, and there is a touching personal epilogue at the end. But for most of the book the author is rather coy about her own views of death. For that one must look to her casting choices. Starting with a set of 20th century cultural icons who wrestled with the concept of death and left written records and accounts of witnesses to prove it, her chosen characters add up to a grim group of players, John Updike being the sole possible exception. The others are grim, not only because they are dying, but because of the bleakness they have created for themselves.

It is probably a consequence of Roiphe’s selection of characters that there is missing in this book any serious discussion of hope—Emily Dickinson’s resilient little creature with “feathers.” Hope is too effeminate for the likes of Susan Sontag, who preferred to submit to a brutal stem-cell transplant in lieu of gentle palliation because the transplant offered a slim hope of survival. Hope is too shallow and totemic for Freud, who prided himself on tolerating pain with what Roiphe aptly calls “heroic clarity” instead of mind-numbing analgesics. Hope was off the radar entirely for that 20th-century poet-maudit, the personification of romantic self-loathing, Dylan Thomas. But for us ordinary folk, readers who are death-fearing, moderately self-defeating but not quite blatantly self-destructive, some consideration of hope just might be welcome.

In an influential article in the geriatric psychiatry literature, Sullivan succinctly formulated how “hopelessness at the end of life is not simply the absence of hope but attachment to a form of hope that is lost.” [1] Consistent with the writings of Erik Erikson, [2] this view holds that a dying person must deflect mental energy away from the goal of survival, the currency of which has been divested of all value, to some alternative ethos consistent with his life and personality; this should ideally be something larger in scope than one person’s life, some experience or value that will outlast and transcend the individual, such as intimacy, democracy, art, or salvation. In the absence of any realistic point of future reference, redirection of hope becomes the urgent task to be confronted when one is handed a final sentence of death.

Considering Roiphe’s cases from this perspective, she shows how Sontag haughtily spurned everything but survival, and by embracing a losing cause, died sadly, though she left a spectacular record of written reflections. She documents how Freud, who worked until the end, died with little psychological adjustment to make, well aware that he had created an incomparably rich legacy; he also had an heir to his intellectual estate, his daughter, Anna, who was eager to perpetuate it. Only Updike seemed to achieve a meaningful transition; his hopeless prognosis spurred him on to new creative heights and enabled him to return, albeit briefly, to the top of his form as a writer, a peak from which prior to his cancer diagnosis he’d felt he had been slipping. Previously it had been sexual affairs that had seemed to energize his writing; now it was the awareness of death. When he could no longer write, he died.  Neither Dylan Thomas nor Maurice Sendak ever entertained any sustained vision of themselves as surviving, so no such transition applied to them.

Reflecting on the absence of hope in the main body of The Violet Hour should not be taken as a criticism, for Roiphe, by clinging to neutrality and avoiding any position other than that of reporter until the book’s final pages, invites readers to abstract their own lessons from these stories and integrate them in a personal way. And it is fortunate indeed that she does not entirely neglect the critical human need for love, solace and inspiration at the end of life. It had to have been for such a purpose that she cited these beautiful lines written by the terminally ill John Updike:

“To live is good / but not to live—to be pulled down  / with scarce a ripping sound,  / still flourishing, still / stretching toward the sun– / is good also.”

 

References

  1. Sullivan MD. Hope and hopelessness at the end of life. Am J Ger Psychiatry. 2003; 11(4):393-405.
  2. Erikson EH, Erikson J, Kivnick HQ. Vital involvement in old age. New York: W.W. Norton & Company; 1994.

The Reading Room: Salka Valka

27 May, 16 | by cquigley

 

Salka Valka by Halldór Laxness: she needs to be alone

 

Reviewed by David S. Baldwin, Professor of Psychiatry

Clinical and Experimental Sciences Academic Unit

Faculty of Medicine, University of Southampton, United Kingdom

Email:  dsb1@soton.ac.uk

 

Born in Reykjavík in April 1902, Halldór Guðjónsson (he changed his name to Halldór Kiljan Laxness in 1923) lived through almost the entire twentieth century. Raised in an isolated and traditional society, he travelled widely and embraced cosmopolitan modernity, though retained an essentially Icelandic identity. In early life Laxness adhered to staunch revivalist Catholicism, then embraced socialism for thirty years. He subsequently espoused ecological and pacifist causes and addressed philosophical questions reflecting an interest in humanism and Taoism. But the principal achievement of Laxness was the authentic portrayal of sympathetic but struggling characters that symbolised the determined aspirations of the Icelandic nation and marked its long path towards eventual independence from colonialist Denmark (1).

 

Laxness travelled to America in the 1927 summer intending to become a Hollywood screenwriter. Writing to his then wife Inga at the end of that year, he described work on a film script provisionally titled Salka Valka (or, A Woman in Pants): the eponymous protagonist is described as ‘tall and strongly built’ with an expression encompassing ‘rustic virginity, dare-devilry, primitive charm’, and ‘dressed like a fisherman: wide pants, the boot-legs reaching up over her knees, a pipe in her mouth’. The script reflects contemporaneous Freudian concepts of human sexuality and is redolent with surrealist images, such as the final scene in a lover’s cottage where Salka lingeringly unfolds and kisses the leather straps of an Icelandic whip (often made from skin of bull penis) and Laxness imagined the cross-dressing Swedish actress Greta Garbo in the title role (1). Not surprisingly, negotiations with MGM floundered so the script was transformed into a two-part novel: the first manuscript was written whilst visiting isolated Icelandic fishing villages, the second was completed in cosmopolitan Weimar-era Leipzig. These were published a year apart with the support from the national Cultural Fund: the first (O Thou Pure Vine) was well received, but the second (The Bird on the Beach) was chastised by conservatives for its perceived lampoon of boorish ‘upper class’ motivations and criticised by progressives for its caricature of labour movement infighting – the Communist Party leader suggesting Laxness approached socialism as an idealist, with only a bourgeois understanding of the workers’ struggle (1).

 

An English translation of the combined parts of Salka Valka was published in 1936. The English language version has been out of print for many years, but Guðny Halldórsdóttir kindly lent me her copy, which was published in 1973 following revision by her father (2). A previous review commended its saga-like objectivity and clarity, and the masterful portrayal of down-trodden characters whose local quotidian travails seem emblematic of wider persistent human suffering (3): another account praised its Christian symbolism and careful balance of honourable parishioners and devious villains on both sides of the class struggle (4). The themes reflect the author’s perennial concerns with the nature of love, position of women, role of the intellectual, and the lot of common people: many chapters are full of visceral emotions and disturbing sexual acts perpetrated against young women. In a notebook Laxness described his wish to provide ‘tragic perspectives on the incomprehensibility of human feelings’, perhaps drawing on his desolation, anguish and guilt at the end of an affair with an Icelandic woman whilst living in America. But neither review has considered how the progressive emancipation of Salvör Valgerður (‘Salka Valka’) – as she first becomes a prominent local activist, then distances herself from the competing attentions of aggressively preying or dependently needy men – may reflect a growing awareness of her own sexuality.

 

The novel starts with the mid-winter night-time arrival by boat of eleven-year old Salvör and her unmarried mother Sigurlína at the run-down fishing village of Óseyri. The daughter disembarks first and reassures her mother, ‘in a low deep voice’ which suggests that of a man. They are grudgingly offered a room for the night at the Salvation Army hostel, but the next day their destitute status is acknowledged but not addressed by the local storekeeper, rector or doctor. They return to the hostel and fall prey to the impulsive but persuasive drunkard Steinþor Steinsson, who leads them towards ‘Marbud’, the home of his elderly aunt Steinunn and almost-blind uncle Eyjolfur, where they are offered lodgings. That evening Salvör tells her mother that whilst she was outside Steinþor had ‘grabbed hold of me here and here, and here’, and ‘whispered some stuff in my ear’ but Sigurlína responds inadequately, by asking for mutual understanding between ‘two women’, a response which has a fatal consequence. During the night Salvör is woken by the sound of tussling in the bed, as Steinþor forces himself on Sigurlína: he is repulsed, but only after he whispers a proposition which makes her recoil ‘Almighty Jesus, no! You know you can’t ask me to do a thing like that’. Later, whilst lying awake, Salvör realises she had often lain alone at night whilst her mother was absent, and for the first time appreciates she will have to rely on herself for her future safety: the narrator commenting ‘perhaps one really had nobody but oneself’.

 

The first part ends at dawn on Easter Day, when Sigurlína is found drowned, ‘a little grey oblong piece of flotsam which had been washed up on the sand’. This suicide is the result of a long process which includes remorse for the relationship with a married man which led to pregnancy with Salvör, regret for a subsequent series of damaging sexual liaisons with exploitative men, persistent grief following the death of her two-year old son Sigurlinni from scrofula (tuberculous cervical lymphadenitis: it is later revealed that Steinunn lost many children at Marbud to the same illness), a demoralizing awareness that Steinþor had once again attempted to force Salka into a sexual relationship, and acute anguish following a second desertion by Steinþor, just a few days before their hastily-arranged ‘Hallelujah Wedding’ scheduled for Holy Saturday. Her fragile personality could not withstand such prolonged adversity, without unconditional support from her daughter for whom ‘her mother’s weeping no longer went so deep to the heart as it had done’. During her testimony on entry into the Salvation Army two years before, Sigurlína had told the Congregation of her intention to commit suicide whilst pregnant with Salvör, but attempts at spiritual consolation by vigilant fellow Congregationalists following this nuptial desertion had made no impact: and the position of the often-derided Sigurlína within the wider community had always been marginal. Salvör, just fourteen years old, guarantees the costs of the funeral and walks back to Marbud, alone.

The second part of the novel charts the rise to prominence of Salvör within Óseyri. She establishes a local branch of the seamen’s union to defend workers against managerial exploitation; educates herself through reading political, evolutionist and philosophical texts; and assumes maternal responsibilities for four children once their mother dies. She is praised for being ‘a match for any man alive’. She is tall, erect and high-shouldered, her thick hair cut short with a side-parting; has courageous clear eyes, strong jaw and full lips, firm hands and a deep voice; and wears Alpine hiking-boots, woollen trousers and a roll-neck Jersey sweater which does not conceal the full curve of her firm breasts. She is commended by her childhood crush Arnaldur (by then a Communist agitator) for being a ‘tovarisch’ (Bolshevik comrade worker) icon, but current observers might recognise her portrait as iconographic of something else. She withstands the pleading entreaties and forcible sexual attentions of now-wealthy but still unscrupulous Steinþor, and leaves Marbud after she discovers it was Steinþor who had provided anonymous funds which enabled her to remain there after the death of Steinunn and Eyjolfur. Once aware of the feckless serial infidelity of the impractically idealistic Arnaldur (and despite some lingering affection for him), she reluctantly but determinedly ends their relationship by encouraging him to pursue his dreams in America. At the end of the novel, when the twenty-two year-old Salvör is finally free of unwanted male attention, the narrator compares her solitary precarious existence to the eggs of winter birds resting on narrow ledges on a high cliff-face: but contemporary readers might contend that having rid herself of both barbarous Steinþor and immature Arnaldur, Salvör may not want but certainly needs to be alone. Though with a typical twist, Laxness suggests she may be pregnant: for as Salvör walks past her most long-standing friend, he comments enigmatically, ‘cold weather to be born in’.

The novel therefore carefully illustrates the potentially damaging consequences of parentlessness, childhood abuse, unexpected bereavement and marital desertion; the corrosive effects of social and economic inequality; and the undermining of the aspirations of women by patriarchal institutions. Sigurlína succumbs after accumulated experiences of deprivation and loss, mediated through demoralisation and despair. It is argued that ‘resilience’ represents a process which allows the resumption of development following trauma or other adversity, and contends that ‘bonding’ and ‘meaning’ are important dynamic features which support this process (5). Those with only fragile affiliation or for whom life has lost its meaning (as depicted by Sigurlína) are less buffered against undermining challenges: but the active community engagement of Salvör provides a supportive network facilitating her eventual passage towards probable independence and emancipation.

 

References 

  1. Guðmundsson H. The Islander. A Biography of Halldór Laxness, trans. by Philip Roughton. MacLehose Press 2008.
  2. Laxness H. Salka Valka, trans. by F.H. Lyon. London: Allen & Unwin, 1973. Originally published in two parts as Þú Vínidur Hreini (1931) and Fuglinn Í Fjörunni (1932).
  3. Magnússon S. The World of Halldór Laxness. World Literature Today 1992; 66: 457-63.
  4. Hallmundsson H. Halldór Laxness and the Sagas of Modern Iceland. The Georgia Review 1995; 49: 39-45.
  5. Cyrulnik B. The Whispering of Ghosts. Trauma and Resilience, trans. by Susan Fairfield. New York: Other Press 2005.

The Reading Room: ‘Making Medical Knowledge’

25 Apr, 16 | by cquigley

 

Making Medical Knowledge

By Miriam Solomon

Oxford University Press, 2015

 

Reviewed by Dr Jonathan Fuller, University of Toronto

 

We should forgive anyone unfamiliar with recent trends in ‘scientific medicine’ for thinking that within scientific medicine there are now multiple medicines to choose from: evidence-based medicine (EBM), translational medicine, narrative medicine, personalized medicine, and so forth. These approaches are not distinct professions in the same sense as allopathic medicine and naturopathy. But just what are the relationships among modern medicines many ‘medicines’?

In Making Medical Knowledge [1], philosopher Miriam Solomon sets out to assess four of these movements introduced over the last forty years: medical consensus conferences, EBM, translational medicine, and narrative medicine. She calls them ‘methods’ to be concise, but notes that they are distinct epistemological approaches, or approaches to (medical) knowledge. Solomon writes that she selected these four methods because of their “dual and paradoxical epistemic character” (p. 14): there is something obvious about each of them (of course medicine should be ‘based on evidence’), as well as something odd (‘evidence-based medicine’ deemphasizes many kinds of evidence, including expert consensus). Given how much time, effort and money is being spent in the name of these movements, a close inspection is certainly warranted.

Solomon’s approach in her book is to examine these methods using an interdisciplinary lens. She situates her study in the realms of social epistemology, philosophy of medicine, integrated history and philosophy of science, science and technology studies (STS), and critical medical studies. She describes her approach as “Naturalistic, Normative, Applied, Pluralist, Social Epistemology” (p. 11); in other words, she aims to describe and evaluate actual medical knowledge and practice using a diverse set of tools, and with a focus on the social. She writes for a broad academic audience, including the medical community.

In the introductory chapter, Solomon argues that “[t]he science/art dichotomy is no longer a fruitful disciplinary divide” or a meaningful way of describing medicine (p. 11). She instead argues that a ‘methodological pluralism’ describes contemporary medicine and its many methods for negotiating knowledge. Solomon then spends three chapters examining medical consensus conferences and group process, two chapters on EBM, one chapter on translational medicine, and one chapter on narrative medicine. The penultimate chapter advances Solomon’s ‘developing, untidy, methodological pluralism’. According to this view, medicine’s epistemological approaches do not have exclusive domains of application; all of the methods she describes are in active use, their domains overlap, they sometimes come into conflict with one another, and there is no “hierarchy of methods” (p. 229) to rescue us when they clash. The final chapter summarizes Solomon’s main conclusions.

Making Medical Knowledge is an excellent and pioneering study of some of the dominant movements in early Twenty-First Century medicine, which – with the exception of EBM – are relatively unexplored by scholars. It provides a good entry point, offering detailed and insightful reconstructions of each method within its historical context, thus satisfying Solomon’s descriptive aim. The historical detail is rich, especially for medical consensus conferences. Solomon is charitable towards each method, and manages to find substance amidst the rhetoric, even for translational medicine, which is especially difficult to pin down and appears at first glance to offer no more than metaphor. She also provides thoughtful criticisms of each method, thus satisfying her normative aim.

Overall, I think Solomon pitches the discussion well for the broad audience she has in mind. The philosopher, historian, sociologist and anthropologist should all find something of interest in her book. I expect that clinicians, especially within academic medicine, will find it fairly accessible. Satisfying the needs of her diverse audience perhaps prohibits Solomon from going into as much depth as some philosophers, historians or social scientists might like. Such is the cost of interdisciplinarity, but it pays off in the form of a study that benefits from its use of multiple disciplinary lenses.

While I generally agree with Solomon’s analysis of each method, I was not fully convinced that an ‘untidy, methodological pluralism’ is the best way to understand the relationships among the methods. Solomon accepts that the methods are often active at different stages of research, but nonetheless argues that they do not fall on a “tidy linear spectrum” from research to practice (p. 206). Yet as her own analysis reveals, translational medicine (research from ‘bench to market’, or ‘T1’) refers to basic medical science research as well as Phase I and II clinical trials, EBM appraises and aggregates the results of Phase III trials, medical consensus conferences make therapeutic recommendations based on the results of Phase III trials or systematic reviews of trials, and narrative medicine (in its integrated form) interprets guidelines and the research literature in the context of the patient’s story. In other words, translational medicine applies to medical research, consensus conferences apply to knowledge dissemination, and EBM and narrative medicine apply to clinical practice. The main purpose towards which each method is put is unique: translational medicine develops new medical technologies, consensus conferences develop consensus statements or clinical guidelines (often pertaining to those technologies), EBM appraises evidence and applies it in clinical practice, and narrative medicine uses narrative techniques at the bedside. Thus, their domains are less overlapping and arranged more linearly than Solomon’s untidy pluralism might suggest.

Of course, the practice of EBM might sometimes conflict with the practice of narrative medicine (more on this point in a moment). Moreover, the practice of narrative medicine or of EBM might sometimes conflict with the products of consensus conferences: clinical guidelines. Narrative medicine locates individuality in the patient’s narrative, and EBM is often defined as the use of evidence in the care of individual patients [2]. On the other hand, guidelines make recommendations for broad groups of patients, not for individuals.

Solomon presents the example of breast cancer screening for women in their forties to illustrate the various ways that the methods can clash with one another. However, most of the conflict that Solomon describes occurs within each method: among pathophysiologic theories of breast tumour development, among primary studies and systematic reviews with respect to the magnitude of benefit from screening, and among guidelines making recommendations about mammography. While some of the products of EBM (systematic reviews) might appear to conflict with some of the products of consensus conferences (guideline recommendations), the former recommending against mammography and the latter often recommending in favour of mammography, this appearance is illusory. The evidence, on its own, does not have the power to recommend. Conflicts arise among individuals and groups due to their differing interpretations of the evidence and divergent recommendations for which they use the evidence to argue.

Similarly, it might appear that generalized breast cancer screening guidelines conflict with the individualized practice of narrative medicine or EBM. However, even though guidelines make general recommendations on mammography for women in their forties, Solomon notes that the guidelines explicitly state that patients and their physicians should make an individualized decision. There is thus less conflict among the different methods than first meets the eye.

Rather than an untidy methodological pluralism, another way to describe the situation is as follows. Medical research has a dominant aim (‘translation’), and medical practice has a dominant epistemology (EBM). The aim of translation regulates the funding of research, and motivates the use of consensus conferences to disseminate knowledge. Meanwhile, EBM has been embraced by leading medical journals and medical training programs around the world. While medical consensus conferences and clinical guidelines predate EBM, they are now based on the principles of EBM and can be considered EBM tools (the use of evidence-based practice guidelines has been called the ‘using mode’ of EBM [3]). The practice of narrative medicine might sometimes conflict with the practice of EBM. But narrative medicine is a developing movement and approach to clinical medicine, not a dominant one. It does not yet have the political power of EBM. Thus, within research and medical practice, there is more hegemony and less egalitarianism than Solomon’s untidy pluralism perhaps suggests.

Making Medical Knowledge raises interesting questions about the function, theory and practice of medicine’s most influential movements. Modern medicine is a mess of many ‘medicines’, and while it is not the intention of this book to make this mess look tidy, Solomon does succeed in making it intelligible.

 

Acknowledgments

I gratefully acknowledge funding support from the Canadian Institutes of Health Research.

 

Funding

Canadian Institutes of Health Research.

References

  1. Solomon M. Making Medical Knowledge. Oxford: Oxford University Press, 2015.
  2. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence Based Medicine: What It Is and What It Isn’t. British Medical Journal 1996;312:71 – 72.
  3. Straus S, Glasziou P, Richardson WS, Haynes B. Evidence-Based Medicine: How to Practice and Teach It. Edinburgh: Elsevier Churchill Livingstone, 2011.

PCMD Medical Humanities Conference 2016

18 Apr, 16 | by cquigley

 

Ian Fussell

Community Sub Dean UEMS

 

In 2002, The Peninsula Medical School (now Peninsular College of Medicine and Dentistry (PCMD)) became the first UK medical school to integrate the medical humanities as core curriculum.

Every year since, year four students engage in a six-month project alongside and mentored by an artist. The culmination of the project is a conference organised by the students displaying and presenting their work.

The work thus created has become increasingly sophisticated over the years, as evidenced by the 2016 conference that just took place in Truro (April 2016). In fact, it was probably the highest quality of work seen to date and would not be out of place at any international medical humanities conference.

The morning session was opened by Professor Alan Bleakly, the current President of the Association for Medical Humanities and a leading world expert in the field. This was a particularly poignant conference as 2016 is the final year that it will be run under the auspices of PCMD following the disaggregation of Exeter and Plymouth Medical Schools. It may have been this, or the unsettled future that the current students are facing, that gave this year’s presentations an extra edge.

Following a superb talk by Alan that encouraged a political voice, we were treated to three songs written and performed by “Dull to Percussion”, a band formed in the “Medical School of Rock” module. The songs were indeed political, satirising the split between the universities and included a protest song aimed squarely at our Health Secretary. Search iTunes or Spotify to listen for yourself, and watch “A Song for a Hunt” go viral.

The day was then jam-packed and it was impossible to experience all that was on offer. The range of skill and talent was breathtaking. We were lectured on the human cost of the western desire for sweetness by students from the anthropology module, and invited to debate “Do Christians make better doctors” by the Christian ethics students. This year a number of new Special Study Units (SSUs) were run. They were also extremely good and included a collaboration with Truro’s Hall for Cornwall team.

The students worked at the theatre, but more impressively wrote a play on mental health in medical students. We were treated to a premiere performance – “Permission to be Human” should be performed at every medical school in the country. There was also a monologue by a shy mature student who helped us understand alcoholism and PTSD in war veterans. The mood was lifted by a hilarious stand up routine; how can dislocating your shoulder be so funny?!

There were a number of writing modules, including poetry. The audience was encouraged to write poems in a short workshop. Another new module was “Writing the Knife”, which generated superb short reflections on memorable clinical incidents. One piece called “Quayside” was outstanding and deservedly won a prize. Read it here https://memorablemedicmoments.wordpress.com/author/memorablemedicmoments/ and add your comments.

There was so much more to the students’ work, and this short piece cannot cover everything. However, I do want to mention a some other excellent pieces: working with clay exploring the professional masks doctors wear; pottery boxes representing the mess that doctors get into as they progress through their careers; moving and uncomfortable films that depicted a child’s journey through a hospital; the doctors strike shown as a frightening political movement; dopamine photography; a project on how we smell; and life drawing in conjunction with Falmouth Art School. At the end of the day we were “kettled” into a small room, and forced to party…

The aim of this SSU is to develop student’s tolerance to ambiguity. But the SSU achieves much more than this: it helps students develop a community of practice; it also fosters development of resilience and peer support; and importantly, the students have fun while exploring other perspectives on life and illness. I am extremely proud of our medical students and feel very privileged to work with them in this way. I hope that both Exeter and Plymouth continue with medical humanities in their developing curricula.

 

 

 

Ayesha Ahmad: ‘Lahore is an Illusion, Lahore is Everywhere’

27 Mar, 16 | by Ayesha Ahmad

The mango tree faded many shadows ago, its fruit became stones and the branches became a skeleton. Yet, the roots remained, and they embrace the soil in the womb of the earth.

images-1

This was the cradle of my family’s birth.

Now, blood is watering Lahore’s gardens.

In sorrow, I remembered these words given to me a few days ago by my father.

 ‘Lahore is an illusion, Lahore is everywhere’

I wondered about them for sometime afterwards and I did not realise the gift that these words were to become.

more…

Franco Ferrarini: The Past: a Friend or Foe? Different Perspectives from ‘Spectre’ and ‘45 years’.

27 Mar, 16 | by Ayesha Ahmad

The Past: a Friend or Foe? Different Perspectives from ‘Spectre’ and ‘45 years’.

Spectre- directed by Sam Mendes, UK, 2015

45 years- directed by Andrew Haigh, UK, 2015

By Franco Ferrarini, Gastroenterologist and film reviewer

In the words of the French philosopher Henri Bergson: ‘The pure present is an ungraspable advance of the past devouring the future. In truth, all sensation is already memory’. In this view the present, as we usually think of it, is virtually non-existent as the past connects directly with the future. Two recent, but very different films, ‘Spectre’ and ‘45 years’ provide thought-provoking insights into this relationship.

more…

Ayesha Ahmad: Introduction to Global Humanities—Through Creation, Violence Will Die

15 Mar, 16 | by Ayesha Ahmad

Against the backdrop of violence, I have been examining through my research the qualities of our human condition that perpetuate both our survival and our spirit.

As an introduction to an ongoing series on Global Humanities, I will be discussing ways we can counter the dominant narrative of violence.

Our globalised world, or rather, the collective ‘Other’, is met through encounters from suffering—the patients that enter our clinical settings, the individuals that sacrifice their lives to reach the shores of safety, and the images that we only ever see from afar of stories that breathe suffering.

more…

Take Me With You: the Museum of Friendship, Remembrance and Loss

8 Feb, 16 | by cquigley

 

Take Me With You: the Museum of Friendship, Remembrance and Loss

6.00-8.30 pm, Thursday 18 February 2016 at the Chowen Lecture Theatre, Brighton and Sussex Medical School, Falmer Campus BN1 9PX

Museum open from 6.00 pm

Clare Best and Tim Andrews in conversation (+q&a) 6.30-7.30 pm

Drinks reception from 7.30 pm

Museum open until 8.30 pm

 

From Clare Best’s blog:

‘Here is what I wrote in my journal after Tim and I first met in a café in Brighton in January 2013:

Met Tim Andrews in Brighton 16 Jan. Thought on train on way home about some kind of flexible/low-maintenance start to a collaboration. Thought more overnight.

‘Take me with you’ – this is the phrase that kept coming to me in the night. It has connotations of journey, of packing, of accompaniment, of company, of gathering in, of sharing.

I see it perhaps for now as making ‘swaps’ by email of what each of us would take with us to the next world, if we could, if there is one… Things/ideas we hold dear. Then each of us interprets or responds to each other’s chosen thing. And so on.

The items sent might be very fragmentary and abstract. They could be anything: a line from a song, a particular person’s smile, a food, a mood, a book, a film, a favourite walk, a memory, etc etc – it could be literally anything.

So we’d build up a collage, a narrative. And each time we corresponded we’d know each other better, so we would construct a kind of overlapping journal, or a conversation, through what we’d choose and send each other.

And here we are, three years later, with a robust friendship and about 50,000 words written, quite literally, between us – and all kinds of things we’d like to show you.

It’s been a stimulating journey, full of laughter and tears and adventure and tea and cake, and we look forward to sharing it at BSMS on 18 February.

The event is free, but if you’re coming along please register in advance here.

Tim has produced a trailer and has blogged about the project.’

 

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