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Writing

Reclaiming Reflection: Creative Writing and the Medical Humanities (2)

15 Sep, 16 | by cquigley

 

Creative Non-Fiction: imagination and the nature of truth

by Eleanor Holmes

 

A copy of Primo Levi’s The Periodic Table lay on my bookshelf for years, a gift from my father, one of his favourite texts. The fact that I’d not actually read it until my creative writing tutor at Newcastle University, the author William Fiennes, re-introduced me to the collection, specifically the final story Carbon, reveals how I had for most of my life considered non-fiction to be less worthy of my time than fiction.

Why had I drawn such a distinction?

I had read numerous books at medical school by Oliver Sacks, such as The Man Who Mistook His Wife for a Hat and more recently Hallucinations. These books, it turned out, definitely fell under the banner of creative non-fiction. On the one hand they could be considered factual science writing, but Oliver Sacks as an author seemed to be doing so much more than that. This realisation made me re-think what this genre was or indeed could be. Since taking William Fiennes’ module in 2013, my consumption of creative non-fiction has dramatically increased and shows no signs of abating.

Creative non-fiction, as I now understand it, is writing based in truth that uses literary techniques more commonly associated with poetry, prose and script. The attention to character, voice, style, shape, structure and form mark out this genre from journalism and reporting; the facts of a piece not necessarily being as important as the way in which it is written. For me, the words ‘not necessarily’ are crucial here.

The suggested reading list provided by William Fiennes surprised me in its breadth and scope: memoir, reportage, nature writing, science writing, portraits, travel writing, case studies and essays. Unwittingly, I had read more than I had expected but it had never occurred to me to ask, “What kind of book is this?”

In favouring fiction, particularly the novel, I’d often sought to escape reality and move away from my own experiences as a child, growing up, going to medical school and latterly working as a doctor. I soon noticed that in writing creative non-fiction, whether telling your own story or that of another person, the writer can leave themselves very exposed. There is something that appeals to readers when an author states ‘this happened’ – to them or to someone else. It creates a stamp of authenticity that can be quite interesting to unpick.

The criticism Jon Krakauer received after publishing Into Thin Air is a reminder of this. In telling his own story, he was also telling the story of those who had died on Everest. His book reads like a thriller, the tension created by the narrative pace is palpable, but the story was never going to be easy to write or to be without its controversies. The moral and ethical debate surrounding consent and sensitivity when writing creative non-fiction is very interesting to me, particularly as this is something I have wrestled with when I have wanted to write about my own work as a doctor, the truth of my own experiences.

Having researched the science behind memory, I now know that when we recall something, memories are created from scratch using different areas of our brain. In remembering, we create our own unique version of the truth, every single time, which begs the question “what is truth anyway?” The latest scientific research on memory, gleaned from my reading of Charles Fernyhough’s fascinating book Pieces of Light, sits quite neatly alongside the fact that creative non-fiction can often blur what has happened (fact) with things that have been imagined (fiction). This creative license and economy with the truth when telling our own stories is something we are all likely to be familiar with, writers or not. I cannot remember with perfect accuracy conversations I had at the age of ten, but I can use my imagination to fill in the gaps, thereby telling the story I want to tell.

This seemed a minefield to me when I started to write, so much so that I wrote under a pen name and still do. This name is no longer a secret, I have become more comfortable writing about my experiences as time has passed. It now acts as more of a separation of my writer and doctor roles. The professional duties I am bound by I take very seriously; those of anonymity, confidentiality and consent. But these same concerns paralysed me for many years in terms of writing about my life as a doctor and all that medicine has done to shape who I am. The subject of family I find far easier to explore than strangers, colleagues or indeed patient encounters; not that I do not also consider and respect those professional parameters when writing about my family, particularly consent, as my mother will attest to in my latest series of creative non-fiction blog posts entitled Consultations with my mother.

The two poems I’ve written and published about clinical encounters (He Blew Me A Kiss in the previous post and The Milkweed Monarchs here) are two examples of how you can blend medical science and clinical detail within a human narrative, writing from different points of view, using characterisation and voice alongside a narrative arc. Interestingly, I can’t seem to write poetry without some kind of narrative inherent in them, perhaps because I was a prose writer before I started to write poetry. It wasn’t possible to gain consent to write these poems from the persons that inspired them, so providing anonymity was very important when I considered publication; a very deliberate blurring of fact and fiction.

One writer from William Fiennes’ reading list particularly stood out for me, and that was Jo Ann Beard. We read her story Werner, and the dramatic tension she created and her poetic prose style mesmerised me. This was a piece of writing based in truth, but it was someone else’s story, that of a man called Werner who the author had read about and contacted. The way she got inside his head, however, and the use of flash backs was so effective at creating this man’s inner world as well as re-enacting the outer facts of his extraordinary escape from a burning building, that you felt you were experiencing what happened as if you were Werner himself.

What particularly struck me after reading this was “how did she achieve this?” I have since researched Jo Ann Beard and found her writing described as ‘dramatic re-enactments.’ I went on to source another essay called Undertaker, Please Drive Slow which was published in Tin House after The New Yorker declined to run it as creative non-fiction. She wrote this forward to the piece:

In December 1997, Cheri Tremble committed suicide with the assistance of Dr. Jack Kevorkian. What follows is a merging of fact with fiction: the external details of Cheri’s life and illness are as accurate as possible, gleaned from interviews with her friends and family, while the internal details – her thoughts, her memories, and what occurred after her loved ones saw her for the last time – are imagined.”

In Undertaker, Please Drive Slow she utilises flash backs to Cheri Tremble’s past and childhood, flickering memories that mark her decline from a healthy, working woman and mother through her diagnosis of breast cancer, the treatment she endures, then her terminal decline. The images she uses to convey the final circumstances of her death are free of cloying sentiment and all the more powerful for it.

This writing is however right on the edge, clearly controversial because of the subject matter and the question of ownership as well as truth, whatever we mean by this. It does however shed light on a subject that is so rarely spoken about, that of death and dying. Clearly we cannot ask the person who has died to tell us about their experience of dying, but in this extraordinary essay I feel Jo Ann Beard comes as close as possible to doing that. There is a kind of alchemy at work here, the way she pushes creative non-fiction as a genre to its very limits to explore an emotional truth that I believe would not have been possible if this had been written as fiction.

Primo Levi notes in Carbon his final essay of The Periodic Table:

The reader, at this point, will have realised for some time now that this is not a chemical treatise: my presumption does not reach so far… Nor is it an autobiography, save in the partial and symbolic limits in which every piece of writing is autobiographical, indeed every human work; but it is in some fashion a history.”

I have now finished reading The Periodic Table, a book that defies easy classification, something I now realise is a positive draw for me and that I seek to explore in my own writing. The blend of short stories, memoir and science writing, woven together by Primo Levi’s love of chemistry, his training and work in this field, his survival of Auschwitz and the horrors of the Holocaust, and his undoubted genius with words is such a moving and life-affirming whole.

BBC Radio 4 have just dramatised The Periodic Table for radio, the different chapters named after single elements from the periodic table broadcast in episodes, ranging from fifteen minutes to an hour. This provides a perfect entry point to Primo Levi’s work as well as a way in to explore this rich and endlessly rewarding genre of creative non-fiction. If you read or listen to no other essay of Primo Levi’s make it Carbon, the story of a single atom of carbon as it journeys from limestone crag to the author’s brain cell as he writes. As William Fiennes said to me it is perfection in writing, the perfect full stop.

BBC Radio 4 iPlayer: Primo Levi’s The Periodic Table, available now: www.bbc.co.uk/programmes/p040d1vz/members

 

The Milkweed Monarchs

by Eliot North

 

I was riding my favourite bike. The Chopper

with the red flag and the silver streamers on the handlebars.

Minding my own business, cruising down Beach Road

to school at Kaikoura Flat. Happened right outside the

Whale Watch Office. “Idiot tourists,” Dad said,

“never bloody look where they’re going.”

 

Don’t remember much after that. Just the pain

in my belly, the voming and that funny shaped

bruise that crept like a shadow across my skin.

“Handlebars mashed his Pancreas,” the guy said to Mum

after they airlifted me to Christchurch. Wish I could

remember the ride. They’d given me the needle by then.

 

Couldn’t understand a word when I came to; most of

the docs were from England. Got my own room

on the kids ward though, was pretty stoked at first.

Turns out nine weeks in one room can really turn you off

a place. Kept telling me I couldn’t eat and put a stupid tube

in my chest, for that pseudo-food to drip in overnight.

 

Would’ve gone mad if it weren’t for the Monarchs.

Mum and Dad bought them in from the farm,

loads of tiny ones on bunches of Milkweed. Boy were

they hungry, just ate and ate whilst I couldn’t. Got fatter

and fatter, the black and yellow stripes growing further

and further apart. They were more interested in them than me.

 

Didn’t mind though, those ugly critters. Gave most of them

names. Watched how they crawled around my room before

they tucked their tails under like upside-down question marks.

Mum said I was daft, but I knew the Monarchs would save me.

As soon as they slipped into those bright green overcoats

and changed for good, with their precious crowns of gold.

 

“Coincidence,” the docs said. I don’t reckon. My pancreas

would’ve been stuffed if it weren’t for them. When the cocoons

turned black and then transparent, I could see the orange

wings inside.  First one came out all small and wet with

a loud POP!  Like the noise my brother makes when

people kiss on TV. I knew it was my time too.

 

Just pressed the buzzer and the nurses came flying.

Pulled out the drips, blood spurting over the sheets

but I was free. Stretched my arms wide and stuffed a

Chocolate Fish in my mouth before they got near my room.

You should’ve heard the shouting but I didn’t care;

there weren’t no Pseudocyst in me no more.

 

Commended in the Hippocrates Poetry Prize NHS category 2014

http://hippocrates-poetry.org/hippocrates-prize/2014-hippocrates-prize-open/2014-hippocrates-commended.html

Published in the accompanying anthology

 

Acknowledgements

This essay draws on the suggested reading list provided by William Fiennes for his Creative Non-Fiction course at Newcastle University and the following books, periodicals and podcasts:

Beard, Jo Ann, 2002, Undertaker, Please Drive Slow, Tin House Magazine, Portland: McCormack Communications. Vol. 3, No. 4, pp 27 – 59.

Levi, Primo, 2000, The Periodic Table, Penguin Books, London. Translated from the Italian by Raymond Rosenthal.

Fernyhough, Charles, 2012, Pieces of Light: The New Science of Memory, London: Profile Books Ltd.

Cusk, Rachel, 2013, New Writing: Memoir, Newcastle: Mslexia Publications Ltd. pp 30 – 42.

Radiolab podcast: Season 3, Episode 4, 2007, Memory and Forgetting, New York: accessed 1/3/13 at www.radiolab.org.

N+1 podcast: Episode 3, 31st August 2011, Both Fish and Fowl – Jo Ann Beard, New York: accessed 16/3/13 at www.nplusonemag.com.

Reclaiming Reflection: Creative Writing and the Medical Humanities (1)

14 Sep, 16 | by cquigley

 

Poetry and Reflection: a powerful tool for learning

This post is part of a series over the next three days on the theme of Creative Writing and Medical Humanities by Dr Eleanor Holmes (pen name Eliot North).

 

 As a GP Tutor I’ve delivered seminars on the patient centred medicine (PCM) component of Newcastle University’s Medical Undergraduate (MBBS) course to 1st and 2nd year students, for the past three years. Professional reflective practice is taught and assessed across all five years of the curriculum.

The ability to reflect and learn from clinical encounters is central to medical education and continuing professional development. Delivered within a creative context, I believe written reflection can also be an important tool to foster wellbeing and resilience in healthcare students and professionals.

Working in an increasingly overstretched and under resourced system such as the NHS, in which clinician burnout and mental health problems are on the rise, the question of how we reflect on the difficult and complex nature of care is becoming ever more important to address.

Stating that the answer might be found outwith Medicine may seem heretical, but it is my belief that we need to look outwards to move forwards. The Arts and Humanities, like Health and Medicine, explore and reflect upon the human condition. What therefore can we learn from each other?

My last seminar with my first year group was entitled ‘Professional Reflective Practice 2.’ After a year of working together trust, an essential element of clinical reflection, had been built within the group. I used my own writing, a poem called He Blew Me a Kiss, as a launch point for discussion, which was published under my pen name Eliot North.

 

            He Blew Me a Kiss

 

She liked Frank, they connected

despite his expressionless face. Behind the wound-up limbs and tremor

a gentle man shone out from the mask.

 

When she visited they would share a cuppa,

chat about this and that. Do the ‘medication shuffle’;

a two-step dance they both knew well.

 

She’d heard about stem cell research.

How they’d taken swabs from patients’ skin. Growing stem cells

from skin cells in dishes, right there in the lab up the road.

 

These stem cells would then become brain cells.

Models of Parkinson’s just like Frank’s. For testing newer and better

medications and perhaps one day even a cure.

 

The last time she saw Frank it was snowing

but he insisted on accompanying her out. Standing by the gate like a sentinel

he’d wave her off that one last time.

 

Later she’d think of stem cells like kisses

blown on the winter air. The moment captured in her rear-view mirror;

A hand lifted slowly, toward a frozen face.

 

Published by EuroStemCell ‘Tales from Within: Imaginative Non-Fiction on Stem Cells,’ 2013. (Frank is a pseudonym)

http://www.eurostemcell.org/he-blew-me-kiss-eliot-north

 

I have found that reading a poem aloud, that I’ve written myself, is an extremely powerful learning tool. There are obvious medical elements I can draw out regarding Parkinson’s Disease and stem cell research, but more than that the poem makes an important statement about connectedness, communication, the complex and varied role of a doctor as well as the limitations of medical science. It speaks to students about the importance of getting to know patients and continuity of care; how embracing the humanity in an encounter can be both powerful and revelatory.

The moment captured in the poem will live with me until the day I die, reading it always chokes me up; I choose to show this emotion to my students. We as clinicians who teach, whether in seminars or on the wards and in clinics, are hugely powerful role models. By stating and showing that this encounter moved me I am by example saying, “It’s OK to show emotion.” This leads to discussions about professionalism, boundaries and clinician wellbeing linked to the evidence base that demonstrates better patient outcomes when doctors show that they are emotionally affected when breaking bad news.

I wrote this poem many years after the event, it was something that sat in my brain waiting to come out. I wish that I’d been able to share it with the man who inspired the poem but he died some years before I got it down on paper. It was a EuroStemCell competition, partnered with the Centre for Regenerative Medicine in Edinburgh that spurred me to write it.

The challenge to submit an ‘imaginative non-fiction’ poem that incorporated stem cell research brought this encounter immediately to mind, the link between stem cells and Parkinson’s a way to explore how I felt about this patient. Discussing the creative process and the fact that I write under a pen name and changed the patient’s name forms a nice link to the importance of anonymity, confidentiality and consent, as well as patient and doctor voice.

With my students I then facilitated a creative guided writing exercise on a memorable clinical encounter followed by small group work, drawing and writing Haiku. The seminar culminated in poster presentations delivered by the students to the group. The results were insightful, empathetic and moving; their use of metaphor and close observation giving authenticity to the explorations they had made of encounters with patients and carers struggling to cope with dementia, a potential diagnosis of cancer and the communication difficulties witnessed for a patient with learning disabilities, linking this to issues of capacity and consent.

As someone who uses creative outlets as a way of coping with the stresses of practicing medicine, it amazes me that the word ‘creative’ can strike fear in to the hearts of medical students and healthcare professionals alike. I believe that by embracing creativity and essentially our inner child, written reflection can be much more than a required component of assessment and appraisal. All humans have the capacity to be creative, no matter how much they protest to the contrary. The skill lies in being able to coax it out of them.

 

Acknowledgements

All of the work I’m currently doing in this area is in collaboration with Sue Spencer with whom I wrote the guided writing framework I used above with my students, influenced by reading the books and on-line resources below. We are delivering a ‘Reflection of Clinical Encounters’ workshop using creative writing methodologies in November 2016 for the Staff Development Programme, School of Medical Education, Newcastle University.

Writing Poems by Peter Sansom, Bloodaxe 1994

The Poetry Toolkit – The Poetry Trust 2010, available as a free PDF download http://www.thepoetrytrust.org/images/uploads/pdfs/Toolkit%20for%20Teachers.pdf

 

Related reading

S E Gull, R O’Flynn, J Y L Hunter. Creative writing workshops for medical education: learning from a pilot study with hospital staff. Med Humanities 2002;28:2 102104

Khaled KarkabiOrit Cohen Castel. Teaching reflective competence in medical education using paintings. Med Humanities 2011;37:1 5859

T J Collett, J C McLachlan. Evaluating a poetry workshop in medical education. Med Humanities 2006;32:1 5964

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.’

 

The Reading Room: A review of ‘Memoirs of a woman doctor’

11 Nov, 15 | by cquigley

 

 

©D. Carpenter-Latiri portrait of Nawal El-Saadawi UK 2015

©D. Carpenter-Latiri portrait of Nawal El-Saadawi UK 2015

 

El-Saadawi, N. (2000). Memoirs of a woman doctor. London: Saqi Books.

Reviewed by Dr Dora Carpenter-Latiri, Senior Lecturer, College of Arts & Humanities, University of Brighton

Nawal El-Saadawi, the famous Egyptian feminist activist, trained and practised as a medical doctor, a psychiatrist and a surgeon. She is also a prolific writer and has written more than 50 books, several of which have been translated into English. Her writings – essays and fiction – address issues of gender and class in Egypt and the Arab world. She is a vocal campaigner against male and female genital circumcision (from 1979 to 1980 she was the United Nations Advisor for the Women’s Programme in Africa and the Middle East), against religious patriarchy and against political Islam. She has also campaigned for education, women’s rights and freedom of expression and was jailed under Sadat. Her life was threatened by the Islamists and she had to flee Egypt. She has been back in Egypt since 1996. Since the Arab Spring she has been campaigning against political Islam and against the counter-revolution.

El-Saadawi was born in 1931 in Kafr Tahla, a small village in Egypt, the second of nine children. She won a scholarship to study medicine, graduated from the University of Cairo in 1955, and specialised in psychiatry.

Memoirs of a woman doctor (2000) was first published in its translated version in English in 1988. The Arabic original version first appeared in a serialised form in the Egyptian magazine Ruz al-Yusuf in 1957. The book was El-Saadawi’s first novel. In a preface to the English edition, she mentions that the book was censored both in the serialised and in the full book versions, but as she ‘was young and inexperienced and eager to see the book in print’ she ‘allowed it to be published with deletions’.

The text is a first person narrative that reads like an autobiography. The author states that ‘although many of the heroine’s characteristics fit those of an Egyptian woman such as myself, active in the medical field in those years, the work is still fiction’.

The narrative is very informative of the medical practices of the time in Egypt and could read like an anthropological text with surprising details (for example there were no regulations for access to the blood bank). In the passage below, the ‘companion’ is a musician with whom the narrator falls in love after a bitter divorce. The divorce was the narrator’s decision after her husband asked her to choose between him and her practice; this ‘companion’ character reconciles her with her femininity and her desire for a male companion that would support her:

‘A thin young man lay on a dirty mattress on the floor. Beside him was a little pool of blood. I sounded his chest, realizing he was desperately ill with pulmonary tuberculosis and that life depended on a blood transfusion. I looked round and found my companion standing beside me. He said instantly, ‘Do you need anything?’ ‘A bottle of blood straightaway from the emergency services.’ (p.97)

The narrative is chronological and describes the narrator’s awareness of the lower and unfair status ascribed to girls and women. The first period is described alongside associated feelings of shame and self-hatred:

‘I hated being female. I felt as if I was in chains – chains forged from my own blood tying me to the bed so that I couldn’t run and jump, chains of shame and humiliation’ (p.12)

The narrator’s family wants to get her married but she is determined that she will study and become a doctor:

‘Put on your cream dress and go and say hello to your father’s guest in the sitting room.

I caught a whiff of conspiracy in the air.’ (p.15)

‘I hated my femininity, resented my nature and knew nothing about my body. (…) I was going to show my mother that I was more intelligent than my brother, than the man she wanted me to wear the cream dress for, than any man (…)’ (p.22).

‘Medicine was a terrifying thing. It inspired respect, even veneration, in my mother and brother and father. I would become a doctor then, study medicine, wear shiny steel-rimmed spectacles, make my eyes move at an amazing speed behind them, and make my fingers strong and pointed to hold the dreadful long sharp needle. I’d make my mother tremble with fright and look at me reverently; I’d make my brother terrified and my father beg me for help’ (p.23).

The narrative moves on to the years of studying medicine when the young student is the only woman in the dissection room and she has to hide her fears and to proceed ‘steadily and unflinchingly’ (p.25). The passages dealing with the dissection allow the narrator to explore the vanity of the male body, the absurdity of the alleged superiority of men in Egyptian society, the equality and frailty of men and women before death and a celebration of life:

‘I was delighted by this new world which placed men, women and the animals side by side, and by science which seemed a mighty, just and omniscient god; so I placed my trust in it and embraced its teachings.’ (p. 32). ‘Ah, how simple life is when one takes it as it comes!’ (p.28)

The narrator also explores the ethics of practising medicine and she describes her transformation from a rich, successful but hard doctor into one who is caring and dedicated. This epiphany comes when she acknowledges the ‘emptiness’ of her life to be followed with her encounter with the character of the musician, who – in connecting the practice of medicine with art – answers her quest for meaning in her life and supportive, loving companionship:

‘My surgery filled up with men, women and children and my coffers with money and gold. (…) I felt a chilling cold as though I was sitting on a snowy mountain top.’ (p.82)

‘Why had I bounded up the ladder of my profession instead of drinking from the cup of life sip by sip (…)?’ (p.83).

‘Being a doctor meant giving health to all who needed it, without restrictions or conditions, and success was to give what I had to others’ (p. 100).

‘For the first time in my life I felt that I needed someone else, something I hadn’t felt even about my mother. I buried my head in his chest and wept tears of quiet relief.’ (p.100-101)

Reading Nawal El-Saadawi’s first novel today, almost 60 years after its publication, gives us an insight into her extraordinary journey and her loyalty to herself. Although simple in its semi-autobiographical structure, the rhythm is powerful and the issues of class and gender are – alas – still relevant in a world where patriarchy, poverty and lack of education are widespread. The issue of FGM, which made El-Saadawi famous in the West through her subsequent essays and her action as a doctor and a feminist, is not mentioned in the book and might have been part of the material destroyed by the Egyptian censor and thus lost. Paradoxically, this adds to the power of the short text as the whole context in which the practice takes place gets more attention and allows the reader an insight into gender discrimination and social inequalities, which are prevalent not only in Egypt.

The Reading Room: A review of ‘A Doctor’s Dictionary’

30 Oct, 15 | by cquigley

 

Iain Bamforth A Doctor’s Dictionary: Writings on Culture & Medicine

2015 Manchester: Carcanet ISBN: 978 1 784100 56 8

 

Reviewed by Professor Alan Bleakley

Emeritus Professor of Medical Education and Medical Humanities

Plymouth Peninsula School of Medicine, Plymouth University UK

 

Iain Bamforth, by his own admission, is a writer who practices medicine. Indeed, while he appears to gorge on writers, essayists and philosophers, he gives medical education short shrift:

“doctors undergo a crammed, often dogmatic training in thrall to clinical ‘bosses’, which tends to hinder critical thinking. Then one fine day they wake up to find themselves as soteriological salesman in the Valley of the Shadow of Death. And they hate to lose face by admitting they don’t know.”

While many doctors I know would cringe in self-recognition at this description they would also think ‘hang on a minute, there’s more to medical education than this’ (simultaneously reaching for their dictionaries to check on ‘soteriogical’). ‘Country’ doctors come off worse, where “Doctor-baiting has long been a clandestinely popular activity in country regions. … my grandmother in Glasgow used to say ‘that’s but ae doctor’s opinion’” for in “country areas, where people have long memories, it is still remembered that doctors themselves were once a source of plague.” Bamforth should know – he worked for a year as a country GP in Scotland and has extensive experience working in a number of areas of medicine, including a long stint in his current practice as a GP in Strasbourg with “twenty-two different nationalities”. Bamforth can afford to be self-effacing about his medical career, for he is first and foremost a talented and dedicated writer, and a jobbing translator on the side. In this collection, he brings a literary sensibility to bear on the, often uncomfortable, recognition that much of medicine is an art rather than a science requiring high tolerance of ambiguity and recognition of personal limits to knowledge and ability. Medicine is a performance whose script has been crafted historically and culturally.

 

A Doctor’s Dictionary: Writings on Culture & Medicine is a collection of 26 essays and book reviews previously published in medical and literary journals, many of which were gathered together to form the core of the author’s manuscript Medicine and Imagination, submitted to Glasgow University (where Bamforth originally studied medicine) for the degree of Doctor of Letters by publication. The collection represents two decades’ worth of industrial strength and erudite commentary. The essay titles follow the letters of the alphabet in order, from ‘Anecdote’ to ‘(meta-) Zoology’, via ‘Depression’, ‘Happiness’, ‘Posture’, and ‘Vertigo’ amongst others. The title ‘A Doctor’s Dictionary’ refers to this conceit of an abecedarium. These single word titles serve less as signposts than welcome glades amongst thick forest, for Bamforth’s prose is baroque and relentless, providing little respite for readers who crave more minimalist approaches to the essay. Those who know the author’s poetry – he has published five collections – might not expect such convolutions and digressions within the essay form. His poetry is leaner than his prose. Certainly, he is not a writer who wears his learning lightly.

 

Where Bamforth provides no connecting thread from one essay to another this collection is more lucky dip than pearls on a string. And sometimes – despite the promise of the subtitle ‘Writings on Culture & Medicine’ – the links with medicine are tentative. A more honest subtitle would have been ‘Writings on Culture & on Medicine’. For example, a riveting essay ‘Emergent properties’ – relating to Joseph Needham’s masterwork Science and Civilisation in China – is linked to medicine only by the fact that Needham was a developmental biologist and his father was a Harley Street doctor specialising in anaesthetics. Further, it is not until you read the Endnotes that you find out this essay is in fact a 2009 ‘review’ of Simon Winchester’s biography of Joseph Needham. The reader is left not knowing how much is Bamforth’s original insight and how much is gleaned from Winchester’s biography.

 

A book review of Ziyad Marar’s (2003) The Happiness Paradox and Carl Elliott’s (2003) Better Than Well (first published in a literary and not a medical journal) contains a few lines on the treatment of depression – otherwise there is again no developed linking of culture with medicine. This leads me to ask just what audience the publishers have in mind for this book. Doctors in general are pragmatic and resist complex ideas (Bamforth quotes from a Robert Lowell poem referring to doctors: “We are not deep in ideas, imagination or enthusiasm – how can we help you?”), so I suspect that the primary audience for this book will be humanities scholars working within the health/medical humanities, although, in an ideal world, medical schools would adopt texts such as Bamforth’s to support the teaching of so-called ‘communication skills’ and ‘professionalism’ and to encourage the kind of liberal education that gives insight into the human condition.

 

Bamforth’s book has its weak spots. A review of Carl Elliott’s Prozac as a Way of Life (under ‘D’ for ‘Depression’) tells us little new where the author notes that depression is a cultural disorder and that many mental health symptoms are manufactured to sell drugs that supposedly treat such symptoms. While we are introduced to a stream of writers who have formed high culture, there is little reference to either popular culture or everyday people, in particular Bamforth’s patients. Are some of these not also extraordinary? Do any of them inspire, or is that just for high art?

 

But mainly, Bamforth offers us industrial strength prose. ‘Galen’ is a model of the essay form – pithy, humorous and insightful. Informed by his long experience of practicing medicine in Strasbourg, Bamforth dwells on the ‘folk illness’ of a crise de foi – a crisis of the liver. The essay is a generous meditation on a French national trait – the liver as embodied metaphor. Bamforth’s most recent (2015) essay ‘Tell Me About Teeth’ (under ‘M’ for Mouth) is a very funny meditation on the American obsession with good teeth (equating with good character). Bamforth takes up Elias Canetti’s challenge to ‘write about teeth’ and produces the best line of the book: ‘How can you believe the soul is a butterfly when the human breath is so foetid?’ There is cheek in the essay – Bamford, a doctor, looks down on dentists who cannot have a proper conversation with their patients “with a drainage pipe, cotton wool and gloved fingers in the mouth”.

 

Bamforth’s conversation with his readers, however, is more like the reality of doctors’ ‘conversations’ with their patients – the consultation is actually one-way traffic: Bamforth does not pose questions, he informs, and his information is more torrential downpour than light drizzle. Read psychoanalytically, Bamforth’s rather suffocating attention to detail might be seen as a desire to impress and to control. There is a clue in the Endnotes to this collection of essays, where referring to the essay on teeth, Bamforth notes that while many writers earn their living as doctors, the same cannot be said of dentists. Reading this, I immediately thought of the Egyptian dentist and novelist Alaa El Aswany’s The Yacoubian Building that I read a few years ago. I was interested in this novel because at the medical school where I used to work we had long established a medical humanities programme, and had just implemented a ‘dental humanities’ programme in the dental school. Aswany was recommended reading. I was pleased to see that Bamforth could afford an error, a relief from his parade of learning. But then I read the after-note to these essays, where Bamforth apologises to the reader for an oversight – dentists do indeed write novels, amongst them Alaa El Aswany’s The Yacoubian Building. The rent in the fabric of the essay is neatly repaired without losing face.

 

But Bamforth should not be worried about the occasional slip – after all, it is in such minor imperfections that humanity shows through (Nietzsche’s Human, All Too Human) and this is, paradoxically (and properly), how he describes the work of doctors. Little ‘holes-in-the-day’ or ‘holidays’ (as the late poet Peter Redgrove described unconscious slippage) allow both writer and reader a mini-break away from the relentless search for perfection. Indeed, such a hole-in-the-day does appear in Bamforth’s collection and is not retrospectively repaired in his Endnotes. It is an omission that also provides an insight into limitations to the author’s writing style.

 

While the psychoanalyst Jacques Lacan is referred to (on p.71), he is not included in the index of names that stretches to an eye watering close to 400 entries (with only a dozen women amongst them). Oddly, the publishers have not included an index of topics – a major omission in a book of this kind that is to be dipped in to and not read cover to cover. I pick up on Lacan because it was this psychoanalyst who famously suggested that the unconscious is structured like a language and shapes experience through metaphor and metonymy. Metaphor (the substitution of one word for another for effect: ‘time is money’), suggests Lacan, serves to repress (often in the form of denial). Metonymy functions to combine, where one word or phrase leads by association to another (such as ‘wand-sceptre-king-ruler’) and is then a form of displacement (often in the form of scapegoating). Bamforth’s writing is characterized by a particular use of displacement and contiguity as a rhetorical strategy. Let me give some examples.

 

There is a rather irritating ‘rock hopping’ technique, where reference to one author or thinker jumps quickly to another. The essay on ‘Happiness’ referred to above – a review of Ziyad Marar’s and Carl Elliott’s books – is only seven pages long yet manages to reference Freud, Plotinus, Nietzsche, Bentham, de la Rochefoucauld, Auden, La Mettrie, Diderot, Holbach, St-Just, Stendhal, Dr Johnson, Rousseau, Robert Burns, Tom Wolfe, Dostoevsky, Veblen, Wittgenstein, Theodor Fontane, de Sade, Montaigne, Aristotle, Erving Goffman, Robert Reich, Georg Christoph Lichtenberg, Alexander Pope and Jane Austen. Bamforth’s technique is not to simply list authors – that would be too crude. Rather, he metonymically links them. But these linkages are often arbitrary.

 

The essay ‘Ethics’ is actually about insomnia. Bamforth reminds us that the sleep state is ethically neutral. An anecdote about Vladimir Nabokov is neatly linked to one about the Romanian philosopher and writer E.M. Cioran. Both were insomniacs – so far, so good. But then, linking Kafka, W.H. Auden, Nietzsche, Freud and James Joyce, we are brought to a discussion of the merits of The Epic of Gilgamesh – a paragraph tells us how Rilke and Elias Canetti were both bowled over by Gilgamesh. But what has this got to do with sleep deprivation and what medicine and science might do about it as well as what literature has to say about it? What about sleep deprivation in junior doctors – a well-known source of medical error – rather than passing reference to Gilgamesh? Digressions and diversions are symptoms of the abuse of metonymy. A discussion of Proust and sleep leads into a section on the Irish writer Flann O’Brien with the link “Proust was unfamiliar with rural Ireland though”. The link is forced – a lazy metonymy. Here, Bamforth’s Baroque style reminds me of billiard balls flying haphazardly around the baize, or a pinball machine.

 

The essays contaminated by this rhetorical style tend to be lacking in narrative and resort rather to lists of events. Where narrative is strong – for example in Bamforth’s marvellous essay on ‘integrity’ – the writing seems to me to be so much stronger and engaging. Here, Bamforth turns a review of Emmanuel Carrère’s novel The Adversary into a meditation on lost identities that confounds notions of moral integrity. The essay is subtitled ‘An Empty Plot’ and this is a double-play on the fact that Carrère writes a novel about a French doctor whose whole life was literally an enacted fiction and then hollow. Jean-Claude Romand was (supposedly) a doctor living in France on the border with Switzerland and working as a researcher at the World Health Organization. In short, he turns out to be a fraud – he never completed his medical degree and lived a life of duplicity in which he pretended to have a prestigious job, convincing everyone, including his family and even a best friend Luc Ladmiral, a general practitioner working in a nearby town. Romand systematically embezzled money to maintain the lifestyle of a successful profession where his profession was in fact mute. At the point of his ruse being uncovered, he murdered his wife and two children. Carrère visited Romand in prison to piece together the story. Here, Bamforth returns us to a fundamental discomfort within medicine where doctors walk into roles prepared for them historically and culturally, and this may jar with their non-medical identities. Where then, to find solace or a moral compass? Bamforth’s suggestion is that such touchstones for reality can paradoxically be found in well-wrought fiction.

 

Readers of Medical Humanities will warm to Bamforth’s topics, but not necessarily to his style. A good editor would have rejected the rather forced abecedary structure of this collection to provide an alternative framework for linking otherwise disparate essays, prefaced by a different kind of Introduction illuminating Bamforth’s thought process and style of engagement. The book reviews sit rather awkwardly amongst the essays. The metonymic name-game could have been tempered. An index of topics would have helped the reader to better navigate around what is important writing in the field of the medical humanities. Finally, there are a couple of cheeky gestures: Bamforth is multilingual (he works as a translator into English from German and French), but it is rather high-handed to preface the book with a quote from the German poet Friedrich Hölderlin that is given in German with no English translation. Later, in an essay on ‘Posture’, a “famous couplet” from Ovid is given in Latin but again not translated. ‘Famous’ perhaps for Bamforth, but he is expecting high standards from his readership. The essays then expose the reader’s ignorance rather than engage her interests, and do not educate as much as lecture. It is a shame that the style sometimes taints the content in what is unquestionably an impressive collection.

 

 

 

The Reading Room: The Lumen Journal – Call for Submissions

10 Sep, 15 | by cquigley

The Lumen is an annual Edinburgh University new writing and arts journal of the mutual dialogue between medicine, the arts and the humanities. We hope to foster creative and critical discourse on the personal experience of illness and healthcare. The Lumen will provide a space for the expression of the deeply personal narratives of the medical encounter, from patients and healthcare professionals alike, and the aspects of the human condition that it exposes. We are pleased to announce that we are now accepting submissions for the Summer 2016 issue of The Lumen. The theme for this issue will be ‘Trauma’.

Contributors are welcome to interpret this theme in any way they wish along the lines of any discipline. We also welcome reviews of books or other artistic work that deals with a discussion of trauma or narratives that emerge thereof. Some possible interpretations of this theme could be:

  • The impact of a traumatic event or process on identity and temporality

  • Narrating and coping with traumatic events

  • Talking about trauma in public discourse

  • The form and essence of traumatic change

  • Trauma as a permanent state of being rather than a singular, momentary breach

  • The trauma of internal processes rather than external intrusions

  • Historical, political or socio-symbolic forms of trauma

The above list is not exhaustive, and is merely indicative of some of the possible interpretations of the theme for the forthcoming issue. Contributors are welcome to interpret the theme however they like.

We welcome submissions in the following categories:

1) Fiction: Short fiction which is no more than 3,000 words in length and can be written in any style or genre. Stories should be stand-alone and complete works.

2) Non-fiction: Narrative/memoir or essays (either critical or academic) that are no longer than 3,000 words in length.

3) Poetry: Poems that are no longer than 70 lines in length in any style, genre or form.

4) Reviews: Short reviews of one work (between 500 and 750 words) or comparative reviews of two or more works (between 750 and 1,000 words). If you would like to review a relevant literary or artistic work or performance, please contact us with a proposal via email and we shall consider it. Alternatively, we will also post a list of works we would like reviewed on our web site.

5) Visual Art: All forms of visual art (illustrations, photographs, et cetera), submitted as digital images (preferably high-resolution .jpeg) of up to 10 MB in file size. Please include the title, date, medium and size as applicable. If you should encounter any difficulty in sending us images via email due to file size, please contact us to arrange an alternative mode of submission.

The deadline for submissions for this issue is Friday, 4 December, 2015. All submissions must be sent on or before this date via email to LitMed.Magazine@ed.ac.uk.

In addition, The Lumen also welcomes contributions for its blog (http://edmedlit.wordpress.com/lumen) on a rolling basis. These contributions can also be stories, poetry, essays, reviews, et cetera as per the guidelines below. These need not necessarily relate to the theme for the print issue, and can be on any subject or theme. We are also open to suggestions for blog posts. Please feel free to contact the editors at the above email address if you would like to make a suggestion for a piece.

For further details, please refer to the full Call for Submissions at http://edmedlit.wordpress.com/lumen/cfs. Any queries regarding submissions can be addressed to the editors at LitMed.Magazine@ed.ac.uk.

Guest Blog Post by Poet and Writer, Clare Best, Part 2: On Scars and Memories

21 Apr, 14 | by Deborah Bowman

Guest blog for BMJ Medical Humanities by Clare Best

 

Recently I’ve been thinking about cutting/editing and scars/memories. In two linked pieces for the BMJ Medical Humanities blog, I take a look at my own relationship first with knives and cutting and then with scars and memories.

 

Part two: Scars and memories

 

If I, as a former artist-craftswoman and as a writer and editor, am some kind of surgeon, then surgeons are also editors and writers. They arrange and rearrange our anatomies, cutting away what is not healthy, what is no longer required, repairing what is not working as it should. They invent and create new mechanisms and implant them into our bodies. The aim of most surgery, it seems to me, is to alleviate suffering and allow bodies and human beings to function as fully as possible. Surgeons facilitate – as far as they are able to – our wholeness. Our bodies, subjected to their hand work, become altered and edited versions of our earlier, or first draft, selves. Surgery is one agency in the mutability of human experience.

 

My own body has been revised and edited in many ways, as of course have all human bodies – by growth, by accidents, by disease, by ageing and even by self-harm, as well as by surgery of various kinds. In my case, the most dramatic revision and editing happened in 2006 when I underwent elective double mastectomy as a way of reducing my risk of contracting a hereditary breast cancer in my mother’s family.

 

I have written elsewhere about the decision-making journey leading to my surgery, as well as about the creative processes that sustained me before, during and after surgery – the creative processes which later developed into the project Self-portrait without Breasts (http://selfportraitwithoutbreasts.wordpress.com). Here, I want to think about scarring as evidence and reminder of trauma and loss. And I want to raise questions about the ways in which scars are read and interpreted – both as signs of surgery and as memorial sites.

 

The surgeon who operated on my mother was a kind and gentle man who nonetheless believed in radical mastectomy, which involved removing not only all the breast tissue but also much of the underlying muscle of the chest wall, and all the lymph nodes. Considering that the particularly aggressive nature of inherited breast cancer was not recognised in the 1970s (when my mother’s cancer was first found) she was lucky to encounter a surgeon who believed in this approach. Her radical mastectomies five years apart, following multiple primary tumours in both breasts, almost certainly gave her the additional twenty-five years of life she enjoyed until she died in her early seventies. But the resulting scars, both visible and invisible, were terrible to her. She never wanted them to be known about, let alone witnessed. She and I were very close, and yet throughout the many times I nursed her, and right up to the end of her life, she made enormous efforts to keep her morbidly scarred torso and upper arms from my sight. I saw the scars only twice, on both occasions by accident.

 

My mother was not unique in her shame and suffering. Although we now find it hard to imagine a world in which the words ‘breast cancer’ were unspeakable, that was the world my mother, and countless other women, inhabited. With the prominent outer features of their gender and sexuality invaded by disease and/or surgically removed, women with breast cancer struggled to maintain a sense of identity. But by the same token there was no language in which to talk about their loss and fear, and the scars had to remain unseen, both literally and metaphorically.

 

So taboo was this disease, in the world and in our family, that when my first cousin was diagnosed with aggressive ductal carcinoma in the mid-1990s, she had no knowledge of her aunt’s (my mother’s) experiences, even though her own mother (my mother’ sister) had also developed breast cancer. It was only when my cousin and I began to correspond about our mothers’ breast cancers that the extent of the deeper family scarring became visible and tangible. We began to read the scars and interpret our own situation, the risks we faced. We could also finally perceive the scars in our mothers’ generation as the memorial sites they were – places where loss and pain should have been respected, remembered and properly grieved, instead of turned away from and covered up.

 

The good news is that the current climate around surgical scarring is much more open. This has to be a very positive change for individuals and for society. Some of the mainstream breast cancer charities such as Breast Cancer Care are now running campaigns that address body image issues with photographs of women at ease with, and baring, their scars. The recent Under the Red Dress project has drawn a groundswell of support for making scars visible, even legible, and the project clearly links that legibility with raising awareness of breast cancer. My own work explores and extends the ways we tell the stories of our bodies; in speaking out through poetry and photographs, I speak for other women in my family and beyond.

 

But there is more work to be done. If scars are both evidence of cutting/editing and sites of memory, we are presently at risk of overemphasising the evidence whilst sometimes failing to properly acknowledge the memories. A recent statement from Judy Kneece, sent around social networking sites by the (American) National Breast Cancer Foundation, asserts that ‘Breast cancer has invaded my body, but it need not invade my spirit. There may be scars on my chest, but there need not be scars in my heart.’ Apart from the use of the stale military terminology by which all experiences of cancer seem to be set up as battles to be lost or won, the core of the message is, I think, distressing in its denial of the need to admit inner wounding and thereby begin to integrate trauma and loss. Of course the scars are in the heart as well as on the chest – how could it be otherwise, and what is wrong with that?

 

We should seek to accept the hand work – the cutting – where it is necessary, and treat with tenderness and care the consequent scars and the memories they represent. Surely this honouring of the memory as well as the scar, the material edited as well as the knife and the cut, makes the move towards true healing both more imperative and more likely.

 

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

Guest Post by Poet and Writer, Clare Best: On Cutting and Editing and Scars and Memories

13 Apr, 14 | by Deborah Bowman

 

 

Recently I’ve been thinking about cutting/editing and scars/memories. In two linked pieces for the BMJ Medical Humanities blog, I take a look at my own relationship first with knives and cutting and then with scars and memories.

 

Part one: Knives and cutting

 

Among my clearest memories of childhood are strong sensory images of my father sharpening the carving knife each Sunday morning. He had an old bone-handled carver with a steel blade worn concave by years of service and he would stand at the kitchen worktop with the carving knife in his right hand and a cylindrical steel in his left, dancing the two metals together in front of him. The scraping and clashing were scary and magical – scary because of the glint of bright metal as the cutting edge became sharper, magical because this ritual heralded the final preparations for Sunday roast lunch. My father was always totally absorbed in the activity, pausing occasionally only to test the blade on the thumb of his left hand. In fifteen or more years, I just once saw him draw his own blood. He was an expert, and maintaining the tool of his Sunday task was a source of pleasure and satisfaction.

 

My father was a papermaker by trade and the plentiful currency of paper in our home had imbued me with a love of the material as I grew up. His passion for sharp knives must also have lodged in me. I put the two together, and for eight years of my life I sharpened blades and used them, in my first career as a fine bookbinder. I had many blades to look after, each one essential to my craft.

 

The guillotine blade was curved and heavy and the length of a sabre. It had to be removed from the work bench every few months to be sharpened professionally. I can still hear the decisive clunk as the newly honed and reinstalled blade sliced down through mill board.

Then there was my binder’s knife, a workaday tool of raw steel with a wooden handle darkened by my sweat. I used it for cutting against a rule. Over time the blade was thinned by sharpening until it became my ideal flexible knife. Just standing and thinking with it in my hand was almost enough to effect a precise cut. It was the first blade I worked each morning on the oiled carborundum stone. I had Stanley knives too of course, and penknives, and scalpels.

When I began work on a leather binding, it was the blade of my spoke-shave that needed attention. The spoke-shave is used for removing areas of the underside of the goat or calf skin, thinning the soft tissue before it is wetted and pasted for moulding around the prepared book block. Once I had chosen the right skin, I would dismantle the spoke-shave and take out the piece of flat steel with its cutting edge angled at 45 degrees. Back at the carborundum stone, I pushed the blade to and fro. Then I reassembled the tool, clamped the leather to a paring stone, and shaved the underside of the skin away from my body, always out and away. The flesh came off in soft rolls of colour until the leather had well-defined thin areas where it would be required to mould across joints, where corners could be mitred and edges turned.

There was another knife – a bone-handled kitchen knife with a tame blade and rounded tip. I used it for cutting gold leaf on a suede cushion. The gold-knife had at all times to be completely free of grease, as did the cushion, or the gold leaf would adhere where it should not. I used to sharpen the fine edge of my gold-knife with glass-paper. I enjoyed laying out the gold from its square tissue-leaved book by blowing one edge of a square of gold across the blade, lifting the leaf slowly on the knife and placing it on the gold cushion. With my mouth positioned over the centre of the leaf, I whistled silently to flatten it across the suede.

When I was ready to lay the gold on the leather binding, I would pick up small sections of gold leaf using greased cotton wool and dab the gold down onto the leather. Now to strike with the hot brass tools! If the flour paste and egg glair in the blind tooled indents had just the correct tackiness, the gold would fuse with the grain of the leather while the smooth surface of the brass tool simultaneously polished it. All this happened, if it was going to, in a second.

The daily ritual of sharpening also honed my senses and my purpose: the work was to measure and cut, fit and cut and refit, mould and fit. I was trained with the motto: ‘Measure twice, cut once’. The blades were extensions of my hands and mind. I cut into animal skins and dressed books in them. I cut gold and tooled it onto the leather. I fitted things to other things, making sense of disparate parts. By the end, if the knives had been sharp and my work skilled, most of the preparation was invisible – pages turned freely, boards opened well along joints, the book had the correct gravity. The mitred corners were so well-judged that they were flat under the thumb. All the cutting and making actions came together in one object. The binding was sensuous in the hands, pleasing to the eye.

 

It was years after I sharpened my knives for the last time and ceased working as a bookbinder that I fully realized how writing and editing are also ways of shaping and cutting, re-forming reality. It is all craft. And – here I come to the links with medicine – it is a surgeon’s work. The very word surgery comes originally from the Greek kheirourgia (kheir meaning hand + ergon meaning work) – the etymology from the Greek having more to do with art, handwork and finesse than with cutting. So I was and remain a kind of surgeon – I have worked with the anatomy of books and with animal skins, and I now work with texts of many kinds.

 

All writers take things in hand. We work, alter, reshape and adapt them. We cut away diseased, superfluous or useless parts, connect ideas to one another. And as we do our hand work we attempt to make whole, to heal, the body of text on which we are focused.

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