Dirty Work describes the “Fitness to Practice” investigation into the work of Nancy, a registrar in obstetrics and gynaecology. The investigation is triggered by an operation which goes wrong, and Nancy’s inability to deal with the situation.
The author, Gabriel Weston, is an ENT surgeon, and so is possessed of some insight into how these things work. She also has a remarkable talent for describing aspects of medical life in ways that are both accurate and poetic.

A good doctor needs to know how to spin a yarn. That’s what they teach you at medical school, though no one ever says in in so many words. They prefer to give it a safe sort of name, the powers that be. The call it history-taking, this supposedly natural process in which a patient and doctor collaborate to weave a shape out of what’s gone wrong. They make its sound straightforward. And to the patient it probably feels that way. In reality, though, the competent clinical inquisitor is all the while asserting their own semantic frame, encouraging the patient to dwell on key symptoms, ignoring the white noise of emotion, veering away from anything that has no pathological meaning, doing what is necessary to help a diagnosis emerge. The doctor is rewriting the patient’s story while seeming only to bear witness to it.

If there’s part of that which sounds a little uncaring, perhaps a little too direct, fear not. An epiphany is coming…

I began to see that the words a patient uttered were not always what counted most; that there might be a more important meaning beyond what was being said, a contrary melody, if only I could train my ear to hear it.

This short novel has more characterisation than plot, which feels right for the story it is discussing. It also has a good deal of tension, uncertainty, and occasional confusion.

The work which most affects the protagonist, and the operation in which she makes her mistake, is the provision of surgical abortions. I think this is a shame. There is little in the content of the book that is specific to abortion-related work, and I think it would almost have been more interesting to explore the pressure on Nancy if she were the provider of any other kind of surgery. The subject of abortion – for better or worse – carries a lot of baggage. Weston doesn’t moralise, but the occasional graphic descriptions of the work Nancy carries out weigh, I think, unduly heavily on the mind of the reader. This becomes a novel about the psychological impact of abortion provision, and the myriad other pressures on Nancy are comparatively minimised.

This minimisation feels a bit unfortunate because it removes the focus from Weston’s talent for describing the universal fears and pressures weighing on all doctors, which are less frequently discussed and so possibly more interesting than the specifics of the pressures of an individual line of work:

How on earth will I manage if I am erased, removed, struck off the medical register? I will lose my entire frame of reference. And what would I have to replace it? What is a doctor, if not a doctor? That that title away and there may be very little left over.

I would have liked to have seen these ideas explored further, without the baggage of abortion. Weston’s descriptions and language speak to me.

I have seen that other reviewers have felt that the book fails to emotionally involve the reader with the protagonist, but I couldn’t disagree more strongly. I felt deeply involved with Nancy’s story, and worked through this book in no time.
However, given that I’ve praised the book for its true to life descriptions, I should also caveat by saying that this isn’t consistently true. There are strange lines here and there which ring utterly false. There is a scene in which Nancy – reputedly a registrar – described a consultant “decoding” very common terms like ERPC, D&C, and ToP for her. This is patent nonsense. The terms aren’t even explained to the reader, so there isn’t a clear explanation for why the line exists. These aberrations, while frustrating, are mercifully few.

As a whole, I very much enjoyed this novel. It wasn’t perfect, but there were parts that came remarkably close to perfect. There were some distinctly wrong notes, but they were few and far between. I found the novel made me reflect on my own life and medical practice, and made me reconsider issues I haven’t though about for some years. I found it moving, and somewhat thrilling. I wouldn’t hesitate to recommend it.

Dirty Work is available now from amazon.co.uk in hardback and on Kindle. Many thanks to Bantam Press for supplying a free copy for the purpose of this review.

My recommended read for this weekend is this sobering paper by Stillman and Tailor in the New England Journal of Medicine. It describes some shocking personal stories, but also this powerful statistic: nearly 45,000 American adults die each year because they have no medical coverage. If you only read one thing this weekend, make it this.

I think this is probably the most tenuously linked pair of articles I’ve chosen for my 2D posts to date, but both are great reads nonetheless… The link I’m claiming is that both discuss religion in somewhat unexpected places.

The first is Ian Leslie’s recent piece for New Statesman, in which he makes a somewhat convincing argument that everyone should wear a veil when appearing in court. It’s a great example of subverting expectations on a subject and revealing fresh insights in the process.

The second was written by one of my public health colleagues in the North East, Avril Rhodes, for the Fuse Open Science Blog. It describes the curious similarities between community outreach events run by the church, and those run by academics. This is a great example of an article that made me view things from a slightly different angle, and perhaps consider them a little differently.

So… the connection between the two might be stretched to breaking point, but they are both worth a read, and both tickled my brain!

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them!

My recommended read for this week is this entertaining New Yorker article by Kevin Romer about the experience of appearing on the US version of Who Wants to be a Millionaire? I think he gives a fascinating insight in an easy-to-read, fun article.

My Brief History, Stephen Hawking’s autobiography, is certainly brief. It is a whistle-stop tour of anecdotes about his life, interspersed with some fairly heavy physics. The tone is upbeat throughout, and it gives some genuine insights into Hawking’s life and motivations.

However, it does feel a little like Hawking is uncomfortable writing about his life. He writes with obvious bitterness about the intrusion of the media into his personal life, and I got the sense from reading this autobiography that he found the process of talking about himself somewhat intrusive too. He rarely gives a great detail of insight into the more emotional side of her personal life. To illustrate, here is the level of detail Hawking shares about one of his weddings:

The fellowship meant Jane and I could get married, which we did in July 1965.

I don’t think this detracts from the book at all: I note it only because it differs from the prevailing tone of autobiographies published recently, and I think it gives some insight into Hawking’s personality.

There are some truly remarkable anecdotes in here, including this one:

On my way home, I and my travelling companion, Richard Chiin, were caught in the Bou’in-Zahra earthquake, a magnitude 7.1 quake that killed more than twelve thousand people. I must have been near the epicentre, but I was unaware of it because I was ill and in a bus that was bouncing around on the Iranian roads.

There are also touches of an especially wry humour:

The colleges were therefore all single-sex and the gates locked at midnight, by which time all visitors – especially those of the opposite sex – were supposed to be out. After that, if you wanted to leave, you had to climb a high wall topped with spikes. My college didn’t want its students getting injured, so it left a gap in the spikes, and it was quite easy to climb out.

All-in-all, I got the very strong impression that this book was very personal to Hawking. It feels like he has related the stories he wants to relate in the way that he wants to relate them – pushing himself a little to reveal slightly uncomfortable details, but no pushed by an editor into shaping the book in any particular way, nor driving too far into personal territory.

My highest qualification in physics is the GCSE I earned twelve years ago, and so it’s hardly surprising that I found some of the physics hard to follow. The discussions of concepts like imaginary time (which is simply at right-angles to normal time, apparently) became more dense towards the end of the book. But the fact that the discussion of wormholes left me a little behind didn’t detract from my enjoyment of the book. While I didn’t follow all of the science, I appreciated the beauty of his descriptions.

This is a brief book. But I felt that it contained a good deal of insight, and I found it a thoroughly enjoyable read.

My Brief History is available now from amazon.co.uk in hardback and on Kindle. Many thanks to Bantam Press for supplying a free copy for the purpose of this review.

Earlier this week, my 2D post was all about BuzzFeed, so it feels right that this week’s recommended read should come from there as well. And so, I’ve chosen Charlie Warzel’s analysis of the paywall, and how the online world is coming to terms with content no longer being free. It’s a great summary… and it’s not even in list form.

BuzzFeed is the incredibly popular site that combines humans and computer algorithms to curate viral content from across the web. It is not uncontroversial, receiving accusations of plagiarism on a reasonably frequent basis. But it is not the ethics of the site that my two chosen articles discuss this week.

The first article, by Eliana Dockterman at Time magazine, has the rather lovely title: How the news got less mean. It isn’t a long article by any means, but it discusses the interesting influence of social media and viral trends – as curated by BuzzFeed – on the type and tone of modern journalism.

The second article, by Mark O’connell at The New Yorker, also has a brilliant title, parodying those that often appear on BuzzFeed: 10 paragraphs about lists you need in your life right now. It discusses the impact of list articles, or “listicles” (ugh), on journalism.

So: two articles essentially discussing two different ways in which BuzzFeed affects journalism. The conclusion appears to be that the future of journalism is snappy and happy. This isn’t all bad news. But I am glad that there are those who also see the future in longform in-depth journalism, and even innovation in the sector, from approaches as diverse as Matter and NSFWCORP, and everything in between. But that discussion is probably for another day…

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them!

This weekend, Lotto relaunches in the UK. But how big would the jackpot have to be to make playing worthwhile? That’s the question James Harvey attempts to answer about the US Powerball game, in this entertaining Medium post.

I should start this review by pointing out that I’m not a “cat person”. I have no particular affection for felines. I suspect that sets me at a disadvantage in terms of enjoying a book about a cat.

This is the story of a drug-addict busker living in sheltered accommodation (James) who takes in a stray cat (Bob) and nurses it back to health. I think a neat parallel is intended between Bob’s recovery and James’s battle with drug addiction – except it doesn’t quite hang properly, as Bob returns to full health within a couple of chapters, whereas James has not completed his drug addiction journey by the end of the book.

There were times at which I found James utterly unsympathetic. His occasionally inexplicably poor choices are related without the insight generated by hindsight that would have made me warm to the character. Because I found the character unsympathetic, I found it difficult to be drawn into the story. And this wasn’t helped by the repetitiveness of the story, and of the emotions described. Really, there are only so many times I can stomach reading about a cat wandering off and it’s owner being worried, or a cat being ill and its owner being worried, or a cat being scared and its owner being worried.

Few things irritate me as much as unthinking anthromorphology, and this is heaped on in spades in this book. We’re constantly told Bob’s thoughts and motivations, and it’s quite possible that over the course of the book he’s ascribed more human attributes than the human protagonist.

In recent book reviews, I’ve been complaining a lot about the standard of proof-reading and editing in recently published books. The standard in this volume is perhaps the poorest I’ve come across. There was a least one point where I found myself unable to follow the plot because a character’s name changed several times. That is pretty inexcusable. Wikipedia is better edited than that.

I accept wholeheartedly that I do not belong to the target audience for this book. It has received excellent reviews elsewhere, and many people find it heart-warming. Many report that it has opened their eyes to the reality of life on the streets, newly reinforced difficulty of overcoming drug addiction, and educated them on aspects of cat care. Those all seem like fairly worthy results, and I don’t intend to suggest through my own negative review that this book hasn’t earned its place on the shelf of the local bookseller. I applaud James’s tenacity and ingenuity in creatively profiting from the story of his relationship with his cat, for tackling his demons, and for building a better life for himself; I wish him all the best for the future.

All of that said, A Street Cat Named Bob did nothing for me. I was unmoved. I found the book tedious in the extreme. I felt that the material on homelessness and drug addiction has been covered far better elsewhere, and cat care tips couldn’t be further from my personal interests. While others clearly see literary merit in the volume to the extent that they have enjoyed very much enjoyed it, I’m afraid I do not. And as such, I cannot recommend it.