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Review: Dirty Work by Gabriel Weston

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.

This 2,076th post was filed under: Book Reviews, .

$15bn Vactican: Being rich is a mortal sin

The Vatican Library
Photo by Lawrence OP, modified under licence
As I mentioned in the diary, The Vatican has pronounced a number of new mortal sins… The twist being that it would seem that The Vatican itself is guilty of most of them. I’m guessing that it wasn’t some kind of point about everyone being a sinner they were trying to make.

The seven ‘new sins’ are kicked off with ‘environmental pollution’. That might sound like a reasonable cause – The Vatican is at least agreeing with the science for once. Except the Vatican has huge investments in the chemical industry, steel, construction, and real estate. Not the most environmentally friendly of industries, but then perhaps its not a sin if you’re merely funding somebody else’s environmental pollution.

The Holy See has also decided that ‘accumulating excessive wealth’ is evil… despite having a vast fortune estimated at over $15bn in the bank. Is that not a little excessive? Certainly wouldn’t fit through the eye of a needle…

Also on the financial front, they’re objecting to ‘inflicting poverty’ and ‘morally debatable experiments’ – both items which are contravened by their extreme stance on the use of condoms in countries riddled with HIV. Both your parents dying from a preventable disease is undeniably inflicting poverty, and preaching that condoms don’t work can be described as little other than a cruel and unusual experiment in failing to halt the spread of the disease.

It could also be argued that this is in ‘violation of fundamental human rights’ – another terrible sin – but I honestly can’t understand how the Vatican defines ‘fundamental human rights’: The policies it advocates on homosexuality, abortion, and euthanasia – not to mention the systemic covering up of child abuse – are certainly not congruent with my understanding of human rights.

The fact that people continue to have faith in Catholicism when the Vatican appears to be so corrupt and hypocritical astounds me – it’s surely either an expression of true, deeper faith, or simple brainwashing and conditioning. I know which theory I prefer.

This 1,277th post was filed under: News and Comment.

My first thoughts on Brown’s cabinet

A fascinating business, this reshuffle lark.  Here are my initial thoughts on each of the roles, and the people now filling them.

Chancellor of the Exchequer: Alistair Darling
Alistair DarlingNo surprises here, then.  He’s always struck me as a sort of inoffensive puppy, who does whatever he’s told, and does it very efficiently.  There’s no chance of this ending in a Blair/Brown relationship, I don’t think Darling has the driving ambition or the nous for that.  His opinion flips with whatever his bosses tell him: From devolution, to independence for the Bank of England, he just thinks what he’s told to think.  And I’m slightly scared of his eyebrows.

Lord Chancellor and Secretary of State for Justice: Jack Straw
I like Jack Straw.  He’s a man of some honour, and he says what he really thinks.  I don’t always agree with what he thinks, but I reckon he’s got his head screwed on, and will work well Justice.  Good for him.

Geoff HoonParliamentary Secretary to the Treasury and Chief Whip: Geoff Hoon
Not a bad move at all.  Geoff Hoon’s slightly ridiculous and bumbling manner makes him bad at some jobs: Secretary of State for Defence being one of them, where I felt he was pretty terrible.  But I reckon he’s got a good political sense about him, and will probably do well as Chief Whip.

Leader of the House of Commons, Minister for Women, and Labour Party Chair: Harriet Harman
Not the person I would’ve put in the position of Leader of the House of Commons if I was hoping to push ahead with the excellent work on Parliamentary reform given a real boost in the last few months by Jack Straw.  Note also, in this age of apparent equality, that there’s still no equivalent Minister for Men.  As for Harriet Harman herself, I really have no opinion.

Secretary of State for Culture, Media and Sport: James Purnell
James PurnellThe Guardian calls him ‘good-looking’.  I don’t see it.  He looks more like one of those slightly suspicious characters in 24 who turns out to be head of the terrorists plotting to detonate a nuclear weapon on US soil.  Again.  Just like they were plotting last season.  But more pertinently, it seems utterly bizarre that the person in charge of culture and sport apparently isn’t in charge of the biggest thing in British culture and sport for decades: The Olympics.  I’m not sure whether that’s an example astounding idiocy or great brilliance.  On the one hand, it could lead to a giant scrap because of overlapping portfolios, but on the other, it could mean that culture outside of the Olympics can be concentrated on and cultivated by one individual, which might help to stop the diversion of all funding and support away from valid projects to be pumped into the Olympics.

Des BrowneSecretary of State for Defence, and Secretary of State for Scotland: Des Browne
No question of who he looks like: His Westminster nickname is Swiss Toni.  He’s been a reasonably good defence secretary up to now, apart from the little upset over the Iranian Hostages being allowed to sell their stories.  A good idea to keep him in his post.

Secretary of State for International Development: Douglas Alexander
A pretty inoffensive Scot, in a pretty inoffensive post.  Meh.

Minister for the Cabinet Office and Treasury of the Duchy of Lancaster: Ed Miliband
Ed MilibandIt’s the Miliblogger’s brother, who looks remarkably like Ernie.  And you can kind of convince yourself that Miliblogger himself looks a bit like Bert, if you screw your eyes up tight.  He seems a less ridiculous politician than his brother, and seems to understand the value of keeping quiet sometimes.

Secretary of State for Children, Schools and Families: Ed Balls
A newly created job, covering one half of the old Department for Education and Skills, though quite why Brown has thrown ‘families’ into the brief is beyond me.  Ed Balls seems to have quite a shrewd political mind, but I’m not sure he’ll be all that great in this post.  But certainly an interesting one to watch.

Secretary of State for Innovation, Universities and Skills: John Denham
A minister for ‘innovation’? What a bizarre title.  But this is the other half of the DfES.  Not quite sure what to think of Mr Denham, to be honest.

Secretary of State for Environment, Food and Rural Affairs: Hilary Benn
Hilary BennIt’s always struck me as odd that there’s a minister for ‘rural affairs’, as if it’s some niche topic, when, in reality, more people in our country live in ‘rural’ areas than cities.  But perhaps that’s not clear to Londoners.  Hilary Benn seems a very committed politician, who’s honest and will say what he thinks.  Despite his relatively low profile, I rather like Mr Benn – and he’s certainly better in this job than the Miliblogger.

Secretary of State for Health: Alan Johnson
Ding dong, the witch is dead! Or, at least, Mad Pat’s gone. For all her wrongs, though, I wouldn’t wish her to be leaving because of her dying mother, and I do feel sympathy for her. Brown has declared the NHS to be his priority (as Cameron did some months ago), so it will be interesting to see where this goes. Mr Johnson could be a great success, or a terrible failure. He’s a bit of a slime-ball, and was a big advocate of tuition fees. But a little bit of slime might just help him to appear amenable to the staff of the NHS, and if he’s slimy in the right way, he could make this work. But if he argues with Brown, as seems likely, and messes stuff up, he could be the sleazeball that loses Brown the next election. It’s a big risk, but it might just pay off.

Secretary of State for Foreign and Commonwealth Affairs: David Miliband
David MilibandOh, dear god, why?  We’ve gone from the mildly bizarre caravanning foreign secretary of Margaret Beckett, to David ‘connect with the people’ Miliblogger – who only wants to connect with those who agree with him.  His much maligned (and hugely expensive) blog, combined with his wiki that had to be taken down, just make him look utterly ridiculous.  Jack Straw brought gravitas and diplomacy to this role.  Miliblogger simply ignores people he disagrees with – not exactly being diplomatic.  Why people think he’s a future Labour leader, I simply do not understand.

Secretary of State for the Home Department: Jacqui Smith
Another slightly unknown quantity.  It’s rumoured that no-one wanted this job, and it’s probably understandable.  Of late, it’s become something of a poisoned chalice.  Will she be the one to turn it round, and flourish in this pressured role?  I don’t see it happening.

Secretary for Business, Enterprise and Regulatory Reform: John Hutton
So, out go the scary eyebrows, and in comes John Hutton. I’m not a fan of his, but I’ve no concrete idea why.  Perhaps it’s the association with the snake that is Alan Milburn, perhaps it’s that he shares a name with Lord Hutton, I don’t know.  But I don’t like him, and I don’t trust him.

Leader of the House of Lords and Lord President of the Council: Lady Ashton
Lady AshtonLady Ashton has got a tough act to follow in Baroness Amos, but she’s got form to do it.  Once Stonewall’s politician of the year, she’s also worked strenuously against forced marriage.  She had strong beliefs, and sticks to them.  I think she’ll do well.

Secretary of State for Communities and Local Government: Hazel Blears
The perma-smile moves to communities and local government.  It’s good that Hazel has got control of local government, for that is where I feel she rather belongs – and the sooner this poor naive woman is out of the national picture, the better for her and us.

Secretary of State for Nothern Ireland: Shaun Woodward
The butlered multi-millionaire ex-Conservative (and ex-editor of Esther Rantzen’s That’s Life) seems such an affably impotent guy that he might just be perfect for this role right now.  With so much progress in Northern Ireland, he’s not someone who’s going to rock the boat too much.  A good pick.

Secretary of State for Transport: Ruth Kelly
Ruth KellyI think Ruth Kelly might go further in government than people think.  She’s a very controversial figure, but, like Mr Blair, nothing sticks.  The number of scandals she’s been involved in, from Home Information Packs, to turning down a job and the Department of Health because she’s against abortion, and at the Department of International Development because it promotes the use of condoms, to sending her son to a private school while at the Department for Education and Skills.  She’s a remarkably intelligent woman, and will be on the scene for a long time to come.  Whether or not that’s a good thing, I’m distinctly unsure.

Chief Secretary to the Treasury: Andy Burnham
One of those posts no-one really cares all that much about.  Burnham’s best bet is to keep it that way.

Secretary of State for Work and Pensions: Peter Hain
Peter Hain used to talk a lot of sense, but appears to have been losing his marbles somewhat of late.  He’s too outspoken for his own good, and I don’t think this job will fit him particularly well.

Minister for Housing: Yvette Cooper
Ed Balls’s other half.  I’m not sure what I make of her, in all honesty.

Minister for Children and Youth Justice: Beverley Hughes
An impressive number of ‘e’s in that name. I haven’t been concentrating enough to understand how her job differs all that much from Ed Balls’s.  Let’s hope she has.

Lord Malloch-BrownMinister for Africa, Asia and the UN: Lord Malloch Brown
A fascinating appointment from outside of Westminster.  The former UN Deputy Secretary General, it will be interesting to see what he gets up to.  Perhaps shows that Gordon is taking Africa seriously – or at least trying to appear that way.

Minister for the Olympics and London: Tessa Jowell
As already mentioned, a role which appears to overlap considerably with Purnell’s.  But her unashamed buddyness with Ken Livingstone should work well.

Attorney General: Lady Scotland
Can only hope that she does a better job than Lord Goldsmith… and it looks like she might be.  Certainly seems to be more of a high-flyer.

Deputy PM: No-one
The fact that no-one needs to take over from John Prescott rather confirms what we already knew: He hasn’t been doing anything of use for months.

So there you go… that’s pretty much what I think of the new gang, right now.  It’ll probably change in about five minutes’ time.

I’m particularly glad to see the backs of John ‘attack dog’ Reid and Mad Pat, but I’m sure this new bunch will have some equally annoying characters.  It kinda reminds me of Big Brother – except we let this bunch of misfits run the country, and there’s only an eviction every four years, and even then it’s David Dimbleby at the helm rather than Davina screaming at us.  Though there’s an idea for Channel 4 next election night…

And if reports are to be believed, the next election night might be earlier than we thought – next year, perhaps.  If that happens, I wouldn’t be surprised to see Brown win.  Interesting times ahead.

This 1,163rd post was filed under: News and Comment, Politics.

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