Review: Atul Gawande, Being Mortal

This is a very well written and very interesting book. It argues that the elderly frail and the dying can enjoy a better quality of life than they often do - and that will often enough involve less medicine than more. It will certainly involve asking the frail and the dying what their own priorities are.

Gawande contrasts nursing homes, organised like penitentiaries, unfavourably with assisted living where even the very frail can keep something like their own front door and the freedom to schedule their own time and occupy it in their own way. Likewise, he is more impressed with hospice care (including hospice care delivered at home) than with medical interventions which go on for too long and often reduce rather than improve quality of life.

The argument is built up through some very finely written informal case studies, including one of his own father. As a result, the book is very easy to read - though, of course, it deals with end of life issues which are often enough traumatic for those involved - the person who is on the way out and the family who will remain. He also looks in detail at the ideas of practical providers who have sought alternatives to over-medicalised, over-hospitalised management and intervention.

I felt that the argument Gawande advances is really more general than he indicates. Even before we get into frailty and end of life, modern medicine often offers us too much and expects us to take it. 

It is now routine, for example, to offer rather unpleasant and often risky procedures as the means by which certain things (usually cancers) can be ruled out. But a good specialist using his or her hands and collateral information could in at least some cases make a reasonably reliable assessment. I would like the option of declining the invasive procedure until I had had a judgment from a pair of hands that concluded there was a real cause for concern.

Likewise, with medication. It is not only the elderly frail who are over-medicated to the point where side-effects are worse than the problem being medicated for. Play-safe prescribing or prescribing-on-request puts many millions of people onto pills they don't really need. 

There are signs that the problem is being recognised and  that things are changing. I hope so.

Review: Hanif Kureishi, The Last Word

Books are read in context. I was working for a couple of days in Wiesbaden and took with me an unfinished Caitlin Moran How To Build A Girl. Well, that’s a book where you speed along, tripping over from one gag to the next, and I finished it faster than I had imagined. I heartily recommend it.

I needed something else to read. The nearest German bookshop could only offer me a dozen novels in English (I’ve given up trying to read in German) from which I picked this one.

Kureishi has a very long back list from which I recognised only My Beautiful Launderette which I remember as a fine film.

This is not a book where you trip along, despite the cover puffs which assure you that it is “Brilliantly funny” and “Hugely entertaining”. Maybe it depends where you are coming from. The novel tells the story of a London-based man commissioned by his London publisher to write the biography of an elderly Indian –born but rural England-resident writer, who in turn writes a novel about the upstart young man sent to write his biography. I guess it’s the kind of plot which goes down well in London literary circles where, Private Eye informs me, everyone is up everyone else’s bum.

As a novel, I found it quite flimsy: unambitious plot and characters who aren’t quite, well, characters despite (perhaps because of) the big brushstrokes with which they are painted. I found white working-class Julia the most interesting of his three leading female characters.

But as a novel of ideas – an essay in other words – it’s very interesting. And when it uses its near-to-death main character Mamoon to say things of which London literary society might disapprove if you said them in your own voice, it’s interesting and fun. 

Thus Mamoon:

"[On George Orwell] All that ABC writing, the plain style,the bare, empty mind with a strong undertow of sadism, the sentimental socialism and Big Brother and the pigs, and nothing about love - intolerable. No adult apart from a teacher would bother with one of his novels." (page 92)

“One falls in love, and then learns, for the duration [of a marriage] that one is at the mercy of someone else’s childhood” ( 115)

“The truth is, everything we really desire is either forbidden, immoral or unhealthy, and, if you’re lucky, all three at once” ( 275)

“[Of his personal archive] It’s all going to the university this week. I should have stuffed it in the grate. Ted Hughes, whom I knew and loved, had the right idea with Sylvia’s diaries – push them in the oven after the woman’s head. Otherwise those unreadable academics never stop trying to make their careers and a good income out of it, while making the man look like an ogre. They see it as they wish, without imagination. And it is ordinary male sexuality that they hate” (300)

But reading this last rant, I did wonder if Kureishi did not quite have the courage of his character’s convictions and has left it to the reader to silently insert "politically correct" or “female” before “academics”. Perhaps that's unfair; maybe an editor took something out as an outrage too far. Elsewhere, Kureishi does allow Mamoon his racism.

Refreshingly, and in defiance of the new norm,  Kureishi does not Acknowledge the help of any Facebook Friends. 

Review: Kirstin Innes. Fishnet

The UK-based The Guardian newspaper organises an annual Not The Booker Prize literary competition and it has just published the Shortlist of six books based on Guardian readers’ voting. This book topped the list so I bought it (via Amazon, I’m afraid) together with the second on the list - which I guess will be reviewed here in due course.

It’s an interesting book with many strengths. There is a strong narrative line which generally held my attention. But towards the end I felt a jump forward in the chronology was awkwardly handled. When I first read pages 220 – 221  I thought they might be in the wrong place or that “Almost four years on…” (p 221) might be an uncorrected slip. If I count as a reasonably attentive reader, that really shouldn’t happen.

There is also an awkwardly handled story of betrayal, the importance of which you can I think easily miss. The narrator, Fiona, “outs” a student  sex worker, Anya/Sonja in a fit of anger or sexual jealousy and then in a disconnected passage interprets her own subsequent behaviour as an attempt at reparation. This is an important part of the narrative and it doesn’t come through as strongly as it should.

The strong, central narrative is single parent Fiona’s search for her long-time missing sister Rona / Tasha who she discovers had been working as an escort at the time of her disappearance which followed immediately on from handing over custody to Fiona of her baby daughter.

As Fiona introduces herself to sex workers in her search for Rona, she brings into consciousness her own frustrations with her job and with parenting. She also becomes more aware of her sexuality and desires which are hard to be open about. By the end of the book, she has become a sex worker herself, with a higher standard of living and greater contentment in her role as parent.

In between, there is a lot of very empathetic writing about the lives of sex workers and a fairly obvious contempt for those who would “save” them by criminalising those who pay for sex (men - who on this issue  are fair game for uninhibited sexist stereotyping by advocates of the "Nordic Model"). The contempt probably gets in the way of giving a rounded portrayal of the saviours – Innes has a character, Claire, who is very cardboard even though Innes devotes quite a lot of space trying to understand  her and humanise her. But maybe these people are cardboard - in another context recently I read an essay by "Nordic Model" Mary Honeyball which would support that thought.

The book is at its best in its assertiveness about female sexuality in the face of the Save Women from Prostitution denial of female sexuality. And, perhaps even more so, it is very strong in its probing into what it might mean to live a good or fulfilling life if you, like very many people, don’t have a lot of money, do have a child to care for, and don’t want to live like a doormat.

Review: William Faulkner, Light in August

Light in August was published in 1932, just twenty years before Harper Lee began writing. In comparison to her books, it's a heavyweight work of literature, initially striking me for its wordplay linguistic inventiveness and its piledup evocative paragraphs. It also struck me for its sexual frankness. It's a slow read because Faulkner is in no hurry and does not maintain a single (or even a dual) narrative line. I found this unsatisfactory only at the end when the introduction of a completely new character, the State Captain Grimm - Joe Christmas's eventual killer - delays the work which is then delayed again by the historical musings of Hightower.

On those Lists which are everywhere, it ranks in the Top 100 American novels of the 20th century and no doubt even higher among novels which treat of the American South and the legacy of the Civil War, whites and negroes, Confederates and Yankee abolitionists. But its themes are in many respects more personal than sociological, focussing on a set of lives early damaged and badly so and intersecting in ways which bring out that damagedness. There is only the merest hint of the possibility of redemption, in the short final chapter.

It's 380 pages in my edition; I doubt I will read it again, even though it is the kind of richly-textured book which would repay a second reading.

Review: Rhidian Brook, The Aftermath

Germany in the immediate aftermath of World War Two is a popular setting for contemporary novels written in English. On this site, I have recently reviewed two others: Joseph Kanon's The Good German and Ben Fergusson's The Spring of Kasper Meier. This book is another one. There must be others and already enough for a Compare and Contrast MA dissertation.

I began with a prejudice against this book. The author is described as a "regular contributor" to BBC's radio "Thought for the Day" which in the days when I listened to radio was an Establishment platform for unctuous religiosity. Oh dear, I thought, I hope that's not what I'm in for with this novel. 

Fortunately, I wasn't, though my suspicions returned when I got to the last of the author's "Acknowledgments". All novelists have to have these nowadays - younger writers think it means providing a list of their Likes - and Rhidian Brook ends his own with an acknowledgment to "The Author of All Things". 

Finger down throat.

The novel maintains a well-structured pace and I didn't at any point want to give up on it. The pace quickens at the end but the end itself could be found unsatisfactory: Brook resolves the situation of  his main German characters, Stefan Lubert and his daughter Frieda but not that of his main English characters, Lewis, Rachael and their son Edmund who have been living in the requisitioned Lubert villa. It's left for us to imagine the outcome for them but it is such a big task that it feels like it's been dumped on the reader.

The strength of the novel is in the feeling of edginess which Brook creates in handling the relations between his main characters. Lewis-Rachael, Rachael - Lubert, Edmund-Frieda, Lewis-his colleagues, Edmund and the street orphans of Hamburg. You can imagine it done as a stage play with silences and exits. 

All the characters are dealing with loss and it is their different responses to loss which the novel explores. The ending simply restores one of the losses, quite literally: Lubert's wife and Freida's mother, who they have believed dead in the 1943 Hamburg firestorm, turns out to be alive.

There are moments of unctuousness but his German orphans are constructed around their knowledge of English swearing, definitely not acquired from Thought for the Day.

Review: Tim Butcher, The Trigger

This is a beautifully crafted and very readable book. The author retraced - literally, as a hiker - the steps which took Gavrilo Princip from his home village in Austro-Hungarian Bosnia to Sarajevo and the intellectual and emotional steps which turned him into the assassin  of the Archduke Franz Ferdinand in 1914. Narrating his journey, he at the same time writes the biography of Princip and compares and contrasts the Balkans in the 1910s with the Balkans in the 1990s, where he worked as a news reporter. There is some original archival research done on the way. In total, it's a very good book.

Tim Butcher presents Princip as a South Slav nationalist - a Yugo-slav nationalist - rather than a Serbian nationalist. He wanted to free all those who were colonial subjects of the Austro-Hungarian empire regardless of their language or religion. Princip was actually (it seems) little interested in how they would then organise themselves.

These claims are important because the rhetorical positioning of the great powers in the run-up to their  First World War cast Princip as a Serb Nationalist in pursuit of what later came to be called Greater Serbia. That positioning allowed Austria-Hungary to point the finger of blame for the assassination at independent (but weak) Serbia and pushed Russia into the role of defender of Serbia, a country populated by fellow Orthodox Christian Slavs.

This is once again one of those fine books which though not written by an academic will force the academics to re-think. 

Criticisms occurred to me at just a couple of points. Butcher makes rather heavy weather of the language issue - is it Serbo-Croat, or Serbian and Croat? - and strangely makes no mention at all of the fact that the south Slavs use two alphabets. Serbians / Orthodox Christians use Cyrillic; the others use Roman. Yugoslavia, when it existed, was obliged to use both. 

Butcher's narrative is about Serbs, Croats and Bosnians (and Herzgovinans - Princip was one). The Slovenes, the Macedonians, the quasi-independent Montenegrins, the Kosovar Albanians, the Jews, the Hungarians, the Roma don't figure. What united them all was merely the fact that for centuries they had been ruled as colonial subjects either of the Ottomans or the Habsburgs. Princip did in fact succeed in freeing all of them from the yoke of those Imperialisms. The brutal conflicts of the 1990s were (at least partly) about freeing themselves from the yoke of a demented Greater Serb nationalism.

Review: Ferdinand von Schirach, The Girl Who Wasn't There

I didn’t find this a gripping novel in the way that the author’s previous book The Collini Case is gripping: I read that book in a single sitting (see my Review 16 March 2014). With this one, I struggled.

Roland Barthes back in the early 1950s developed the concept of a “Degree Zero” of unmarked prose in modern writing; he had in mind works like Camus’ L’Etranger – the original English translator of that novel found its plainness so unacceptable that he or she simply padded out the Spartan text with invented flourishes. Von Schirach adopts a Spartan style reminiscent of Camus. For well over a 100 pages everything is described in flat prose, short sentences resisting emotional charge or effect. I don’t think this is the translator getting it wrong.

For example, though there are clear similarities between this book and some of Houellebecq’s writings (notably La carte et le territoire reviewed here 1 August 2012), von Schirach – unlike Houellebecq who is very good at it - does not try to write erotically charged and arousing prose; he just narrates sexual scenes as he might narrate having a shower.

I was on the point of giving up (even though the book is very short) when the murder mystery section opens – at page 115 of the 215 page book - and the writing becomes more lively, more open and even funny. The first joke appears as late as page 142 (top line) and I found it inordinately funny – that’s what emotional starvation does to you.

Alternatively, you could say that it shows good crafting, good pacing. I don’t think so. I think the pace – or if you like, the tone – is unchanged for too long (115 pages say) and then the murder mystery is compressed and underdeveloped.

Like Houellebecq in La carte et le territoire von Schirach imagines himself into the work of a modern artist of conceptual orientation (actually a photographer) and is thus able to create a complete work – a project, an installation – for his character just using words. The reader can enter fully into this totally imaginary art work. This perhaps illustrates the weakness of conceptual art, which is often no more than a narrative illustrated with a few props. But von Schirach has done his background reading and some of the more interesting passages in the second half of the book are those which give the background to his photographer’s disappearing trick.

There is a happy ending which is so brief and abrupt that it could be called trite.

My advice: in his next novel, von Schirach should give himself another 50 or 100 pages and he should change the pace, the emotional tone, more often. Trite but possibly true.