30 June 2011

Mirror Image II

I was leafing through Richard Ellmann’s biography of James Joyce, when a photo of Oliver St John Gogarty caught my eye. Gogarty was an ENT surgeon, poet and wit, sometime friend of Joyce, and was the model for ‘Stately, plump Buck Mulligan’ in Ulysses. I found the photo online:

Gogarty is wearing a double-breasted frock coat. Normally, the left half of a double breasted suit or coat goes in front of the right half. Here, the arrangement is reversed;  or the picture is laterally reversed.

I also found a picture of James Joyce, though I forget where. I did find it, or one very like it on Google:

Joyce had bilateral eye problems for many years, and underwent multiple operations on both eyes. His left eye was the poorer, and more troublesome. All other pictures of him with an eye patch show it over the left eye. I’m not totally convinced that this is a mirror image.

23 June 2011

Eunuchs in the Cage

I’ve just read about female eunuchs. Not Germaine Greer’s Female Eunuch, literal female eunuchs. Now, male eunuchs are well known, and it’s an operation which is relatively easy to perform (either with retention of the penis, or not). However, when the operation was commonplace, operative mortality was very high. The story of the female eunuch goes like this.
The Ottoman Sultans’ successor usually dispatched his brothers (strictly, half-brothers) as quickly as possible when he inherited the throne. It may seem brutal, but it worked. The new Sultan then had no rivals.
In the early 17th century, Achmet I changed this. Instead of dispatch, potential rivals and claimants were sent to the ‘Cage’, a small building within the Harem. They were incarcerated there, sometimes for decades. They had a few women to keep them company.
These women had the services of the court physicians, and given contraceptive advice and potions, pessaries and the like. Then I read that they ‘were usually rendered sterile by removal of the ovaries’.
No, I don’t think so. Firstly, at this time the function of the ovaries was unknown. Conception, it was thought, came entirely from the male essence, the female acted merely as an incubator.
And secondly, removal of the ovaries requires a major abdominal operation, one that would have been impossible without anaesthesia. And there wasn’t any any anaesthesia then. 
Female eunuchs simply could not have happened then. Not.

06 June 2011


Kidnapped: Being Memoirs of the Adventures of David Balfour in the Year 1751: How he was Kidnapped and Cast away; his Sufferings in a Desert Isle; his Journey in the Wild Highlands; his acquaintance with Alan Breck Stewart and other notorious Highland Jacobites; with all that he Suffered at the hands of his Uncle, Ebenezer Balfour of Shaws, falsely so-called: Written by Himself and now set forth by Robert Louis Stevenson.

There’s an article in a recent ( 5 June 2011) Observer about role models in literature; Samantha Ellis reflects on what she read as a kid. There’s a competition to win a set of the books she describes; you have to tell them your favourite childhood novel, and what influence it had on you.
Which set me to reflect: what had I read that had had a significant influence? As a lad, I’d read books like Treasure Island, The Thirty-nine Steps, Sherlock Holmes; did these have a significant influence? I wasn’t sure, though the deductions in Sherlock might have influenced my career choice.
Out of nowhere came Kidnapped. This is a boys’ romance, the story of David Balfour and how he met Alan Breck (Stuart) — “I bear a king’s name”; it mingles fact and fiction. The fact part concerns the Appin Murder on 14 May 1752. I should express an interest here: Colin Campbell must be a relative, though my forebears had returned to Ireland more than a century before. Yes, returned: the Scots came from Ireland.
I was perhaps ten when I read the book for the first time; and even then, I was puzzled by something in one of the introductions — for that is what they are — purporting to be a letter to Mr Baxter, Writer to the Signet, a reader. Stevenson admitted to some factual abnormalities in the book; he specifically stated that he knew the date of the Appin murder was wrong (it’s given as 1751 in the book).
This puzzled me at the time: why would an author deliberately falsify the date of something so relevant, so important? And why would he make this public in his introductory letter to Mr Baxter? It’s puzzled me ever since.
I’m not sure even now that I know the answer to this; perhaps, it was a way of disguising a novel, making clear the difference between fact and fiction; perhaps he meant us to believe that David’s memory was at fault; perhaps he actually knew who the murderer was — it’s said to be a secret known to only a few — and didn’t want us to know that he knew. Perhaps.
Whatever; this must have been one of the first — perhaps the first — clashes of exactitude, and just perhaps it lead me to be an Empirical Reader, a searcher for paradoxes, for details that just don’t fit.
The sequel to Kidnapped is Catriona, the further adventures of David Balfour, with some references to the trial of James of the Glens, but concentrating on his relationship with Catriona Drummond (Macgregor). Alas, when I first read it, I was far too young to understand what was going on. Mind you, Catriona is pretty turgid compared to Kidnapped: it’s no surprise that it isn’t nearly as popular as the original. Mistress “grey eyes” is utterly captivating. It took me a few years to understand what David saw in her.


I've just read Ian McEwan's novel Saturday. The hero is a neurosurgeon, and the book follows one day in his life. To me, the story felt just a little too contrived, too improbable. Yes, I know it’s a novel, it’s about themes and all that, yet it didn’t feel right. And too much as if the author was reciting all the neurosurgery he had learned for the purpose of reciting it. It takes around 10 — 15 years as a student and junior doctor to become a specialist, an ‘expert’ — another example of the necessary 10,000 hours of study and practice. Neither a novelist nor a lawyer can really expect to get this depth of learning from observation and reading. They may be able to recite things parrot-fashion, but they don’t give the impression that they understand, that they know.

Neurosurgery isn’t what people seem to think it is. It’s not about operations on the mind, it’s as much about ‘non-brain’ things that go wrong inside the cranium as the ‘brain’ itself. It’s no different from things going wrong in the chest or belly except that access is more often limited. There are plenty of non-neurosurgical operations that can be technically much more difficult. Curiously, the most common problem for neurosurgeons — head injuries — is the one they are happiest to leave to others to sort out, the one area that, in general, they don’t really want to know about. Yet neurosurgery attracts an aura that other branches of surgery don’t; it’s no coincidence that neurosurgeons hold themselves in very high regard.

In Saturday there are descriptions of multiple neurosurgical operations at the start, and a further, different one at the end. All the operations are  depicted in considerable detail — and the details checked by experts —  yet somehow it doesn’t seem quite right to me. There isn’t enough information to enable you to do the operation, yet more than I would have thought necessary in a novel. I didn’t really see the point of these extensive discourses. There’s nothing technically wrong with them, but the combinations that are described don’t seem to go together; it’s like describing an author as a (superb) poet, novelist and biographer simultaneously. No one person is likely to be expert in these three fields, yet that is what is being suggested. The non-surgical reader wouldn’t see this, or would perhaps suggest that it was ‘poetic licence’.

Without spoiling the denouement, the final operation does merit some description, if only to indicate the time that it takes to do — but yet, it’s not such a common procedure, it’s the sort of thing associated with bleeding of nightmarish proportions, though as said of another operation, more ink has been spilt in its description than blood has been lost during its performance.

Saturday was generally well received; reviewers were taken with the themes, and not apparently distracted by the extensive descriptions, so perhaps it’s just me. Then again, perhaps it’s what a novelist would write, for operations are a very significant part of the story. Still, I preferred Direct Red by Gabriel Weston as an author’s view of surgery: she knows about surgery and writing.

A Threesome on the NHS

Three books on special offer — perhaps a ‘3 for 2’ sort of deal, but if it was, I’ve removed the stickers; I don’t want casual visitors thinking I’m cheap.
The three books all about working in the NHS; two of them are blogs or diaries, the life of a very junior doctor and life as an Accident and Emergency doctor. These are accurate enough, though the A&E doctor does rant on a bit about the inefficiencies of the NHS. There is nothing particularly literary about them — and there do seem to be lots of similar titles in the ‘Confessions’ style. A way to waste a couple of hours reading them, but I didn’t get much out of them.
The third is quite different. Direct Red by Gabriel Weston is a short book of short stories, fictionalised things that happened to her during her training to become an ENT surgeon. I heard it on the radio, but didn’t realise that Gabriel is female — I thought that it was a boys’ name. Anyhow, she’s taken an unusual route to medicine; she studied English Literature at Edinburgh, then qualified in medicine through a ‘fast track’ programme for arts graduates. She does seem to have gone through this rather slowly.
There’s no doubting the accuracy of her medical descriptions (I didn’t find any errors!), but operations etc aren’t the point; she describes feelings of how it is to be involved with procedures, operations and people, and how she reacts to them. Medicine sets a scene, but doesn’t overwhelm. It’s not an autobiography, more a series of vignettes, related only by her passage through the ranks.
I can empathise with a lot of her descriptions; the consultant who asks the same questions during every operation — yes, I plead guilty, though I like to think I caught myself on, and changed the questions — at least when I realised that the chaps had the answers off pat.
I did think that some descriptions of other female surgeons were if not harsh, then critical. Not critical of their abilities, but of their personalities — though this is as much a cultural thing. I have the feeling that English surgeons are much more arrogant than people I’ve known in Ireland, though perhaps we are more sexist. I didn’t recognise some of the bitchy things that both male and female surgeons said to her; then again, perhaps my anima isn’t well enough developed for me to be able to appreciate them.
There’s a wonderful description of ‘JFDI’. We’ve all been there, we know how it feels, and she captures the feeling exactly. What she doesn’t (yet) capture is the feeling that ‘Sir’ or ‘Miss’ waiting outside has, on the one hand having to let the trainee proceed unaided, but on the other the awful wondering if help should be offered, and if so, would it be psychologically damaging. And only getting second-hand descriptions from the nurses about how things are going, and not being sure just who is being reassured.
I have wondered for quite a while if the way we ‘educate’ medical students is as good as it’s supposed to be. Much of it seems more a test of memory, recall of largely irrelevant facts for the examinations — and I’ve also wondered why it was necessary to have to relearn all this for the post-graduate examinations. I used to try to provoke people by describing medical training as being no better than learning brick laying at a FE college. You get to know lots of facts, you get to see lots of people, but what you don’t get is educated in the sense of constructing an argument or of having to write an essay. I’d never heard of the ‘necessary of sufficient’ type of argument during my training, and I’ve never met any other consultant who has. To my mind, university is where you go to be educated (and socialised, and to find yourself — you know exactly what I mean) — it’s not a crammers. Doctors, I feel, have missed out on this in general, yet have the concept that because they know a lot more about how people work this entitles them to pronounce as authority figures. It’s common enough to see this thinking in presentations from people who ought to know better, but don’t seem to. The ability to think is something that wasn’t emphasised when I was a student, and I guess it still isn’t. You could call it the difference between education and training.
If I were to study medicine again, I’d start with an arts degree in something unrelated, and then ‘fast track’. And I’d combine this with a better idea of what speciality I’d choose long before I’d chosen it. More processed in this choice you might say, but I’d respond by saying that I’d be more balanced when I qualified, more mature and more capable of making a reasoned choice.
Back to Ms Weston; she’s taken the advice to write about what she knows, in her case herself and her profession. Hers is a literary work, from someone involved who can still stand back and think.
So, get the finger out and JFDI. Read it.