Month: April 2017

Homer: rest in peace

~ Jennifer Barraclough ~ 2 Comments

clare & homer

Sad news for the many friends of Homer the cat.  He had developed an untreatable abdominal lymphoma, and yesterday the heartbreaking decision to euthanise him was made.

Being officially my cat, he has been buried in our back garden, though he never really regarded our property as his home.  After many wanderings he settled with my mother Clare (pictured) and they spent several happy years together until she died in 2015. After that he chose to live in turn with two younger couples, both of whom cared for him lovingly and are devastated by his loss.

To read more about Homer’s remarkable life, search for his name on this blog.

Wounded healers

~ Jennifer Barraclough ~ 2 Comments

During my medical career I met several doctors and nurses who had achieved excellence in their work despite – or maybe because of – health  difficulties of their own. I am sure I could not have coped so well as they did, but my recent experiences of the patient’s role have made me wonder what it would have been like if I was still in practice.

The term “wounded healer” is usually attributed to Carl Jung, who used it in a psychological context. Many of those who choose psychotherapy or counselling as a career are seeking, consciously or not, to cure problems of their own. If they have insight into these and have taken steps to resolve them, it may make their work more effective. If not, they risk causing further damage to their clients.

The term is also associated with Chiron, a figure from Greek mythology, who suffered from a chronic physical wound as the result of a poisoned arrow. He was able to heal other people but could never cure himself. I don’t know how Chiron felt about this, but many of today’s clinicians would be embarrassed by such a scenario – in line with the mantra “physician heal thyself”, there is a widespread assumption that healthcare professionals should not be ill themselves. Some patients do lack confidence in staff who have something evidently wrong with them. Others feel comforted to know that their attendants are vulnerable to the same ills as the rest of humanity, and encouraged to see them overcoming their limitations and carrying on their careers.

Compared to those in robust health, clinicians with personal experience of ill-health tend to be more sensitive and empathic, which within limits is a good thing but if taken too far can lead to over-involvement, excessive self-disclosure, loss of objectivity, and emotional exhaustion.

There is also the question of fitness to practise. There are both legal and ethical imperatives to give equal opportunities to those with illness or disability, and not discriminate against them. At the same time it must be acknowledged that they may be less capable of work than their healthy peers. Every case is different depending on the skills required in the specialty concerned, the nature of the physical and/or mental symptoms, and the time course of the condition – whether there is a chronic but stable handicap, or an episodic illness with recovery in between attacks. Whatever the diagnosis, it is likely that stamina will be impaired.

The main points that stand out from my own experience of the patient’s role relate to communication. I realised first-hand what a big impact the words of a healthcare professional can make; a casual or clumsily phrased statement regarding diagnosis or prognosis can stick in the patient’s mind, whether instilling fears that may prove unfounded, or providing reassurance that turns out to be false. Also, that the position of the patient’s relatives needs to be acknowledged, and considered in management of the case. Of course I knew about these things before, though I don’t recall being taught anything about them in my medical school days, and did not fully appreciate them till later in my career. Today’s students get more training in “soft” topics like communication skills, and hopefully do not need to wait till they or their loved ones are seriously ill to understand their importance.

Murder in the Library

~ Jennifer Barraclough ~ Leave a comment

Last night, along with two of the other authors entered for this year’s Ngaio Marsh Award, I had the pleasure of taking part in a “Murder in the Library” event in Takapuna. Besides describing our own books, we discussed some questions about crime fiction in general.

My husband came along for moral support but he is not a fan of this genre, and had asked me privately why on earth people enjoy reading novels about something so unpleasant as murder. I agree it is a challenge for writers to create entertainment out of such a serious subject. But crime novels are enduringly popular, and I think there are several reasons for this. They have a clear structure and focus, with a mystery to be solved and a solution at the end. They can provide insights into criminal psychology, and raise ethical and moral issues. The good ones have interesting characters and settings as well as convincing plots.

The crime genre as broadly defined covers novels of many different kinds. The traditional whodunnit, often featuring a private detective who is more competent than the police, begins with discovery of a body and ends with unmasking of the killer – usually the most unlikely of suspects from a circle of middle-class characters. This format may now seem old-fashioned but the books of “Golden Age” writers such as Agatha Christie are still very readable. Modern sub-genres of crime fiction are many: cosy, hard-boiled, police procedural, courtroom, spy, psychological thriller, and “noir” from diverse places including Scandinavia, Scotland and New Zealand.

There may be an overlap with other fiction genres, as with my own entry Unfaithful unto Death which combines crime with black comedy, and touches on the themes of corruption in medicine and the pharmaceutical industry. It could almost qualify as a historical novel, because I wrote the first draft in the 1980s following a spell of working as a doctor in general practice in rural England. I had nearly forgotten about the manuscript until I found it among some old papers last year. Reading it through again, parts struck me as rather outrageous compared to my more recent work, and the practice of medicine has certainly changed a great deal since it was written. All the same I decided to publish it without changing the content too much.

The protagonist is Dr Cyril Peabody, who also made a brief appearance in my other two 1980s novels. He is a clever and hard-working doctor who means well but has developed a hefty dose of the arrogance and cynicism which besets his profession, and his bedside manner is appalling. Having failed to gain promotion as a hospital cardiologist because of his awkward personality, he takes what he considers to be an inferior position as a country GP. Predictably he soon clashes with his partners, his patients and his wife. He sets out to improve his status by mounting a trial of a new drug, but finds it has some unexpected side effects. One of the men who has been taking it dies, apparently from a heart attack. Cyril is called to his house in the middle of the night. Having examined the body and considered the history he decides that a post-mortem is indicated, but encounters vehement opposition from the dead man’s wife …

As discussed in a previous post the medical setting provides ample scope for murder both in fiction and in real life.

Medical murder in fact and fiction

~ Jennifer Barraclough ~ 2 Comments

Having one of my medically themed crime novels entered for this year’s Ngaio Marsh Award has led me to reflect on the topic of murder in healthcare settings.

Deliberate killings by doctors or nurses, though rare, are probably more common than can ever be known. Clinical staff are better placed than most people to get away with murder. They have ready access to drugs, anaesthetic gases and surgical instruments, and deaths due to these agents can easily be passed off as natural or accidental. They are privileged to know intimate details of their patients’ lives. And as members of trusted professions they are not readily suspected.

Among the most notorious murderers of modern times was Dr Harold Shipman, who incidentally trained in the class ahead of me at medical school in Leeds in the 1960s. He was found guilty in a court of law of murdering 15 patients in his single-handed general practice and it is likely that he killed many more over his long career, usually by injecting large doses of diamorphine. The estimated number of his victims was 250, most of them being elderly women who were in good health although he fabricated a diagnosis of serious illness on their records. The nature of the mental aberration that led him to commit all these crimes is unknown, because he continued to deny them up until the time he hanged himself in his prison cell. As a result of Shipman’s case, much stricter controls were imposed on medical practice in the UK.

Other convicted serial murderers from medical settings have been nurses, popularly dubbed “angels of death”, working in hospitals or care homes. Their crimes usually masqueraded as mercy killings, but rather than arising from any genuine sense of compassion for someone whose incurable illness was causing unbearable suffering, they were committed for the perpetrators’ own satisfaction and without the knowledge or consent of the victims or their relatives.

Psychiatric evaluation of medical murderers would usually lead to a label of psychopathy, or personality disorder: the lack of moral sense, the inability to feel empathy, the enjoyment of killing, the grandiose belief of having a right to decide that certain persons are not fit to live. These are the extremes of the arrogance, cynicism and wielding of power that are occupational risks in medicine and related professions. Hallucinations and delusions secondary to psychosis or drug abuse are sometimes implicated.

Most if not all murderers are found to have a psychiatric diagnosis of some kind, and this may be sufficient to explain their crimes. In the context of fiction, however, using mental disorder as the sole reason for killing would usually be seen as a cop-out. Readers of crime novels expect a murder mystery to have a more complex solution,  perhaps involving money, sex, revenge, or concealment of discreditable secrets. These motives may of course account for real-life cases too.

Some would say there is a fine line between deliberate criminal killings and the various other forms of unnatural death that can occur through the actions of medical personnel. Some result from malpractice, others are sanctioned by law in certain jurisdictions. They include euthanasia, abortion, execution, experiments such as those carried out in Nazi Germany, drugs or surgery used inappropriately for commercial gain, and simple carelessness or incompetence.

My novel Unfaithful unto Death is intended as a light read with elements of black comedy, but touches on some of these serious themes.