Writing a medical memoir

Regular readers of this blog will know that in 2015 my husband Brian had a near-fatal heart attack, and that this was followed by a whole series of medical and surgical emergencies affecting our family. I had spent many years working on the medical staff of hospitals and hospices, but experiencing serious illness from the perspective of patients and relatives was very different.

After recovering from the traumas I decided to write a short memoir about them, and this is now available on Smashwords, Amazon US and Amazon UK under the title Across a Sea of Troubles. The first part tells the story of what happened, and the second part is a review of various topics including life event stress, the mind-body connection, post-traumatic syndromes and the role of  the carer.

I wrote this partly for myself as a way of coming to terms with things. Whether it has actually been therapeutic I am not sure – revising the manuscript involved rather too much focus on painful memories. So even if it still not a perfectly finished book, I have decided to publish it and move on. I hope it will hold some value for people who are coping with illness, whether as patients or relatives or health care professionals. But as always when publishing something new, I feel apprehensive about its reception: have I revealed too much personal information about myself or others? does it come across as morbid and self-pitying? is the medical information accurate?

A memoir can be defined as “a record of events written by a person having intimate knowledge of them and based on personal observation”. In contrast to an autobiography, it describes one particular aspect of experience rather than a whole life. Naively perhaps, I have always tended to assume that both memoirs and autobiographies are historically accurate. So I was a little shocked to be advised on one on-line site that it is acceptable, even desirable, to alter the facts to make them more interesting or inspirational for the reader. Although I did wish there were more positive aspects to my own story I resisted any temptation to embroider the truth, and wrote it exactly as I remember, checking all the dates from my diaries. So, rather than one of those books about “illness as a precious gift that transformed my life” it is an honest account of a rather gruelling sequence of events. Here again are the links for Smashwords, Amazon US and Amazon UK. I will share a short extract in my next post.

ast-smashwords-cover

My top twelve books of 2016

My reading for 2016 once again included mostly mysteries and psychological thrillers set in the UK, a few novels in other genres, and a few non-fiction works on medical and metaphysical topics. Here are the ones I enjoyed most. It was too hard to choose only a top ten, or to rank them in order of preference, so I have included twelve books and listed the titles in alphabetical order. The links refer to the pages on Goodreads.com.

A Dictionary of Mutual Understanding by Jackie Copleton: an original and brilliant novel about the aftermath of the Nagasaki bombing.

After the Crash by Michel Bussi: translated from the French, a mystery novel about the sole survivor of an air disaster.

Black Widow by Chris Brookmyre: a woman surgeon, nicknamed “bitchblade”, is on trial in Scotland for murdering her husband …

Do No Harm by Henry Marsh: reflections of a British neurosurgeon, with numerous case histories.

Exposure by Helen Dunmore: London 1960, the Cold War at its height and a secret file goes missing …

One Mind by Larry Dossey: evidence for the Jungian concept of the collective unconscious.

Spare me the Truth by CJ Carver: a man recovering from a breakdown is challenged to remember the circumstances of his son’s death.

The Light between Oceans by ML Stedman: set in Australia after World War 1, a rather harrowing novel about a lighthouse keeper and his wife.

The Widow by Fiona Barton: should a woman remain loyal to a husband accused of child abduction?

You are the Placebo by Joe Dispenza: neuroscience and self-help are combined in this book about the mind-body connection.

You Belong to Me by Samantha Hayes: a psychological thriller about a woman and her stalker.

When I was Invisible by Dorothy Koomson: two girls, once best friends in ballet class, have become estranged as adults due to a secret from their past.

I hope you enjoy some of these recommendations.

“What are you writing next?”

I recently updated my author interview on Smashwords and one of the questions What are you writing next? made me review my future aims.

I am currently working on a short memoir about the catastrophic series of medical events that affected my family in 2015. There were two reasons for starting this project. First, I hoped that writing about what happened would help me come to terms with it better; as I discussed in an earlier post there is evidence that writing about illness and trauma can be therapeutic. Second, other people who are faced with the challenges  of cardiac surgery, bereavement, and stress-related symptoms in themselves or their families might benefit from reading about what helped me to cope, or otherwise.

Writing this memoir is proving quite hard going. Perhaps I have reached the point of  wanting to move forward in life rather than keep dwelling on what happened. I am also wary of conveying the negative and self-pitying attitudes which can so easily mar this kind of book. I look forward to writing something lighter, though my only recent effort has consisted of some sentimental poetry about cats.

What I would ideally like to write next is a really substantial novel. I have already self-published six short ones, and I think that like the vast majority of the thousands of new books coming out every day they are good enough to provide readers with a few hours of entertainment, but will prove to be ephemeral.

Nobody knows which, if any, modern novels will become classics but it is my personal experience that only the occasional book creates a lasting impression. For example, one that I have just finished reading is A Dictionary of Mutual Understanding by Jackie Copleton, a drama set in wartime Japan. I am never going to write a book of comparable quality, and the ambition of producing my own “magnum opus” seems likely to remain unfulfilled in this lifetime, but I do hope to be inspired towards something new. Meanwhile Blue Moon for Bombers, the middle volume of my Three Novellas trilogy, is free from Smashwords till the end of this month. To download a copy click here.

“Unfaithful unto Death”

My latest novel is a black comedy called Unfaithful unto Death. Here is a short extract:

Chapter 1: A Doctor’s Lot

Somewhere in southern England around 1980

Evening surgery was running late, and Dr Cyril Peabody wanted his dinner. He tried to ignore the rumblings of his empty stomach and concentrate on his work.

His tenth patient, the village postmistress, waddled into his consulting room with maddening slowness. “Evening, doctor.”

“Yes, Mrs Bream, what’s the trouble?”

“Just a touch of indigestion, I shouldn’t wonder,” she replied complacently.

Cyril did not consider this an adequate reason for taking up his time on a fine Friday evening. He said “You’re grossly overweight, you know.” Mrs Bream looked so indignant that he tried to make a joke of the matter by rubbing his hands together and adding “Don’t worry, my dear madam, we’ll soon have you looking as sylph-like as a schoolgirl once again.” She gave him a hostile stare.

“Now. What exactly do you mean by indigestion?” asked Cyril.

Mrs Bream looked at him as if he was a backward child. “Dr Greatorex used to give me some white medicine,” she informed him.

Cyril murmured “Curse these country bumpkins” to himself as he wondered how far to investigate her case. He wrote in Mrs Bream’s file “?Indigestion?” enclosed by prominent quotation marks, and added “Low IQ.” He recalled with nostalgia his time as a hospital doctor, when there would have been a student nurse to undress this old biddy ready for him to carry out a physical examination, and to write out the cards for the relevant tests: chest X-ray, barium meal, cholecystogram, full blood count, urea and electrolytes, liver function, ECG. As it was, doing it all himself did not seem worth the effort.

He reached for the prescription pad, saying in a bracing tone “Jolly good. I’ll give you some more white medicine. Come back and see me if by any chance it doesn’t do the trick. And we need to get rid of a stone or two.”

“Evening, doctor,” said Mrs Bream, and before she was out of the room, Cyril firmly pressed the bell for his last patient: Sebastian de Winter, age forty-four, of Easton Green Manor.

Sebastian de Winter was a giant of a man with a thatch of black hair, a jutting forehead and a worried expression. He glanced suspiciously at the notes on the desk. Cyril asked briskly “Well, Mr de Winter, what’s the trouble?”

“I had another bout of chest pain after lunch today. Scared the hell out of me. My blood pressure’s way out of control – you know that I suppose? Garth Greatorex has been handling the problem but he’s off duty this evening. Well, you know that too of course.” The patient leaned forward and continued earnestly “Frankly, Dr Peabody, I want a second opinion. They tell me all this is due to stress. It’s a month since I had a full physical checkup, and I’d like you to give me another ECG.”

Cyril’s interest was aroused by talk of chest pain, blood pressure and ECGs. He decided to ignore the mention of “stress”, for it would be too bad if this case turned out to involve one or both of his two pet hates, “social problems” and “psychiatry”. Cyril was interested in human bodies; he enjoyed finding out what was wrong with them, and gained satisfaction from putting them right. He was not at all interested in the human mind. He replied “By all means, Mr de Winter, delighted to oblige. As you may know, I had a great interest in cardiology in my most recent hospital post. We’ll give the problem a thorough review.” Fatigue forgotten, he rose to the challenge of demonstrating his medical expertise and, with any luck, outshining his senior partner Garth Greatorex in diagnostic skill.

Sebastian de Winter gave a history of chest pain occurring after meals and accompanied by a sensation of dread. He also complained of headaches and disturbed sleep. Cyril did not ask about his personal circumstances but the patient volunteered an account. The symptoms had started soon after his father’s sudden death from a heart attack. Sebastian had inherited the Easton Green estate with two hundred acres of farmland, and a vineyard just starting production. The burden of managing these assets was a heavy one, and his wife did not give much support. He was drinking up to half a bottle of Scotch every night in an attempt to relax and get a few hours’ sleep. He worried about his high blood pressure; Dr Greatorex’s various prescriptions had either failed to bring it down, or caused unacceptable side effects.

Physical examination revealed no abnormality except a raised blood pressure reading of 175/95. Cyril fetched the portable ECG from the clinical room. He took pride in this machine, which had been out of order when he arrived at the practice. He had got it working properly and used it on many of his patients, though none of the other doctors showed any interest in the tracings he obtained.

Sebastian de Winter’s ECG showed mild left ventricular hypertrophy, but Cyril felt able to give an honest reassurance that it was “essentially within normal limits”. The patient replied “Thank God.” Cyril wondered what to do about the raised blood pressure. The man had already been tried on many of the standard drugs: frusemide, propranolol, bethanidine, methyldopa. In the drawer of Cyril’s desk there were some free samples of a new drug called Amaz. It was claimed to reduce blood pressure by some novel mechanism that Cyril could not remember. Recalling the excellent lunch at the Angel’s Arms which Millford Pharmaceuticals had given to celebrate the launch of this new product a week or so before, Cyril announced “I’m not too happy about the blood pressure, but I’ve got some splendid new tablets here which should bring it under control. Come back next week and we’ll see how they’re suiting you.”

“The stuff Greatorex gave me made me feel sick as a dog all day,” said Sebastian de Winter mournfully. “I suppose I’ve got to expect the same with these.”

“Nausea is a common side effect from medication of any kind,” Cyril told him. He added an opinion of his own “Mainly psychological in origin – don’t think about it and you won’t get it, in other words.”

The patient made no move to leave. He asked “Couldn’t you give me something to help me sleep?”

“Never prescribe sleeping pills. Deplorable things,” said Cyril, who never suffered from insomnia himself. He had had enough of the consultation, and was determined not to be drawn into anything that smacked of psychiatry or social problems. Defeated, Sebastian de Winter put the bottle of Amaz into his pocket and shambled out of the consulting room.

Eight o’clock. Cyril put his stethoscope into his medical bag, snapped it shut, and was striding out of the Health Centre when Linda, the young receptionist with the fluffy blonde hair and curvy figure, waylaid him. “Dr Peabody! There’s two late visits come in!”

He cursed his bad luck under his breath. “Not your day, is it?” remarked Linda brightly.

“I sometimes think a doctor’s lot is not a happy one, Linda. Are these visits really that urgent?”

“Well, I should think the first one is. Poor Mr Harland, he only lives up the lane there, he’s got lung cancer and he’s very bad. His wife’s a nurse at Harphamstead Hospital – she wouldn’t ask for a visit over nothing, I’m sure.”

“Suppose not,” said Cyril. “And what’s the other?”

“Old Miss Gray from Cottage 2 by the duck pond. Says she wants to see one of the male doctors urgently. She’s a little bit eccentric, you know,” said Linda. “Actually, between you and me, she’s plain batty. Don’t tell anyone, but she came round here one day and told the whole waiting room Dr Greatorex was a brazen libertine – whatever that may mean. He was awfully cross.”

Cyril smirked with relish over the anecdote. He asked “And what’s wrong with this Miss Gray?”

“She wouldn’t say. She wants to speak to you in confidence.”

“And where is this duck pond?”

“In the dip past Graves Farm. At least it’s on your way home.”

Cyril did not appreciate the tranquil summer evening scene as he drove away. He was beginning to suspect that his recent career change had been a big mistake. His only previous experience of family medicine had been as a single-handed locum in a quiet West Country practice during his summer holiday. He had rather enjoyed that, and considered he had achieved several significant diagnostic triumphs. But working as a dogsbody at Market Beeching Health Centre, with the senior partner breathing down his neck, was what his mother would call quite a different kettle of fish.

***

Unfaithful unto Death is available for Kindle or in print from Amazon.com or your local Amazon site, and as an ebook from Smashwords and other online retailers. Please share this with any of your contacts who might enjoy it.

UUD Smashwords cover

Medicine in memoir and fiction

I’ve been staying up late to read Do No Harm – a compilation of clinical case histories,  interspersed with personal memoir, by British neurosurgeon Henry Marsh. It gives a riveting, though sometimes gruelling, account of the challenges involved in operating – or deciding not to operate – on patients with life-threatening conditions such as brain tumours, brain injuries, and strokes.

Henry Marsh writes with honesty, thoughtfulness and compassion and his book would seem equally accessible to healthcare professionals and general readers, though it is not for the squeamish. I would strongly recommend it to anyone considering a career in neurosurgery, for it can be difficult to find authentic accounts of what working in this or any other medical specialty is really like. Although my own ambition to become a doctor was partly inspired by the library books I read as an impressionable teenager – The Healing Knife by George Sava was one, and another was about a leper colony in Africa – they were already out of date, and I suspect conveyed a romanticised picture. When I got to medical school and was confronted with the reality it became clear that I had little interest or ability in either surgery or tropical diseases, and chose quite a different career path.

Why don’t more doctors write books along the lines of Do No Harm? One reason must be the risk of breaching confidentiality and causing distress to patients themselves or to their relatives. The books by the late neurologist Oliver Sacks – for example The Man who Mistook his Wife for a Hat – are among the best-known examples of the genre, and won wide acclaim from many sources, but have been criticised in some quarters for exploiting vulnerable people.

Another consideration is that any realistic and balanced account is bound to expose the limitations of medicine, and the vulnerability of its practitioners. Perhaps this is not so important now that doctors and hospitals are no longer regarded with unquestioning trust and respect. Henry Marsh makes no attempt to gloss over the fact that some of his cases had a bad outcome, whether because the prognosis was hopeless to begin with or because he or his colleagues made mistakes. He clearly feels these failures keenly, agonising over them even if they were not his fault, giving parts of the text a confessional quality. He is also remarkably outspoken about his frustration with hospital management and the ways that modern NHS bureaucracy can hamper patient care. His frankness about these negative aspects is refreshing, although if I had the misfortune to be needing neurosurgery I think I might regret having read this book and realising how much can go wrong.

I have no intention of writing a factual account of my own medical career, partly for the reasons given above, partly because I don’t remember the details well enough. But writing is therapeutic and when channeling my work experiences into fiction I often find myself emphasising the darker side of my former profession. Readers may find my books unduly cynical unless they appreciate the role of black humour in defusing the stresses of working in medicine.

A giveaway backfires

I recently gifted a print copy of my novel Fatal Feverfew to the winner of my latest Goodreads Giveaway. Soon afterwards she posted a rating on the website, giving it 1 star and commenting “the writing was dull, the plot was poorly written, and the characters were extremely unlikeable and boring. I really struggled to finish this book.”

In my younger days I would have been depressed for weeks after reading a review like that. Now I am more philosophical, reminding myself that you can’t please all of the people all of the time. All the previous novels that I put through the giveaway programme received 4 or 5 star ratings, and I can’t believe this latest one is so much worse than the rest. I do wonder whether someone who has to “struggle to finish a book” would do better to abandon it and move on to something they enjoy reading – this is my own policy now, and I don’t write a review unless I can say something positive.

So, my latest giveaway has backfired as a marketing method – or has it? A day or two after that damning review was published, a little peak in sales of both Fatal Feverfew and some of my other books showed up online. Maybe this proves the truth of the saying that there’s no such thing as bad publicity.

Here are some suggestions about how to cope with bad reviews.

Reflections on self-publishing from Margaret River

I spent last weekend in Margaret River, a small town south of Perth in Western Australia, at an informal reunion meeting for doctors from Oxford UK who now live in the Antipodes. Besides visiting some local vineyards, beaches, and limestone caves, most of us gave short talks to the group. Mine was on a non-medical topic – a basic overview of self-publishing. The content was not specific to doctors, but relevant to aspiring “indie authors” from any profession, so I’ll summarise it here.

First a brief personal background. Back in the 80s and 90s it was easy enough to find a traditional publisher for books about my medical specialty. I wrote or edited eight titles for academic publishers in the UK, and was sometimes even invited to produce new ones. It therefore came as a humiliating shock when my first novel was met with a series of rejection letters – some polite and encouraging but others not. After a particularly painful rebuff I gave up for many years. Then, when the self-publishing movement came on stream, I retrieved my faded typewritten manuscripts from the boxes where they had languished for so long and started revising them, as well as writing new ones. I have now become an indie author with eight titles to date, published as print-on-demand (POD) versions with Amazon CreateSpace, and as e-books on Smashwords and Amazon Kindle.

While so-called “vanity publishing” used to be expensive and stigmatized, now in the digital age self-publishing has become acceptable and affordable. So much so that everyone seems to be doing it – thousands of new books are self-published every day. A few, most famously Fifty Shades of Grey, are highly successful but most sell only a few copies. Those who embark on indie authorship in the hope of financial profit are therefore likely to be disappointed but there are many other rewards, as well as some potential pitfalls.

Besides writing the best possible content, indie authors have to deal with all the other aspects of the publishing process, although rather than do everything yourself you can employ some of the many freelance experts who can be found online. Editing and copy-editing are essential and I would strongly recommend that besides carefully checking the text yourself you ask several other people, whether professionals or honest friends, to point out the typos and mistakes in continuity that are almost always present. Formatting the text properly requires some technical expertise, and while some self-publishing platforms will accept whatever is submitted to them, others have strict formatting requirements. Uploading the completed text from a PC or Mac to your chosen online platform(s) is usually easy to do.

The following points are relevant for marketing purposes. Cover design is important because a split-second glance at the thumbnail image is often the basis on which potential readers will decide whether or not to “look inside” the book. Writing an enticing blurb, and choosing the most suitable categories and key words, will also help to attract readers. As regards pricing, the option of offering your e-books free of charge is undoubtedly the best way to obtain plenty of downloads but, unless your motive is to inform and uplift your readers rather than make a profit, giving away any more than a 20% sample would seem to devalue all the work which goes into their creation.

Self-publishing has both pros and cons when contrasted with the traditional route. Indie authors are assured of publication and have the freedom to control most aspects of the process. They have the flexibility to write books of almost any length, in any category or cross-genre. Publication can be complete in a few days or even a few hours. POD books and e-books need never go out of print or be remaindered. But the process is perhaps too easy, and the downside is that lack of independent quality control has led to a glut of mediocre books, meaning that many of the good ones are overlooked, and downgrading the status of indie authorship.

Many indie authors would say that having to handle their own marketing is the hardest and least enjoyable part of their work. They prefer to spend their time and energy on actual writing; feel diffident about promoting themselves; and be unsure how to go about it. But it has to be done and there are numerous methods available, for example:

Family and friends: tell your personal contacts about your book, and invite them to pass the information to their own circles. Some will be supportive, but others will not be interested to read it, or may not like it if they do.

Email signature: add a link to the book’s website to your personal email signature.

Social media: such as Facebook, Twitter and Linkedin.

Newsletter: hosted by a service such as Mailchimp.

Blog: the content does not have to relate directly to the book – someone who recently read my blog about cats emailed to tell me that she went on to buy a few of my medical titles.

Reviews: send free copies to selected book bloggers and media, but be aware they are overwhelmed with requests and may not respond.

Author pages: set up a profile on Amazon and other platforms.

Printed fliers or bookmarks: to give away at events, or through local libraries or cafes.

Presentations to groups

Online forums: discussion groups, such as those on Linkedin, relating to writing and/or to the subject-matter of your book.

Paid adverts and publicity campaigns: though expensive, these are not always effective.

Luck undoubtedly plays a part in determining which of the books in this supersaturated market will succeed in terms of sales. But even if you do not sell many copies it is satisfying to have your finished product “out there” and to have learned some new skills along the way.

This was quite a long post, but has only provided a highly condensed overview of the self-publishing process. More detail of my own take on how to enjoy being an indie author can be found in my short e-book Wellbeing for Writers.

Cover W4W