Category: Books and Writing

“Unfaithful unto Death”

~ Jennifer Barraclough ~ Leave a comment

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.

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Medicine in memoir and fiction

~ Jennifer Barraclough ~ 1 Comment

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

~ Jennifer Barraclough ~ 1 Comment

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

~ Jennifer Barraclough ~ 3 Comments

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.

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Books I’ve enjoyed #0

~ Jennifer Barraclough ~ Leave a comment

My own creative writing has been on hold lately because of illness and death in my close family, but I’ve continued to read a few books both old and new, and with the help of the “Your Year in Books” service provided by Goodreads.com compiled a list of my personal Top Ten from 2015.

In the fiction category, I like mystery novels and psychological thrillers. Three of my favourites are The Girl on the Train by Paula Hawkins, The Mistake I Made by Paula Daly, and Unravelling Oliver by Liz Nugent, all by women writers from the UK.

I didn’t read many new titles in the field of orthodox medicine and psychology last year, with the exception of Trauma by military psychiatrist Gordon Turnbull who specialises in PTSD. Besides reviving memories of my own former career, this was relevant to personal experiences of recent months. For a less orthodox approach, Health Revelations from Heaven and Earth is jointly written by Tommy Rosa who is a survivor of the near-death experience, and holistic cardiologist Stephen Sinatra. While many of the spiritual insights are not new, they are always worth repeating, and this is an uplifting text. As is is A Course in Miracles Made Easy by Alan Cohen, a readable overview for those of us who are unlikely to tackle the original text.

The quirkiest book on my list is The Life-Changing Magic of Tidying Up by Japanese author Marie Kondo, who has a lifelong passion for organising material possessions. I have yet to attempt putting her system into practice, except to follow the command “Never ball your socks”.

Three very different biographical titles: The Dragon’s Blessing by Guy Allenby tells the life story of Ian Gawler, who has done so much to promote holistic cancer care since his remarkable recovery from a sarcoma. In Disgrace with Fortune by Jean Hendy-Harris, a racy account of the life of a sex worker in London’s Swinging Sixties. And The Last Enemy by Battle of Britain hero Richard Hillary – a book I first read in my teens and have re-read several times since.

This was a difficult choice because there were many other books I found entertaining, interesting or inspiring.

The lure of the murder mystery

~ Jennifer Barraclough ~ Leave a comment

I’ve always enjoyed reading crime fiction, especially the more benign kind of murder mystery epitomised by Agatha Christie’s books. Old-fashioned though these may be, they are still popular today. I think several elements contribute to their enduring appeal: An intriguing puzzle, with a credible solution that is not too obvious, although it could in theory have been worked out from the clues hidden in the text. An ending that demonstrates the triumph of good over evil, and the restoration of justice. Descriptions of crime and criminal psychology that manage to be both sympathetic and entertaining, and never sordid or sensational. Perhaps the universal fascination with death. I could never aspire to anything near the standard set by Agatha Christie, but her influence may be apparent in Fatal Feverfew, one of the books I wrote about thirty years ago but did not publish until now.

The main action takes place in an isolated healing retreat in England’s west country. Lucia, accompanied by her husband and cat, arrives there to recuperate from a recent illness only to find that she is suspected of poisoning their hostess. Lucia reluctantly takes on the role of detective and, with the help of the local doctor, succeeds in uncovering the true course of events.

It can be purchased online as an ebook in various formats from Smashwords.com; and also from the Amazon website for your country of residence, either as a paperback or for a Kindle device.

 

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The portrayal of illness in fiction

~ Jennifer Barraclough ~ 1 Comment

I spent most of my working life as a doctor, so it is not surprising that medical topics often find their way into my fiction writing. Looking back at my completed novels I recognise the themes which have arisen, sometimes more than once: conflicts between mainstream and alternative medicine, overlap between “organic disease” and “functional symptoms”, how serious illness can bring about changes in mood, attitudes and relationships for better or worse, the scope for weakness and corruption in the healthcare professions.

Books, films and television dramas with a medical theme have a widespread appeal. In addition to their entertainment value, when well researched and sensitively presented they serve an educational function, and help to reduce the fear and stigma associated with certain diagnoses whether physical or mental.

There is a risk that fiction with a medical content will distress some readers, especially those who suffer from the conditions in question themselves. Information which was accurate at the time the book was written may have become out of date later on. The use of labels and stereotypes, black humour, or gratuitous sordid detail which promotes morbid fascination with sickness and disability, may cause offence. If the characters are based on real people, or even if they are not, medical authors may be accused of breaching patients’ confidentiality, or of libelling their colleagues.

I don’t know how far I have managed to avoid these pitfalls in my own novels. Most of the illnesses mentioned are ones which I felt entitled to write about because I have experienced them through family, friends or patients, or in myself.

Writing as therapy

~ Jennifer Barraclough ~ 2 Comments

Anyone who ever kept a secret diary as a teenager, or indeed in later life, can attest to the cathartic and healing effects of putting distress into words. Research studies have shown that “expressive writing”, as described below, can be of benefit to patients with a wide range of medical and psychiatric conditions.

Most published autobiographies include some account of the more upsetting aspects of their subjects’ lives. The authors of so-called “misery memoirs” carry this to an extreme, taking the adversity they have suffered – for example being abused by parents or partners, suffering illness or injury, or born into a disadvantaged minority group – as their main theme. Some books in this class are authentic and moving, have an educational function and even help to bring about social change. Some are so full of self-pity as to make their readers cringe, and might have been better left unpublished. Some distort the truth for dramatic effect, and a few have been exposed as entirely fraudulent.

Many writers of fiction draw on the more challenging aspects of their own life experience for their plots and themes – whether directly or indirectly, and whether consciously or not. This is certainly true of myself though I hope that readers of my latest novel Overdose – a tragicomedy about the misadventures of a lovesick psychiatrist – will not take it as literally autobiographical.

Besides including fictionalised versions of real events, novelists may use writing as a means of expressing their “shadow side” – perhaps this would explain why so many highly respectable middle-aged women are good at writing murder mysteries.

For the record, here is a brief description of the usual methodology for the expressive writing research. Patients in the study group are asked to write either by hand or on a computer every day for 3 – 5 days, for 15-20 minutes per session, about the most traumatic experience or emotional issue that has affected their lives. This does not have to be directly related to the medical or psychiatric condition they are suffering from. They are advised to write as freely as possible, without regard for spelling or grammar. Patients in the control group are asked to write for the same amount of time, but about some factual objective topic. The material is confidential and need not be shown to the researchers. Some subjects choose to destroy what they have written.

Like any other therapy, this technique does not suit everyone, and responses vary widely. In the main, studies report that those who did the expressive writing, compared to the controls, became more distressed immediately afterwards and that their physical symptoms sometimes temporarily worsened. But in the longer term they reported improved health, mood, and social function. Many of them said that the expressive writing, though upsetting at the time, had been valuable and meaningful.

Wellbeing for Writers

~ Jennifer Barraclough ~ Leave a comment

I’m pleased to announce that my little ebook Wellbeing for Writers is now available from Amazon Kindle, Smashwords and other online sites.

Born out of my long experience as a part-time author alongside former careers in psychological medicine, life coaching and Bach flower therapy, this is a guide about how to maximise the satisfactions and minimise the frustrations which often arise while writing, publishing and marketing a book. Topics include structuring the process, finding inspiration, maintaining physical and mental health, coping with criticism, aligning personal values with writing, and more.

While mainly focused on the psychology of authorship, it also includes plenty of tips about the basic practicalities.

Most of the content is available for free on this blog … but for a nominal cost you can read it combined in one volume, rearranged in a logical order, and revised and updated throughout.

Please have a look on Amazon or Smashwords, and forward this to any of the aspiring authors among your circle of contacts.

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Turning a blog into a book

~ Jennifer Barraclough ~ Leave a comment

Having covered quite a wide selection of topics on this blog, I decided to combine some of the posts into a short ebook.

Turning a blog into a book would be quite an easy project for a writer who had started off with that aim in mind, and planned out the topics of the posts in advance. A non-fiction example is the cookery blog which formed the basis of the book Julie and Julia, and of the film with the same name. The method can also be used for fiction, as the modern equivalent of the Victorian fashion of serialising the chapters of a novel in a magazine before publishing it as a whole. It gives the writer the option of making changes to the book as it develops, in response to comments from readers.

The contents of this blog were not planned out in advance, and if I had used one of the paid services which can handle the technical aspects of “booking a blog”, the result would have been a hopeless muddle. My posts were written in random order rather than in any logical sequence, and there was some overlap of content between them. Adapting them into a book involved a great deal more editing than I expected. But I have finished it now and I hope the resulting ebook, called Wellbeing for Writers, will be published this week.