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.

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Sugar

 

Guidelines for “healthy eating” come and go. At one time we were advised to avoid fat, now it is said that certain fats are extremely valuable. There are conflicting views about whether such foods as meat, dairy and legumes are good to eat. But one thing on which most of today’s experts do agree is that sugar is extremely bad for the health, and contributes to diverse forms of chronic disease.

Many authorities are now telling us to give up refined sugar completely, although a moderate intake of naturally occurring sugars such as fructose in fruit is okay. I don’t presume to question their advice, which is based on good evidence from large population studies. But there are always individual exceptions to general rules – consider for example the case of my friend Jenks.

Jenks is about to celebrate his 104th birthday. A widower, he lives alone and independently in his own house in England. Every year he flies, on his own, to New Zealand to visit his daughter. He cannot walk very well, but otherwise he is in good physical health and is not overweight. His mental faculties are intact and he uses the internet to keep in touch with the outside world. He has a calm and cheerful temperament.

Jenks has a hearty appetite and has loved sweet foods all his life. In England, besides the main meal of the “meat and two veg” variety which is delivered to his home each day, he eats plenty of processed cereals, biscuits and cakes, fruit juice, fruit tinned in syrup, milk chocolate, cakes and sweets. He takes sugar in coffee and tea. He also enjoys cheese and wine.

His daughter has been keeping a record of his diet while he is staying with her in New Zealand, and here is a typical day’s entry:

Breakfast: Apple juice, Muesli type cereal with milk, Toast and jam, Coffee with 1 sugar, Nectarine

 Mid-morning: Coffee with 1 sugar, 2 sweet biscuits

 Lunch: Bread, crackers & cheese

 Afternoon: Tea with 1 sugar, Cake, Biscuit

 Dinner: Fish & chips, Passion fruit, Chocolate, 2 glasses wine.

In between meals he will have eaten nibbles of sweets, dried fruits and nuts. He has a secret stash and tucks in on demand. 

Most people who ate like this every day without taking any exercise might be expected to become obese and diabetic and die from heart disease long before the age of 104. But not Jenks. Perhaps, as my late mother-in-law was fond of saying, “It’s all in the genes”.

On turning 70

Today was my 70th birthday. I had been dreading this particular milestone, despite telling myself that it is pointless to feel defined on the basis of age, and that I know plenty of people who are still going strong not only over 70, but over 80 or 90 or even 100. Despite my misgivings I don’t feel any older than usual this evening, and I had a lovely day including lunch with friends at a seaside restaurant in the glorious sunshine of our New Zealand summer, and a big bouquet from husband Brian.

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Ageing has many negative aspects, but also some positive ones. Ideally, it is said to be a time of contentment, enhanced wisdom and spirituality, liberation from old constraints and perhaps a chance to start something new. I’ve ordered a book called 70 things to do when you turn 70, no doubt full of inspirational ideas along these lines. For myself I have few ambitions at present, though having just finished the memoir that will be described in my next post, I do hope to write more books. And in my next life I would like to learn to fly. Meanwhile I appreciate being in happy circumstances and good health – having finally grown out of the severe migraine attacks that blighted most of my adult life is a huge bonus. It is a relief to be free of the responsibilities of paid work, and seldom having to do anything unless I want to, although I still feel an obligation to spend my time on something “useful” and am not comfortable with a life of pure leisure. The free travel pass is very nice too.

Mind that wish!

My dear friend and mentor Beata wrote this delightful story about the Law of Attraction.

The Way I See It

Three years after her divorce my friend has found her perfect partner. Perfect in every detail, she assures me; exactly as she had specified him in advance. Didn’t I know, she wonders, that if you really, really wanted something, provided it wasn’t going to harm others, you just had to order it and wait for it to arrive?

Aha. She was talking about the Law of Attraction, without knowing its official name, the process that allegedly uses the power of the mind to turn into reality whatever is in our thoughts and wishes. Of course. I suddenly remembered when I had first come across this idea many years ago, and the ways in which it worked – or didn’t. At the time I was working on a popular magazine, reporting on whatever was trendy, noble or downright weird, and one day I was told to investigate the revival of – wait…

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Soldier’s heart, shellshock and lack of moral fibre

When I was unwell last year, my husband Brian explained my symptoms in military terms: “You’ve been in the front line, and now you’ve got shell shock.” Brian had researched this condition while editing A Physician in Spite of Himself, the autobiography of DW Carmalt Jones who was in charge of a shell shock hospital during World War 1.

Stressed and exhausted by dealing with a series of medical and surgical emergencies in the family, I had developed a variety of symptoms. Repeated attacks of rapid irregular heart beat and breathlessness accompanied by high blood pressure, on two occasions so severe that I was taken to hospital by ambulance. Separate episodes of feeling very cold, or very hot, shaking all over, or suddenly feeling drained of energy and having to lie down. Loss of appetite and weight. Insomnia. The symptoms were  mainly of a physical nature, but various medical tests did not indicate a definite diagnosis. As a former psychiatrist I knew they might be due to anxiety and depression, but a trial of antidepressant drugs made me worse.

Syndromes of this kind can be triggered by any sort of traumatic experience, especially when there seems no scope for controlling the situation or escaping from it. Most of the early descriptions were carried out on servicemen exposed to great physical and emotional stress in wartime. In the American Civil War, men who complained of palpitations, chest pain, shortness of breath and fatigue but had no signs of organic heart disease were said to have “soldier’s heart”. Other terms included da Costa’s syndrome, cardiac neurosis, and neurasthenia. In World War 1, the condition of “shell shock” could include symptoms in many different bodily systems, for example headache, tremor, confusion, nightmares, loss of balance, impaired sight and hearing, as well as the cardiovascular symptoms listed above. Some sufferers received no sympathy or understanding, being accused of cowardice or malingering and punished by firing squad. Others were sent to field hospitals for a brief period of sleep, food and graded exercise before being returned to duty. In World War 2, British airmen who refused to fly on bombing missions were labelled as “lacking moral fibre” (LMF) and usually demoted to menial jobs. Some of these men would have been suffering from the type of illness described above, others just could not bring themselves to take part in the killing of civilians. LMF was highly stigmatised, and concealed as far as possible, so that when I came to write something about it in my novel Blue Moon for Bombers I found little published information. In more recent conflicts, notably the Vietnam war, attitudes were more sympathetic and it became more acceptable to talk about the psychological side of these conditions. The concept of “post-traumatic stress disorder” (PTSD) was born, and continues to generate a great deal of interest and research.

Body and mind are interconnected, and patients with stress-related illness usually have some combination of physical and mental symptoms. For this reason the orthodox medical system, in which the different specialties are separated, may not be well placed to meet their needs. Patients who present with mainly mental symptoms would often be diagnosed as having PTSD and referred to psychiatrists or psychologists, perhaps without having a medical evaluation to exclude the organic pathology that will in fact be present in some cases. Patients for whom physical symptoms predominate might find their way to cardiac, respiratory, neurological or other specialist clinics, and if no organic disease is found the psychological aspect may not be taken seriously if it is recognised at all. The plethora of terms that have been used for such conditions over the years – psychosomatic, functional, medically unexplained, somatoform, and many more – suggests the difficulty of understanding and managing them. Many patients turn to alternative therapies for a more holistic approach.

There is no specific treatment although different medications, psychological therapies and natural remedies prove helpful for individual patients. Sometimes the illness becomes chronic so I was fortunate that my own symptoms recovered within a year, with support from kind relatives and friends, orthodox and alternative healthcare professionals, and an improvement in my life situation.

Only a minority of people who are exposed to severe stress will develop a stress-related illness. Those who do may well feel ashamed about being over-sensitive and lacking in resilience, as I did myself, even though I have chosen to go public by writing about it in this blog and in a forthcoming memoir.

The domestic arts

When Brian and I were first married back in England I aspired to be a good housewife. I knitted jumpers for us both, with matching patterns. I made our own breads, cakes and ice creams. I grew vegetables, and turned the fruit from our garden into marmalades and jams, or stewed and froze it for later use. I quite enjoyed these practical activities, but was never much good at them and the results did not always come up to expectations.

As the years passed, more of my time and energy became channelled into writing, and I gradually gave up any attempt to be a domestic goddess. The range of clothing and foodstuffs available in the shops had improved so much that there seemed little point in making my own. We could afford to eat out a couple of times a week. I almost gave up entertaining people for dinner, being unable to complete with the many excellent cooks among my women friends here in New Zealand. I never did any ironing, and despite periodic attempts at organising and decluttering, the state of my wardrobe and cupboards left much to be desired.

But there are signs the tide is turning. I have been doing more home baking lately, though tending to stick to foolproof recipes for boiled fruit cakes. And I sorted out a bag of wools and knitting needles that had lain untouched for about thirty years. Having watched a YouTube video to remind me how to cast on and off, I have started making small blankets for the foster kittens at Auckland SPCA. This simple form of craftwork is very easy, and surprisingly relaxing. There is in fact research evidence that knitting, being a quiet repetitive activity akin to meditation, can relieve stress and improve cognitive function. Carried out in moderation, knitting can improve manual dexterity for people with arthritis. Because knitting keeps the hands occupied, it may help those wanting to cut down smoking or drinking. And, unlike meditation, knitting has a tangible end product. Even Brian has expressed an interest in taking it up.

If anyone else would like to knit or crochet blankets for the kittens, the required size is approximately 40 x 40 cm and if you need more details please contact me.

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Top twelve books 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.