Until recently, most insights into the human side of modern medicine were gleaned either from watching episodes of Casualty with dinner or having the misfortune of being literally hospitalised. Harder to come by were experiential accounts of surgery and medicine beyond textbooks and soldier's memoirs. In a piece for The Guardian two years ago, for instance, William Boyd said that when he was researching his 1994 love story-cum murder mystery The Blue Afternoon, it was "surprisingly difficult to find first-person accounts of surgery by surgeons". These days, that’s changed.
From junior doctor Adam Kay’s This Is Going to Hurt, to heart surgeon Stephen Wesaby’s second offering The Knife’s Edge, to nurse Christie Watson’s The Language of Kindness, there have been an influx of medical memoirs in recent years detailing both the scientific and psychological aspects of the profession. At this point they’re more of a mainstay in UK best-sellers lists than lupus in a series of House.
This isn’t something young writer and cardiac nurse Molly Case realised when she started writing her first nonfiction book, How To Treat People. After a poem she delivered at the Royal College of Nurses Conference in 2013 went viral, kicking back against relentlessly negative media portrayals of NHS staff in the wake of the Mid Staffordshire inquiry, Molly’s insight into the nursing profession is a similar mix of observation and empathy. Mixing personal history with medicinal history and insights into life on the ward, How To Treat People is ultimately a narrative of human connection.
I sat down with Molly to talk about the medical memoir, what it’s like to become a nurse under austerity and how not everything is terrible.
VICE: Why do you think there’s such an appetite for medical memoirs at the moment?
Molly Case: When I started writing How To Treat People I actually didn’t realise I was part of this "wave" of medical memoirs, which might sound really ignorant, but I was mostly reading fiction. Plus, I was busy at nursing school trying to learn how to...
Yeah! Or at least not kill people. So I didn’t realise I was part of something at all. But I’m very proud to be a part of this [wave of writers], and it’s a really interesting question to think, 'Why are we doing this?' I think perhaps it’s because we’re living these lives that are very much online, which in lots of ways there’s nothing wrong with – I get a lot of enjoyment out of being online – but I certainly don’t find I have loads of time, and I don’t even have children or anything like that taking it up. It’s just how fast-paced our lives are now, and being online makes everything feel even more accelerated. I think perhaps medical memoirs and nursing memoirs give us a chance to look inside, look back, look at how we work. There’s also a lot of professions now that are so new. If you transplanted them outside of the city they probably wouldn’t even exist, which doesn’t make them any less important, but looking at these public service professions – which are ancient, really – people are interested in that, in how society is built. Or perhaps everyone’s like me and I’m very nosy. I like other people’s stories, and probably a lot of other people feel that way, and I think these books offer a way of nosing at other people.
One of the things about the book that seems to be resonating is the connections you draw, through time, between the medical and the emotional. Whether you’re talking about the way ancient Egyptians viewed the heart, the role of public service in terror attacks or your own family history, the overall narrative is about the ways in which people are connected.
Absolutely. And tracing the threads of where we’ve come from. One of the most valuable lessons I learned as a nurse – and this sounds very obvious, but one can forget it in four 12-hour night shifts – is that the way a [patient] is presenting to you now is not that person. We’ve all got these threads of legacy and history and stories that built us into who we are now. Not necessarily that this illness doesn’t define them, because sometimes an illness really can define a person if they’ve lived with something for so long, but it’s understanding that there are layers. It sounds so obvious when I talk about it now, but working in intensive care, the tasks you’re doing are so incredibly specific and detailed it’s easy to not be thinking, 'Now, was this person a paratrooper?' rather than, 'There’s an airway here splurging blood clots, I should suction them.'
It’s an interesting first point of contact to have with a person, to start with the outside and work backwards. It must give you a fairly unique perspective on people as a writer.
Without sounding like a wanker, I think nursing really is an anthropological pursuit. I’d never written non-fiction before – I was always inspired by music or fiction. But when I was writing this book I [came across] Claudia Benthien’s book Skin and I thought, 'Oh, that sounds cool.' I love skin in every sense. I’m really interested body art and horror movies and torture and things, and this book is so fascinating. It’s about how differently we’ve perceived skin over time, and how in the 17th century we perceived illness and things that happened to us through things that appeared on the skin. We didn’t delve inside.
I might look at you and think: 'Emma’s got a rash on her face, what could that possibly be? Maybe she’s got gallbladder problems…' It was all projection on the surface. It wasn’t until we started stealing bodies from graves and opening them up in medical schools that we realised we could go inside and actually find out what was going on, and that’s when physicians and surgeons got better at their jobs. We realised, ‘Okay, it’s not all based on what we’re seeing on the skin.' I thought it was absolutely fascinating, that moment in time when we just analysed aspects of the self based on how we saw someone, and that was my first foray into non-fiction. [My husband] reads so many manuals of "How to Do This" or "What’s Going On with This", but I just grew up on stories.
How do you feel the representation of NHS staff has changed since you read your poem at the RCN conference?
So much, which is amazing. It was only 2013, but it really was a very different time. This awful thing had happened in the UK with the Mid Staffordshire Hospital, where terrible, negligent care was happening – which probably was happening around the country, but in particular that hospital. It was horrendous and happening for awful reasons, but it was also very much a product of an NHS that was not being looked after and nurses that had very little support, very little funding, not enough resources and [were being] overworked. Certainly, again, no excuse. This was people’s lives that were being affected.
So, that happening and the subsequent report that came out was a real change for healthcare. It really shamed us. Public opinion was cautious, skeptical, nervous. There were big headlines about "nightmare nurses" and "evil nurses", but I think that’s come full circle now for many reasons. I think nurses have realised what a force they are. There’s so many of us; hundreds and thousands. And I don’t put this down to the poem at all, but when I performed that poem I think it was a bit of a lightbulb moment in that we all realised we were thinking exactly the same thing and nobody yet had said it. Everyone was going "oh gosh, I am sorry for that, I’m really sorry that was awful" and taking things upon themselves. Morale was horrendous. So just vocalising that sentiment [made] people think, 'We are better [than our representation in the news] – I did do that today, I was with that person who died and that meant something to a lot of people.'
In terms of the wider societal context, though, I think the gradual dismantling of the NHS under the Conservative Party has meant that the public can now see that it isn’t the nurses but rather the government that’s starting to pull things down, privatise things and take things away.
The entire time you’ve been a nurse has been under austerity. How do you feel that has coloured your experience of nursing, if it has at all?
I think, again, I must say that I’ve only worked in London, and London hospitals are very different to those across the country, purely because they’ve got more funding, so I can’t speak for the whole of the UK when it comes to the crisis – but the biggest thing for us is under-staffing. Working in intensive care in a London trauma hospital, the kit that you’ve got will save your life when your life is down the road. I’ve only worked in hospitals where I’m never worried we won’t have the kit, but the staffing is awful.
To bring it down to what it means to not have enough staff: you start a shift, you’ve got, say, ten patients on a high dependency unit, six of them are post-operative, i.e. they’ve just had major cardiac surgery and need very fine tuning to make sure they recover well. You should have four nurses and a healthcare assistant to do that, but sometimes you’re short two nurses and that patient care… an example: you simply cannot ensure that the drug you’re giving, which mustn’t ever stop – you have to piggy back the drug, so you turn on a machine just as the other is finishing, so there’s a smooth handover – you haven’t got time to check that’s going to happen. Simple things that are impacting upon people. That’s [down to] staffing and cutting the nursing bursaries so nurses aren’t even signing up to join. I mean, I cannot believe that has happened.
You end the book talking about London Bridge attacks and the image of a figure eight – 8PM tea and toast, 8AM tea and toast, as public service workers come together to help people – and things just carrying on. I think between 2013 and now, regardless of where it’s being directed, there is an overwhelming sense of everything being terrible. Do you feel it was intentional to end this book on a hopeful note?
The book didn’t originally end like that at all. It ended quite softly, with a scene between me and my dad, which was really nice but, as you said – it’s really nice to hear you talk about it, actually – it was meant to end on hope, or something like it. So I thought about a few things and I talked with my dad, who had been a writer in his career, and two things came to me. Firstly, it was the quote that ends the final chapter that says, in these awful moments where everything is terrifying and frightening, look for the helpers, because there’ll always be someone that’s helping. I remember not quite that quote, but that sentiment, from being a child myself. I remember being in my mum and dad’s bed as a kid, because they had a TV at the end of it, and I remember watching things and thinking ‘that’s frightening’, but there was something within me... I don’t know whether it’s what my mum and dad would’ve taught me, but we always find the good in it.
My mum is someone who’s very optimistic, and I’m a bit of a catastrophiser, but she genuinely believes that people are good – and I do as well, but sometimes [I don’t]. So that sentiment had huge weight for me, and when I tried to think about how to literally write that I thought about London Bridge and how frightening that was for so many people in the country, for the people who were actually caught up in it, for people watching abroad. And not just that specific attack, either. What we’re part of now, whether that be the rise of Islamic militancy, the rise of right-wing extremists – because we’re talking about the same thing, really – is the time our generation will remember the most. I’d recently been away for a European break where we’d gone and looked at some old Soviet stuff, and there was a garden set out in a figure eight. The reason the garden was set out that way was to talk about the cyclic nature of history and how we must always understand that history repeats itself, and therefore be cautious. I looked a lot into the history of that shape – forever, eternity – and thought, 'That’s like nursing, actually.' Regardless of what’s going on and who’s doing bad things, people looking after you – whether it be in a formal capacity or just people reaching out – that’s eternal. We’re not all suddenly going to stop doing that.
How To Treat People is out now through Penguin Random House.
This interview has been lightly edited for length and clarity.