Thursday, 27 April 2017

The Child Garden by Geoff Ryman

We're all hurt. But not hurt by the fall.
If art has taught me nothing else, then in all the world, in every situation, it feels like every single person is conflicted by the need for stability and the inescapable contradictions of the mutable self. We're idiosyncratic. We're unpredictable. We vacillate. We waver and flip-flop. We believe we hold deep-seated philosophies and morals, profound ethical positions and beliefs, and yet these can be unseated at any given moment. We want things we know are bad, and we desire things we probably know will make us miserable, or at least definitely not ameliorate our misery, no matter how shiny or expensive. In the Buddhist sense, it is our desire which leads to suffering. That's a hard thing with which to come to terms. And yet many significant advancements in science and technology come not out of actual necessity, but out of desire; a desire to help, a desire to heal, a desire, ironically, to stop suffering; a desire to murder as many of our enemies with little cost to our allies. Arguably, these desires go against our nature. We evolved to the beasts we are, and now we desire to artificially develop further, quicker, smarter, with no long view of the consequences. 

Personally, I'm ambivalent, as I imagine most people are, to this artifice. I desire more comfort at home; year-round tropical fruit on the shelves; a cure for all fatal diseases. And yet I know food should be seasonal, that we evolved eating only those things we could grow or kill ourselves. I know a larger more comfortable sofa might mean facilitating sweatshop textile manufacture in a third world archipelago. But what of disease? What if disease serves a purpose?

The Child Garden posits a future London, nay, world, where cancer is cured, by the coating of proteins with sugar, or 'candy' which prohibits the spread of corrupted genetic information. The population is cancer-free! Unfortunately, it appears that cancer served an essential function and without it, the lifespan of a human is halved to approximately thirty-five years. Although now able to photosynthesise for energy, humans can no longer afford the luxury of a childhood, so learning is advanced exponentially, utilising viruses which share knowledge like implanted tech, so that children can contribute to the workforce. And each mind is 'read' by The Consensus, which is a repository of all human knowledge, and which makes decisions for the good of all, in place of a government; to quote The Orb, 'Huge Ever Growing Pulsating Brain That Rules from the Centre of the Ultraworld'. An ultimate socialist dystopia. 

Quite science fiction-y so far, eh? That's not all! The world is depleted of natural resources, particularly metal, so the Consensus is mining the galaxy and beyond through the use of 'angels', gravitational beings capable of riding the strings of interdimensional webbing that stretch across the universe, joining everything together.

Wow!

Remarkably, for such a huge concept, this is not even the main strand of this quite amazing narrative. For our protagonist is Milena Shibush, a Czech immigrant who is immune to the viruses. She, of all people, shunned and ostracised as a child, lacking implanted social conformity, fearful of the discovery that she has never been 'read', is the key to the survival of the human race. She learns, the hard way, to live like everyone else, tries to accept the viruses, to no avail. She falls in love with a genetically engineered woman but can't articulate this for fear of her 'bad grammar' coming to light. But in her love she discovers purpose, and works towards the production of the most ambitious musical project the world has ever seen, and in the process comes to the attention of the Consensus, which, having become self-aware, realises that she is the one thing it lacks, the one thing that could put an end to its gargantuan loneliness, and the one thing that can bring back cancer. That's right–by the end of the book, the people of London are cheering the return of cancer.

That's some synopsis let me tell you. AND, so you're conscious of the enormity and excellence if this novel, it barely does it justice, if at all. While I've concentrated on the literal aspects, the practical narrative of the book, it develops themes of love and loss, of music and poetry; it challenges the reader to consider his or her own sense of self-worth; it reaches far and wide across the panoply of human experiences and flips them like cards on a table. It's sad, moving, (I didn't get the Dickensian humour the cover touts, but you might), and thoughtful. It's also damning. We don't know what we're doing.

Thursday, 20 April 2017

Timequake by Kurt Vonnegut

You were sick, but now you're well
and there's work to do.
Please assume I’ve included the usual Vonnegut disclaimer here to start with. That way I can charge straight into the regulation waxing lyrical.

OR NOT.

Cue gasps of horror and disdain etc. and so on.

Well. I should probably explain. Timequake is Vonnegut’s “last” novel, published in 1997. It struggles somewhat with the fact that the main plot device, a blip in the linear nature of time which causes everyone on the planet to jump back ten years and live it all over again with no ability to affect the direction of their lives or change any decisions already made, is ostensibly that of a novel which he hasn’t been able to write to his own satisfaction. It became this novel partly because he lacked the focus and willpower to shape it into a novel in its own right, and so instead, like the many Kilgore Trout short story ideas that litter this and other novels, it is just the bones of an idea lacking the meat (which would be ‘eaten by sharks’ anyway, so he reports in a prescient statement as to its eventual critical reception) of a really excellent book.

The other drawback, in my opinion, is that most of the vignettes, the little asides about Vonnegut’s own trials and tribulations, including his trips to the shop for an envelope each time he needs to send his typewritten manuscript to his copy-editor in his own inimitably Mock-Luddite fashion, have been seen before. Lovely as it is to reminisce about his other works, notably ‘Fates Worse than Death’ in which much of the autobiographical stuff first breathed air in 1991, and to meet Trout once more at the end of his life, it’s a bit of a hash. Or a ‘stew’ as the author suggests.

Now, that’s not to say that what we have here is not full of writerly merit. He is poignant, dark, soulful, and tear-jerkingly beautiful. He makes sound political observations (he suggests a new and forward-looking amendment to the Constitution to the tune of ''Every adult who needs it shall be given meaningful work to do, at a living wage.”) and sharp social comments, and his pseudonymous alter-ego keeps coming up with the goods in terms of his short story output, many of which are summarized as examples of Vonnegut’s conclusions on the world. But the borrowing of Hemingway’s dark metaphor and the apathy of the world to the new-found self-determinism at the end of the timequake decade portend the darkening of his mood, evidence of the struggle to come to terms with the entropic nature of his creative energies. In my eyes it feels very much like the last book, and with that comes a sense of loss. This, in turn, engenders anger that it could all come to this. I’m annoyed there will be no more (notwithstanding the tranche of posthumously published work that appeared as if by magic once he had no veto on their publication).


But then maybe he’d just had enough. "You were sick, but now you're well, and there's work to do,” yells Trout in the ears of those paralysed by the availability of free will, and maybe Vonnegut’s lack of the creative imperative finally left him free to make his own choices, among them to not write. 

  

Tuesday, 4 April 2017

The House Of God by Samuel Shem

GOMERs go to ground
but they never die.
This book is as old as I am. Not necessarily the copy I own (that was reprinted in the 1990s and I got hold of it through the amazing Free Books Carmarthen initiative that is keeping books from adding to landfills), but it was written in 1978, a good year for the world by all accounts*. Back then, it wrought much anger from the medical community in America, leading the author and psychiatrist Stephen Joseph Bergman to assume a pen name to avoid suffering the professional backlash - it didn't work, but then he says his patients didn't seem to care.

Told in flashback, from the sunlit terraces of a holiday in France where the narrator still feels the spectre of his internship haunt his every waking moment, it is a riotously, bawdily furious work. Dr Roy Basch is a mature** intern at The House of God, the best Jewish hospital in the city. He and other interns are grist for the hospital mill, often taking the worst cases and saddled with the care of the hospital's GOMERs - that stands for Get Out Of My Emergency Room, a reference to the old and infirm who clutter up the admissions and wards but ironically, never get so ill that they die. Basch's first senior resident is the iconoclastic Fat Man, whose teachings inspire Basch and his colleagues to great heights of patient care, again ironically by doing as little as possible in terms of actual care. By the end of the book, the Fat Man's list of LAWS of the House Of God reaches thirteen:


  1. GOMERs don't die.
  2. GOMERs go to ground.
  3. At a cardiac arrest, the first procedure is to take your own pulse.
  4. The patient is the one with the disease.
  5. Placement comes first.
  6. There is no body cavity that cannot be reached with a #14G needle and a good strong arm.
  7. Age + BUN = Lasix dose.
  8. They can always hurt you more.
  9. The only good admission is a dead admission.
  10. If you don't take a temperature, you can't find a fever.
  11. Show me a BMS (Best Medical Student, a student at The Best Medical School) who only triples my work and I will kiss his feet.
  12. If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.
  13. The delivery of good medical care is to do as much nothing as possible.

By 'buffing' charts (skillfully and artistically altering patients' medical charts) and 'turfing' patients (getting patients placed in other wards, such as gastroenterology, G&O or, more worryingly, the morgue), Basch becomes the hospital's MVI - most valuable intern - but in the process finds himself de-humanised and callous. In one scene he puts out of his misery one terminal patient in excruciating pain on whom the other, fastidiously thorough senior resident is determined to try every medical procedure in the book (thus proving law 13), and he and his team become ragged, mentally and physically exhausted and demoralised by the demands of the job. In a particularly upsetting chapter, one intern commits suicide after a rookie error leads to the lingering death of a patient, a death which lasts the majority of the book and of which he is reminded every day until the end. Meanwhile, the interns take every opportunity to indulge their sexual appetites in a vain attempt to fuck away their problems and to reaffirm their humanity, with the contrary results.


It's no wonder the medical community were aghast when this was published, and one can see why Shem sought to protect his identity. Nowadays, Shem is more sanguine about its impact, feeling that it brought to light the pressures under which medical interns were routinely forced to work, citing one clinician who credits Shem's book with saving him from suicide. He's travelled the world since then speaking to audiences on a simple topic: "the danger of isolation, the healing power of good connection. And any good connection is mutual." He's also added four more laws:

  1. Connection comes first.
  2. Learn empathy.
  3. Speak up.
  4. Learn your trade, in the world.

Coming from a place similar to that of Joseph Heller's Catch-22, it's clear to see the impact the book has had on medical shows, in particular, satires like Bill Lawrence's excellent Zach-Braff-vehicle, Scrubs***. It's in turns hilarious and savage, slapstick and poignant, and the punchline is that all the residents (and amusingly both the policemen routinely on duty at the Emergency room) choose not to stay for a second year's residency but instead opt for the more emotionally connective and humane choice of psychiatry, leaving the hospital with a shortfall in workforce. It might disturb, but it also educates and amuses, greatly.

*By MY account...

**'Mature' meaning of relatively advanced years compared to his peers - any wisdom acquired from these additional years is not in evidence.

***Wikipedia has all the Scrubs references you need to know.