The quick and the dead


All That Remains, written by forensic anthropologist Sue Black, thinks about the significance of cadaver identification and the fates of dead bodies in a number of contexts: identifying victims during civil war in Kosovo, the preservation of donor corpses for medical students to dissect, and seeking clues to the cause of death of skeletons found in isolated places. Some bits of it worked for me and some bits didn’t; Black’s voice is not especially sympathetic (although she occasionally made me laugh!), and she sometimes falls prey to the temptation to discuss a particular professional achievement in too much detail. However, certain chapters were both informative and thought-provoking. I loved the section when Black clearly explains the difficulties of identifying the height, sex, race and age of a skeleton, and I’ll probably be nit-picking a lot of crime novels on this point from now on (no, dental records are not the only way to identify bones, and so smashing up the teeth of a corpse and substituting different ones isn’t going to effectively hide your crime, murderers in Tim Weaver’s ridiculous Chasing the Dead).

Black also makes a passionate case for the necessity of appropriately identifying bodies, even when the cause of death is known and the fact of death is certain, to allow families to properly grieve and to restore some dignity to the dead. This is a topic I find difficult; it’s always seemed to me to be wasteful to expend huge resources to retrieve dead bodies, and I don’t see that the dead mind whether or not they have dignity, as long as their corpse isn’t being desecrated and they don’t end up on public display. However, some of the incidents that Black describes – in particular, the horrific death of an entire family except for the father in Kosovo – have made me think that this kind of work and expense is absolutely appropriate in certain circumstances. This commitment, however, sits in strange contrast to her proclaimed ‘unsentimental’ attitude towards death.


Heart, by cardiologist Sandeep Jauhar, has been longlisted for this year’s Wellcome Prize. It’s a stroll through the history of heart surgery interwoven with Jauhar’s own career as a surgeon and his own family’s experience of heart disease – a history that’s catching up with him, as he discovers plaques in his own coronary arteries during a CT scan. Jauhar writes better about cardiology than does Stephen Westaby in Fragile Lives, but his prose is still workmanlike rather than memorable; it never reaches the heights of Henry Marsh’s Do No Harm or Atul Gawande’s Being Mortal. The structure, at times, was a bit annoying, as Jauhar deliberately interweaves the story of a single real case between chunks of history and medical detail – I found that I kept skipping forward to find out what happened to the patient, as the intervening material was not directly relevant to my understanding of the case. I was also sorry that there was so little about heart transplants, purely because organ transplantation is a particular fascination of mine.

Nevertheless, I enjoyed Heart more and more as it went on, and unlike Westaby, Jauhar himself comes across as likeable and modest – he manages to write about his own personal experiences without forcing himself to the forefront. I preferred the technical medical bits to the gallop through the history of cardiology, finding the chapters on ventricular fibrillation, stress and implantable defibrillators, which can link the two by causing panic attacks in patients who repeatedly receive unexpected shocks to kick their hearts back into rhythm, especially interesting. There are also unintended cross-links with Black’s book. Both writers describe the death of their parents, and how it feels to be part of the oldest generation of your family that remains; as Jauhar puts it, ‘while your parents are alive, there is always someone who thinks of you as a child.’ Both muse on the fact that a sudden heart attack is both the most welcome and the most fearsome way to die, although they reach different conclusions; Jauhar welcomes the heart as ‘a safety valve that can facilitate a quick and humane end’, whereas Black admits that despite the mercifulness of a quick death, she herself wants to spend at least a little time dying so she can put her affairs in order and understand what it feels like to die. Both worthwhile reads, if a little short on literary skill.

Thanks to Rebecca for sending me her proof copy of Heart!


The Wellcome Book Prize Longlist, 2019


I’m delighted to once again be part of the Wellcome Book Prize shadow panel organised by Rebecca, alongside brilliant fellow bloggers Clare, Paul and Annabel. The prize highlights ‘the best new novels, memoirs and non-fiction that illuminate the breadth and depth of our relationship with health, medicine and illness’. The longlist was revealed yesterday, and it’s quite exciting! Here are my initial thoughts, organised by theme.

Masculinity and gender identity


I’ve had Thomas Page McBee’s memoir of his transition, Man Alive, on my TBR list for a while. I’m still most interested in the first book, but Amateurwhich focuses on McBee training as a boxer, sounds like a fascinating glimpse into the experience of living as a trans man, something that is hugely neglected by the mainstream media, which tends to focus on trans women. I’ve become increasingly interested in what happens to ‘masculinity’ when it isn’t seen as solely a property of those born male – i.e. what it feels like to be a trans man, or a butch lesbian – and Amateur promises to explore this with style.

Sarah Krasnostein’s The Trauma Cleaner is a biography of Sandra Pankhurst, a trans woman who runs a ‘trauma cleaning’ business, mopping up after sudden death, removing bodies that have lain alone and undiscovered for weeks, and dealing with living people who have taken to hoarding. As Krasnostein describes her, Sandra is ideally suited to this line of work, because she manages to provide ‘a bespoke blend of respect, warmth, humour and interest that establishes a basic human equity’, to all her clients, drawing from her own abusive past. I had mixed feelings about The Trauma Cleaner, which I reviewed here: the scenes of Sandra working with her cleaning clients are vivid and moving, but Krasnostein treads a little too carefully at times when dealing with Sandra’s past.

Finally, Matthew Sperling’s debut novel, Astroturf, promises to explore modern masculinity from the point of view of a man who starts taking steroids to bulk up his physique, and then starts a black-market business of his own. Promising to be ‘brilliantly funny’, I can’t say that this one especially appeals to me, but maybe I’ll be pleasantly surprised.

Memoirs of chronic illness


Jean Hannah Edelstein’s This Really Isn’t About You looks at how she deals with finding out that she’s inherited the gene for Lynch syndrome, which gives her a higher lifetime risk of certain types of cancer. This has been on my radar for a while, and I’m hoping it’ll be the book about finding your way in life that Meg Fee’s Places I Stopped on the Way Home wanted to be, with the added complication of Edelstein’s genetic inheritance. Very keen to read this one, and I’ve already requested it from my local library.

Arnold Thomas Manning’s memoir, Mind on Fire, deals with his experience of living with manic depression and delusions after experiencing his first episode in adolescence, following the death of his mother. I’m not sure I’ll get on with this one – I struggle with books about mental and physical illnesses where the person’s perception of reality is severely distorted – in other words, I’m happy to read about depression and anxiety but don’t really find it very interesting to read about dementia and schizophrenia. I’m not sure where Manning’s book will fall.

Everyone’s already heard of Tara Westover’s Educated, her account of growing up in a fundamentalist Mormon family in rural Idaho who didn’t send her to school, so she first set foot in a classroom when she was eighteen. While I liked Educatedfinding it insightful, if uneven, I must admit I’m baffled as to what it’s doing on this longlist. I understand that Westover’s abusive father was probably mentally ill, but the memoir is primarily about Tara’s relationship with her family and how she copes in the outside world. Wellcome’s description, which focuses solely on the theme of education, isn’t illuminating either.

Proper medicine


Sandeep Jauhar’s Heart: A History is another of the titles on the longlist that really intrigues me. Jauhar, director of the Heart Failure Program at Long Island Jewish Medical Center, has already written two medical memoirs about his own career, neither of which I’ve read, but both of which I want to read now I’ve heard about them! Heart takes a wider view, considering the history of research on the heart and Jauhar’s own family legacy of heart problems. This is one of those books that will definitely give me more flashbacks to GCSE Medicine Through Time.

Will Eaves’s Murmur sounds like important, but very grim reading: it deals with the legally enforced chemical castration of the homosexual mathematician Alan Turing, after he was convicted of ‘gross indecency’ in 1952. It promises to explore what ‘great bodily change… does to a person’s mind‘. I’m not sure I’ll be rushing out to pick this one up, though I’m pleased that Eaves has written it.

Finally, Thomas Abraham’s Polio: The Odyssey of Eradication sounds like it might have a lot in common with last year’s shortlistee, Meredith Wadman’s The Vaccine Race. Unlike Wadman, however, this book focuses on the campaign to wipe out a single disease: polio. While I enjoyed The Vaccine Race, and learnt a lot, I’m not sure I’m especially keen to tackle this one, especially as I imagine there will be crossover between the two.

Medical fictions


I adored Jessie Greengrass’s Sightwhich I read when it was shortlisted for the Women’s Prize for Fiction in 2018. One of my favourites on a very strong shortlist, Sight forms part of an emerging genre of autofiction, switching between the perspective of a woman pregnant with her second child to the subjects of her medical historical research in the Wellcome Library. Greengrass is especially good on pregnancy and motherhood; I don’t think I’ve ever read anything else as good on the subject.

I’ve been avoiding Ottessa Moshfegh’s My Year of Rest and Relaxation, despite the hype, because I intensely disliked Eileen. It sounds like a very different novel, however, focusing on a young woman’s year spent under the influence of a cocktail of drugs in New York at the turn of the millennium. I’m not sure what’s up with the ironic cover, which is pretty misleading and a big part of what’s been putting me off.

Akwaeke Emezi’s debut novel, Freshwater, deals with a young Igbo woman, Ada, who is ‘peopled with spirits’, and it’s narrated by the different selves within her. I’m torn about this one: I love the idea of the tension between Nigerian folklore and mental health diagnoses, but I think it’s very unlikely I’ll like something that sounds as surreal as this (and deals with mind-distorting mental illness; see above!) Apparently, this is also trendy autofiction. I’ll probably be reading it simply because it’s one of the two titles I can get at my local library, albeit in e-book form.

So there we go! I’m delighted by the freshness of the shortlist, but sad that there’s still no science fiction or speculative fiction on the list – James Smythe’s I Still Dream and Katie Williams’s Tell The Machine Goodnight were only two of the many novels that I thought could have been interesting contenders.

Have you read any of the books on the Wellcome longlist? Are there any worthy contenders that have been missed off?

Wellcome Book Prize 10th Anniversary Blog Tour: The Two Kinds of Decay by Sarah Manguso


The Wellcome Book Prize 2019, which rewards exceptional works of literature that illuminate the many ways that health, medicine and illness touch our lives, marks the 10th anniversary of this prestigious award. Over the last decade, the prize has recognised an eclectic variety of titles from novels (Mend the Living, Maylis de Kerangal) to memoirs (The Iceberg, Marion Coutts) to popular science (It’s All in Your Head, Suzanne O’Sullivan). In 2019, the prize will celebrate this legacy and this extraordinary genre of books that add new meaning to life, death and everything in between.

I hugely enjoyed being a part of the Wellcome Book Prize Shadow Panel in 2018, so I was  thrilled to be asked to participate in the Wellcome 10th Anniversary Blog Tour. Along with Harriet Devine, I’ll be showcasing a title from the 2011 shortlist, which was as follows:

  • Turn of Mind by Alice LaPlante [winner]
  • The Two Kinds of Decay by Sarah Manguso
  • My Dear, I Wanted To Tell You by Louisa Young
  • Nemesis by Philip Roth
  • The Emperor of All Maladies by Siddhartha Mukherjee
  • State of Wonder by Ann Patchett

I’d only read one of these titles before – Patchett’s incredible State of Wonder – so I had a lot of fun deciding which title I wanted to review. In the end, I went for Sarah Manguso’s The Two Kinds of Decaya memoir which chronicles her experience of living with CIDP (Chronic Idiopathic Demyelinating Polyradiculoneuropathy), which has been described as a chronic form of Guillain-Barre syndrome but, like many autoimmune diseases, is still poorly understood.


Rather than attempting a chronological account of the nine years she spent suffering from CIPD, Manguso presents us with a series of arresting and disturbing vignettes. The first treatment she received for the condition, she explains, was apheresis, or the removal of her blood from her body in order to separate it into its constituent parts to allow the purging of the diseased part, which in her case, was the plasma. She was then reinfused with healthy plasma from a blood donor, a procedure that took four hours each time. This removed the antibodies secreted by her immune system that were destroying her healthy neurons and causing her symptoms, which included a creeping paralysis.

However, each time Manguso had to have the apheresis performed, she shook with cold, no matter how many heated blankets she covered herself with. Why?

The temperature in blood vessels is warmer than room temperature… I was very slowly infused with several liters of  fluid that was thirty degrees [F] colder than the rest of my body… the cold infusions went in very close to my heart. I need to describe that feeling, make a reader stop reading for a moment and think, Now I understand how cold it felt.

But I’m just going to say it felt like liquid, thirty degrees colder than my body, being infused slowly but directly into my heart, for four hours.

The plasma infusions also gave her a persistent chemical taste in her mouth: ‘there was nothing I could do to change the taste of it. It wasn’t touching the surface of my tongue… it was in my tongue.’ She found that only sucking on wintergreen candy throughout the course of the treatment gave her some relief.

Manguso’s brief glimpses into the world of her illness mean that The Two Kinds of Decay, unlike other chronic illness memoirs such as Porochista Khakpour’s Sickdoesn’t become repetitive but remains continually riveting. Manguso doesn’t try to draw together her experiences into some great message about life – even the title of her memoir remains somewhat oblique – but simply presents them to us, in prose that is totally and brilliantly boiled down.

Since publishing The Two Kind of Decay in 2008 (it wasn’t published in the UK until 2011, hence its eligibility for the Wellcome Book Prize of that year), Manguso has gone on to publish three more works of biographyThe Guardians (2012), Ongoingness (2015) and 300 Arguments (2017). I’m very glad to have been introduced to her writing.


Some of my other favourite titles from past Wellcome shortlists are as follows [links to my reviews where they exist]:

Make sure to check out the other stops on the blog tour! And thanks to Charlotte at Midas PR for inviting me to participate in this tour and sending me a free copy of Two Kinds of Decay.

Wellcome Book Prize Shadow Panel: The Winner!

And the winner of the Wellcome Book Prize shadow panel is…


See Rebecca’s full post on the decision here.

The winner of the Wellcome Book Prize will be announced  on Monday 30th April.

My predictions, with links to my shortlist reviews: I’m concerned that With the End In Mind, my least favourite on the shortlist, and a book that worried me in a number of ways, has a strong chance of taking it. But I still think To Be A Machine must be a contender, as must Lindsey Fitzharris’s wonderful medical biography of Joseph Lister, The Butchering Art.

I’d be surprised to see either Meredith Wadman’s The Vaccine RaceSigrid Rausing’s Mayhem or Ayọ̀bámi Adébáyọ̀’s Stay With Me take the prize, though this is not necessarily a judgment on the quality of any of those books. The Vaccine Race is perhaps too densely scientific for the average reader, though I enjoyed dredging up my A Level Biology to get through it, Stay With Me, a novel I liked very much, does not seem to me to put medical themes at its centre, and Mayhem’s fragmentary telling and huge gaps are likely to divide readers.

What are your thoughts on the most likely winner of the Wellcome Book Prize 2018?

Update 1/5/18: I was thrilled to hear that To Be A Machine has been pronounced the winner of the Wellcome Book Prize, and intrigued that both the shadow panel and the actual judges chose the same book. Having now read virtually the whole longlist, bar Behave and The White Book, I think that I’d still have selected O’Connell as the winner, though he’d have had stiff competition from Maggie O’Farrell’s I Am, I Am, I Am, which would definitely have made it onto my imaginary shortlist. Looking forward to seeing what happens with the Wellcome Book Prize next year!

You can read Rebecca’s report of the awards ceremony here.

Wellcome Book Prize Blog Tour: Mayhem



I’m excited to be taking part in the Wellcome Book Prize Blog Tour today, featuring an extract from Sigrid Rausing’s Mayhem. This deliberately fragmentary, thought-provoking and intelligently observed memoir is best summarised in Rausing’s own words:


This is a story about witnessing addiction. In some ways it’s an ordinary story: two people, Hans and Eva, my brother and his wife, met in recovery, fell in love, got married, had children, then relapsed. He survived; she did not. Addiction stories are the same the world over – the individuality of addicts is curiously erased by the predictable progress of the disease and of recovery. In our case, what made the story different was partly the fact that it became so public. Witnessing the apparently voluntary physical and mental decline of people you love is inexpressibly painful. In that context, whether the story is public or not doesn’t matter: the sadness and anxiety are so overwhelming that headlines are irrelevant. But you don’t want the media to own the story of your life. That might be a good enough reason to write a book. But I had also always assumed that when dramatic events occur, there would be a narrative, followed by a conclusion, to be filed in the family archive. The story would be told, probably by lawyers; facts would be revealed, and future generations of the family would know what happened. But it turned out that no one was collating the facts. There was no timeline and no coherent family narrative. And yet Hans and Eva’s addiction was the worst thing that had ever happened to us. It dragged us to the underworld of mute slow- motion grief, the realm of sudden breakdowns and uncanny delusions. It brought us rounds of disturbing disputes; time- consuming and complex exchanges of emails; endless reports and conversations; engagements with psychiatrists, therapists and addiction experts of every kind. It made me think deeply about the nature of family and the limits of our responsibility for one another; who we were, and who we had become. Hans and Eva got married in 1992. It was the culmination of years of recovery. They had gone to 12- step meetings; they had sponsors, they may even have sponsored others, and they gave money to addiction charities. By 1999, they had three children. Then, eight years after they got married, they had a catastrophic relapse. It lasted for twelve years. I was thirty- eight when it began; fiifty when it ended. I want to understand how it all began, long before the relapse. But who knows how, or why; what prehistory of emotions, or predestination of genes, leads people into addiction. I know some things. In the early 1980s, Hans, aged eighteen or nineteen, travelled with friends by train through the Soviet Union, China and India. In Goa they met some young Italian women staying on the beach: that was his introduction to heroin. Eva was an expat American, born in Hong Kong, raised in England. She became a drug addict when she was even younger than Hans. There were many rehabs along the way. In the late 1980s they happened to go to the same place. At this point they hadn’t met. Eva was further on in her recovery and had already left when she was asked by the rehab to persuade Hans to stay on – he was close to walking out, back into drugs. She had a knack, it seemed, of helping fellow addicts, and she did talk him into staying. They became friends. Sometime later – they were more than friends now – Hans took Eva down to my parents’ house in the country to meet the family. I remember her well, at that first meeting. She was leaning against the back of the library sofa in a pink Chanel suit; blond, thin, and a little guarded. She looked simultaneously young and old, conventional and wild, groomed and unkempt. She had grown up in London, but she seemed more American than English to me. Her mother was from North Carolina; her father had come to America from Europe quite young. My mother knew them; they had attended the same Families Anonymous group in Chelsea.


My full Goodreads review of Mayhem can be found here.

Don’t miss the other stops on the blog tour this week, especially Rebecca’s review of Mayhem today.

Shortlist Blog Tour Banner

Finally, there are two public events happening in London at the end of the week, culminating in the announcement of the winner of the Wellcome Book Prize on Monday 30th April:

  • Wellcome Book Prize: Authors in Conversation, Saturday 28th April, 3-4.30pm, Wellcome Collection. Five of the six shortlisted authors will be discussing their perspectives on how medicine can touch our lives.
  • Wellcome Book Prize: 5×15, Sunday 29th April, 3-4.30pm, Cecil Sharp House. The same five shortlisted authors will be given 15 minutes each to present their work.

I’ll be attending, and live-tweeting from, the Sunday event, and am very much looking forward to it!

Wellcome Book Prize Shortlist: The Butchering Art


My interest in medical history was sparked at the age of fourteen when I started studying Medicine Through Time for GCSE history (favourite school history module ever), where we romped through at least two thousand years of medical history in the course of relatively few lessons. Somewhere along the way, we learnt that Joseph Lister popularised antiseptics in medical treatment in Britain, leading to a dramatic reduction in deaths from post-operative infection, but that was about all. This book is a great, entertaining and immensely readable summary of how Lister came to accept Louis Pasteur’s controversial germ theory and how he put Pasteur’s findings into practice in hospitals across Britain, following in the footsteps of other pioneers of surgical hygiene such as Ignaz Semmelweis, the Hungarian physician who was eventually hounded out of his job for insisting on thorough hand washing, and died in a mental asylum.

I was a little concerned about the potential goriness of this book, but was relieved to find it less explicit than I had expected. While Fitzharris doesn’t shy away from depicting some of the excruciating detail of nineteenth-century surgery without antiseptic, and the horrors of infection in dirty and overcrowded wards, the book never feels gratuitous or titillating, and some of the very worst incidents are described as briefly as possible. Nevertheless, we are transported vividly to an utterly unfamiliar world, feeding my belief that the gulf between the early and late nineteenth century is in fact wider than the gulf between the late nineteenth and late twentieth. Life is so cheap in this period and the slightest wound can spell the end, as a number of unlucky surgeons find out for themselves.

Fitzharris is especially good at swiftly contextualising the world in which Lister lived and worked for readers who may not be especially familiar with nineteenth-century history. I currently lecture on the social and economic history of Victorian Britain, but still appreciated the way in which Fitzharris’s book filled in a number of gaps in my knowledge of the history of the medical establishment, and surgery as a discipline, during this period. It’s easy for me to feel a bit impatient with popular histories of periods or subjects that I know well, but Fitzharris strikes exactly the right note, writing clearly and accessibly with no dumbing down.

This book thoroughly deserves its place on the Wellcome Book Prize shortlist, and I would recommend it to historians and non-historians alike.

See also Rebecca’s review, Paul’s review and Annabel’s review.

Wellcome Book Prize Shortlist: The Vaccine Race


The subject-matter of Meredith Wadman’s The Vaccine Race: how scientists used human cells to combat killer viruses seems to have taken a number of readers (including me) by surprise. Partly – at least in my case – this is due to not reading the sub-title and the book blurb properly. But it’s also because The Vaccine Race is about lots of things, all at once, so it’s difficult to summarise in a few sentences. One big story that Wadman is telling is about the life and career of Leonard Hayflick, best known today for discovering the ‘Hayflick limit’, or the fact that cells in a petri dish will only divide a fixed number of times before they cease to divide at all, and then die. While this may not sound especially exciting to non-scientists, Wadman emphasises both how revolutionary this was when Hayflick first proposed the idea in 1961, and how the discovery ‘opened the door to the study of cellular ageing.

Later, scientists such as Alexey Olovnikov would build on Hayflick’s work by proposing that the Hayflick limit was due to shortening telomeres on the ends of cell chromosomes. When cell DNA is replicated by DNA polymerase (the protein that copies DNA sequences when cells are dividing), DNA polymerase is unable to copy bits of DNA on the very ends of the chromosomes, and so the telomeres shorten each time. Olovinkov proposed that it’s these shortened telomeres that lead to cell ageing (although scientists think today that it’s much more complicated than that). This could be a book in itself – but actually everything I’ve just said is contained in a couple of short chapters of The Vaccine Race.

One of the main subjects of the book – although again, not its only concern – is Hayflick’s other key discovery, the development of the WI-38 cell line. In short, Hayflick grew cells from the lungs of an aborted human foetus to create healthy diploid cells (cells with two sets of chromosomes, like all human cells except egg and sperm cells) that could be infected with viruses. These cells could then be developed into ‘clean’ vaccines, addressing concerns about vaccines currently on the market, such as one rubella vaccine that was grown in green monkey cells even after researchers caught the Marburg virus from these monkeys. Wadman details how polio, rubella, adenovirus and rabies vaccines, among others, were developed from Hayflick’s WI-38 cells, and how, after initial resistance from the National Institute of Health (NIH) in the US, they came to be in great demand.

But alongside its account of the development of scientific knowledge, The Vaccine Race also touches on the history of biology as a discipline in the US during the period covered by the book (roughly 1940 to 1980, although it occasionally stretches back further or jumps forward.) Biographical sketches of the main actors, most notably Hayflick and his one-time colleague, Stanley Plotkin, play a significant role. Wadman also talks very briefly about how biological research was understood in the US at the beginning of this period, and how that changed. In short, she suggests, biology shifted from a form of public service to something that it was acceptable to make money out of. In 1980, two key events marked this metamorphosis: the Diamond v. Chakrabarty case, which allowed living things to be patented in the US for the first time, and the Bayh-Dole Act, which stopped ownership of inventions that had been developed through federal research funding passing automatically to the federal government. (One of my favourite scenes in the book was when Hayflick drove cross-country to a new job carrying a portable nitrogen freezer full of WI-38 cells, defying the rule that the government had automatic ownership of his work.) As a historian, I couldn’t help wondering (again) if it was all a bit more complicated than that; but Wadman doesn’t have the space to delve any deeper.

I enjoyed reading The Vaccine Race. Wadman writes clearly and compellingly, and given how much material she’s handling, managing to structure the book sensibly is a feat in itself. But I felt that The Vaccine Race was often not one thing or the other. Is it a history of biology in post-war America or a layman’s account of how vaccines are developed? Is it about cell ageing, immunology or epidemiology? I liked hearing about all these subjects, but I wondered if a tighter focus might have made the book more memorable, although it’s still very much worth a look.