20TH CENTURY MEDICINE, EGYPTIAN STYLE

Posted in Pills, Places by carolcooper

Covid-19 has already altered medical practice forever but, thinking back, there’ve been many changes in medicine over the years. Most have been more gradual than the ones made necessary by this pandemic, but no less dramatic. The NHS care that I practise, and receive, is far removed from the care I experienced as a child growing up in Egypt.

Antibiotics were few back then, and usually given by injection with a freshly boiled syringe and a reusable needle. I can still feel the cold oily pain of penicillin as it inched its way from my bottom down my leg.

Penicillin was better absorbed in this way than by mouth. There was also a trend of sparing a patient’s delicate digestion, hence the usual recovery diet of rice with boiled chicken, as recommended by every doctor. If the patient ran a fever, suppositories were deemed preferable to a couple of Aspro.

The French occupation of Egypt may also explain how often the middle and upper classes suffered from liver complaints. “C’est de la bile, chérie.” At least bilious attacks can be genuine. A tired liver or le foie fatigué isn’t even a real diagnosis.

Injections of vitamin B12 were popular in the mid-20^th century, and not just for cases of proven deficiency. The impressive bright red colour of B12 flowing into a vein could hardly fail to make the patient feel better, never mind what was actually wrong with her.

The divide between haves and have nots dominated every aspect of life in Egypt. With no national health provision, the poor died young, blindness from trachoma was common, and amputees were everywhere.

If you could afford one, your family doctor would visit whenever requested, often with a cigarette in hand as he puffed his way upstairs. Once he extinguished it, he would examine the patient. As he usually wheezed more than the patient, I’m not sure he heard much through his stethoscope.

*Granny waiting for the doctor to arrive*

What medicine lacked by way of treatments back then was made up for by personal attention, much as alternative medicine still functions today. A little baksheesh to the receptionist ensured that you got seen ahead of others in the waiting room. It seemed unfair to me then, as a young child, and it was even less fair that most of the grownups around me couldn’t see a problem.

Photo by Martyn E. Jones from FreeImages

It’s almost incomprehensible now, but polio was a scourge that went back thousands of years. With outbreaks of paralysis among young children every summer, no wonder we all feared it. Jonas Salk’s polio vaccine didn’t come into use in the Middle East until the late 1950s. For some reason, both doses were injected into the back (not the buttock or thigh). The prospect made me run off into the garden where I promptly fell on the gravel. The two skinned knees and two grazed elbows actually hurt for longer than the polio jab. I’m pleased to say that the Salk vaccine, followed by Sabin oral vaccine, began the long road towards conquering polio worldwide.

According to hieroglyphics and papyruses, bilharzia was known to the Ancient Egyptians. The flatworms that cause the disease are water-borne, with a complicated life cycle that involves freshwater snails as an intermediate host. Bilharzia causes a heavy burden of ill-health, especially for rural children who paddle (and piddle) in the Nile or in one of the many canals. And yet, despite the toll on the population, many people living a comfortable life in Alexandria or Cairo 50 years ago had barely heard of it. The best remedy is prevention with clean water and good hygiene, so the story continues.

***

Although my forthcoming novel The Girls from Alexandria isn’t a book about medicine, you’ll find many aspects of a cosmopolitan world that has long since ceased to exist.

24Feb2020

Fax for the Memories

Posted in Modern life, Pills by carolcooper

Fax machines were once cutting edge. “I just got a sandwich faxed to my desk!” claimed a colleague in the early 90s.

He wasn’t quite right, as it happens, since only his order was transmitted by fax.

For those who aren’t sure how a fax works, the gist is that the original document is scanned, converted into a bitmap, then transmitted down a phone line as audio-frequency tones. The receiving fax machine deciphers the tones, recreates the image, and prints it more or less legibly.

Before email, fax was the only way to send a sizeable amount of data quickly without an expensive courier. It made it possible to send letters quickly and, for reporters, to submit articles to newspapers on the day without dictating them to copy-takers.

It also enabled my mother, who lived abroad and had, like most seniors, a keen interest in the weather, to keep me updated without phoning. I well remember the message in which she said it was SNOWING! (underlined three times). She seemed a bit miffed when I faxed back to ask what she expected from Switzerland in January.

I also had a relative in the Middle East who liked using fax. She generally rang first to tell me her message was on its way, and her pronunciation was different to most. As my children enjoyed putting it, “Aunt Delia likes sending fux.”

The desktop fax came into existence around 1948, but it wasn’t widely used until the 1970s and 1980s. Some machines used dedicated lines, while others shared with a regular phone by means of a switch which didn’t always work. Well, mine didn’t.

Another snag is that one rarely knew how many pages would come in, so the supply of paper had to be kept topped up. My roll of thermal paper often ran out inconveniently mid-flow, like a loo roll. And the paper, being thermal, was useless for archiving as the print soon faded like a receipt. You’d have to photocopy the image or message to preserve a record.

Some machines were advanced and did colour, but smaller businesses, like individuals, tended to have basic models and the image definition wasn’t great. When I was arranging the funeral of a cousin, there was a choice of coffins. As it wasn’t clear over the phone how they differed, the undertaker offered to fax over images of each one. This generated a long ribbon of paper with blurred photos that looked identical. Still, I expect the details made little difference to dear cousin Gladys at that stage.

The arrival of email meant the end of the fax for most, but the NHS doggedly continued to favour faxes for important communications such as urgent referrals, citing confidentiality as the reason. Emailing was banned for transmitting patient info – despite the fact that NHSmail is encrypted. Perhaps nobody at the top considered the risk posed by a clutch of paper messages sitting in the out tray of a machine for all to see.

Thus the NHS became the biggest purchaser of fax machines. Some hospitals had over 600 of the things each, and of course GP practices needed them too, using up money that could have found its way into patient care.

Now the NHS has seen the light and the new GP contract decrees that by April 2020 all GP practices should become fax-free. Some already are, but it’s possible that not all practices, or the agencies they deal with, will be prepared to unplug their faxes despite the 17 pages of guidance on the subject. The death throes of the fax, I suspect, could go on for a while.

7Jan2020

The Most Disgusting Diseases in the World (and how to catch them) – part 3

Posted in Modern life, Pills by carolcooper

If your stomach has now settled post-Christmas, you may be ready for the final instalment of the most disgusting diseases in the world. Those who were born a lot longer ago than yesterday may notice that it’s in the same vein for which the late lamented Punch magazine was known.

Should you fancy a condition that goes the distance, consider keeping a pet worm like dracunculus medinensis, aka the Guinea worm. The best place to pick one up is in Africa with your drinking water. Maintenance is dead easy. There’s no need for an aquarium, hutch, or a garden, as it lives just under the skin.

I remember one patient who had his worm for so long that he named it Ali, which seemed the best bet as he couldn’t tell if it was male or female. Ali kept him company for some time, forming little red bumps all over him, until the day she (as we discovered) tried to escape through a huge blister on his arm.

When the blister finally burst, the little dracunculus poked through. Ali turned out to be several feet long. She had to be wrapped around a stick and pulled out gently to avoid breaking her during her outward journey which took two and a half weeks. Bon voyage, Ali!

You needn’t leave these shores to catch something sensational. Syphilis is all Columbus’s fault since, or so the story goes, his sailors brought it back to Europe in 1493.

An epidemic of syphilis spread from Naples throughout Europe in the 16^th century. The English and Italians called it the French disease, the French called it the Neapolitan disease, and pretty well everyone thought of it as the Great Pox because smallpox was small potatoes by comparison.

Syphilis is far more contagious than leprosy, as just a few minutes in a shared bed will do. A bed may even be superfluous. One man, inspired by notices in public WCs, claimed to have caught the infection in the loo. “That’s a filthy place to take a woman,” replied the consultant.

Syphilis can mimic anything from tonsillitis to athlete’s foot. It all depends on the stage of the infection.

Early syphilis can be just a painless ulcer called a chancre (pronounced Shankar, which is most unfair on Ravi and family). A few months later, the secondary stage produces symptoms like fever, headache, general malaise, aches and pains, mouth ulcers, enlarged lymph nodes, and rashes. Of course, that’s pretty much what everyone goes to the GP with.

Late syphilis takes years to develop, and it’s downhill from there. Nerves in the legs no longer transmit signals about position, which is one cause of the stomping gait you can see all over London. It also makes you fall into the handbasin when you close your eyes to wash your face. If very wobbly, you may fall into the toilet unless you’ve closed it.

No account of dreadful diseases would be complete without that scourge of the western world that has medics clamping their hands over their mouths and recoiling in horror. You may not be able to get a hospital referral, or, if you do, you’ll find yourself being bundled out of the clinic as soon as possible, usually while you’re still talking, so that the consulting room can be fumigated forthwith.

They may offer you surgery, but you may not live long enough to get to the top of the waiting list. Should you manage to reach the operating theatre, the procedure is likely to be relegated to the most junior doctor because nobody else wants to do it. Blood and pus often pour out, and the hapless trainee surgeon may throw up as a result. The patient has it relatively easy by now, as the whole gory mess is soon tidy and bandaged.

Unfortunately, this unsavoury condition is on the increase. Experts call it IGTN and claim that it spreads via shoe shops. It will impair games of footsie-footsie. It may even interfere with walking.

Like many disfiguring conditions, IGTN has a long incubation period. As I’d like you all to enjoy a healthy and happy New Year, I believe the public should be told more about this disorder. I particularly look forward to the day when every pair of winkle-pickers carries the government health warning Wearing shoes may cause ingrowing toe-nails.

27Feb2018

What Nobody Told Me about Having Children

Posted in Family life by carolcooper

Even before I had children, I considered myself clued up. I’d looked after plenty of kids as a family doctor, though my education actually began in my teen years. As a fifteen-year old, I used to baby-sit a feisty brood of five living round the corner from me. Four of the children moved so fast that I could barely tell them apart, let alone stop them wrecking their home. The baby, less mobile, needed constant nappy changes, which was a challenge as he was in a ‘frog plaster’ for developmental dysplasia of the hip.

The scales fell from my eyes, however, when my own kids arrived. Here’s what I learned from having my three sons.

1 Everyone has an opinion on raising children, especially those who never had any. The fewer children someone has, the more insistently they share their wisdom. Experienced parents rarely dish out advice because they know that not all kids are the same.

2 Yep, all children are different. Before you ask: yes, even identical twins. My own twin boys had different personalities from day one. After all, why should they be exactly alike? The environment begins in the womb, and there are always differences in the closeness to the mother’s heartbeat, to her dominant hand, even in the amount of blood flow from the placenta, to name just a few factors.

3 Babies need a lot less sleep than their parents. They don’t have to go to work. They can just loll about all day looking cute and innocent, and save their strength for another fun night ahead. Had I fully appreciated this, I might have stayed on maternity leave longer rather than dragging my befuddled brain (plus a breast pump) to work.

4 The best toys engage the child’s ingenuity, not the toy designer’s. That’s why empty boxes, old saucepans, wrapping paper, and key rings make great playthings. By the way, if you’re still looking for your keys, try checking inside your boots, behind the radiator, in the toilet, and out through the cat-flap. Or keep a spare set somewhere.

5 The longer you take to prepare a meal, the less likely your child is to eat it. Strangely, letting a child make his own sandwich does not put him off wolfing it down, even if it contains the most outlandish food combo and looks nothing like a sandwich.

6 Shopping and mayhem go hand in hand. Before supermarkets provided trolleys for more than one child, I’d have to push one trolley and pull another one. This was the moment when I’d be accosted by a patient who wanted to chat over the baked goods about her test results, or even show me her painful knee. On the plus side, my kids rarely had tantrums while out shopping. Instead, they amused themselves by pulling toothbrushes off the shelves and stuffing them down the front of their dungarees.

7 Children have an infinite capacity for embarrassing their parents. At a neighbour’s house one morning, I was offered coffee, only for one of my sons to pipe up, “Mummy likes gin and tonic.” Another memorable event was a job interview, the kind where you’re invited to bring your entire family (GP interviews can be like that). One of my little lads promptly removed his shoes and socks, gleefully shouting “Sock, sock!” The snag was that, at the time, he pronounced every S as an F.

8 Being a doctor helps you cope with children’s illnesses, but doesn’t make you superhuman. One of the low points was the Christmas when both twins, aged eight weeks, had bronchiolitis. Their older brother didn’t get much attention that year. Another low was a convulsion which landed one of the boys in hospital at the age of eighteen months. The little lad was fine in the end, but my husband drove into a bollard on our way to A & E.

9 The biggest lesson? You have to put your child first, before yourself, before anyone else. But that’s perfectly OK, because, until your own baby come along, you have no idea how intensely you can love a little person.

If you’d like to help a new parent cope when their child is seriously ill, please take a look at Lucy Air Ambulance for Children’s Mum Matters campaign. This great initiative comes just in time for Mother’s Day.

You can find out more about Lucy Air Ambulance for Children right here.

9Feb2018

Four Hours in the Eye Surgery Day Unit

Posted in Pills, Writing by carolcooper

On looking back, the signs had been there for years. First, Nadia had trouble at night from the glare. Then reading got harder, especially the day she picked up an Egyptian newspaper in Paddington. Arabic, with its tiny script and its proliferation of vital dots above and below the letters, is the least appropriate language for someone with poor vision.

She wonders why she’d got cataracts by the age of 55. Probably to do with a stupid game they used to play at the beach in Alexandria. She, Zeinab, Chou-Chou, and of course her sister Simone all dared one another to look straight into the sun for as long as they could. Nadia still has the memory of the after-burn. How was she to know, until Simone told her, that her school friends all cheated by shutting their eyes when she wasn’t looking at them?

“The Nile has cataracts too,” says Chou-Chou. She is still stupid despite being middle-aged now.

“They’re not the same thing,” Nadia replies loftily, even though she is unsure of the difference.

Nobody gets a bed on this day surgery unit. They get an armchair, but only if there’s one free at the appointed time. There isn’t. Along with three other patients, Nadia sits in the corridor. Waiting in corridors is normal in the NHS. It was never like this in Egypt, if you could afford bakshish.

An Iranian nurse and two Irish nurses seem to run the place. Each of them asks Nadia if she is diabetic.

“I’m not diabetic.”

In a nearby office, a doctor sits with the door open. Nadia can hear her complain about the computer system. Doctors always do this.

Once Nadia is installed in her allocated chair, an Irish nurse comes in to put drops into her left eye. “Are you diabetic?”

“No.”

After two lots of eye drops, her vision is so blurred that she can no longer decipher the stream of bile about immigrants, shameless young people, and disgraced celebrities in the newspaper someone discarded.

A young doctor comes to explain the op, reeling off a long list of potential complications. “There’s a one in 1,000 chance of losing all the sight in that eye.”

Nadia recalls a handsome man at Montazah who wore tiny briefs and an eyepatch. He liked to say he’d lost an eye in a duel, though, as her sister told her later, it was really a cataract operation gone wrong. She signs the consent form, sure that things have moved on and that it won’t happen to her.

The surgery is under local while her surgeon hums snatches of an aria and asks about her family.

“There’s nobody left.” Still, Nadia cradles the hope that improved vision will help her find her lost sister.

Everything is bright with a watery blue light. A machine buzzes, and the lens fragments are washed out before a new lens is put into place. She feels nothing.

Soon he says, “All done,” and peels the plastic drape off.

“You can sit up now,” says someone else.

So many voices she doesn’t know, and her head swims when she sits up.

Once back on the ward, a nurse offers her tea and asks again if she is diabetic.

Nadia checks in the mirror that she always keeps in her handbag. There she is, a plastic shield over one eye, with two long strips of tape holding it down.

The nurse returns with tea and instructions: eye drops for the next four weeks, eye shield on at night for a week, sunglasses for a few days, and no hair-washing for five days.

Of course Nadia will wear sunglasses! If her hair is going to be filthy, she doesn’t want anyone recognizing her.

The next day, she removes the eye shield for the first time. Everything is so bright. She can see every leaf on the trees, every speck of dust on the windowsill, every wrinkle on her face. They don’t make mirrors like they used to, that’s for sure.

***

Nadia is a character from my next novel, which is set in Alexandria and London.

If you’d like to know more about cataracts, try this link from Moorfields Eye Hospital.

You may also enjoy Six Lessons from the Eye Clinic.

10Jul2017

What Your Doctor is Really Saying

Posted in Modern life, Pills by carolcooper

Confused when you see the doctor? It’s no great surprise. Medics are famed for their jargon. But, even when they remember to use simple English instead of medicalese, they come out with euphemisms and other phrases that conceal what they really have in mind.

I know, because I do it too. Now, with the benefit of years of experience, I can help you decode what your doctor really means.

What the doctor says	What the doctor really means
I see you’ve brought a list. Splendid!	Now we’ll be here all day.
Any thoughts yourself as to what it might be?	OK, what did you find on Google?
As it happens, my colleague has a special interest in your problem.	I’m all out of ideas.
It’s a classic example of Tsutsugamushi Fever.	Never seen a case of it, but doesn’t it sound grand?
You’ve got a case of pendulum plumbi.	You’re swinging the lead.
I think I should examine those feet of yours.	Hope you’ve had a bath recently.
Or perhaps I’ll get Nurse to send toenail clippings to the lab.	Actually, I’m bloody sure you haven’t.
I’m not in the slightest bit worried, but I think you should go to A&E just to get it checked out.	I’m shitting myself.
This won’t hurt a bit.	It’ll hurt a lot.
Now just a little prick with a needle.	Now just a little prick with a needle.

So, with the benefit of this little chart, you can make the most of your next appointment. If you can get one, that is.

20May2017

A Day on a Hospital Trolley

Posted in London, Pills, Writing by carolcooper

Even though he’s a fictional character, GP Geoff is not so very different from most other medics. If he needs to see a doctor, all he does is look in the mirror.

But the swelling and dragging sensation in his left groin have become hard to ignore, and today he’s going into the Day Surgery Unit of his local hospital. Hernia repair used to mean a sizeable incision and several days in hospital, but, with keyhole surgery, Geoff will be home the same day.

About 90% of operations are now done as day case surgery. Beds are as rare as unicorns, thinks Geoff as he meets Cecil, the day care nurse who’s looking after him today.

Today Geoff doesn’t get a bed, just a trolley on a six-bedded ward. If a patient turns out not to be fit to go home the same day after all, then he gets to stay overnight. On that same trolley.

Geoff has been qualified just 15 years and already things have changed beyond measure. Or have they always been like this for patients?

A junior surgeon pops round with a consent form, then the anaesthetist visits. Geoff is distracted by her dazzling smile, her shock of red curls, but mostly by her multiple nasal piercings. What happens when she has a cold?

“With modern anaesthetic drugs,” she tells him, “you wake up so clear-headed that you can do The Times crossword.”

Which is wonderful because Geoff’s never been able to do The Times crossword.

He won’t get a pre-med, which is a shame. It used to be the best thing about having surgery, but there’s no scope for such things on the day surgery conveyor belt. Besides, Geoff needs to be in charge of his feet, because, when he’s changed into a flimsy gown and paper underpants, a nurse takes him for a long trek to the operating theatre. He hopes he doesn’t run into any of his patients.

Geoff meets the consultant surgeon for the first time in the anaesthetic room. He’s more Doogie Howser than Dr Finlay. Geoff resists asking if his mother knows where he is.

When it’s all over, he can hardly feel he’s had anything done, but he’s lying in a large well-lit room where a nurse is telling him to drink. He had not realised he was clutching a small Styrofoam cup.

Back on the Day Surgery Unit, Nurse Cecil checks his pulse, blood pressure, and oxygen saturations every half hour, and reminds him to eat and drink. There’s an obligatory six hours before he can go home. There’s also the requirement to consume the tea and roast beef sandwich placed next to him.

The man on the neighbouring trolley is smiling at a film on his iPhone. Geoff can’t see the man opposite, as his girlfriend is busy delivering a prolonged post-op snog.

Geoff decides against powering up his phone. The pre-op instructions were clear: do not do anything important in the next 24 hours. The last thing he needs is a spirited twitter exchange with one of those anti-vaccine types.

Geoff doesn’t have a newspaper so he can’t test the anaesthetist’s promise. He brought the latest British Medical Journal, but he doesn’t much feel like it now. Or the sandwich.

The patient by the window has already regained his appetite, judging by the takeaway his family brought in. The red and white packaging is already open, filling the ward with the heady aroma of grease, along with 17 different herbs and spices.

Eventually Geoff does what’s required of him: drink, eat, and pass urine. Post-op pain is breaking through by the time he gets to the tiny WC, where someone has already hosed down the floor.

In the corridor, one of the female patients is asking Cecil where she can find a nurse, oblivious of the fact that she is speaking to a nurse. “I’m a nurse,” says the nurse. The patient’s face is blank.

Finally Geoff goes home with a paper bag. It has spare dressings, a packet of painkillers, and instruction leaflets on not picking your scabs.

There’s supposed to be a responsible adult with him for the first 24 hours at home. Geoff, who’s single, fibbed about that bit. Luckily nobody checks, and he absconds in an Uber.

Nothing will go wrong, Geoff tells himself. Aside from the little lie he told the hospital, he plans to be a good patient and take careful note of all the instructions. At first, he is a little confused by the stated telephone times.

Then he realises it’s exactly like Sainsbury’s, trolleys and all.

Geoff lives in North London where he looks after patients, longs for a meaningful relationship, and rants about the NHS. You can find out more about him and his life in the pages of Hampstead Fever.

You may also like these posts:

How Are You Today, Grandma?

Germs and Geriatrics.

19Feb2017

How to Alienate Your Doctor in 10 Easy Steps

Posted in Pills by carolcooper

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

National Health Service logo

But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.

23Jan2017

Feedback Frenzy

Posted in Modern life, Writing by carolcooper

My pocket chirrups as I descend the steps from my bank. The text message asks me to rate my recent customer experience. This happens to be one of a hundred or more perfectly routine transactions I’ve made at that bank.

Irritated, I delete the text.

At school, there was a girl who was forever checking what people thought of her. Sadly, the answer was ‘not much’, but this didn’t stop her beaming at everyone and trying to decipher their expressions. When she couldn’t read the emotional temperature, she would ask what we thought. I wince to report that we thought our classmate stupid. Looking back, however, she was well ahead of her time.

These days, Waitrose sends me emails asking how my groceries were. Would I rate and review them?

I get similar requests after almost every commercial interaction of the day. If not during it. A text thanks me for travelling with Addison Lee, and invites me to rate the driver. I get this message before I’ve even reached the destination.

Ditto Moonpig, who want to know how everything went with the card I ordered. It’s not even scheduled to be delivered till next week. Stop asking me!

Now an email thanks me for collecting my parcel from the Spar in Chesterton Road, and asks me how I would ‘rate the service in store’.

The bottom line? It was fine. I got my parcel. Had the guy behind the counter not found it, or handed me a damaged parcel or something entirely different like a Mars Bar or a lottery ticket, you can be sure I’d have let someone know, loud and clear. Feedback can certainly be useful. Book reviews, for instance, help guide the author as well as people looking for their next read – though it’s worth noting that the most useful reviews have actual words in them, not just a star rating.

Evaluations from the students I teach can also be valuable, if they help improve the outcome for the next lot.

For feedback to be most useful to others, it pays to ask the right questions. One pension provider invites me to rate my recent dealings with them. A more pertinent point might be whether I was happy with the return on my investment.

Nowadays, detailed feedback from patients is an integral part of a doctor’s appraisal process. It’s a two-page form that demands a certain level of literacy and attention. That makes it difficult for many patients, especially those who’ve just had bad news or been sent to hospital.

Feedback from colleagues is even harder to come by. In smaller practices, family doctors may resort to asking people they haven’t worked with for years, just to make up the numbers.

Feedback shouldn’t be just about collecting all the data we can, because we can. To have any value, it needs to be more selective, and to ask the right questions at the right time.

***

If you’ve read a book you enjoyed lately, please think of leaving a review on Amazon or your favourite reading site. It doesn’t have to be long, just your overall impression and anything you’d like the author and prospective readers to know.

Here’s more detailed guidance, should you feel like it: How to write critical book reviews – and why I think you should, by Debbie Young.

22May2016

Just How Fictional is Fiction?

Posted in London, Writing by carolcooper

There’s a socking great disclaimer at the front of my novels.

“This is a work of fiction. All characters and events in this work, other than those clearly in the public domain, are entirely fictitious. Any resemblance to any persons, living or dead, is purely coincidental.”

The real bits should be obvious. All you have to do is check out Marylebone, or amble down Hampstead High Street.

I’ve made up almost all the rest. Not that readers believe authors’ protestations.

Friends and family are apt to dissect published novels with an eye on ‘real life’. Even Ian Fleming, I’m told, suffered from this problem. People don’t just ask “Am I in it?” They go straight for “Which character am I?” I have half a dozen friends who believe they’re the single mother from One Night at the Jacaranda, and one who still thinks she’s the femme fatale.

“I’m Geoff,” insists my husband Jeremy. He has no discernible similarities with the doctor in my novels, though someone did once call him Geoffrey by mistake at a party.

Of course authors draw on reality when inventing their stories. Jane Davis says her favourite description of fiction is ‘made-up truth’. Her next book My Counterfeit Self was inspired by the plight of UK atomic war veterans. She even mentions many of them by name, but her book is still made up, and all the better for it, in my opinion.

Finnish author Helena Halme also uses the truth as a springboard for fiction. Her romantic series The Englishman is based on her own life story of meeting her Navy husband and moving to the UK. The prequel The Finnish Girl is now out, but, like the others in the series, reality has been fictionalized to provide the right pace and tension for a novel.

Fiction certainly benefits from an injection of fact. That’s what makes it relatable. I lost all faith in a story where the NHS doctor ‘worked shifts’. In those days, hospital doctors often worked a one-in-two rota. Going to work on Friday morning and not leaving till Monday evening was called many things, but a ‘shift’ it was not.

(I can’t help thinking a lot of non-fiction could do with a few facts too. Books on curing cancer with carrots really should move to the fantasy shelves, but that’s another story.)

A novelist invents stuff, but it needs to be right. While I can’t define ‘right’, I had to make that call with the image on the front of my forthcoming novel Hampstead Fever. Cover designer Jessica Bell suggested adding a little red boat to the pond. The flash of red on the water seemed a delightful counterpoint to the red hat and red lipstick. But the pond in question is Hampstead Heath’s Number One Pond. Luckily one my sons, a local councillor, knows all about Hampstead’s ponds. As he explained, only the Model Boating Pond is a model boating pond. Cute as it was, my little boat had to be hauled out of the water.

Being right is more about authenticity than fact. Being authentic, or so the Oxford dictionary puts it, includes

“Made or done in the traditional or original way, or in a way that faithfully resembles an original.”

Ain’t that the truth?

Pills & Pillow-Talk

Carol Cooper – trained to observe, born to write.

Tag Archives: doctor

20TH CENTURY MEDICINE, EGYPTIAN STYLE

Fax for the Memories

The Most Disgusting Diseases in the World (and how to catch them) – part 3

What Nobody Told Me about Having Children

Four Hours in the Eye Surgery Day Unit

What Your Doctor is Really Saying

What the doctor says

What the doctor really means

A Day on a Hospital Trolley

How to Alienate Your Doctor in 10 Easy Steps

Feedback Frenzy

Just How Fictional is Fiction?