posted on 05 Aug 2017

Direct Red by Gabriel Weston

When I wrote here about the new school of surgeon-writers I did mention Gabriel Weston’s Direct Red, but only in passing. I also failed to mention that it is one of the few books of this type by a woman.

Weston is still only in her late-40s. She became a member of the Fellowship of Royal Colleges of Surgeons when she was just thirty-three. The book is about training to be a consulting surgeon – and, ultimately, deciding to abandon this ambition, and her reasons why.

But to assume that her book therefore offers an especially (or solely) feminine – or even feminist – perspective grossly oversimplifies things. Indeed, in her early days Weston was as attracted as any alpha male by the power, glamour, prestige and esteem that accompany the punishingly high-pressure job of consulting surgeon and in fact seemed to see surgery – its slashing decisiveness, its suppression of self-doubt, its focus and formality and repeatable procedures of success – as almost a state of grace. One of the greatest pleasures of the book is Weston’s refusal to conform to predictable stereotype.

Weston is unflinchingly frank in describing instances where peer pressure, exhaustion, poor judgement or the other intolerable burdens of life in the modern NHS led her to lose sight of compassion. She recounts one particular example from her early training and it is of course significant that it involves caring for children.

She is nearing the end of a month’s training in paediatric emergency care at a large London hospital. Ben, a ten year-old boy, has been admitted because of persistent severe headaches. He is alone in the hospital, his mother having gone home to rest. Exhausted, Weston is called out in the early hours of the morning by a duty nurse who says that Ben can’t sleep and is complaining again of the pain in his head. The problem, Weston concludes, is that the morphine dose he has been prescribed is too small and not frequent enough. She has a short conversation with the boy, amends the drug dosage on his chart and goes back to bed, secure in the knowledge that the duty staff will now be able to administer sufficient morphine to control the pain until further scans and examinations can be carried out.

A week or so later back at her own hospital Weston learns that Ben died within a day or two of her seeing him, killed by a rare brain tumour before a scan had even been done. With lacerating self-honesty she says, “…when a sick child cries in the night, medicine is the last thing on their mind… [W]hat Ben needed was whatever small amount of my heart’s warmth I could afford. Without a parent nearby, and in the appalling solipsism of his pain, Ben sought the nearness of another person, a need to which he was too young to give a voice. And he was unable to find this comfort in me.” She concludes: “I still feel ashamed of how I behaved that night.”

In instances like this Weston explores the central paradoxes of surgical care: that compassion and proper communication are paramount, but so too is the ability to quell emotional doubt and act decisively – for without this, the surgeon cannot even begin to function. But this “toughness” that is so central to the surgeon’s professional persona must also on occasion be subdued – for if it isn’t, the very qualities that most make surgeons able to do their job become those most likely to make them fail their patients.

I had forgotten just how bloody (in all senses) marvellous this book is. It is a sometimes gruelling examination of what happens when working under immense pressure and compassion falters. At times it is an emotionally draining read. And certainly, some readers will want to skip some passages (there is one particular section that I had forgotten about that quite literally made me squirm and look away as I read it on the bus home one night). You will already know whether this is a book for you or not, but rest assured that Gabriel Weston’s scalpel sharp prose, unflinching moral gaze and steely self-honesty are truly important additions to the best that these new surgeon-writers have to offer.

 

Alun Severn

August 2017