Author Eileen Merriman.
By Paula Morris
Two recent novels report from the hospital frontlines of our healthcare system, and the writers are both deep insiders. Amy McDaid, author of the darkly comic Fake Baby, has been a NICU nurse at Starship Children's Hospital for the past 13 years. Eileen Merriman is not only a prolific author, she's also a consultant haematologist at North Shore Hospital.
The Silence of Snow, Merriman's second novel for adults, is a cautionary tale of medical adventure and misadventure amid "the claustrophobic urgency of the hospital," as Sally Blundell, reviewing the novel for the Academy of New Zealand Literature, writes. The book "traces the story of young Jodi Waterstone, a first-year doctor at Nelson Hospital, the daughter of a respected cardiologist and GP; and Scottish anaesthetic fellow Rory McBride, recently transferred from Wellington Regional Hospital. Waterstone is waiting out the next six months before she can be transferred to Christchurch Hospital and join her IT specialist fiance Fraser. McBride, with his Scottish accent, his love of poetry and admirable abs, is waiting for the results of a medical inquiry."
McBride seeks escape from his guilt with "a little help of the chemical variety", the drugs he can easily access at the hospital. Although Merriman has no personal experiences with addiction, she says The Silence of Snow draws on her experiences early in her career. "I vividly remember the long hours, stress and fatigue of my junior doctor years —working 12-day stretches, up to 70-odd hours some weeks and working night shifts in a peripheral hospital, where I was the only doctor on site. In my second year, I recall hearing about a doctor collapsing in a corridor in another peripheral hospital after taking fentanyl, a potent drug used for pain relief, and I wondered what the story was behind that."
She also knows how easily mistakes can be made. "It's rarely the fault of one individual when such incidences occur," Merriman contends. "There are usually failures at multiple levels." One story strand of McDaid's novel also pivots on a mistake: a prescription mix-up, for which earnest, diligent pharmacist Lucas must take the consequences. On his 40th birthday, Lucas panics, afraid "his mental function was on the decline. What if he made another error? What if he killed someone?"
Both novelists are cautious about the ethical implications of drawing on real patients, colleagues and cases, and focus on fictional re-invention. Merriman has "treated thousands of patients over the years, so it's not so hard to amalgamate details of several cases and add my own fictional twists". McDaid says she "didn't use any real-life cases: all characters are entirely fictional. However, I used my real-life experience to inform the NICU hospital scenes. I worked in a pharmacy while I was studying nursing, so was able to draw on that for Lucas's story."
Mark Broatch, reviewing Fake Baby for the ANZL, notes we "are all capable of self-deception and the line between mental anguish and mental illness is sometimes slim".
All three story strands of Fake Baby involve characters dealing with that porous border and interacting with the health system: Jaanvi has recently lost a baby and Stephen— described by Broatch as "an itinerant with a penchant for mumbling rhymes and free-associative jabber" — finds himself back in "the system" again, where he believes the nurses "all had the same goal: imprison and medicate".
The mental health aspect of the novel "was based more on personal rather than professional experience," says McDaid, who dedicated Fake Baby to her two brothers. "My 16-year-old brother Carl took his life when I was 9 and I have another brother who has bipolar. Into my 20s I was depressed and anxious, off and on anti-depressants. I went from evangelical Christian to a very wild 20-something-year-old. I lived one extreme to another."
In the novel, McDaid explores how people — and our health system — reacts to those in mental distress. "We try to 'fix' someone without understanding what's actually going on for them," she says. A grieving Jaanvi gets platitudes from friends and her mother urges her to get "on with it and have another baby." Stephen, first institutionalised as a young man, is in and out more than ten times, growing more traumatised and feral. Lucas approaches his mother's bipolar mania from a one-sided medical point of view, seeing her "problem" as something medication can address.
In The Silence of Snow, Merriman is also interested in the way the wheels of the health system can sometimes crush the more fragile, both patients and staff. "I hope this book paints a realistic picture, particularly with regard to the many shades of grey present in both addiction, particularly in the medical profession and medical misadventure. The latter is rarely the fault of one individual. Usually there are failures at multiple levels."
The sympathetic scrutiny both writers bring to their workplaces has won them new readers among colleagues. "I'm writing about a world that is familiar to them and in an authentic way," Merriman says. McDaid's NICU colleagues "rushed out and bought Fake Baby," she says, "and brought their copies in for me to sign." Her most welcome feedback, however, is "from people who have had mental health struggles. One person, with whānau experiencing mental distress, said they recommended Fake Baby as a 'tool to build empathy, understanding, and insight'. I couldn't have hoped for more."
Paula Morris (Ngāti Wai) is a fiction writer and essayist, and the founder of the Academy of New Zealand Literature, where reviews of all these books appear: www.anzliterature.com
'We have been going backwards for too long,' the cafe said.