Mind that Child: A Medical Memoir
Simon Rowley with Adam Dudding
Penguin, $35.00, ISBN 9780143771982
We can Make a Life: A Memoir of Family, Earthquake and Courage
Victoria University Press, $35.00,
Dr Simon Rowley is a Senior Consultant Neonatologist at the Auckland City Hospital, and Adam Dudding is an award-winning journalist. Mind that Child is Rowley’s professional memoir, in which he reflects on his experiences and career as a neonatologist and on his interest in neonatal brain development.
Chessie Henry is a freelance copywriter. We can Make a Life, her first book, is a family memoir centred around her father, a rural Kaikoura GP who was awarded the New Zealand Bravery Medal for his role in the collapsed CTV building following the Christchurch earthquake in 2011.
It is clear from the language used in Rowley’s memoir that his book has been designed to be accessible to the non-medically qualified reader. As well as presenting an account of the day-to-day work and problems of neonatal intensive care to a wide general readership, it will be of particular interest to those who have had family members in a neonatal intensive care unit (NICU), or may indeed have been a patient in one themselves. There is also much that will be of interest to other medical and allied professionals wishing to gain an insight into the viewpoint of a neonatologist whose long and eventful career has spanned huge developments in neonatology, particularly in New Zealand.
Rowley has had, as he puts it, a “box seat”, observing these developments in the field of neonatal intensive care, and he reflects that, although about half a century of medical progress has made the NICU a place of miracles, it is always a place of death. He offers an account of some of the more taxing periods of his career, in particular in relation to research conducted in Auckland that revealed that, under certain circumstances, chest physiotherapy was harmful to premature babies. Rowley and his team felt that they had a moral obligation to tell patients’ families and alert the world about the problem, and they did so. Despite their having stopped a harmful practice, a complaint was made against them which resulted in a ministerial enquiry. Rowley describes the strain and stress of working during that period of his career, something that is increasingly pertinent in an era with an increased incidence of litigation and complaints being encouraged against doctors. He was brave enough to disclose openly to families that treatment had been harmful and, even though this had not been by his own hands, he took responsibility. Rowley is to be admired for maintaining that open disclosure, despite the adverse consequences for himself, and it is entirely appropriate – and, one hopes, beneficial to modern medical practice – for him to have given an account of the affair in his book.
Henry’s memoir also depicts the stresses of a medical life – in this case with the story of her father, Chris, and of the emotional fallout of rural medicine, not just on him, but also on his family around him, culminating in his ultimate courage to address his depression, anxiety and post-traumatic stress disorder following his experiences during the 2011 Christchurch earthquake.
Although Chris’s practice as a rural doctor in the South Island, isolated and under-resourced, is a galaxy away from Rowley’s NICU in Auckland, there are many similarities in their experiences, particularly in relation to coping with the deaths of their patients. Henry highlights the immense, and sometimes impossible, challenge of being a rural GP, in describing what it was like for her father and family when, very early in his career, he spent time as a GP in Fenuafala (Tokelau), and his immense sadness at losing an eight-week-old baby, and also when she later interviews him about his role at the CTV building where 115 people lost their lives.
Death is a central theme in Rowley’s book. The French surgeon René Leriche wrote in La Philosophie de la Chirurgie (1951):
Tout chirurgien porte en lui un petit cimetière dans lequel il va de temps en temps faire oraison. Cimetière d’amertume et d’hysope, auquel il demande la raison de certains de ses insuccès [Every surgeon carries within himself a small graveyard into which he goes from time to time to pray. A cemetery of bitterness and regret, of which he seeks the reason for certain of his failures].
Leriche refers to the internal cemetery where a surgeon keeps memories of the lives they have lost. Imagine if this cemetery were full of babies and small children – as it must be for a neonatal intensivist. From the early chapters, Rowley makes the point that life and death decisions are daily occurrences in an NICU:
Today’s ward round is an eventful one, but it’s nothing out of the ordinary. Reading back through my account I can’t help noticing how many times I’ve had to use the words “died” or “death”. I imagine from the outside this evening’s work could appear depressing or overwhelming – but curiously, that’s not the case at all.
Not only is death commonplace for Rowley, he can occasionally see beauty in it: one of the most enticing moments in his memoir is when he describes the slipping away of a severely impaired baby as a “curiously beautiful moment”. The impression that I was left with was that, despite all the emotional pressures upon him, Rowley finds his job on NICU as essentially heroic and glamorous.
The impact of being a rural GP is completely different. Henry opens her memoir with an email written by her father to a colleague and friend in 2017, in which Chris describes himself as burnt-out, overwhelmed with work, suffering anxiety, depression and financial stress, and with family relationships teetering on the brink. He is frightened and unable to go on.
Henry then describes her father in happier times, and we get a sense of him as a young man, an adventurer with a joie de vivre, and we get to know him through his wife and children. The strength and beauty of Henry’s writing is formidable, and it is impossible not to feel involved and invested in her father’s story, as, for example, when she speaks of the time that her parents left England for their new life in New Zealand: “My mother and father waved from the outdoor deck until their parents and brothers disappeared into the ocean, the wake from the ferry streaming out behind them like a final outstretched arm.” And again, when she says of her mother that “She missed her family but she didn’t miss England. She simply shed it, like a skin.”
Throughout Henry’s narrative we are told of her father’s long battle with depression and anxiety, the toll of long hours and stress, living in a state of exhaustion, his passion for doctoring becoming crushed, and of his often being too emotionally drained to connect with his own family.
Reading her interview with her father about the Christchurch earthquake is incredibly moving, and although what he did was truly heroic, Chris didn’t see it that way: he didn’t feel brave. Ultimately, Henry’s story is that of her father’s bravery in facing up to the impact of his experiences and having the immense courage to get help. However, it is so very much more than that. It is the story of a New Zealand family affected by both the Christchurch and the Kaikoura earthquakes and, in doing so, it acknowledges everyone touched by those events.
There are other similarities between Rowley’s and Henry’s memoirs. Both include themes of medical ethics at various points, albeit from different, but both very practical, perspectives – particularly with regard to neonatal screening and life-and-death decision- making by doctors. Rowley leaves us in no doubt about his love for NICU and his view of the world of child health: if you have a small baby give it love, food and warmth; you don’t need to be a super parent, but cuddles are still important. His description of mature trees that he guerrilla-planted many years ago in an Auckland park is an apt metaphor for the benefits of his work often not being seen until many years later. He has undoubtedly made a profound contribution to the people of New Zealand, and his memoir is a fitting reflection of that. Henry’s book is an altogether different project: a deeply compelling and life-changing story.
Both books reminded me, though in different ways, of Do No Harm and Admissions by the renowned British neurosurgeon Henry Marsh, and it is difficult to imagine that Rowley’s memoir has not been to some extent inspired by Marsh’s books. Marsh was once referred to as the “Knausgaard of neurosurgery”, and Evan Hughes of The New Republic described reading the Karl Ove Knausgaard novels as like opening someone else’s diary and finding your own secrets. That is how I felt when reading We can Make a Life – almost a form of family therapy in which we are all invited to join. Henry says she had doubts when she was writing – but it has come out the way it was meant to. It is her first book, and I have no doubt that her future writings will be eagerly awaited.
Reuben Johnson is a neurosurgeon based in Wellington, who also reads novels.