Posted by: Lisa Hill | April 28, 2019

A Mistake, by Carl Shuker

Carl Shuker’s fifth novel A Mistake, is a confronting novel, one that makes the reader think deeply about human fallibility and the impulse to blame.

Based in Wellington after an international career in Tokyo and London, Shuker is one of the authors I’m going to hear at the Auckland Writers Festival. His writing appeals to me for the same reason that I like the novels of fellow Kiwi Lloyd Jones: he reinvents himself as an author with each title and each novel is completely different to the last one.  According to Shuker’s profile at the Academy of New Zealand Literature, The Method Actors (Shoemaker & Hoard, 2005), is an historical/thriller/love story set in Tokyo at the turn of the century.  The Lazy Boys (Counterpoint, 2006) is about toxic masculinity in a NZ setting.  Three Novellas for a Novel (Mansfield Road Press, 2011), is a trio of horror stories set in Tokyo, London and Cannes, and Anti Lebanon (Counterpoint, 2013), is apparently a political thriller and vampire story (really?!) set in Beirut and Syria.  I decided to order A Mistake on the strength of reviews at Booksellers NZ and Alys on the Blog, and the book has turned out to be very interesting indeed.

At first glance, that cover image looks a bit like a lush tropical flower.  But it’s not, it’s the innards of the human body and those protrusions are tweezers and a scalpel.  A Mistake is about an emergency operation that goes horribly wrong and the patient dies, and the chronology of that narrative is punctuated by a parallel narrative about the Space Shuttle Challenger disaster in 1986, a preventable tragedy of seven deaths—caused by an apparently minor mistake rendered catastrophic by NASA’s organisational culture and decision-making procedures.  The high profile surgeon responsible for the deceased 24-year-old patient is the improbably named Elizabeth Taylor, and the issue of medical accountability is brought into sharp focus by a new system for making surgeon’s outcomes publicly available online.  For Elizabeth, the problems with this transparency system morph from being an abstract issue that she contests in the pages of a medical journal, to being a real life issue that impacts on her career and the careers of others in her team.

Lately, I’ve been refusing to engage with those persistent emails demanding that I rate the services and products that I buy.  If I’m happy, I ignore them so that the seller can assume, as they always used to, that I would complain if there’s a problem.  If I’m not happy, I hunt out the bricks-and-mortar address of the corporate HQ and send the head honcho a letter that explains that the questions I’m supposed to rate between 1 and 5 stars don’t allow for any nuance, and then I tell them what the problem is.  (Classic example: how should I rate a product I really like when it comes packaged with excessive single-use-plastic that goes straight to landfill?  Seriously, is there anyone in the universe who hangs up their undies on a plastic hanger in the wardrobe?)  I know from Twitter that I am not alone in rejecting this ratings nonsense, and Tom Slee articulated my misgivings in his book What’s Yours is Mine, Against the Sharing Economy. (See my review, about 2/3 down the page.) Slee says reputation systems are also the wrong tool to deal with extreme failures of trust.  Carl Shuker’s novel shows us, (as did the case of Dr Bawa-Garba in the UK, as reported on ABC RN’s The Health Report) that mistakes are rarely attributable to one person, and that the anger of the bereaved can these days use social media to generate outrage that is ultimately counter-productive in terms of improving patient outcomes.  (See this Health report article that explores the pros and cons of tracking surgeons’ performance.)

The novel tackles other issues too.  Elizabeth Taylor is a strong, decisive surgeon who behaves in much the same way as any medical specialist, but she is judged harshly for her demeanour because she is a woman.  Her manager even has the gall to raise her sexuality as a problem.  Her intense dedication to her work leaves her all but friendless, and in extremis, her subconscious is at war with her confidence that no one in the surgical team was responsible for the death.  (This reminded me of other fine novels about the pressure on doctors to be perfect: see my reviews of Dustfall by Michelle Johnston and Dissection by Jacinta Halloran).  There is a junior doctor too, who becomes a victim of this situation, and (inevitably) there is also hospital management which wants to massage its reputation.  (It would be easy to judge that as well, but where does it leave us if we don’t have confidence in the public hospital system?  Especially if there’s an unstoppable drift to private practice not subject to the same constraints.)

A Mistake is a short work of fiction, under 200 pages, and I read it overnight, unable to put it down.  The first chapter is difficult: it describes the medical procedure in detail, using a lot of surgical vocabulary that I didn’t understand (and wasn’t going to get out of a warm bed to Google).  At first I didn’t see the point of writing such dense, impenetrable descriptions.  Until it dawned on me that it’s this very complexity that makes a ‘transparent’ rating system so absurd.  The difficulty for the reader in understanding what’s going on in the operation, reinforces the idea that it’s ridiculous that consumers might trust algorithms making judgements about such complex procedures on unpredictable human bodies.

An added bonus is the confident New Zealand setting.  I like books that avoid anodyne settings that could be anywhere in the world, and I’m looking forward to seeing Wellington for myself!

Author: Carl Shuker
Title: A Mistake
Publisher: Victoria University Press, 2019, 184 pages
ISBN: 9781776562145
Source: personal library, purchased from Fishpond $32.09

Available from Fishpond: A Mistake.  (Due to high demand, it’s sold out again, but the publisher’s website says there are more being printed.)


Responses

  1. This sounds like a terrific read, Lisa. I’ve checked on Amazon and it looks like it’s going to be published in the UK in September.

    It does sound a little like Gabriel Weston’s novel Dirty Work about a surgeon who makes an error while performing an abortion. It’s a dark book but it does highlight that these kinds of mistakes are not black and white, but in the victim and blame culture in which we live someone has to take the blame.

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    • Also, in August last year Dr Bawa-Garba won her appeal against bring struck off. There was quite a high profile media campaign here by other doctors and medical professionals who claimed it was unfair to punish her when it was partly the result of failings in the system, including ongoing staff shortages that put pressure on doctors working long hours and covering more patients than was deemed safe. They have always argued it’s a waste to train a doctor for 8+ years then hang them out to dry when they slip up in situations beyond their control. Learn from mistakes, fix the system failings, give junior doctors more support & retrain if necessary.

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      • Quite so. I hadn’t thought about the economics of it, but yes, it’s daft to waste all those years of training.
        How have we become so judgemental these days? It’s horrible.

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    • I think the success of the book has been a bit of a surprise to all! This is the first time he’s been published by VUP and I think they underestimated the print run. They were out of print when I ordered mine from Fishpond, and their website says they’re out of print again!

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  2. This sounds really interesting Lisa – the pressure of being a surgeon must be astonishing.

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    • I think the pressure on most professionals is great. Even in teaching, we were expected to be perfect… and though it’s not life and death as it is for surgeons, it’s certainly true that what we remember from our school days is never the acts of kindness, but rather the times when the teacher lost her temper and said something hurtful.

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  3. […] guess is that Carl Shuker (whose book I reviewed here) will come in for some hostile questioning at the Auckland Writers Festival later this […]

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  4. […] take off overseas?  I hope no one detected a note of panic in my hasty reviews of The New Animals; A Mistake and The Resurrection of Winne Mandela but I have managed to dash through them in under a week, […]

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  5. […] Shuker is the author of A Mistake, which I read and reviewed just before coming over here for the festival.  But he has also written a number of other books, […]

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