A bout of depression, the Challenger space shuttle disaster, editing at the BMJ and stern words for critics are all in the mix as Carl Shuker releases a new novel.
A Mistake is the prosaic, triggering title of Shuker’s short, scalpel-sharp tale of misadventure, medical and moral, set in a version of Wellington Hospital. The body reading it may soon find itself pumping and flexing uneasily in unison. When a narrative is punctuated by short sections tracking the remorseless unfurling of the 1986 space shuttle Challenger disaster – “T+2 min 08 sec. Nesbitt: ‘We have no downlink’” – it’s clear things aren’t going to go well.
“I’m halfway through and trying not to have an anxiety attack,” I email Shuker before we chat. “That’s a fantastic reaction,” he replies. “‘I want heart attacks, I want ambulances’, as Alexander McQueen used to say …” Later, he’ll say happily, of the work of Canadian writer Michael Ondaatje, “You’re sort of stabbed in the side and then murmured gently to for the rest of the paragraph and you don’t realise you’re bleeding out till the end.”
Fair enough. Fashion designers and novelists need not heed the dictum “first do no harm”, unlike the medical staff at the hospital where Elizabeth Taylor is a star. At 42, she’s the youngest and sole female consultant general surgeon in a patriarchal institution. She stalks the hospital corridors like a boss, operates to thrash metal and calls nurses with inconveniently foreign names “Betty” or, on a bad day, “You silly c---”.
The book’s forensically observed interactions take on a certain ritualised quality; ER meets Kabuki theatre. “The girl looked at her accusingly … Elizabeth smiled wider for her.” In Shuker’s world, the wider the smile, the less there will be to smile about. Elizabeth has been up for 27 hours. Living on coffee, she’s constipated. “It was useful for operating.” On her watch, an operation on a critically ill young woman is about to go wrong.
This time, Shuker dives right into the pared-down action. “I’m notorious for dicking readers around, taking too long to get to the thing,” he says, of his reputation for postmodern bells and whistles. “I got sick of myself.”
Consequences unreel. It’s not giving too much away to say that the story touches on suicide and at least one animal is harmed in its making.
“Healthcare is like fiction,” says Shuker, on the phone from his home in Wellington. “You have this very high-level fascination with craft. And then you simply have a person in front of you, in their person-ness and their vulnerability. It’s going on at the same time as the highest level of biostatistics.”
He knows a bit about both. He has worked as an editor for the British Medical Journal in London. He is principal publications adviser to the Health Quality & Safety Commission. In A Mistake, Elizabeth is co-authoring a paper for the Royal London Journal of Medicine on the fraught subject of the public reporting of surgical outcomes. As a speaker says at a conference Elizabeth attends, “You’re going to start measuring and putting your surgical outcomes out there into the public sphere and you cannot expect it not to be. It’s gonna be a shitstorm.”
Elizabeth is not for it. She has a point, says Shuker. “We may all want to nail that person to the wall. That’s satisfying some kind of blood lust, a desire for simplicity in us that the real world possibly doesn’t offer us. This is the whole controversy around public reporting of surgical outcomes.”
Such reporting happens overseas. “In my job, I’m actually working on how we should do it in this country. This story is kind of a cautionary tale in what might be the unintended consequences of going down a particular road.” It’s complicated. Data is not always as it seems. “In 2011, I edited something in the BMJ on surgical reporting – essentially, very experienced surgeons working on sicker people and having worse outcomes because of it.” Yet, he adds: “As someone wise once said, the medical profession’s had 200 years or thereabouts of self-regulation and of a closed shop, essentially. [There are] not many other public services like that.”
The idea of catastrophic human error, your error, is the stuff of nightmares. “Especially if you have children,” says Shuker. Reads a passage in A Mistake: “Babies die in hot cars, left behind by tired parents in workplace car parks.”
The book deploys as a counterpoint to the narrative an extreme example. “We’d got used to shuttle launches every few years. It was kind of like a new Prince album coming out. It was something the whole family could share and it was a great celebratory sort of thing. And then it just went so dark, so fast.” In 1986, Challenger broke apart 73 seconds into its 10th flight, killing five astronauts, one payload specialist and a civilian teacher. The cause was traced to two O-rings, circular gaskets that sealed the right rocket booster.
“That sense of having overlooked something; that fear of forgetting something. It seems to be kind of an obsession of mine, I’ve realised, for all the books.”
Later, I email to ask where that comes from. The reply is thoughtful, harrowing, about growing up in Timaru. “I went into a huge and lingering depression from about the sixth form that I emerged from in my early twenties like wandering out of a storm – that is, the exit was slow and interrupted and characterised by still-high winds and flurries and squalls. But I began to breathe again.” He was at university. “I never went to lectures, and collected fail grades and debts and bad drama. I was previously pretty high-performing, so it all felt like a mistake, like I’d made a mistake.”
He managed to think his way clear, “seeing the terms of my depression as a function not of me personally, but of the world I was trying to live in, the wave I was asked to surf”.
The theme of suicide in the book tracks back to that period. “There was a suicide of someone very close to me at that time. But in the atmosphere before that there were suicides all around us – mostly young men … This was the early 90s, another spike in suicides in New Zealand youth. So, in high school there were all the rumours and magic and dreaming around deaths of our peers by suicide. It was in us like a new drug.”
He would encounter this terrain again in healthcare. “The burnout and suicide in younger doctors is frightening. One of the original titles was going to be The Second Victim.” That’s when healthcare providers involved in an “adverse patient event” become traumatised.
Such themes make for taut, page-turning reading but Elizabeth didn’t get where she is without a mordant sense of humour. “What do you think of the new staff photo on the website?” wonders a unit manager. “Looks like a line-up from Nuremberg in their prison fatigues,” says Elizabeth. “About to be taken out and shot.”
To say she’s a perfectionist is sorry understatement. There’s a terrific, farcical scene in which she wreaks havoc in her home trying to fix a tiny flaw in a wall. “I couldn’t possibly comment on how personal that might have been,” says Shuker. He does volunteer something of his own driven process while writing A Mistake: “I’m looking at the folder where I’ve got all the drafts and, before I sent it to the agent, I was up to version 298.”
He was working on his first published novel, The Method Actors, inspired by time spent living in Japan. “This idea that it’s some kind of conveyor belt for writers is simply not the case. You get access to nine or 10 individually brilliant people who collectively, if you’re lucky, if you get that good class, pull you up on every step. I could only hide for so long.” So it was a sort of breaking-down process? He considers. “Did Bill Manhire break me down?” It sounds like the title of a new collection of ironic New Zealand poetry. “No, it was a getting bigger,” he decides. Every word you write scrutinised. “Page by page. In a non-smoking environment.”
That’s where he met his wife, Anna Smaill, whose first novel, The Chimes, was Booker Prize long-listed. A good class, then. “Brash and fearless,” said the New York Times, of The Method Actors. It won the 2006 Prize in Modern Letters. There have been three well-received novels since, including Anti Lebanon, a political thriller with vampires.
And yet The Method Actors initially joined the roll call – think television’s Flight of the Conchords – of brilliant work not wanted here. Shuker couldn’t find a publisher. “I always had this goal that it was going to be a big, international novel and it should be published in the States. It was a lofty goal and I finished it and you’re desperate for someone to say to you, ‘Okay, you’ve pulled it off’, or you haven’t, so I submitted it locally.” Cue rejection slips. “I went to bed for a couple of hours, had my migraine, then decided to return to the original goals and shoot higher.”
It took six months to find an overseas agent, another nine to find a publisher. Then he won what was one of the richest prizes in the world for an up-and-coming young writer. That must have been gratifying. “I felt so golden at the end of that. I wonder if I’ll ever feel that again? You know, when you feel like you’ve really pushed the envelopes of yourself. I coasted a long time on the feeling.”
The critical reception received by I’m Working on a Building, and Adam’s audacious 2017 novel, The New Animals, saw Shuker give some local reviewers a telling-off. “Condescension”, “stupefying banality”, “point comprehensively missed”, he railed. The New Animals won the top gong, the Acorn Foundation Fiction Prize, at last year’s Ockham Book Awards.
A Mistake’s Elizabeth, putting in the extra hard yards often required of a woman who shines in largely male terrain, is not entirely unlike Catherine in Adam’s I’m Working on a Building.
In fact, Elizabeth was inspired by someone Shuker encountered in healthcare. “A person without a filter who has survived, not to say thrived, in her field. There was a deep connection and obsession with helping patients, but when it came to colleagues, it was a complete inability to suffer any kind of fools or politics.” Did he like her? “I loved her.”
Elizabeth, it must be said, can be entitled, privileged, less than lovable. “She literally says ‘I’m God’ at one point.” Exactly. “She’s a person who acts and she’s come to the end of that potentiality for herself. I think that’s an issue for surgeons generally. They’re taught to make individualistic decisions, they’re drilled in it for 10 years, then suddenly something else happens you can’t control. What then?”
What happens, for the reader, is that facile judgments, the desire to blame, are undercut. It’s a useful corrective in the age of the online pile-on, the pitiless hot take. “It’s not like there’s a death and then you can go home and process it for a month or two weeks or even a day. You leave that patient and go on to the next one. And you don’t take a sick day. You turn up and you turn up and you turn up. From the outside, it can be hard to acknowledge that this is something that they have to live with all the time.” The book offers the opportunity to consider the forces at work, the system in which Elizabeth works, the wave she is asked to surf.
As to what’s next for Shuker after this electrifying exercise in brutal minimalism, there’s a book in the drawer that he’s tinkering with. There’s the day job and family. “Lotte, my daughter, is seven and my new son is Alexander, 10 months.” Busy times in a two-writer household? “I don’t know how much writing is going on at present.”
A Mistake’s March 6 local launch will be followed by a September US release. So Shuker, scourge of reviewers, is about to offer himself up to the critics. How is he facing up to that? “With a clear brow and a full heart,” he says gamely. You can’t imagine he has much to worry about.
A Mistake, by Carl Shuker (Victoria University Press, $30).
This article was first published in the March 9, 2019 issue of the New Zealand Listener.