Carl Shuker, author of the year’s most acclaimed New Zealand novel A Mistake, on the kinds of failure – personal, and medical – that make up his book.
In 2013 I was working at the British Medical Journal as the UK grappled with the aftermath of a couple of major healthcare scandals. An inquiry was calling for ‘increased transparency’ – this was going to be public reporting of the patient deaths and complications rates of individual surgeons in the NHS. They intended to name them and shame them for what they’d done and people were losing their minds over it.
As part of my daily grind editing articles for publication, I was working on a piece about ‘risk adjustment’. This piece had a visual aid showing a pretty graspable concept – how a brilliant, experienced surgeon working on very sick patients could quite easily have a higher mortality rate than a less experienced (or less technically proficient) surgeon who worked on younger, relatively healthy patients. Reporting that publicly could destroy a brilliant career.
One of my key memories was an extended back-and-forth with the author (the piece was called Publishing individual surgeons’ death rates prompts risk averse behaviour) over the surgical caps the surgeons in the image wore – they had to look properly surgical, not, god forbid, like something a nurse would wear. It was about fairness, and attribution of blame, and it spoke powerfully to me because I felt things had been unfair to me. Life had been.
In 2006 things looked good. I had a New York agent, I’d won a prize, I moved to London. But then came the poisoned chalice of my book The Lazy Boys. The agent it had taken me nine months and endless searching, emails, letters and, back then, actual huge, expensive printed manuscripts to find dropped me in a four-line email. The reviews were horrified or baffled, particularly in the US. I was hard at work on a set of novellas, not immediately cognisant of the fact no publisher really wants to publish novellas, ever, let alone novellas set in the near future, one of which written in machine-translated Japanese, about concrete, and, well, yes, a rape scandal in Japan.
So, indefatigable, and a strong believer in countering setbacks with positive actions, I set about the process of emailing a new cohort of agents with who I was: suddenly, I realised, at 32, a ‘mid-period’ novelist with two novels that made no one any money, and what I had to sell: a ‘difficult’ book about awful stuff set nowhere anyone recognised. Self-belief, early promise, suddenly met cold, hard world. I was over.
And then I ran out of money.
I was starting to make an informal investigation into the emotions and sensations, the practical manifestations – the acting out, the moods, the angers, the subsequent and compounding failures – of failure, and starting to perform an informal version of what in healthcare adverse events is known as a ‘root cause analysis’. I started to learn the little rhythms, the delicious details of failure. Agents reject authors on Fridays. Thank you for the opportunity. However, I’m afraid my list is just too. I don’t think this one is for me. Publishing is a matter of taste. Not a good fit. Someone else is sure to think differently. Though there is much here to recommend, I just didn’t fall in love with it enough to. This isn’t connecting wholeheartedly with me, so I’ll step aside. I’m just completely the wrong choice for you. Thank you for giving us this opportunity.
Reject them on a Friday, I realised, and the agent can go home without confronting some awful wounded writer’s reply. Three in an hour, one Friday afternoon, I collected. It all felt so unfair. Both too young to project or believe in any arc of potential ‘career’, and too deep inside the work to see how a market might not see it was the best and most important thing I’d ever done, I was made almost sick by this sense of being so thoroughly over when I felt I‘d only just begun. What had I done wrong? What was my mistake?
I started carrying around the piece of text describing the breakup of the Shuttle Challenger that now appears in the dead centre of A Mistake: ‘Challenger’s fuselage was suddenly open like a tube with its top off. Still flying at twice the speed of sound, the resulting rush of air that filled the payload bay overpressurised the structure and it broke apart from the inside out, disintegrating in flight. Challenger’s wings cartwheeled away on their own but the aft engine compartment held together, falling in one large piece toward the Atlantic Ocean, its engines on fire.’
I was not aware of the literature around resilience in healthcare workers, though in capital-L Literature there is plenty of it, and it doesn’t mention money and boils down to this – keep writing. Write for the writing, not publication. Write for the love of the craft, etc etc. All right, all true, all incredibly unhelpful.
My entire sense of self depended on working, working well and being told by the universe this was a Good Thing I Was Doing And To Have Hope. So the not being told began to affect the working well, which began to affect the working at all. Keeping writing meant keeping writing about being down about writing. A death spiral, that I then in turn began to study as an inherently interesting thing, part of the mode of failure, an aesthetic in itself.
Looking back I kind of admire the ability to stick it out and stick with it. It’s excruciating rereading the dozens of emails I sent out – so ambitious, so grasping, so increasingly desperate, and long. In my back pocket I had an increasingly worn trump card: I had the feeling I had when I finished certain scenes, certain sequences, to call upon – I had that feeling of Doing Good Work and though increasingly ground down to something resembling a nub that sense of having touched something radioactive in power sustained me for a long time. Something to do with pushing the envelope of oneself, and being able to look in the mirror almost blankly, calmed by the beauty of something surprising I had done. Something to do with competence.
I could point to that feeling and say, you did good work.
Writing parts of A Mistake, especially the opening surgery sequence, I felt that. It was sometimes most glorious fun. When I knew what to do – when I had sufficient research to know what happened when and how to say it, and I simply had to hang on long enough to get it down and get to the end Because I Knew What I Was Going To Say – doing it was simply the most exciting thing I know of to do. I knew what to do and when to do it, I felt competent, and that has to be the measure of success.
But with failure that sacred space becomes undermined as well. You doubt previous achievements, any of them, all of them, at will. You stop, you stall, and you start to make a hobby, a practice and a study of it. You collect little injuries, neck strains, pulled muscles. You lose interest in stuff you liked. You lose will to do stuff you don’t like. You hate people because you hate yourself. Failure is this process of accrual, attrition, the wearing down. The debts become unbearable, the chores undoable, the friends unmeetable. The piles of dishes, the sneer in the mirror.
All of which and more I gave to surgeon Elizabeth Taylor in A Mistake, as, following a mistake in theatre, her (so much more palpable) gifts can no longer offset a universe’s need for unfairness to exist and touch her deeply, and personally.
Inquiries into health care scandals often focus on the particular alignments of culture, attitudes and expectations that give rise to ‘failing services’. Surgical units run as personal fiefdoms. An unwillingness, sometimes rooted in class in the UK, to believe what someone says the data are saying. Arrogance. I was interested in the aftermaths. In the 1990s the major scandal was at Bristol Royal Infirmary’s paediatric cardiac surgical unit. Arterial switch operations on very young babies were taking too long. A whistle-blower – a new anaesthetist named Stephen Bolsin – suspected something was wrong and began to collect and compare numbers.
He took those numbers over the head of the director of the unit, one James Wisheart. And, while Bristol became informally known by neighbouring hospitals as ‘the killing fields’, Wisheart shut him down, shut him out, and told him: ‘If you wish to remain in Bristol you should not disclose the results of paediatric cardiac surgery to people outside the unit ever again.’
What was life like for Wisheart in the days following the publication of the Bristol Inquiry? What, more pertinently, was life like for the younger Janardan Dhasmana, the other surgeon implicated at Bristol who, unlike Wisheart, was the junior, and retrained, practiced, attempted to improve, and unlike Wisheart was struck off without a pension and rendered unemployable. ‘They have ruined me professionally and personally,’ he testified. ‘My family life has gone and I have lost confidence in myself.’
That last phrase, so badly judged and poorly timed, but so palpably important for a surgeon. And for a writer.
I was not ruined. I was not even guilty. I had bad habits but health and fairly substantial will. Anna backed me. Writers backed me. And I went back to work. ‘Just work,’ Elizabeth tells her distressed and vulnerable registrar, whose error has gone on her numbers, about to be publicly reported to the nation. ‘Keep your head down and work. Don’t start looking unlucky.’
I had gotten so interested in these koans survivors deploy to explain their own success, but do not inform or aid those actively teetering on the edge of failure. What does failure look like when there aren’t data, grades or benchmarks to confirm it? How do we know when we’re failing, if we’ve failed, if it’s already occurred months, even years back? Is it simply relative – to other people’s idiosyncratic – even insane – personal standards, personal achievements? What is failure if we haven’t adequately defined success? What is it in literature? ‘Publishing is a matter of taste.’
From the inside I began to suspect, failure is just a new reality: the bathwater gone cold. It is like knowing suicide of someone close to you. Sudden, all-consuming, crippling doubt. It is like, as in The Winter’s Tale, having drunk and found the spider at the bottom of the glass.
Surgery can be measured, though it is intensely difficult and awfully complicated, and as Dennis O’Leary wrote in 1995, ‘The problem with measurement is that it can be a loaded gun—dangerous if misused and at least threatening if pointed in the wrong direction.’
There is no measurement of writing but time and what Nabokov called the ‘telltale tingle between the shoulder blades’. It took until about halfway through the writing of A Mistake before I unreservedly earned that tingle, working on the opening chapter. I’d described an operation undertaken on a young woman with sepsis. Elizabeth’s registrar makes a mistake and injures the patient. Elizabeth responds, fast, authoritatively, and she takes over. With her registrar plugging one hole in the girl’s abdomen with his thumb, she sews up the other wounds, in order of severity of bleed, one after another, systematic, calm, professional, competent. And when I knew the patient’s fate and saw it coming a page ahead of myself and what it meant for the entire narrative and all the fragments I’d shored up to date, I knew all I had to do was hang on for the ride, and turn up, again and again, calm, competent, and climb that hill and the whole valley would lay itself open before me.
A Mistake by Carl Shuker (Victoria University Press, $30)