I wrote in a previous review that my previously unchanged top five books had been shaken up in 2020 for the first time in years. Joanna Cannon’s memoir Breaking and Mending has done just that. In little over 150 pages, this book made me laugh, cry, and shut the pages to sit for a while and think. It made me both despair and revel in my decision to study medicine.
Published in 2019, Breaking and Mending is Cannon’s first non-fiction book and is one of the best I’ve read for a while. In it, Cannon writes of her decision to take three science A-levels and apply to study medicine in her thirties, after completing a first-aid course she noticed advertised in a newsagent’s window. As a medical student myself, I have countless copies of junior doctors’ autobiographies and non-fiction medical books. However, after studying all day, I usually prefer to dive into fiction afterwards rather than hear about the trials and tribulations of the career that awaits me. I often find that it is not a wise genre for me to read. As someone who has had more “should I drop out of med-school?” wobbles in three years than I care to admit, it seems foolish for me to choose to read about the ways in which it can break a person. Yet, despite its title, Breaking and Mending felt different. This is a book about a medic who loves to read and write. One who felt as though she was breaking under the stresses of medicine but found her feet and her love of it in psychiatry – a speciality she always wanted to pursue. After describing this to a friend, she replied, “This sounds like it was written for you!”. And yes, honestly, I loved it. Unlike other books in this genre, Cannon really focuses in on the idea of belonging, and that of ‘wild cards’. She writes of how ‘Psychiatry became [her] landscape’ where she was ‘the most comfortable [she] had ever been in [her] life’. I found this a real comfort as I start studying in the hospital this year; something I am equal parts excited and terrified about. This book taught me so much about kindness, empathy, and how our stories are what unites us as people — all things I will take with me onto the wards and into conversations with patients. Some of the chapters reminded me of works by Rachel Clarke, author of Dear Life, which focuses on her experience as a palliative care doctor. Both women care deeply about their patients, which really shines through in their writing.
Throughout Breaking and Mending, Cannon discusses what it was like to be an older student in medical school, as well as her journey into her foundation medical years and beyond. Following concerns about her age, her outburst to a medical school admissions officer was on the surface quite amusing. However, underneath the humour, there was a sadness to it. She said, ‘I completely understand if you reject me. Reject me because you don’t think I’m smart enough. Reject me because you don’t think I’ll make a very good doctor. Reject me for the hundred and one reasons you reject people but please – please – don’t reject me just because of my date of birth, because that wouldn’t be a very good reason at all, would it?’. Since the vast majority of my cohort began medical school aged 18 or 19, I realised that the age demographic of medical students is not something I’d thought much about before. It was therefore really eye-opening to read from someone with a different perspective. Cannon discusses how ‘there is a certain comedy value in being the junior doctor on a team where everyone else is a very great deal younger than you are’. The General Medical Council’s 2017/2018 Medical Schools Report stated that the first-year intake of standard entry medical students across the UK was 7,321 whilst the number of graduates was just 715. The standard entry students were not broken down into varying age ranges and I could not find any information on the average age of medical students in the UK. This surprised me and I feel it may be off-putting to those who are contemplating beginning their route into medicine at a later date. Although it seems inevitable that many future doctors start med-school immediately after sixth form following much discussion of careers and next-steps, this is not the only route. If anything, Cannon’s later start made her stand out as a doctor. She was taking richer life experience into a degree (and eventually a career) all about people and their experiences.
Towards the end of the book, Cannon writes that on her first day of medical school she was told that ‘there are two kinds of doctor: white coats and cardigans. Those who love the science and those who love the people’. She understandably disputes this, stating that there are as many kinds of doctors as there are people – a sentiment that I wholeheartedly agree with. However, much of the book focuses on her experience as a ‘cardigan’; a people-loving doctor, something that others weren’t always appreciative of. Her approach to medicine made a truly positive difference in many of her patients’ lives but was also partly responsible for her burnout when the weight of the world she was working within became too much. The descriptions of these events were honest, moving, and emotional and will stay with me a long time after reading them. Cannon writes, ‘Perhaps it might have been possible to face the misery and unfairness inside it [the hospital] each day with the right support… I wondered how someone could walk through a landscape and be at the very lowest point of their life and yet no one who passed them by even noticed’. Her evocative language here invites reflection, particularly in the current pandemic, on how we look after the people who look after us. According to a recent study by the British Medical Association, almost half of the doctors surveyed were currently experiencing ‘stress, burnout, emotional distress, or other mental health condition[s]’. Cannon writes first-hand of her experiences with this throughout Breaking and Mending. From my experiences so far within the clinical medical school, the support can be excellent. However, having read the work of Cannon, and many other medical authors, it seems that this is not always the case in the workplace. Changes must be made to protect doctors and other healthcare workers who do so much with so little.
Alongside these poignant stories, there were also many tales of hope scattered throughout the book, a dose of which I feel very much in need of this winter. Towards the end of the chapter in which she describes her burnout, Cannon decided to ‘give it a week. If, after a week, [she] felt the misery creeping back, [she] would unfasten [herself] from medicine forever. No matter the shame and the humiliation, and no matter the inevitable chorus of ‘I told you so’’. She writes of heading to the speciality she had always wanted to pursue (psychiatry) and working with so many amazing people; getting a chance to really hear their stories and listen. Although this was heart-warming to read, her words do raise larger questions about the culture of medicine; the idea that doctors should ‘stick it out’ and keep a stiff upper lip. There are not many other professions I can think of where there is as much ‘shame and humiliation’ associated with leaving a job that causes this degree of emotional distress. Other ex-doctors such as Adam Kay, author of This is Going to Hurt, have written of similar experiences. Perhaps it is time to revaluate our collective attitudes towards doctors and realise they too are only human.
I am in awe of Joanna Cannon and can’t wait to read more of her work, although I wonder if any of her fiction can match the brilliance and the beauty of this. For me, it is Cannon’s complete honesty and authenticity which make this an astounding read and I’m eager to see whether these hallmarks also come across in her fiction. I think Breaking and Mending is the perfect book to read as a medical student, a doctor, or anyone who wants to have their heart warmed by tales of genuine compassion and kindness. In particular, to any other medics who are just getting ready to tackle the world of wards and real-life patients, I cannot recommend it enough. Though it slightly terrified me, it also made me very excited and taught me a few wise lessons that I don’t think will be found on the page of a textbook or a slide of a lecture. I know I will come back to Breaking and Mending time and time again to remind myself of what’s important, not just in medicine, but in life.
Image Credit: Pixabay