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At the Heart of the Universe: a novel by Samuel Shem

Hannah Milton is a GP, mum, and a runner.

 

Samuel Shem is probably most famous for his book, “The House of God”, which I have often heard described as “mandatory reading for all new doctors”. However, it really didn’t ring true to my experiences of being a junior doctor and I found it sexist. It is one of the few books I was unable to finish! So, I began “At the Heart of the Universe” ready to criticise and find fault, but I was quickly drawn into a beautiful story about China, family connection and international adoption.

Shem is a pseudonym for an American psychiatrist who adopted his daughter with his wife. Whilst this book is fictional, I could feel his real-life experience in the sensitivity of his insights. I expect all parents go through a conflict between closeness and attachment to their children and letting them separate to explore the world, but adoptive parents can have a feeling of inadequacy and a fear of birth family that I felt the book fully captured. There were points in the book that resonated so strongly with me as an adoptive parent that I wanted to shout out loud “that is exactly how I feel!” and many page corners were turned down to discuss with my husband.

 I wanted to shout out loud “that is exactly how I feel!” and many page corners were turned down to discuss with my husband.

The story follows Pep and Clio and their daughter Katie on a trip back to China to try and find out more about Katie’s birth mother and her difficult decision to give Katie up for adoption. I was taken on a vivid journey through rural China, exploring the far-reaching consequences of the one child policy. The story swaps between the different narratives of each main character, a story-telling technique that I found particularly thought-provoking. The adoptive mother’s viewpoint showed much conflict: wanting her daughter to have all the truth about herself, but also the fear of losing Katie back to her birth mother (physically and /or emotionally). Clio felt a strong connection and love towards the woman who had given birth to Katie as well as a large dose of defensiveness and jealousy. Experiencing the emotional viewpoints of Katie and her birth mother at different parts in the process was a good way to challenge my own ingrained thoughts about adoption.

Experiencing the emotional viewpoints of Katie and her birth mother at different parts in the process was a good way to challenge my own ingrained thoughts about adoption.

I came to reflect on the cultural differences that inevitably occur in adoption, even when it is not an international adoption as in this story. The child can feel adrift between two different families, wanting to belong in both. I aspire to the bravery as well as vulnerability that the characters displayed.

The story unfolds in a slightly far-fetched way, but it is told so beautifully and thoughtfully that I could see past the implausibility. The observations of human nature and emotional growth are wonderful, and I think they would benefit all readers, whether they are parents or not.

Featured book: At the Heart of the Universe: a novel by Samuel Shem, Seven Stories Press (2016), 320 pages, ISBN: 978-1-60980-641-5, RRP £18.99 (hardback)

Featured photo taken by Andrew Papanikitas, 2023

The BJGP is the world-leading primary care journal. At BJGP Life we add multi-media comment and opinion for the primary care community.

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