Rebecca Quinn is a GP in Battersea, South London.
Elizabeth is Missing by Emma Healey is a fictional account of Maud, who is investigating the disappearance of her friend Elizabeth on the background of progressing dementia.
This book is an old gem and an engaging read. It captures from the patient and carer perspective the milestones of dementia that we GPs increasingly see as our ‘bread and butter’. It faithfully and amusingly records scenes with which we are familiar; the home visit, the appointment, the performance of the mental state examination.
But these events are placed off centre on the wider stage of Maud’s life; we also see her defiant visits to the corner shop to buy yet another tin of peaches because she forgets to look at her shopping list; we fret over her wonder at the bruises that appear on her daughter during the daily visits to check on her; we feel Maud’s shame at being told to stop volunteering at the charity shop; and we chuckle at the fact she deliberately ignores the notes dotted around her house as memory aids.
“The brutal interactions between Maud and a time-poor GP are a clarion call; these patients need time”
Emma Healey skilfully presents the stubborn essence of Maud as a permanent entity, even as her present reality recedes. As it retreats in ever diminishing waves, we see that it uncovers an unresolved past, which tantalisingly involves another missing person. The hunt is on, and we follow Maud in two parallel investigative journeys, with one laying the foundations for the other.
From our clinician’s perspective, Healey’s extraordinary technique of alternating between past and present events with increasing rapidity hammers home empathy with our patients. It creates an unnerving sense of disconnection with reality coupled with a deep sense of helplessness. The plot and its final conclusion crescendo and diminish while Maud observes, separated from the drama by her illness, and yet being central to its cause.
As befitting its subject, there is a deep poignance to this book. We reach the end of the journey unsettled. The brutal interactions between Maud and a time-poor GP are a clarion call; these patients need time, and we are obliged to take it. The need for professional curiosity will require us to take even more time with relatives, and to brave a little exposure to the storms that they are weathering.
This book is topical also in that it speaks a little into the current debate regarding assisted dying, and underlines the importance of protecting those who are unable to process or articulate their needs. It raises timely questions regarding the concept on a ‘use by’ date to a life. It stirs in us the realisation that despite not having ‘capacity’ to make decisions about medical or financial affairs, a patient may nonetheless be immersed in a separate reality in which they live, love, think, and forgive.
In a fast-paced world, where family carers are beleaguered and few, the essence of a person is so easily overlooked. Society tends towards valuing that which is visible and current. We need to remember that even if they are unable to convey it, people consult us with the richness of a past unseen, and that we have a role to do more than just respect that richness, but to champion it.
Featured book: Emma Healey, Elizabeth is Missing, Penguin, 2015, PB, 304pp, £7.85, 978-0241968185.
Featured photo by Patrick Tomasso on Unsplash.
