The binding thread of the book is that humans are mutable things. We begin as two things – an ovum and a speedy spermatozoon – and will grow, mature, perhaps reproduce, age and end up as food for worms. Humans are, as Francis eloquently describes, things that are in perpetual flux (although flux, in Elizabethan terms and in the Gospels, meant illness as much as changeability). Life, it seems, is a pendulum between change and blood.
Francis frames the book with the Roman poet Ovid, whose Metamorphoses is a baroque catalogue of things which change from one form to another. Ovid himself did so – the suave and witty poet of The Art Of Love would eventually be exiled by Emperor Augustus to Bithynia, because of (as he says) “a song and a mistake”, where he would compose (lost) works in the native Getic language. But the Ovidian undertone of this book is always moving. We are all always moving and changing. And that is not a bad thing. Could anything be worse than to be perpetually the same?
The essays are impressively wide-ranging. Across the book, Francis takes in lycanthropy, conception, somnolence, bodybuilding, horns on humans, birth, attempts to arrest aging, tattooing, anorexia, delusions, puberty, pregnancy, gigantism (which brilliantly contrasts human giants with the soaring arrogance of the philosopher Nietzsche), transgenderism, circadian rhythms, bonesetting, the menopause (he doesn’t mention, despite the Ovid references, that it is often referred to as “the change”), castration, laughter, artificial limbs, memory (perhaps the oldest thing we have: our bodies might recycle but our memories do not), the end of life, and a final chapter celebrating the transformations we go through in this sublunary sphere. In each case, the focus is on how the body can be adapted, developed, disfigured, restored and allowed to reach its natural conclusion. The body is never a fixed thing, and part of Francis’s work as a general practitioner is to try to fix the unfitted form.
In one chapter, Francis writes of an academic paper – Tanner and Marshall – as being “a model of dispassionate clinical language” where nevertheless “a note of humanity breaks through”. This might well be his own manifesto for this kind of book.
The humans whom he has treated are accorded the dignity of anonymity. Nothing is untrue but nothing is identifiable. Patients – sufferers in the original Latin – are given “confidentiality” – again, from the Latin meaning “with faith”. It is difficult to write something about the actual without the sly revelation, but Francis has managed it with grace – a word I think he would slightly shirk at, given its religious connotations. He upholds the Hippocratic Oath while making explicit to the world the problems and quandaries he has faced.
Perhaps the most challenging chapter is on the menopause. Francis does consider the idea that there is a male equivalent, an idea I find naïve. But in discussing a topic not discussed that often, he is at least frank, honest and kindly. The idea of a “third age”, and the climacteric that ushers it in, is a good way to start rethinking our attitudes to age, femininity and the roles we adopt.
As with many of the other essays, Francis is open about treatment not necessarily being about prescriptions or surgery or processes. Sometimes just being able to talk is as healthy as a diagnosis. The way the book discusses how a doctor can learn a form of empathy is moving, particularly when Francis admits to his own ambivalences and anxieties.
This is a fascinating account, full of detail that one would otherwise not know, and full of openness in terms of the difficulties, triumphs, disasters and glories of a career in medicine.
The Greeks used the symbol of twinned snakes as the icon of Asclepius, the god of healing. His sign was because a snake could shed its skin – all intervention is transformation – but it also harks back to the Judeo-Christian mythology of snakes: dangerous, wily, untrustworthy. Francis treads the line between the traditions with elegance and kindness.
I doubt there are any readers who will not leave this book knowing more than they did before. But over and above the specifics about the pericardium, the hippocampus, scarification or epiphysis, what comes across, luminously, is a human.
Shapeshifters: On Medicine & Human Change, by Gavin Francis, Profile Books, £16.99