The Anti-Canon series is a collection of short essays focusing on writers less well known, positioned outside of the literary mainstream or simply deserving more attention. An alternative (but by no means definitive) list of works that have influenced the writers at Influx Press, offering a different perspective to what is, and what is not, considered ‘important’, and hopefully giving you some new books to read into the bargain…
My own experiences in hospital are as follows: hare lip and cleft palate operation, broken leg in traction for seven weeks, bone graft from my hip to my upper jaw, abscess in my knee, concussions, fractured fingers, a broken ankle and false alarm ball cancer. I’m pretty au fait with both Canterbury hospital of the 1990s and Homerton hospital of the 2000s. I’ve been in the back of an ambulance enough times to remember what it smells like. I know how much morphine is enough to knock me out. I’ve got some scars.
Even so, for something fictional I’m writing at the moment, I’ve been researching emergency medical surgery procedures. I may have experience as the patient on the operating table, but I know next to nothing about medicine itself. I’ve read medical textbooks, surgery journals, spoken to friends who are doctors, watched a lot of ER. I’ve also read first person non-fiction such as Jonathon Kaplan’s The Dressing Station, Oliver Sack’s The Man Who Mistook His Wife for a Hat and Other Clinical Tales and Better: A Surgeon's Notes on Performance by Atul Gawande. Everything I’ve read, seen and researched has been useful, enlightening and is now covered with blue ink notes in my handwriting.
Life-long physicians such as Kaplan and Gawande are fascinating people; at top of their profession, successful and lauded - they describe surgery with precision and teach me words I would otherwise never know. But, perhaps because they are surgeons, their writing lacks the heavy weight of emotion. Kaplan talks about abstraction in his book; “For all of us – even the most dedicated and skilled – the dead pile up. Every loss diminishes us, yet with clinical detachment, with fatalism, we continue.” It is this ability to detach - to remove oneself from the patient - that influences these books to such a degree that the writing itself becomes, well… a bit too clinical.
I felt like this placed a limit on my understanding of surgery and emergency procedures. I couldn’t quite jump into the detachment as readily as the authors wanted me to. As a patient myself, I often felt the emotional coldness of the surgeon, the way everything just seemed routine. I know, technically, that it was routine for the surgeon, but it was never routine for me. It was always a big event in my life. Throughout these non-fiction books, I couldn’t take that leap to see the human body as a biological object that needs specific solutions and practices. I kept thinking about the person on the operating table, rather than the procedure happening. I wanted back stories and narratives. Of course, I shouldn’t expect them. I’ve been the body, I know my own back-story, I wouldn’t want the surgeon to know it. And what surgeon wants to know the back-story of their patient? That human connection is exactly what would impede their professional capacity to perform the surgery.
I needed something to force me to detach myself from thinking about the patient. I needed a guide, someone to hold my hand and show me how to only see the body, not the person.
I needed fiction.
Enter Black Flies, by Shannon Burke. The greatest novel about paramedics you’ve never read.
I know very little about Shannon Burke. A quick Google search tells me there is a much more famous radio host in the USA with the same name. Black Flies was given to me by a friend, it is published in the UK by Vintage, yet there is very little information about the book anywhere. The blurb on the book tells me that Burke lives in Knoxville, Tennessee and used to be a paramedic in Harlem. He was a medic, like Kaplan and Gawande before him, but he writes so evocatively that you would never believe it.
Black Flies is a taught, tense and brutal book set on the streets of Harlem in the mid-90s. It is narrated by Ollie Cross a suburban kid who failed his medical exams and decided to get some experience as a paramedic before re-sitting. Ollie joins the crew at, “Station 18 on 136th Street, between Lenox and Fifth Avenue.” His girlfriend, Clara did pass her exams and starts medical school in New York. They have found apartment together.
The book opens with Ollie’s first serious medical intervention; an old Dominican guy lying half dead on a picnic bench under the George Washington Bridge. Rutkovsky, Cross’s grizzled, laconic, hard-ass partner decides to let Cross intubate the old man. Cross has never done this before and pleads for Rutkovsky to do it instead. His partner insists, “You’ve gotta learn sometime.” Cross struggles to do the procedure correctly. Burke expertly racks up the tension within ten lines:
I looked up, I saw a swaggering, thick-necked medic named
LaFountain hurrying across the grassy field. He was smiling
as he lumbered on.
“What is this, amateur night?” he bellowed.
“He’s gotta learn,” Rutkovsky said.
“I can’t see the cords,” I said to Rutkovsky.
“He’s dying,” I said.
Rutkovsky stands over Cross and tells him exactly what to do. Ollie follows his instructions, having found an inner calm listening to the sound of the traffic on the bridge. The tension dissipates and you’re allowed to feel pleased for Ollie. What comes next sets the mood for the rest of the novel:
Afterward, cleaning up in the ER bay, I tried to act like it was a normal thing–saving a life–like it was something I did everyday, like I wasn’t impressed with what we’d done. It was useless. I couldn’t hide it. I felt pretty fucking good. I mean, we’d just saved a guy’s life!
La Fountaine grinned at Rutkovsky.
“You should’ve let the patient code. Teach Cross a lesson.”
“What lesson would that teach me?” I said.
“If you miss your tubes your patients die.”
The rest of the novel tracks Cross’s descent into the murky, moral maze of paramedic work in '90s Harlem. He befriends Rutkovsky, tries to understand why his partner is still working at Station 18 when he feels nothing for any of the patients. Cross adopts a tough-guy persona to fit in with the other medics, he feels shame for his middle-class, privileged upbringing. Eventually, he skips his re-sits and loses Clara. His nights become a flurry of gun shots, crack addicts, domestic violence and flatliners. His days are spent walking the city, wondering where all his patients come out from at night, wondering where his life is headed, worrying about Rutkovsky’s mental health.
Burke manages to make you sympathise and dislike Ollie Cross at the same time. This is a rare feat. I think he manages this because he doesn’t detach Ollie from the emergency procedures he performs. The reader lives through the mistakes, the panic, the elation and finally the desensitisation of Cross. In the non-fiction I highlighted earlier, we are reading the words of doctors who are already desensitised, already detached. The reader isn’t allowed to go through that desensitising process with that narrator. This is the special thing about Black Flies, by the end of the novel, you don’t care whether the bum in the park dies or if the crack-head mum’s baby gets delivered in the hallway. I have never read a novel where I am led to care so little about the lives that are saved in it. Black Flies holds more rumination on emergency medicine then all the memoirs and non-fiction I have read.
Burke’s writing is minimalist and intense. His dialogue zips along at a good pace and he never lets his narrator slip into sentimentality or over the top coldness. It’s a thoroughly believable account of how easy it is to slip into apathy when one is exposed to so much violence and tragedy in the work place.
“What happened to you today?” Clara asked that night on the telephone. She was studying for her finals. We lived a mile away from each other now. But we hadn’t seen each other for two weeks.
“Another exciting day of saving lives,” I said.
I’d started taking on an ironic, callous tone when I talked of my work.
“Oh come on, Ollie. You used to talk about it all the time. About your hero Rutkovsky. Whatever you tell me has got to be more exciting than my A and P textbook.”
“Well, we watched the cops beat on a skel today,” I said. “That’s exciting. They kicked the shit out of him. And then the skel became our patient.”
Clara was silent for a moment. Then she said, “So, what’s your definition of a skel?” That sort of annoyed me. That she’d pick on the word I used.
“A skel is someone who deserves it,” I said, and she said, “Congratualtions, Paramedic Cross. Only three months and you’ve already become one of them.”
The book is difficult to read at first. The destitution of most of Cross’s patients is disturbing, the fate of some of Harlem’s residents is sad and tragic. Cross is sympathetic for at least the first half of the book, and with that sympathy, he draws us in. However, the second half is brutal. We are exposed to guts and gore, violence and mutilation but we are encouraged to view this as the patient’s fault. The paramedics play silly games with the patients, take the piss out of them as they are dying, rib the cops for shooting on sight, let patients die to teach the neighbourhood a lesson. It’s not pleasant, but it does make you see how institutions can fast become places that lack empathy, that lack any sort of humanity when faced with tragedy twenty-four hours a day. Weaved between all this are the personal lives of the paramedics unravelling under the stress of the streets. I shan’t spoil too much, as I urge you to read it, but let's just say – no one ends up happy.
Black Flies is an exhausting read.
But I got what I wanted from it. I wanted to experience the process of detachment. I wanted to hear someone tell me how surgery becomes a game where the patient isn’t viewed as human, but as a puzzle or physical task to be completed. I needed fiction to do that for me. I needed story to guide me, characters to believe in and a narrator who suffers all his flaws but doesn’t dwell on them. Burke leaves the book with Cross saving a girl’s life that hints at start of a redemption, or at least, touches Cross emotionally. I will leave you with the last paragraph of the book, part of a video from a “famous graduation speech” given by the head of Station 18 to medics when they leave the academy. I think it sums up the ideas and morals of this compelling, savage and brooding book:
“Everyone in this class thinks they’re here to do good. Look around. Most of you will inadvertently kill someone in the next year. Some of you will be subtle murderers who neglect patients out of indifference and laziness. All of you will watch people die. It will be a hard thing to see, and it will teach you something about what’s inside yourself. And not everything will be good. Not all of it will be pleasant.
But if you make it through this year, you’ll come out with the skills and the opportunity to make a real difference in a few peoples’ lives. And that’s about as much as you can hope for. That’s the essence of being a real paramedic.”