BGS #geribookclub discusses 'Three Things About Elsie'

Charlotte Squires is the BGS Digital Media Editor, and a specialist registrar in Geriatric Medicine at the Borders General Hospital in Scotland. She tweets @charsquires, and hosts #geribookclub

We were delighted to host our first BGS Book Club on Twitter on September 15th, using the #geribookclub hashtag. Our aim was to provide a platform for people to come together and examine how themes relating to older adults and their healthcare, appear in literature. Our chosen first novel by Joanna Cannon, who worked as an NHS doctor before turning her hand to writing, centres on Flo, an older lady living in sheltered accommodation who we first meet when she is lying on the floor of her flat after a fall, and who is waiting for someone to find her. What follows is a story that moves around in time as Flo struggles to work out whether a mysterious issue from her past might be catching up with her. With help from some of the other residents and staff members at Cherry Tree House, and her great friend, Elsie, we are taken along on a story that spans a lifetime and raises questions about friendships, ageing, and how the past continues to impact the present. You can also see the discussion from our first meeting on Twitter by looking up #geribookclub.

The topics we discussed were as follows:

How does cognitive impairment drive the story line?

"Even though my feet had walked tens of thousands of miles, pulling me through the last eighty-odd years of my life. Even though they had become slower and more measured, and they had faltered as time passed by, my feet hadn’t forgotten who I used to be. Even if my mind sometimes did…

"'I didn’t buy all those (Battenberg)’ I said. ‘I only bought one. Who put them all in there? Was it you?’ She didn’t say anything. She carried on staring. There were twenty-three. She counted them. I wanted her to take them away.”

Participants felt that the moving between past and present gave a good insight into how people might experience cognitive decline, and difficulty in sequencing events. It was felt that this kept the reader guessing, and wondering how the plot would end. Occasionally this was difficult to follow for some readers, and we wondered whether this was a deliberate narrative device to make the reader understand how Flo might have felt as she tries to piece together the world around her. Details in the story such as when Flo is found to have stockpiled her favourite cake were felt to serve as a reminder about the day-to-day aspects of living with cognitive impairment and how bewildering this must be.

How does the book portray healthcare workers, and did this lead to any reflection on practice?

“They will find me a ward, and nurse with quiet hands. She will move very slowly but everything will be done in a moment…..and I won’t worry, even when the lights are switched off”

Healthcare workers were felt to be shown in a fair light – often overstretched, and poor on time, but usually well-meaning. This was also the case for the staff at Cherry Tree House, who try to balance the competing needs of residents, and their safety. Interestingly, Flo often simply hopes that when she finally gets to hospital, the people looking after her will be kind and gentle. This reminded us that particularly for confused patients, our manner is how we will be remembered, but can also therapeutic in its own right alongside other more tangible interventions. A favourite moment for several tweeters, was a reference to the #hellomynameis campaign, which was started by Geriatrician Dr Kate Granger prior to her death in 2016.

“The doctor smiled and asked for our details……’And you?’ I said. The doctor stared at us. ‘Hello my name is?’ I said. ‘I’ve watched Holby City. I know the rules….’”

How is sheltered housing portrayed, including ‘Greenbank’, the nearby nursing home that Florence is aware she may be moved to…?

“Another problem with Cherry Tree is that there are no cherry trees…it’s the kind of name you give these places though. Woodlands, Oak Court, Pine Lodge……Forests full of forgotten people, waiting to be found again”

“Within each room was a small piece of torment…. I stared into each room, and a parcel of life stared back.”

Cherry Tree House was felt to be well-meaning, but often a little patronising, with an emphasis on enforced activities and socialising that may not be everyone’s cup of tea at any age. We discussed that this must be a fine line in many residential homes and sheltered units, as it may be difficult to balance people’s preferences, particularly as their ability to engage without prompting may change over time. An exception to this was the portrayal of residents at Greenbank, the local nursing home, a place felt to be so terrible that our main characters feared being transferred there, and that was used as a threat. The lack of choice over this move was clear, and made us wonder how these transitions could be approached differently in real life.

Does the novel view ageing positively or negatively?

“Jack pointed at the screen with his walking stick. ‘At our age, it’s an act of optimism, planting seeds….’”

Book Club members felt that ageing was mostly presented positively – residents at Cherry Tree House go on trips to the seaside, form new friendships later in life, and are treated respectfully by the staff charged with their care. Putting older characters at centre stage was also felt to be positive. We also teased out that social capital is acknowledged to make a substantial contribution to how the older characters perceive their lives, as those with family close by have an additional layer of support that is not accessible to Flo, who never married, and who has no children.

To round off, we asked what one activity book club members would want to continue to do if they were to enter a residential care facility…..

We had a great range of ideas for this – from access to gardening for the green-fingered, well-stocked kitchens for keen cooks, to spin, yoga and exercise classes, access to nature walks and bookshops, playing instruments, and regular cocktail hours. The stereotyped activities of Bingo and watching TV did not make an appearance…..

We were delighted to see that our first meeting drew together participants from nursing, allied health, hospital and community backgrounds and hope that future meetings will similarly enable us to share wide perspectives on older adults and their care. We aim to meet bimonthly, alternating fiction and non-fiction works. All are welcome. 

Our next #geribookclub will be on Tuesday 17th November at 8pm, and we will be discussing ‘Elderhood’ by Louise Aronson. The book was a finalist for the nonfiction Pulitzer prize and a New York Times best-seller. More details will be available here.