Letter From the Editor: The Children Act

Clinical Advances in Hematology & Oncology
January 2016, Volume 14, Issue 1

The white was Matua Sauvignon Blanc, from Marlborough (New Zealand, not the prestigious girls’ school in Los Angeles), and the red was Petite Petit (see last month’s letter for its pedigree). Our most recent book club selection marked our first foray into fiction.

I selected The Children Act, the latest novel of Ian McEwan (the Man Booker Prize–winning author of Amsterdam and Atonement, among numerous others). It is the story of Fiona Maye, a prominent High Court judge who deals with family law. She has previously provided thoughtful, albeit controversial, decisions in difficult cases. For example, one decision involves the separation of conjoined twins in which one twin will not survive the procedure. Another decision involves the daughters of an Orthodox Jewish couple undergoing a divorce; the father wants the children to remain in the faith, even if it means never seeing their mother again, whereas the mother wants her daughters to experience opportunities in the real world and make their own decisions about their future when they come of age.

Fiona’s life’s work is bringing “reasonableness to hopeless situations.” However, she becomes so emotionally involved with her cases that they leave her depressed and affect her relationship with Jack, her husband. Fiona is childless because she has been so focused on her career. Jack is threatening to have an affair because he and his wife have not made love in seven weeks and a day. And now, enter Adam. Adam is a boy nearly eighteen years of age who has a rare form of acute leukemia. He is in desperate need of a blood transfusion; however, he and his parents are devout Jehovah’s Witnesses. Before rendering her decision on whether to compel him to receive the lifesaving blood, she does the unconventional—she actually goes to meet him in person in the hospital, where he reads her his poetry and plays his violin. As he plays, she sings with him lines from a poem by Yeats, Down by the Salley Gardens. They are a clear harbinger of things to come: “She bid me take life easy, As the grass grows on the weirs; But I was young and foolish, And now am full of tears.”

Although Adam describes how he understands his role as a martyr to his faith—albeit in a rather naive sort of way—does this boy sound ready to meet his maker? Does Fiona see in him the child she never had? In this case, Fiona once again renders a decision after considerable research and thought. Her thinking is supported in large part by the Children Act 1989, which requires that the welfare of a child be safeguarded while the child’s religion is also considered. As in McEwan’s prior books, there is conflict: science versus faith, Fiona versus Jack, Adam’s mother versus his father. At one point in each of McEwan’s novels, there occurs an event, sometimes quite small, that shatters the lives of many of the characters (no spoiler alert here). I recommend this book as one of the author’s best of several recent offerings.

Some of the first-year fellows were new to the book club and did not know what to expect. One woman even expressed that she had “never done this kind of thing before.” I reminded her that this was probably not the first time she had made that comment, in other circumstances, and yet seemed to have turned out well. Nonetheless, the discussion was lively and thoughtful. What sort of person was Fiona really? What drove her, and is that what was driving Jack away? And why couldn’t he actually consummate the affair he kept threatening his wife he would have? Issues regarding boundaries abounded. Most importantly, was Fiona’s ruling regarding Adam correct? One fellow said that the state, not the parents, should have primary responsibility for the welfare of children (an opinion that was far from unanimous). If the parents are in charge, who must assume responsibility for a child when the religious beliefs of the parents threaten their child’s life? What will be the consequences of the decision for Fiona herself, for her relationship with Jack, and for Adam?

The consensus of the group members, with a single exception, was that the book was a good, thought-provoking read. The dissenter was a fellow who said that it confirmed his habit of reading only nonfiction; novels are too much about feelings. Whatever the verdict within and regarding the book, it made for a pleasant day’s end and a reminder to all that there is a world out there beyond our daily chores.

Until next month . . .

Bruce D. Cheson, MD