Writing a book that combines personal memoir with social science analysis is not easy. Several decades ago, I attempted this mixed genre and abandoned it in favour of writing the memoir and leaving the social science for later. Ann Oakley is older now than I was then, and she comes as close to making the combination work as anything I have read. Fracture is a highly polished essay on the body, medicine, ageing and gender. If the book attempts no startling new insights in any of these areas, it dramatically demonstrates their interdependence. Not least, Fracture is about writing as an act of reclaiming a damaged self.
The memoir begins on a cold night in Colorado, where Oakley and two colleagues are hoping to enjoy a brief holiday before a conference. Oakley slips on an icy pathway, causing an especially nasty compound fracture to her right arm. Medical assistance arrives as quickly as the rural setting allows, and surgery repairs the arm with multiple screws and a steel plate. Ominously, before the operation the surgeon tells Oakley that, ‘we rarely manage a good outcome in such cases’ (p. 4). Even more ominously, when she awakes from surgery a lawyer – ‘what they call an “ambulance chaser”’ – is there to offer his services (p. 7). The surgeon will prove to have been more competent in his work than the lawyer will be in his, but in neither case will there be a good outcome.
Oakley's reflections early in the story on her X-rays set the reflective tone for what follows. ‘The X-ray films reorganize my body, the living flesh of my arm, so that only the hard white lines of the surgeon's metalwork are really visible. … Not only has the flesh of my arm completely gone, but even the bones appear ethereal, insubstantial, in some way fundamentally flaky, perhaps just as the bones of ageing women are supposed to be’ (p. 11). Oakley proceeds to reflect on how her body is herself, but also how it is not. She thinks about loss and the inability of professional medicine to acknowledge it. As the surgical incision heals, her main problem is absence of sensation in her hand. That complaint has already been given detailed literary consideration by Oliver Sacks (Reference Sacks1984), describing the loss of sensation in his leg following surgery to repair extensive damage incurred in a walking accident on a mountainside. Oakley follows Sacks back to the neurologist Henry Head, who surgically severed the same nerve in his arm that Oakley damaged in her fall. Head and his colleague, physician and anthropologist W. H. R. Rivers, wanted to study how the nerve regenerated, or failed to do so. Oakley captures nicely what is, in a scientific sense, heroic about Head and Rivers, but also what is bizarre and even perverse in their detachment.
Each chapter follows this design of moving from what Oakley faces to research that generalises the issue. The chapters proceed from the particular importance of hands for humans and the curiosities of right and left-handedness to bodies, scars, disabilities and what medicine leaves out, and to Oakley's ‘feeling that I'm being left out of this medical appraisal of my condition' (p. 91). In her medical care as in her legal case, Oakley has the sense ‘of playing a part that somebody else has written’ (p. 131). The chapter on bones becomes a critique of the medical use of hormone-replacement therapy as an example of how medicine is captured by the financial agenda of big Pharma. But Oakley is most scathing in the final chapter about the absurdities, exhaustion and degradation of her negligence suit against the lodge where she fell.
No topic, however peripheral to Oakley's fractured arm, is left unresearched: the book abounds in facts. At times the research departs far from the memoir; in a chapter on conjoined twins, I lost the plot almost completely. The facts are always engaging, but I found Oakley at her best when she speaks from her own experience, whether that is about physicians – ‘what worries me isn't what worries the doctors' (p. 20) – or lawyers. ‘Only the naïve, and I was certainly one of them at the beginning of all this, would suppose that lawyers are interested in the truth, and that an important part of the truth is the victim's perspective’ (p. 135). In the end, Oakley's hand works well enough, and she receives a cheque from an out-of-court legal settlement. But writing well may be the best outcome that we humans, with our brittle bones, are able to hope for. May we all reclaim ourselves as elegantly from the indignities of age and accident. Fracture can be recommended as a classroom text, both for Oakley's eye for what is unfortunate, absurd or just wrong, and for reunifying what textbooks too often compartmentalise: age, gender and breakable bodies.
