“You bring your whole self to this job,” says Dr Emma Espiner (Ngāti Tukorehe, Ngāti Porou). Her passion for medicine – and for people – is evident throughout her memoir. She consciously cultivates optimism – despite setbacks, despite long hours and grueling shift work, despite having to tell patients they have cancer or that there are no further treatment options for a family member.
“Do you regret it?” someone asked her recently, while they were grumbling about the health system over drinks. “No,” she replied, “I fucking love it.”
Throughout the book she shares her fears, motivations, disappointments and successes.
“The best days,” she explains, “exceed everything we hoped for.”
Although this is Espiner’s first book, she is an experienced broadcaster and political commentator who has had work published online and in academic and literary journals. She has received several awards for her writing and her podcast on Māori health equity.
Espiner describes the responsibilities and conflicts of being a Māori doctor who grew up in a primarily Pākehā environment. When treating Māori patients, she may be seen as both a “cheerful brown face trying to mihi” and yet “part of the system designed to let [Māori] die sooner, sicker, unloved”. As a medical student, she believed that she needed to be “twice as good … to offset the assumptions and racism of other students” who wrongly believed that Māori students received unfair advantages. Espiner’s connections to tūpuna and whānau, and to other personal and professional communities, are central to her practice. The strength of her relationships as a daughter, mother, partner, whānau member, clinician and colleague provide security and stability. “I’m tough,” she says, but even so she often has to draw on every ounce of her resilience. She also sees a therapist.
It’s been suggested that in writing a memoir, the author must re-examine their own experiences, rather than simply re-telling them, and Espiner does this superbly. She is frank about some of the unwise choices she made as a young person: the alcohol and cigarettes, wild parties, unsuitable partners. She shows that it’s possible to change direction – and how and why she made this happen. From being a “bookish nerd with an interest in boys, drinking and bad decisions”, she’s now a qualified doctor who ably navigates the bureaucracy of medicine, guided by tikanga.
I wonder if a mark of a well-written memoir is that it provokes reflection on one’s own life journey. Espiner and I have a few things in common, including attending the same secondary school (decades apart), and juggling parenting and demanding tertiary study after changing careers. Reading this book prompted me to consider how our similarities and our differences, alongside generational and societal changes, have shaped our lives and expectations.
Espiner references other writers whose work she respects and whose writings have influenced her approach. Authors such as Atul Gawande and Glenn Colquhoun are favourites of mine as well, for the compassionate insights they – like Espiner – bring to their writing, and their ability to demystify what Espiner calls “the big ship medicine”. She acknowledges the influences and impacts of Māori academics, such as Professor Papaarangi Reid (Te Rarawa), and the high and ongoing personal costs to those working to ensure equitable health outcomes for Māori. She mentions other writers whose work takes her outside the “stone weight” of medicine – Patricia Grace, Tayi Tibble, and Megan Dunn, for example. There’s a brief notes section at the end of the book with references for some of the works Espiner cites.
Pithy chapter headings provide a glimpse into the topics covered. Please explain the gaps in your CV, for example, summarises Espiner’s zigzag career trajectory en route to becoming a surgical registrar, The End of the Beginning explores the transition from medical school to real-world doctoring, and He was the author of his own demise includes a moving account of an uncle lost to a work-related accident. Espiner writes about the effects of his death on the wider family, particularly his mother who was Emma’s much-loved English Nana.
Although Espiner uses some medical terms, the book is fairly jargon-free. Her writing is elegant, confronting, tender: “Nana is a ghost now. I see her sometimes … in the feather-soft skin of elderly hands that I occasionally hold and more often draw blood from. …I explain to her, as much as to my patients, what’s happening, what they can expect, that we will look after them.” Studying for a career-defining exam, she is intensely focused as she sets out from her house “… reciting the course of arteries through the abdomen out loud to myself like a madwoman … tapping out the nerve roots of the brachial plexus on the warm brick.” During exam prep she names her Spotify playlist ‘Keep Going’ and now loathes every one of those songs. Much later, now qualified, she describes heading off to meet an old man’s family after surgery as they wait for her “full of trust and fear”. Those five words – how apt they are. I’ve waited too.
Faced with so many digital distractions it’s rare for me to start and finish a book in a couple of days, but this memoir had me hooked. Most of us have been patients, and many of us have also taken family members to doctor’s appointments. Espiner’s memoir provides interesting and insightful perspectives on the role of the doctor (and on doctor-as-patient too). It would be of particular interest to anyone considering studying medicine, and people wanting to learn more about health equity in Aotearoa. The memoir explores many other topics too, including the effects of colonisation, activism leading to social and cultural change, and parenting a bicultural and bilingual child. Espiner emphasises that she wants her daughter “to know that she belongs in her reo, in te ao Māori”.
Espiner is a reader, a writer, and sometimes the subject of stories herself. Towards the end of the book, she reiterates the value of storytelling. Taking a patient’s medical history is an essential skill for every doctor and she has learned to listen carefully to the “person in front of you with a problem you might be able to help solve”. Repeating the patient’s story back to them helps to ensure that nothing has been missed. She recognises the importance of remembering and acknowledging who a patient’s story belongs to, and the need to protect the dignity of those whose stories she has included in her memoir.
Ngā mihi nui ki a koe Emma. Thank you for the thought and care that has gone into sharing your own story too. I’ve learned heaps.
Reviewer: Anne Kerslake Hendricks
Penguin Random House
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