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September 2017

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Into the Grey Zone
26th September 2017 - Adrian Owen

 Read an Extract from Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death

 

Cover of Into the Grey Zone 

 

A world-renowned neuroscientist, ​in 2006 Adrian, together with his team, made medical history. Through their groundbreaking work with patients whose brains were thought to be vegetative or non-responsive, they discovered a new realm of consciousness, a twilight zone somewhere between life and death, which they called the Grey Zone. In up to 20 percent of cases, patients whose brains were considered vegetative were in fact found ​to be vibrantly alive, existing in the​'Gre​y Zone', an intact mind trapped deep inside a broken body and brain. Not quite living, and not quite gone, they have existed silently in these shadowlands. But now, through Dr Owen’s pioneering techniques and MRI scanning technology, we can talk to them – and they can talk back. Through unsettling and miraculous stories, Owen challenges us to think about the difference between a brain and a mind, a body and a person. In probing the borderlands between life and death, Owen begins to unravel the mystery of what makes us us - and what it truly means to be alive. 

 

Read an extract below

 

 


 

Into the Grey Zone

 

PROLOGUE

 

I’d been watching Amy for almost an hour when she finally moved. She had been sleeping when I arrived at her bedside in a small Canadian hospital a few miles from Niagara Falls. It seemed unnecessary, even a little rude, to wake her. I knew there was little point in trying to assess vegetative-state patients when they are half-asleep.

It wasn’t much of a movement. Amy’s eyes flicked open; her head came up off the pillow. She stayed that way, rigid and un­blinking, her eyes roving around the ceiling. Her thick dark hair was cropped short, but perfectly styled, as though someone had been working on it only moments earlier. Was this sudden move­ment simply the result of automatic firing of the neural circuitry in her brain?

I peered into Amy’s eyes. All I saw was emptiness. That same deep well of emptiness that I had seen countless times before in people who, like Amy, were thought to be 'awake but unaware'. Amy gave nothing back. She yawned. A big openmouthed yawn, followed by an almost mournful sigh as her head collapsed back onto the pillow.

Seven months after her accident, it was hard to imagine the per­son Amy must once have been — a smart college-varsity basketball player with everything to live for. She’d left a bar late one night with a group of friends. The boyfriend she’d walked out on ear­lier that evening was waiting. He shoved her and she toppled, slamming her head on a concrete curb. Another person might have walked away with a few stitches or a concussion, but Amy was not so lucky. Her brain hit the inside of her skull. It pulled from its moorings. Axons stretched and blood vessels tore as ripples of shock waves lacerated and bruised critical regions far from the point of impact. Now Amy had a feeding tube surgically inserted into her stomach that supplied her with essential fluids and nutrients. A catheter drained her urine. She had no control over her bowels, and she was in diapers.

Two male doctors breezed into the room. 'What do you think?' said the more senior of the two, looking straight at me.

'I won’t know unless we do the scans,' I replied.

'Well, I’m not a betting man, but I’d say she’s in a vegetative state!' He was upbeat, almost jovial.

I didn’t respond.

The two doctors turned to Amy’s parents, Bill and Agnes, who’d been patiently sitting while I observed her. A good-looking couple in their late forties, they were clearly exhausted. Agnes gripped Bill’s hand as the doctors explained that Amy didn’t understand speech or have memories, thoughts or feelings, and that she couldn’t feel pleasure or pain. They gently reminded Bill and Agnes that she would require round-the-clock care for as long as she lived. In the absence of an advanced directive stating otherwise, shouldn’t they consider taking Amy off life support and allowing her to die? After all, isn’t that what she would have wanted?

Amy’s parents weren’t ready to take that step and signed a con­sent form to allow me to put her in an fMRI scanner and search for signs that some part of the Amy they loved was still there. An ambulance shuttled Amy to Western University in London, Ontario, where I run a lab that specialises in the assessment ofpatients who have sustained acute brain injuries or suffer from the ravages of neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Through incredible new scanning technology, we connect with these brains, visualising their function and mapping their inner universe. In return, they reveal to us how we think and feel, the scaffolding of our consciousness, and the architecture of our sense of self — they illuminate the essence of what it means to be alive and human.

Five days later I walked back into Amy’s room, where I found Bill and Agnes by her bedside. They looked up at me expectantly. I paused for a moment, took a deep breath, and then gave them the news that they hadn’t allowed themselves to hope for:

'The scans have shown us that Amy is not in a vegetative state after all. In fact, she’s aware of everything.'

After five days of intensive investigation we had found that Amy was more than just alive — she was entirely conscious. She had heard every conversation, recognised every visitor, and listened intently to every decision being made on her behalf. Yet she had been unable to move a muscle to tell the world, 'I’m still here. I’m not dead yet!'

----------------------------

Into the Grey Zone is the story of how we figured out how to make contact with people such as Amy, and the profound effects for science, medicine, philosophy, and law of what has become a new and rapidly evolving field of inquiry. Perhaps most important, we have discovered that 15 to 20 per cent of people in the vegetative state who are assumed to have no more awareness than a head of broccoli are fully conscious, although they never respond to any form of external stimulation. They may open their eyes, grunt and groan, occasionally utter isolated words. Like zombies, they appear to live entirely in their own world, devoid of thoughts or feelings. Many really are as oblivious and incapable of thought as their doctors believe. But a sizable number are experiencing something quite different: intact minds adrift deep within dam­aged bodies and brains.

The vegetative state is one realm in the shadowlands of the grey zone. Coma is another. Comatose people do not open their eyes and look completely unaware. In the Disney version of Sleeping Beauty (which most parents know all too well), Aurora’s condition resembles coma, akin to a bewitched slumber. In real life, the picture is far less romantic: disfiguring head injuries, contorted limbs, broken bones, and wasting illnesses are the norm.

Some people in the grey zone can signal that they’re aware. Referred to as minimally conscious, they occasionally respond to requests to move a finger or track an object with their eyes. They seem to fade in and out of awareness, occasionally emerging from some deep pool of oblivion, breaking the surface and signalling their presence before sinking back into the murky depths.

Locked-in syndrome is not technically a grey-zone state, but it is close enough to give us insight into what life might be like for some of the people we scan. Locked-in people are fully conscious and can typically blink or move their eyes. Jean-Dominique Bauby, French editor of Elle magazine, was a famous example of someone locked in. A massive stroke left him permanently paralysed except for the ability to blink his left eye. With the help of an assistant and a writing board, he composed The Diving Bell and the Butterfly, a memoir, which took two hundred thousand blinks to complete.

Bauby vividly recounted his experience: 'My mind takes flight like a butterfly. There is so much to do. . . . You can visit the woman you love, slide down beside her and stroke her still-sleeping face. You can build castles in Spain, steal the Golden Fleece, discover Atlantis, realise your childhood dreams and adult ambitions.' Of course, this is Bauby’s 'butterfly': the mind unbound, unconstrained by physicality or responsibility, free to flit here and there. But Bauby was also locked inside the 'diving bell', an iron chamber from which there is no escape and which sinks ever deeper into the abyss.

Back at Amy’s bedside a few days after her MRI scans, I again sat watching her closely, desperately wanting to know what she was thinking and feeling. All of those convulsive movements and spasmodic gurgles. Was her experience like Bauby’s? Had she entered Bauby’s imaginative realm of freedom and possibility? Or was her inner world an excruciating prison from which there was no escape?

Following our scans, Amy’s life changed beyond recognition. Agnes would barely leave her bedside, reading to her more or less constantly. Bill popped in each morning, delivering the daily papers and updating Amy on the latest family gossip. A constant stream of friends and relatives visited. Amy went home on week­ends, and parties were held on her birthdays. She was taken to the movies. The care staff always introduced themselves to her, explaining that they were going to wash or change her before approaching her bedside. Every intervention, every drug, every change of routine, was carefully explained. After seven months in the grey zone, Amy became a person again.

I didn’t delve into this new field of science with anything resem­bling a clear idea in mind of what I wanted to do. The beginning felt like a fluke, an offhand coincidence. Yet as I look back, it’s clear that what set this story in motion points to the inner fabric that binds all of us together in ways that are monstrously complex and impossible to anticipate. My explorations into the grey zone emerged out of something dark and strange that happened in a leafy, genteel suburb of south London on a warm July day twenty years ago. . .

 

 

 

 

#FoylesFave: Dr Seuss
25th September 2017 - Matt Blackstock

#FoylesFave: Dr Seuss

Matt from our Web Team is very silly. Maybe this explains his love for Dr Seuss, especially this new glow in the dark edition of What Was I Scared Of? 

 

What Was I Scared Of?Everyone loves Dr Seuss. Be it his charming and absurd rhymes, dizzying illustrations or just the nostalgic tingle you get from having read his books as a child. Yes, Theodor Seuss Geisel is one of the greatest picture book authors in history.

 

Only Dr Seuss and his entertaining turn of phrase could turn an empty pair of trousers into ghoulish, yet hilarious tales that are best read loud and aloud! Dr Seuss' books span generations of readers who've all grown up with his stories, such as Green Eggs and Ham and The Cat in the Hat. These tongue-twistingly good picture books delight, bamboozle and feed the imagination, and should be a staple in everyone’s home.

 

This new glow in the dark edition of What Was I Scared Of ? is especially spooky - imagine finding yourself alone and being chased by a seemingly haunted pair of trousers. Full of mischief and laughs, this is a great addition to anyone’s picture book collection and is perfect for reading under the covers! 

 

 

 

 

 

 

Read an Extract from A Skinful of Shadows
21st September 2017 - Frances Hardinge

Read an Extract from A Skinful of Shadows

 

Frances HardingeFrances Hardinge spent her childhood in a huge old house that inspired her to write strange stories from an early age. She read English at Oxford University, then got a job at a software company. However, by this time a persistent friend had finally managed to bully Frances into sending a few chapters of Fly By Night, her first children's novel, to a publisher. Macmillan made her an immediate offer. The book went on to publish to huge critical acclaim and win the Branford Boase First Novel Award. Known for her beautiful use of language, Frances has since written many critically acclaimed novels, including Verdigris Deep, Cuckoo Song and the Costa Award-winning The Lie Tree.

 

Author photo © David Levenson

 

 

 

Cover of A Skinful of ShadowsIn Frances' new book, A Skinful of ShadowsMakepeace, a courageous girl with a mysterious past, defends herself nightly from the ghosts that try to possess her. Then a dreadful event causes her to drop her guard for a moment. And now there's a ghost inside her. The spirit is wild, brutish and strong, but it may be her only defence in a time of dark suspicion and fear. As the English Civil War erupts, Makepeace must decide which is worse: possession - or death.

Intrigued? Read the first chapter here.

 

 

 

 

#FoylesFive: Elsewhere-Elsewhen
18th September 2017 - Jennifer Jenkins

#FoylesFive: Elsewhere-Elsewhen

 

Although I am a pretty eclectic reader I do find myself particularly drawn to a certain kind of book, the sort that can transport me to other times and other places and allow me to see life from a new perspective. Sadly, nobody seems to have thought of grouping them in a handy category, so I came up with a term of my own for them: the Elsewhere-Elsewhen genre. Here’s a small selection of my favourite titles.

 

Burnt Shadows by Kamila Shamsie 

This ought to be recommended reading for every human being on the planet. Spanning from the drop of the atomic bomb on Nagasaki to the recent wars in Afghanistan and Iraq, this book beautifully demonstrates how ordinary people’s lives are affected by historic events and how tragically easy it is to find yourself on the wrong side of history.

 

The Wake by Paul Kingsnorth 

Although this book does not score very high on the elsewhere scale, what it lacks in miles it more than makes up in otherworldliness. Written in as close as you can get to Old English whilst still being intelligible to modern readers, this amazing book narrates the attempt at resistance against the Norman invasion by a small band of desperate men.

 

The Secret Chord by Geraldine Brooks 

To be honest I could have picked any of Geraldine Brooks’ books for this as she is an author with a unique ability to bring the past vividly to life. Here Brooks cleverly takes up the story of David, of biblical fame, not to tell us the story of the boy who cleverly defeats the odds and muscles stacked against him, but of the mighty king whose sharp mind has been clouded by many years in power.

 

Heaven and Hell by Jòn Kalman Steffanson  

If you tend to avoid translated books thinking they inevitably lose something in the retelling from one language to another, this book will dispel all your fears. Beautifully poetic, this story of a boy growing up in early twentieth century Iceland is best read with a hot chocolate close at hand as it involves a lot of perilous journeys in the middle of snowstorms.

 

The Gift of Rain by Tan Twan Eng 

A word of warning about this book, Tan Twan Eng’s masterful prose brings time and place so vividly to life that you might suffer from severe disorientation when you finally lift your eyes from the book and discover you are not in fact in 1939 Penang. 

 

 

Growler: The Inspiration for the Now Iconic Bear
18th September 2017 - James Campbell

The Evolution of Winnie the Pooh

 

James CampbellJames Campbell has worked for sustainability and environmental organisations for more than 20 years. He is married to E. H. Shepard's great-granddaughter and has had responsibility for the oversight of E. H. Shepard's artistic and literary estate since 2010. He currently lives in Oxford. His new book, The Art of Winnie the Pooh: How E. H. Shepard Illustrated an Icon, explores the partnership between A A Milne and E. H. Shepard, and follows the evolution of Shepard's work, from his first tentative sketches through to the illustrations that are so well known today, and also the characters' later incarnations at Disney.

Below exclusively for Foyles, James describes how the groundbreaking approach to illustration adopted by Milne and Shepard came about, which bear provided the inspiration for the drawings and which of the characters was Shepard's secret favourite.

 

 

 

 

 

 

Cover of  The Art of Winnie the PoohIt’s hard to find anyone who doesn’t have a soft spot for Winnie-the-Pooh – very few childhoods have not been touched by that funny old bear and his friends in the Hundred Acre Wood.  And when we reflect and think back, almost inevitably our favourite illustration comes up in our mind’s eye, seamlessly creating the image to match the wonderful words.  Alan Milne and Ernest Shepard together created four iconic books collectively known as the Winnie-the-Pooh books – but relatively little is known of how these illustrations came about.

My new book, The Art of Winnie-the-Pooh: How E. H. Shepard Illustrated an Icon, now tells this story, largely through Milne’s words and Shepard’s drawings (or ‘decorations’, as they are always referred to in the books), delving into the history of how Milne and Shepard came together, established a harmonious and fruitful professional working relationship, and together created the images and impressions which still resonate with children almost a century later.

Milne and Shepard both had a long-standing professional relationship with Punch magazine, and it was here that the author and publisher E. V. Lucas approached Shepard to ask if he would be interested in illustrating some ‘charming poems’ by A. A. Milne. Shepard was delighted to accept the commission, but Milne needed some persuading. Shepard’s preliminary drawings soon convinced him, and the great success of the poems and illustrations in Punch led to the swift publication of When We Were Very Young, the first of the four books. The instantaneous success of the book inspired Milne and Shepard to collaborate even more closely over the next volume – Winnie-the-Pooh – whereby the two met regularly to discuss not only the text and the drawings, but the layout of the pages and the free-form of the illustrations through the book. This was a ground-breaking approach, one which had been received with extreme nervousness at Punch and with some anxiety by the publisher, Methuen, not only because this was a very different look and feel to a book, but also because production costs were more expensive.

Shepard drew from life, and spent considerable time with the Milnes in both London and at their weekend home in the Ashdown Forest in Sussex, drawing Christopher Robin, his surroundings and his toys. Interestingly, Winnie-the-Pooh himself was not modelled on Christopher Robin’s bear – first Edward Bear and later renamed Winnie (after the Canadian bear cub at London Zoo) –the-Pooh (after the nickname for a swan) – in fact Shepard did use this bear as his first model, but both he and Milne agreed it did not work – the bear was too angular and serious-looking.  Shepard fell back on the teddy-bear belonging to his own son, Graham – called Growler.  Growler was a much better likeness for the stories of Winnie-the-Pooh, and so it is Growler who ended up as the model for the bear we know and love.

This new book shows the evolution of the images of Winnie-the-Pooh and his friends, from just a few lines in Shepard’s sketch book through preliminary drawings with corrections, mark-ups and changes, to final versions, some never used, and most of which have never before been seen and published. These wonderful drawings and illustrations, which add so much to our understanding of how Shepard brought about the iconic images we know so well, have been hidden for nearly a hundred years in E H Shepard’s own private archive. Towards the end of his long life – he died in 1976 at the age of 96 – Shepard donated all the original black-and-white illustrations in his possession to the Victoria and Albert Museum in London, where they remain, and will form a crucial part of a major exhibition at the Museum on Winnie-the-Pooh from December 2017 – April 2018.  Only very recently has the existence of this new material been revealed, and it adds a significant additional dimension to our understanding of Shepard’s approach to creating these matchless illustrations.

While Milne finished writing about Pooh and his friends in 1928, Shepard continued to be in demand for the rest of his life in revising images, creating new illustrations for editions in different sizes and languages, and introducing colour, and the book shows how the original black-and-white ‘decorations’ in the 1920s gradually made way for first spot and then full colour, and how the images changed as a result. There are some wonderful cameos, such as Pooh depicted in a laurel wreath to accompany the Latin edition, Winnie-Il-Pu, and Shepard’s draft cover for a French edition, showing the Bayeux Tapestry incorporating Pooh and his friends set within a Tricoleur.  Whilst Milne had some concerns about being remembered only for Pooh, Shepard never lost his affection for ‘the bear’, and so many correspondents in his later years, particularly children, received a personal drawing of Pooh, Piglet or possibly Shepard’s secret favourite, Eeyore, in reply. 

 

 

Blog - Sound and Silence: Emma Viskic on Creating a Profoundly Deaf Protagonist
14th September 2017 - Emma Viskic

Sound and Silence

 

Emma ViskicEmma Viskic is an award-winning Australian crime writer. Her critically acclaimed debut novel, Resurrection Bay, now available in the UK, won the 2016 Ned Kelly Award for Best Debut, as well as an unprecedented three Davitt Awards: Best Adult Novel, Best Debut and Readers' Choice. It was also iBooks Australia's Crime Novel of the year in 2015. She is currently writing the second in the Caleb Zelic series, And Fire Came Down. Emma studied Australian sign language (Auslan) in order to write the character of Caleb Zelic. Below, exclusively for Foyles, Emma describes how and why she came to learn sign language.

 

 

 

 

 

 

 

 

 

 

Cover of Resurrection BayWriting and music have always been the twin pillars of my life, so it’s probably not surprising that I ended up becoming both a musician and an author. It’s a little harder to understand how I came to write a profoundly deaf protagonist in my debut novel, Resurrection Bay.

 

As a teenager, I wrote the usual bad poetry, read the usual good books and listened to the not-quite-so-usual good music. I wasn’t into punk, or grunge or even jazz and blues – I loved classical music. I was drawn to its nuanced sounds and carefully crafted phrases, its finesse and fire. My understaffed high school didn’t run to a music programme, but my parents found a nearby music school that offered tuition in a handful of instruments. I tried the clarinet and fell in love.

 

I went on to become a professional clarinettist, playing in everything from chamber concerts, to the Phantom of the Opera orchestra and arena concerts with José Carreras. I loved being a musician, but by the time I reached 30 I was missing writing with a quiet desperation. Eventually I grew so sick of myself, that I decided to write a book. I had a long history of childhood short stories and half-finished novellas, but that manuscript was my first attempt at writing a novel. It was terrible. I didn’t know how to fix the writing, but I did know how to practise. I kept going, writing short stories and another full-length manuscript, and slowly came to realise that words were just a different kind of music.

 

I started reading my work aloud, listening to its rhythms. I added passages here, and entire chapters there, writing and rewriting until the words flowed smoothly. Eventually, I felt confident enough to begin what was to become Resurrection Bay, a contemporary crime novel featuring the wry, stubborn and profoundly deaf investigator, Caleb Zelic. Everything went smoothly for a while, but I came to a grinding halt after a few months. I had no idea how to write a deaf character. After a lifetime dedicated to sound, how could I write about silence? I tried to make Caleb hearing, but it didn’t work. The seeds of his character came from a profoundly deaf girl I’d known in childhood. She’s been appearing in my writing in one form or another ever since, but never as clearly as in Resurrection Bay. Caleb was deaf, not hearing, and unless I wrote him that way, I couldn’t write the novel. After months of agonising, I finally summoned my courage and began what would turn out to be a five-year journey of writing and research.

 

I began by reading books and speaking to people in the deaf and hard-of-hearing communities. Caleb’s character began to take shape as I learned their stories. I soon decided that he’d become deaf as a child, was a skilled lipreader and that hearing aids gave him only minimal hearing. But that was just background information: I needed to get inside his head if I was going to make him feel real.

 

After doing an online course in lipreading, I bought a pair of foam earplugs and ventured into the world to try out my skills. It was a disaster. I missed train announcements and inadvertently ordered strange coffees in cafes, experienced a range of attitudes from pity and irritation, to anger. And the more I experienced, the more I understood Caleb. His stubborn streak and inability to admit defeat, his bone-dry sense of humour. It also made me wonder if he should use Australian sign language (Auslan). Because Caleb is so determined to live in the hearing world, Auslan wasn’t an obvious choice for his character, but the idea intrigued me. Lipreading is hard, inexact and tiring; Auslan could be a good way of showing Caleb at ease in one area of his life.

 

I enrolled in an Auslan course and knew within minutes that I’d found the final key to his character. Not only is Auslan a beautiful language, it’s expressive and emotional. So Caleb became bilingual, speaking English most of the time, but signing with those he loves. I went on to study Auslan, and began to see how the people around Caleb would communicate with him. That his estranged brother would speak English these days, but change to Auslan as they grew closer; that his adored ex-wife would sign fluently; that others would insist on speech, or attempt rudimentary sign, depending on their closeness to him.

 

I’ve just finished the second Caleb Zelic novel, And Fire Came Down, and have learned a lot along the way, including the unexpected benefits of writing a deaf character. After decades of focusing on sound, I’ve learned to notice much more. Like Caleb, I watch people’s expressions and body language now. I pay attention to the light in a room, and the colours and scents and textures. It’s added untold layers to my writing, and to my life.

 

 

 

Latest Blog
Into the Grey Zone
26/09/2017

Read an extract from Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death

#FoylesFave: Dr Seuss
25/09/2017

Matt from our Web Team is very silly. Maybe this explains his love for Dr Seuss, especially this new glow in the dark edition of What Was I Scared Of?

Read an Extract from A Skinful of Shadows
21/09/2017

Read an extract from the eagerly awaited new novel by the Costa-winning Frances Hardinge, A Skinful of Shadows.

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