Gavin Francis appears to dance, quite happily, between award winning author and GP in Edinburgh’s South Side. His first two books explored travel into the Arctic and Antarctica, the second of them winning Scottish Book of the Year and landing him on four further shortlists. Adventures in Human Being came next and added a few more awards and shortlists to his collection. His latest book, Shapeshifters, was published in May and explores the many transformations humans experience. Francis views transformation as an essential part of being human, whether those transformations are puberty and menopause, recovery from illness, life changing injuries, or the self imposed changes that have people flocking to gym, tattoo artists, and plastic surgeons.
Francis speaks as much about compassion as he does about medicine. To him compassion for the patient is the beating heart of clinical practice. There is an apparent sense of wonder there too. He seems fascinated by every minute part of the human body and its ability to function and adapt, and his books draw everyone else in to look.
Chair Allan Little has become equally fascinated, both in the subject matter and the way Francis has woven modern sources with ancient ones into a rich story of human transformation and adaptation. He steers the discussion through increasingly interesting topics and tells a self deprecating story about his hearing to make us laugh and prompt a question about laughter itself.
Around a quarter of Shapeshifters is dedicated to points of change that we all experience: birth, growth, puberty. He speaks at length about one change that few think about: the shift from a baby receiving oxygen through the placenta to breathing on its own. Most of us wait for the cry and the flush of pink cheeks and never wonder about the mechanism that makes it work, unless your child is one of the few in which it fails. He explains clearly the bypass circuit that allows 90% of the blood to bypass the lungs before birth. This minute structure must close in the hours after birth and if that closure fails then the baby struggles to thrive.
Then there are other, less common transformations. Francis takes us back through historical concepts of gender, explaining that our strictly binary ideas are relatively new. We imagine that binary stretching far back into history but it’s really a product of the rigidity and rationalism of the Enlightenment. Before that point there are references to gender a something fluid and flexible, more like a landscape people could travel through with ease than two strict lines that never meet.
Francis also discusses the many forms of imposed transformations. Sometimes these are traumatic: paralysis from an accident, amputation after an injury. Many others are a choice. More and more people are flocking to the gym, sometimes with the theoretically helping hand of steroids, often bought online from unclear sources. He finds the conflict between the purpose and effect of steroids fascinating. They are taken to increase bulk and visual masculinity. They can often cause an increase in violent behaviour and ‘roid rage’ has been used as a defence in murder trials. On the other hand the side effects are almost feminising. Steroid use can cause infertility and breast development, the last thing the young men abusing them wanted. In the theme of unintended consequences and regret, more and more of us are seeking out plastic surgeons and tattoo artists. Nearly half of adults now have a tattoo, but half of all recipients regret them.
Finally it seems no discussion of human transformation would be complete without touching on the supernatural. Francis brings up a slide depicting werewolves and Morticia Adams. He thinks some tales of the supernatural may have been derived from poorly understood illnesses. For example, certain types of porphyria result in periodic mania or psychosis, light sensitivity, and if left untreated cause hair to grow across the face. There are also plenty of cases of people becoming convinced that they have been transformed into an animal. Francis wonders if this is really so strange. Children play at being animals constantly. Is it so surprising that an adult brain under stress might try and transform those games into a reality?
Questions from the audience pick up on the theme of stress: epigenetic effects, social pressures, pressures on the doctors themselves. Francis returns to the compassion at the core of his practice. He has many patients who simply want to offload and be heard. In the past they might have gone to a clergyman but with church attendance in decline many now turn to their doctors. Those appointments are not about offering solutions but about acknowledgement of suffering. Like most of us, all those patients want is for someone to say: ‘I see you. I hear you.’