Why I’m Cross with Ian McEwan

I’ve read all of Ian McEwan’s novels from The Cement Garden (1978),  but I am frustrated and annoyed by The Children’s Act, his latest.

Briefly, the novel is about a period of crisis in the life of a high court judge, Fiona Mayes, who is emotionally exhausted from her collapsing marriage and the stress of making life and death decisions in family court. Then she receives the case of Adam Henry, a 17-year-old suffering from leukemia whose parents have refused to grant permission for him to receive blood transfusions, and to complicate matters, the patient himself has said that he will not go against the dictates of his Jehovah’s Witness church.

To prepare the reader for this central episode, McEwan develops Mayes’ character by reviewing her thoughts on several other judgments she has found difficult. These cases, used to develop a fictional character, are based on actual rulings evoking the Children’s Act of 1989, which orders that in any court action pertaining to a child, “the child’s welfare shall be the court’s paramount consideration.”

McEwan has discussed the factual rulings for his novel’s cases regarding conjoined twins, a mother falsely accused of murder in her infant’ crib deaths, conflicts between ex-spouses over the religious upbringing of their children, and even a case of a teenage Jehovah’s Witness who needed and wished to refuse a blood transfusion. The first two chapters are what I’ll call factional — at least as much fact as fiction.

I have no problem with this. But in the third of the novel’s six chapters, McEwan abandons factual fiction for fantasy, and the departure is abrupt, bizarre, and structurally and thematically unjustifiable.

After hearing testimony in the matter of Adam Henry, Judge Mayes decides to stop proceedings while she goes to his hospital room to visit with the boy.

The problems begin as soon as Fiona and the social worker after taking cabs through London enter Adam’s ICU room. Do they first scrub their hands? Put on protective masks? Gowns and booties? I’d think they would, not of course to protect themselves from his cancer, but out of concern for his steadily weakening immune system. That morning in court his doctor testified he had a white blood count of 1.7 (the normal range is 5 -9).

Adam looks pale and wan, and is short of breath. Otherwise, he hardly seems like the person described in court who was diagnosed  with leukemia after two days of “unbearable” sharp stomach pains, which began in mid-May (this scene is set in mid-June). There is no sense that he is still in any pain. The leukemia is not being adequately treated, so why is the pain gone? He certainly does not reason and act like a person on painkillers would, especially not on those that would alleviate “unbearaable” pain.

What impresses Fiona first is that Adam is surrounded by “life support and monitoring equipment” as well as “books, pamphlets, a violin bow, a laptop, headphones, orange peel, sweet wrappers, a box of tissues, a sock, a notebook, and many lined pages covered in writing. Ordinary teenage squalor, familiar to her from family visits.”

Ordinary teenage squalor? In the ICU? Really?

What else do we know of Adam’s medical history? Early that afternoon, his doctor reported that when Adam was admitted to the hospital, his hemoglobin was 8.3. Three days prior to the court hearing, it was 6.4, and that morning it was 4.5. The doctor added that if it dropped to 3, “the situation would be extremely dangerous.”

What’s normal for a 17 yr old boy? Between 13.8 and 17.2 g/dL, according to the World Health Organization. So if his hemoglobin had dropped another half point over the course of the day, his organs are receiving one-third of the oxygen they should. That is what hemoglobin does; it carries oxygen.  I think it safe to say he passed into the extremely dangerous category some time ago. Usually a transfusion is ordered when the hg drops into the 8’s, and while a gradual loss of hg might be easier for the body to adjust to than a sudden bleed from an accident, remember that not only is Adam extremely anemic, he has cancer.

Now, I find it very hard to believe that someone with an hg below 8 or 7 or 6 is going to be composing poetry and suffering no more problems than occasional shortness of breath.

But it’s the final moments of Fiona’s visit with Adam that had me banging my head. Since he became ill and as the anemia began to steadily worsen, Adam has been teaching himself to play the violin.

So this boy with less than a 4.5 hg plays his guest a piece, and Fiona starts singing along to “The Salley Cardens.” But wait, there’s more. They do a second take, and on Fiona’s instruction, Adam flawlessly changes key, now playing C sharps.

When the body is starved of oxygen, the brain is starved of oxygen. Confusion is a big problem for as long as the patient retains consciousness. The oxygen afforded the brain is going to be used for the most critical funtions of survival. Getting the C#s right in a violin piece is not a critical neurological function.

It’s an absurd and ridiculous scene, and it is the central one of the novel. If all leading up to it hadn’t been so fact-based, maybe it wouldn’t have been so jarring. If McEwan had waffled about the bloodwork, calling Adam simply seriously anemic rather than including specific real-world based numbers, it wouldn’t have seemed as preposterous a scene.

Why then? Why go through all the medical testimony regarding Adam’s labs and then present him in a way that does not reflect the implications of the facts presentd? I can see no thematic reason for this sudden departure into fantasy.

A failure of fact, a failure of faction, a failure of fiction.

The Guardian called A Children’s Act “a masterly balance between research and imagination.”

I call it inane.

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2 thoughts on “Why I’m Cross with Ian McEwan

  1. I agree with all you say, and I’ll go on to add that I found the depiction of Adam a romanticizing of illness, and thus highly irresponsible and insensitive. If I hadn’t been reading the novel on a Kindle, I would have thrown it across the room after the violin scene.
    I’m most fond of McEwan’s early work. The Cement Garden is a very strange little tale of children who lose their parents but are determined to keep their family unit together. Black Dogs deals with depression on the personal and national levels. The Daydreamer is classified as a children’s book of interconnected short stories, I guess because the protagonist is a child, but very satisfying to this adult reader, especially the story of young Peter discovering a zipper on the back of his elderly cat that allows him, Peter, to enter the cat’s body with his boy’s strength, and give a bit of payback to the neighborhood cats who have started bullying his own. The Child in Time, in which the central event is the random kidnapping of a child, is moving in its depiction of the parents’ grief and a novel of ideas about time and causality. Atonement is widely hailed, with reason, as was On Chesil Beach, which I didn’t find impressive.
    You can tell me. Based on my experiences with anemia down to the low 8’s, I cannot believe someone in the low 4’s could make the adjustments Fiona suggests in the encore performance of “The Salley Gardens.” I can’t imagine lifting and holding a violin in that state, and then there are the IV tubes. It just couldn’t happen, right? If anecdotal accounts of living with hg in the 4’s are out there, I can’t find them. There is one case of someone who got down to 1.7, I think it was, who survived without major organ damage, but what it felt like to be at 1.7 — well, that’s not the stuff of studies.
    And thank you for making this a conversation!

  2. I haven’t read as much McEwan as you, but after The” Children Act” I’m another disappointed fan. The prose was brilliantly descriptive, as always; I loved the experience of living in the world he created for me. And the descriptions of Fiona’s analytical legal mind were just wonderful. Your analysis of the ICU fallacies was right on, but that wasn’t the only or even the most bothersome problem for me. Adam, the sick 17-year-old was, I’m sorry, way too gold-plated to stomach. The accounts of Fiona’s marital problems were stilted and implausible. Worst, the chaste but wildly inappropriate liaison between Fiona and Adam was essentially dropped into the reader’s lap and walked away from without analysis.
    Thanks for starting this discussion! What McEwan should I read next?

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