I saw a frail, severely kyphotic 80-year-old lady mobilising slowly with her Zimmer frame in surgery this week. I confess to not being overly excited by her presenting complaint of a cough. However, as she apologised for coming to see me for what was ‘probably just a self-limiting viral infection, doctor, but I was worried I might not be able to compensate for much longer given my age and comorbidities’, I sat up straight, turned my hunched body away from the computer, looked at my patient, and asked what she had done for work before. Her face blossomed into a knowing smile as she informed me that she was a retired casualty sister of a large London teaching hospital. In that instant I did not see a frail, kyphotic older patient — I saw a colleague.
By chance I came upon former psychiatrist, now writer Joanna Cannon’s new novel and I thought of my patient as I read it. Three Things About Elsie is ostensibly about Elsie but the real protagonist of this delightful and bittersweet novel is 84-year-old Florence Claybourne. We first meet Florence at 4:48pm lying on the floor of her flat in Cherry Tree Home for the Elderly, and the novel is structured with Florence’s life unfolding in front of us — alternating between past and present, and different points of view from Handy Simon the young but not-so-young-any-more handyman, Miss Ambrose the put-upon and reflective home manager, and Florence herself. At the centre of the novel is a mystery involving a new resident to the home who looks identical to a man from Florence’s past. Who is this Gabriel Price and why has he come back to haunt Florence?
Elsie helps Florence and the reader navigate this mystery and we quickly learn from Florence within the opening chapters that:
‘There are three things you should know about Elsie, and the first thing is that she’s my best friend’,
the second is that Elsie ‘always knows what to say to make me feel better’, and the third that Florence cannot quite remember because her memory is not as good as it used to be. Forgetful she may be, but Florence delivers some razor-sharp insights and observations. While lying on the floor she imagines the sequence of events that will occur when she is found: the paramedics who will call her Flo even though they don’t know her and she has never said that they can call her Flo, the ambulance racing to the hospital, being rattled across A&E to people who will ask the same questions as the paramedics:
‘they will wheel me down blank corridors and put me through their machinery. A girl at a desk will look up as I pass by, and then she will turn away, because I am just another old person on a trolley, wrapped up in blankets and trying to hold on to the world.’ Later ‘… they will find me a ward, and a nurse with quiet hands. She will move very slowly, but everything will be done in a moment, and the nurse with quiet hands will be the first person to listen with her eyes.’
Part whodunit, part thriller, part nostalgia narrative, part ode to the redemptive love and refuge of friendship, Three Things About Elsie is above all a meditation on ageing and society’s view of the aged. Beyond the fragile appearance, the deteriorating mind, and the weathered hands, inside there is a retired casualty sister, a best friend, a father, a daughter, a person.
This book ought to be mandatory reading for all doctors, surgeons, and GPs alike, and is a poignant reminder that ‘even the smallest life can leave the loudest echo’.
- © British Journal of General Practice 2018