Book review

There’s a reason (think John Green meets Stephen King) this debut novel is all the rage in the West

In ‘My Absolute Darling’ Gabriel Tallent successfully combines the trauma of child abuse with teenage romance.

It was undoubtedly the debut of the year. A New York Times bestseller. A novel praised by none other than Stephen King with these words: “The word ‘masterpiece’ has been cheapened by too many blurbs, but My Absolute Darling absolutely is one.” And Bitch Media has headlined its review of Gabriel Tallent’s first novel “Male Authors Are Still Profiting From Women’s Pain”.

In other words, everyone, but everyone, in the book business in America is talking about My Absolute Darling, a novel depicting 14-year-old Turtle Alveston’s survival in extreme conditions. Turtle lives in coastal Mendocino, California with her father Martin – an abusive, alcoholic nutcase who stocks up on canned food and gun supplies, believing that the world might end any day.

Turtle is forced to eat raw eggs, the occasional scorpion, and rabbits that she hunts. She struggles to keep up in school, knows how to fire a Sig Sauer firearm on target, and is capable of surviving with only her gun in the middle of the forest at night in pouring rain. She can even come back alive after being washed up on isolated rocks with the tide. In short, Turtle Alveston can survive both man and nature. It is the “how she does it” that this book goes into.

Those horrible things

The first chapter begins with ominous details of Turtle’s living conditions in the house where raccoons lick the dishes clean and her father flips out at her for getting spellings wrong in her homework. Tallent pulls us straight into the uncomfortable with a seemingly mundane day of breakfast, walking to catch the school bus, middle-school vocabulary classes, and the principal’s meeting with the parent. Along the way, he shatters the illusion that being part of a small town community can mean any kind of safe space. It is a jungle out there, at home and in Turtle’s mind, and there is no way to escape it.

“…I thought at least you could give me this, you could at least do that, but the truth is that you give me nothing, she thinks, pulling up her pants and shashaying them on to her hips and holstering the gun as Martin watches her dress, and she thinks, go ahead and watch, asshole. I don’t know how to get away, and I don’t know if I can get away, so we will find out, I guess. Go ahead and watch, she thinks, because there is something wrong with me that I would take this risk that I would allow you to do this to me.”

Much of the novel is dedicated to Turtle’s inner thoughts, running in the form of monologues, and this is where we get the measure of psychological trauma that a survivor of sexual abuse goes through. Turtle’s conversations with herself are repetitive in which her mind switches between reminding herself how much her daddy loves her and how she can escape or kill him. This is where the book differs from other stories of sexual abuse and survival.

Tallent shows us the psychological underpinnings of Turtle’s mind, which she has trained to believe that she loves her father and is equally responsible for her father’s actions. She feels guilty every time Martin hurts her, thinking that it is because she provoked him through something she did.

The intriguing aspect of Tallent’s writing is that it is thoroughly goosebump-inducing, and capable of taking your heartbeat up a notch. The prose makes you sick in the stomach out of curiosity, fear and excitement about what is happening on the page. You will not have a moment’s peace until the scene has ended, and the aftereffect is in the form of unpleasant dreams.

John Green meets Stephen King

Turtle’s life changes when she encounters two high school boys, Jacob and Brett, who are lost in the forest while camping. She helps them survive the night and get home safely, and for this, they are in complete awe of her. For the first time, she likes a boy and knows how dangerous an act this could be. But it is here with the boys’ entry that lightness also enters the prose. The book shifts gears from being a psychological thriller to a young adult novel, which makes for a welcome change.

When the boys are lost in the woods, they come across a cottage and consider going in. This is the conversation they have:

“Brett says, ‘Dude, dude, what if you go in there – and there’s just, like one deformed albino child on a rocking chair with a banjo?’

Jacob says, ‘And he takes us prisoner and makes us read Finnegans Wake to his peyote plants?’

Brett says, ‘You can’t tell anyone that my mom made us do that. You can’t.’

Jacob says, ‘Why Finnegans Wake, do you think? Why not Ulysses? Actually, why not just read The Odyssey? Or – or The Brothers Karamazov?’

‘Because, dude – you read fucked-up Russian bullshit to your peyote plants, you’re gonna have a bad time.’

‘Okay, so: To the Lighthouse. Or – you know what? – people die in subordinate clauses in that book. Maybe DH Lawrence? For a passionate, make-love-to-the-gamekeeper kind of high.’

‘Dude, with your voice you are like, look at all these books I’ve read but with your eyes you are like, help me.’”

Tallent fuses the two genres – YA novel and psychological thriller – and moves back and forth between them. I could swear I was watching a dark, twisted Gilmore Girls episode towards the end, where all hell breaks loose where but at a high school party. On one page you find yourself laughing at a Jacob-Brett conversation, or read about a lovely moment between Jacob and Turtle straight out of John Green’s The Fault in Our Stars where the cigarette is a metaphor, and the next thing you know you’re in Stephen King’s short story Survivor Type in which a surgeon stuck on an island eats his own limbs to survive.

Even the cluelessness doesn’t kill it

A debut novel that took Tallent eight years to write, the book speaks of his command over prose, his ability to make you cringe and yet be curious as if it were a slasher film whose gory scenes you cannot watch but cannot look away from either. And yet, the book has its minute loose ends, certain spaces of cluelessness, a lack of knowledge for the reader. Perhaps this is because it is told from the perspective of a 14-year-old girl who herself doesn’t understand why her father does what he does. But that cluelessness becomes a little frustrating after a point. However, by the time this feeling surfaces, the reader is so into the book that it does not matter terrible.

This is a not a once in a lifetime kind of book. But if you’re feeling a bit numb and want to go through a magnitude of emotions, from pure horror through laugh-out-loud humour to spine-chilling sensations, this might be it. For these reasons alone, Tallent could end up being the next-generation thriller writer we’ve been waiting for.

My Absolute Darling, Gabriel Tallent, 4th Estate.

We welcome your comments at
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.