Close to Where the Heart Gives Out: A Year in the Life of an Orkney Doctor

by Malcolm Alexander

Close to Where the Heart Gives Out is the unflinchingly honest and moving memoir of rural life in Orkney, from the only doctor on the island ...

Genres: Nonfiction, Memoir, Medicine, Medical, Scotland, Biography, Autobiography

320 pages, Hardcover

First published June 13, 2019

About the author

Dr Malcolm Alexander graduated from Edinburgh University in 1980 with the single thought of becoming a General Practitioner in a rural setting and nothing more. Life had other plans and in time he became Clinical Director and then Medical Director for Orkney Health Board, before working as Director of Strategy for the Scottish Executive Remote and Rural Initiative. He finished his career working for 11 years as Associate Medical Director for the Scottish National Telephone Triage service, NHS 24, before finally returning to face to face practice as a locum in his local GP practice on one of the Scottish islands. His medical interests are widespread and include training in homeopathy, medical hypnosis, pre-hospital care as well as his expertise in clinical algorithm and computer systems development, a field where words and their use is critical to success. During his time in Orkney he also trained as a Reader in the Church of Scotland and lead worship in several congregations across the islands. He has always been deeply interested in people and in the relationship between their whole well-being and the physical illnesses. An acute observer of people and places he blends all his training and experience together when working as a GP.

When not actively being a doctor he likes to try out many creative and outdoor pursuits. He is an able singer, knitter, fisherman and spends a lot of time ripping out and repairing his old Victorian home where he lives with his wife and eight children, six of his own and his nephew and niece.

Reviews

[Rebecca · Rating 3 out of 5]

Alexander was the sole GP on the small Scottish island of Eday in the Orkneys in the late 1980s. Coming from Glasgow, he knew the job would mean a big change for him and his family: his wife Maggie, also a medical professional; and their four young sons. Everyone knew everybody’s business on Eday, not because they were nosy but simply because they were observant. And there were advantages to such enforced intimacy – when a laborer didn’t return to his home overnight, his neighbors knew to report him missing the next morning.

But the small population meant Alexander was sometimes called upon to fill roles for which he didn’t feel qualified, including preacher, Religious Education teacher, and large-animal veterinarian (you try taking the rectal temperature of an injured seal). The dentist only made an annual visit to this island. Obtaining a heart monitor and defibrillator represented a real step forward – a chance that someone who had a heart attack wouldn’t die before they could be transported to the nearest major hospital.

The book is structured around a personal crisis: Maggie’s fifth pregnancy was risky and required her to fly to Aberdeen to be on bedrest. The separation was a scary time for both of them, and Maggie’s mother came to help take care of the other children.

I liked hearing about the rhythms of island life and the way extremes of weather affect people, but I would have liked some more about the day to day of treating patients. I can’t remember many treatment scenes beyond visiting an old lady with back pain. (Her simple croft is his first glimpse of traditional Orkney life, with no electricity, a well or rainwater for drinking, and a box bed.)

This is a pleasant book for readers of Gervase Phinn. We readers like learning about the everyday lives of people in interesting careers, whether it’s herding sheep or selling books. The writing is decent, apart from the few poems inserted between chapters. But what I did notice was a dozen or more dangling modifiers* – where was the proofreader!? I also would have preferred an upfront indication of the time period and what has changed since that time; I fear the lack of such details (as in Shaun Bythell’s memoirs) means his publisher is going to try to turn this into a series. I wouldn’t read a sequel, though. [According to his publisher’s page on him, Alexander later became the Medical Director for the Orkney Health Board and Associate Medical Director for the Scottish National Telephone Triage service before returning to general practice on the small island of Bute, where he now lives.]

Note: The wonderful title was inspired by the poem “Orkney: This Life” by Andrew Greig.

*For instance, here are two in a row on p. 242 of the Michael O’Mara paperback: “Turning it over with my foot, the eggshell is quite fresh but smashed on one side by a powerful beak. Standing looking at the destroyed dream beside my foot, my thoughts return to the phone call all those weeks ago.” Do you see what’s wrong here? “The eggshell” and “my thoughts” are, absurdly, made the subjects. Instead, the sentences should have Alexander as the subject and read “Turning it over with my foot, [I see that] the eggshell is quite fresh but smashed on one side by a powerful beak. Standing looking at the destroyed dream beside my foot, [I let] my thoughts return to the phone call all those weeks ago.”

[Alyson Million · Rating 5 out of 5]

I was passed this book, in a huge pile, by my neighbour; I started reading the first few pages, not seriously intending to read much more but I knew I was hooked in. I read most of it this evening and highly recommend it. Perhaps being in the middle of yet another, movement constraining lockdown, this book transported me to the Orkney island of Eday. I have walked up hills, along the seashore, felt the wild winds of a great storm and all the while learning about the doctor who took his young family from Glasgow to a completely contrasting way of life. Not my usual genre of choice but a brilliant read - and, it just shows that sometimes you should judge a book by its cover.

[Pernille · Rating 3 out of 5]

An easy, enjoyable read. Like others, I found myself occupied by working out the timing - when was this? - turns out the year he described was in the late 80s. I most enjoyed the descriptions of island life with all its idiosyncrasies, and the challenges of being the sole doctor (vet/pastor) on the island. I didn't necessarily always warm to the author himself.

[Rhiannon · Rating 4 out of 5]

I grew up on Eday, from age 11 to 18. This was more recent than the book was set, so it was fascinating to see the recent history of the island. The description of the location and scenery is spot on , and maybe so vivid because I am intimately familiar with the island, but I really felt very present on the island.
It is a realistic telling of island life. I’d have liked to have felt a bit more connected to characters - so much of a small community is the people. I can understand the author wanting to protect privacy, and can see the difficulty with such a topic, but a bit more connection to people would have made the book feel more real - there was a dreamlike quality to it, sort of fuzzy in places , that more rounded characters would have helped. Ultimately though this is an interesting and realistic memoir that gives some accurate (as far as I can tell, given it’s set twenty years or so before my time) insight into life on the northern Orkney islands.

[Amélie · Rating 2 out of 5]

(2 to 2.5/5)

Won the "uncorrected edition" at a raffle.

Biggest thing to learn from this (although it's something I already knew): correctors and editors are here for a reason, guys. I mean. So many adjectives. Why. And the typos. And the occasional nonsensical sentence. Why would you even publish this version???

Anyways, once you get past the style it was actually an ok book. Not exactly my cup of tea, but not as bad as I'd dreaded. I can also see why some people would like it, it's just... not for me, I guess.

[Sarah · Rating 2 out of 5]

I would have enjoyed more anecdotes about Island life. More about different cases & patients/islanders. I thought if he’d let them tell their stories he wouldn’t have needed to tell us how to feel in order to try and create the atmosphere of their lives. The same with his story. Otherwise interesting read.

[Kinga · Rating 4 out of 5]

This was a very heartwarming book about a live of a doctor and his young family on the island of Eday, which one of the Orkney islands. I really enjoyed reading about how the family settled into the gentle rhythm of the life on the island and how Dr Alexander adjusted to a new way of working.

[Vanya Prodanova · Rating 3 out of 5]

Не познавам някой, който да не се е заигравал с идеята да живее отдалечено от шума и забързаността на големия град. Тази идея има съвсем други измерения, когато става дума за малките северни шотландски острови, които имат странно очарование и малко население.

Книгата е приятна. Наистина показва колко странен, омагьосващ и различен е животът в отдалечените и ненаселени места. Напомня ти как в малки общности и най-вече острови - нещата се движат с различен ритъм, отговорността придобива нов смисъл, общността е истинска, и шокът като си заобиколен отново от много хора - е учудващ. :)

Щях да се насладя повече на книгата ако епизодът с петата бременност и раждане на жена му, ги беше пропуснал, но съм съгласна с него, че езикът, инструментите и процедурите, които се ползват в акушеро-гинекологията са варварски и не са мръднали с много последните 40 години. Мисля, че действието в книгата се развива някъде около 1990-та, което е и въпросителната в книгата - какво е в момента положението на Orkney островите? Не мисля, че е много по-различно, но може би поне интернет да имат хората, знае ли човек.

Книгата е много нежен начин да ни напомни, че никога не спираме, винаги сме на тръни, стресирани и най-малката болежка ни плаши. И в повечето случаи се чудим защо реагираме толкова крайно на най-малкото нещо? Може би защото не живеем животите си така, както бихме искали и ни е страх, че ще умрем, преди да имаме тази възможност? Кой ти знае, но към такива мисли ме отведе книгата. :)

[Jo · Rating 4 out of 5]

Malcolm Alexander was working in a busy Glasgow surgery, becoming slowly disillusioned with medicine when the post of GP to the island of Eday came up. He moved there with his family and found they needed to adapt to a totally different way of life and medicine. This was an interesting medical memoir, as much about island life as about doctoring.

[Tony The Bookmark62 · Rating 4 out of 5]

I enjoyed this book and there are laugh out the moments when the doctor has to also be the vet the vicar and where the grapevine is faster than emails
There are sad moments such as when a patient killed himself but overall very enjoyable

[Helen · Rating 4 out of 5]

Lovely easy read, great descriptions and very evocative of Island life.

[Claire · Rating 4 out of 5]

I can't pin point what it was about this book that I loved. It was a random selection whilst browsing the shelves. I flew through it somehow drawn in by the story of the remote life of the GP and his family. An easy read to start 2023.

[Katie Roper · Rating 4 out of 5]

I really enjoyed this book. Understated but emotional, giving you the details I have never thought about. And a little mention for Carlops ✨

[Johanna · Rating 2 out of 5]

I enjoyed it well enough but it needed more. Verges on sickly sweet at times. All tied up a bit too neatly. Landscape wasn't as much of a Character as I expected. But did cover a lot of the challenges of being a remote and rural GP (a lot of these challenges have not changed in the last 30 years!)

[Tuva Westgaard · Rating 5 out of 5]

Reading this book feels like sitting nestled under a blanket with a cup of tea on a stormy but beautiful Autumn eve

[Sian Powell · Rating 4 out of 5]

4.5 out of 5

[Jane Wilson-Howarth · Rating 3 out of 5]

I have had a bit of a mixed reaction to this book. Very early on when he said he didn't need to talk to his wife as they understood each other so well, I did wonder whether she agreed (and it turned out that their relationship wasn't perfect - whose is??)
I liked the atmospheric descriptions of the landscape and the people but I was expecting a more intimate tale of the islanders rather than of his only family life. Tho to be fair to Dr Alexander he was only looking after 126 people so his clinical encounters must have been few. I was put off rather by learning that while working in Glasgow, he'd grabbed a patient by the lapels and held them up again a door but more than that he believes homeopathy is efficacious. I also didn't realize until well into the book that this describes an experience in 1988 when he and wife and five children lived on the small Orcadian island of Eday, presumably for a fairly brief stint. I wondered whether the health board still funds a GP to look after such a tiny population. An update might have been nice - indeed did he ever go back?
He does have an interest in the island wildlife but do the Scots really call great northern divers loons? That, I thought, was their name on the other side of the Atlantic. He just didn't fill me with confidence he always knows what he's talking about. I would also have liked a better explanation of the title; the book mentions the poem it is taken from but not the relevance.

[Mel · Rating 2 out of 5]

Maybe my rating for this is slightly unfair as I marked it so low for not meeting my expectations. I was hoping for more stories of the people who lived on the island, and a more profound awakening in the author with regards to his medical practice. There was a lot of time spent on island life and how that related to his own childhood. Interesting in it's own way but not what I wanted. I found the obstetric areas frustrating since it's very out of date practice and he looks at it with GP eyes whereas my midwife eyes see things very differently.

[Margaret P · Rating 5 out of 5]

I am so sad to have finished this! I want to read more! I do hope there is more to come from this author or perhaps from another member of his family to tell us what happens next
A great and a highly recommended read

[Steph · Rating 5 out of 5]

Loved this book. So well written you feel you really are with Malcolm and his family on Eday.
Would love to know what happened next so another book would be great!

[Maggie · Rating 2 out of 5]

This is my first read by this author. I was so eager to read it but I found it really boring and overly religious
Very disappointed

[Rebecca · Rating 4 out of 5]

Lovely book, the descriptions of the island, her wildlife & her human inhabitants totally transported me there. And it’s gentle for a medic’s memoir, respectfully telling the islanders’ stories.

[William Fuller · Rating 5 out of 5]

Some time ago, I came across and greatly enjoyed a book by Mary MacLeod entitled Nurse, Come You Here! More True Stories of a Country Nurse on a Scottish Isle so, when I encountered a reference to Close to Where the Heart Gives Out: A Year in the Life of an Orkney Doctor by Malcolm Alexander, I added it to my wish list and have now enjoyed it as well. Both are assuredly five-star reads if one likes out-of-the-ordinary situations in unusual environments. Both books are well composed and draw the reader ever onward from one personal encounter to another until the final page is turned.

Despite both books being personal memoirs of medical practitioners who find themselves facing all sorts of unanticipated situations in remote locations without the support of laboratories, hospitals, specialists, or even ambulances, the books do have their own foci, MacLeod's incorporating somewhat more humor and Alexander's being a bit more philosophical as the reader sees his relationship to Eday Island develop.

Alexander's development encompasses much more than an isolated medical practice, which, by the way, also involves some psychological and unofficial veterinary work. He learns the culture of island society and the particular expectations of the sparse population which he must master in order to be accepted as trustworthy. We come to appreciate his relationship with his wife (also a doctor but not officially practicing) and his four sons. We see his worry as a husband and a father when his wife must be flown to the mainland for a difficult pregnancy, a time when he becomes a relative rather than a physician to a patient. Most of all, though, we see the island of Eday through his eyes and his philosophical acceptance and even his embrace of its rugged isolation and its dire winter storms.

We hear the cry of the shorebirds and smell the blocks of peat burning in the stoves of the crofts scattered about the island. We certainly get a sense of the rough houses in which islanders live (and I'd never heard of flagstone roofs before).

Now, I seem never to be able to leave a book alone without picking a few nits. Alexander did not write this memoir with British colonists in mind, and we who live across the pond from Scotland find some of the terminology just a tad challenging of interpretation although context does give generally adequate clues. There are several references to a “locum,” which turns out to be a British noun meaning a person who stands in temporarily for someone else of the same profession, especially a cleric or doctor. Then, while describing the ancient stones of Eday, Alexander mentions “Viking boat knousts.” and both Internet searches and reference to an unabridged dictionary still leave me a little unsure as to what a knoust may be. A new verb I picked up was “hirple,” as in sheep hirpling behind Alexander as he carries them hay to keep his human patient off his feet for a day. That word does lend itself to an English language dictionary, which shows it as Scottish in origin, and I've indeed done a little hirpling myself without previously knowing the word for it. I know you want me to define it right here, but I had fun looking it up, and who am I to deprive any readers of this review from their own fun?

Britishers would likely not see any of the vocabulary in the book as nits to be picked, but we North Americans might find a few footnoted definitions convenient. Very well, the few vocabulary words that stumped me are very minor nits and possibly not even worth the mention I've given them. There is, however, one pure error in Alexander's observations. While describing the clear black starry nights on Eday, he mentions that he has bought a telescope and has seen the four visible moons around Neptune. I'm rather certain that he means the four Galilean moons of Io, Europa, Ganymede and Callisto, all of which are visible through amateur telescopes around Jupiter but definitely not around Neptune! For that paragraph, the book could have used a proofreader a little more knowledgeable about the solar system.

Despite Alexander's astronomical faux pas, his book is fascinating. Any reader curious to know more about the Orkney Islands and the people who inhabit their rough and wild environment will enjoy the descriptions in this book, and anyone who wonders what life may be like without its usual support structures and mechanisms will find this memoir highly instructive. I'm comfortable giving it the highest praise I can, that it is worth the time expended from one's lifetime in the reading of it

[Andrew Kyle · Rating 4 out of 5]

Orkney is a fantastic place, but that is just one of the reasons i picked up this wildcard non-fiction. I am a massive fan of the way things are worded, and how they sound when spoken and "Close to Where the Heart Gives Out" tickles me pink.

The story is a short summary of a year in the life of a man driven mad by the cityscapes and a desire to escape to the country. I went through this and i moved to the west coast, three hours from Glasgow. Malcolm Alexander chooses a more distant extreme: not just Orkney, but a remote island in the Archipelago.

Its not all sun and roses, unfortunately, with a baby on the way amidst complications and the frankly unforgiving weather that befalls the edge of the world, but alongside that we get to experience, first hand, the welcoming hand of human nature, and the gradual acceptance from the island itself. (we have to assume the island is a character in this story - it has too much of a personality, however unpredictable, for it not to be).

I don't often read non-fictions but this was a wonderful little aside from my usual fare.

[Mur McEwan · Rating 4 out of 5]

This was an interesting account of being a single handed Doctor on Eday, one of the smaller Orkney islands, contrasting with the author's earlier experience of working as a GP in a more atypical GP practice in urban Glasgow. I asked myself several times how long ago all this took place. (I worked it out, pretty accurately, eventually.) I also wondered about questions of patient confidentiality when he sees "X" at X's croft at ..... location. On an island of c 125 people it should not be hard for X to be identified and / or to recognise themself. At the end of the book I still wasn't sure if and how he got round the questions of patient confidentiality. It would be interesting to read an account of a predecessor's lifestyle and pressures from a generation or two back in time from this book; and equally interesting to read an account of a medic currently working in a similar role ~ changes in lifestyles / communications / medications available, and so on.

[Ashley · Rating 3 out of 5]

A 3.5. I picked up this memoir at a bookshop in Edinburgh, intrigued by what the sole doctor on a little Orkney island might have to say. Alexander strikes me as someone very difficult to edit (which his acknowledgments page confirmed), and I sensed a lot of compromises on the part of the editor(s). Some of the writing flows beautifully; other times, metaphors become labored, transitions jolt, and the sentence structure stumbles along rather clunkily. But these writerly whoopsies occur in an endearing sort of way. I would've liked more medical cases and tales of medical creativity in such an extreme locale instead of 3 whole pages devoted to a game with the young sons while Mum is away, but I got a good sense of Eday (the island), what constitutes a real gale, and the interdependence of the wee community.

[Raven · Rating 5 out of 5]

I don’t know what it is with me and these kinds of books but I can’t help but love listening to audiobooks of doctors tales.
This one gave more of a family feel to the life of a doctor as our author had a wife and children and they were a large part of the narration as well how their lives were affected by his work.
It is an interesting perspective as there is less of a focus on the medical cases instead we see a stronger emphasis on how healthcare differs as you don’t really think of the difficulties that living in such a secluded location would bring. Instead he is forced to take on additional roles including trying to be a vet in emergency situations.
Truthfully this book has now made we want to go live on a secluded island in Northern Scotland the life there sounds so calm 😂

[Kayleigh McMillan · Rating 4 out of 5]

An easy to read memoir detailing the early experience of a GP who takes on the tiny island of Eday in the Orkney archipelago. Whilst it lacks some of the granular detail that interests me (how exactly do you fill your time with a population of just 125?), it's an intriguing insight into this unique job and the challenges that come with it, both professionally and personally. I'd have liked to have known exactly which "year in the life" this was, as it was a little hard to place in time (we have pagers and a big old computer), and it might have been nice to have a reflection on how things have changed since this time. In the current fad for memoir by doctors who have had more unique experiences, this one ranks among the ones I've enjoyed more.

[✰matthew✰ · Rating 5 out of 5]

this book was absolutely not what i was expecting but i really enjoyed it.

my expectation was that this book would be roughly half about being a doctor on eday and half about life. we got much more life, as well as a lot of brilliant, atmospheric nature writing than medical non fiction.

personally i loved the beautiful writing on nature and the island of eday, i found this my favourite part of the book. i really loved the descriptions of the island, it’s residents and ways of life.

a few medical patients cases are written about, i found how medicine differs on a small island to be really interesting too.

[Kim · Rating 5 out of 5]

I enjoyed this book. Malcolm Alexander w was an unhappy GP working in a city GP practice. This is his story of settling on the Orkney island of Eday with his wife, four boys and a baby in the way. His story of adapting to an island way of life where everyone knows each other’s business but uses this information to help each other such as when a labourer goes missing. Also how he has to adapt to not just being the doctor but also a preacher and at times a vet!
It is also the story of separation from his wife when her pregnancy means she has to go to the mainland to be looked after.
This was a charming story, ideal for people who like Gervase Phinn or even James Herriot.