Hush, Hush/Headscratchers


 * Okay, someone needs to enlighten me: What the hell is going on with Nora's anemia? It's specifically the kind of anemia that is the result of an iron deficiency. And I'm going to say right now that the way it's presented confuses the hell out of me and makes no sense at all.

Speaking as someone who has severe iron-deficiency anemia, and who takes very strong iron supplements on a daily basis to make up for my deficiency, I have no idea where Fitzpatrick is getting her ideas on how anemia is treated. Popping iron pills to combat a sudden (or anticipated) "anemia" attack isn't like taking, say, a lorazepam to deal with or prevent an anxiety attack. Iron supplements do not work that way. They don't kick in within twenty minutes or so to up someone's iron levels when said iron levels have apparently inexplicably (and impossibly) plummeted, which is the only reason I can assume for Nora's sudden attacks of OH GOD I CAN'T BREATHE. I have severe generalised anxiety and anemia, and I've never experienced anything like what Nora describes in the book. Not even when in the middle of a full-blown panic attack, which, in my case, includes hyperventilating. I also have a deviated septum, which means that I can barely breathe through my nose. So far I have managed to avoid having my anemia launch a potentially deadly assault on my ability to suck in sufficient amounts of oxygen.

Of course, that's not to say that my personal experience is in any way the set standard for people with anemia, but that also doesn't mean that my personal experience is all I know.

When Nora's anxious or upset, her immediate reaction is to say that she "need[s] [her] iron pills." Why? What are they going to do for her? She feels sick and dizzy, and oxygen deprived. How are iron pills going to help that on short notice? Short answer: They're not.

She also never experiences any other symptoms of anemia, ever. No mention of restless leg syndrome -- unless you attribute some of the weird physical sensations she experiences when Patch is around to manifestations of RLS -- or pica Definitely no mention of jaundice, or swelling of the limbs, or random ugly and discoloured bruises that show up for no apparent reason and refuse to heal within a reasonable amount of time. Hell, she doesn't even experience fatigue. Essentially, Nora suffers from none of the "unattractive" symptoms of severe (or even mild or moderate) anemia. Just dyspnea.

Which is not to say that anyone suffering from anemia has to experience every symptom ever, or that it's impossible for dyspnea to be the only symptom, but it seems very telling that it's Nora's only real problem when her anemia is apparently so bad that she needs to inhale enough iron pills to constipate an elephant. And on that note, it's never brought up what kind of effect taking iron supplements like that can have on the body. You can't take those things like candy. Tossing back iron pills the way Nora does is not healthy, and any pharmacist with half a brain will tell you that. She also never monitors her Vitamin C intake, or even mentions it. All Fitzpatrick had to do was include a single line about drinking orange juice to down the pills. But Nora just chokes down those iron pills like they're the sole antidote to a deadly poison.

Speaking of antidotes, we're given this line: "The anemia wasn't life threatening ... as long as I took regular doses of iron."

Really? Really, Fitzpatrick? Anemia can be life-threatening, but nothing Nora says or feels indicates that her anemia is, unless nearly dying of fucking oxygen deprivation counts, and that is not going to happen with anemia unless you are way beyond the help of any pitiful little iron supplement. I seriously, seriously doubt that it would happen even then, because there are a whole slew of other problems that would come first. I'm not even convinced that anemia can cause that severe of a reaction on its own. Or at all.

It's as if Fitzpatrick did a Google search to find something that would make Nora appear weak and vulnerable that wasn't klutziness, hit on anemia, and didn't bother to do any further research than that. In short, I am calling bullshit on this "Nora is anemic" business. Nora clearly has some kind of physical health problem, but it's not anemia that's causing her so much trouble.

Which is not to say that anyone suffering from anemia has to experience every symptom ever, or that it's impossible for dyspnea to be the only symptom, but it seems very telling that it's Nora's only real problem when her anemia is apparently so bad that she needs to inhale enough iron pills to constipate an elephant. And on that note, it's never brought up what kind of effect taking iron supplements like that can have on the body. You can't take those things like candy. Tossing back iron pills the way Nora does is not healthy, and any pharmacist with half a brain will tell you that. She also never monitors her Vitamin C intake, or even mentions it. All Fitzpatrick had to do was include a single line about drinking orange juice to down the pills. But Nora just chokes down those iron pills like they're the sole antidote to a deadly poison.

Speaking of antidotes, we're given this line: "The anemia wasn't life threatening ... as long as I took regular doses of iron."

Really? Really, Fitzpatrick? Anemia can be life-threatening, but nothing Nora says or feels indicates that her anemia is, unless nearly dying of fucking oxygen deprivation counts, and that is not going to happen with anemia unless you are way beyond the help of any pitiful little iron supplement. I seriously, seriously doubt that it would happen even then, because there are a whole slew of other problems that would come first. I'm not even convinced that anemia can cause that severe of a reaction on its own. Or at all.

It's as if Fitzpatrick did a Google search to find something that would make Nora appear weak and vulnerable that wasn't klutziness, hit on anemia, and didn't bother to do any further research than that. In short, I am calling bullshit on this "Nora is anemic" business. Nora clearly has some kind of physical health problem, but it's not anemia that's causing her so much trouble. I'm still disappointed in the publishing industry as a whole, though, as well as in Fitzpatrick as a writer. This isn't some random, obscure knowledge you'd have to contact an expert about. This is something you could go online and ask any relevant forum about. But seriously, all it would have taken is a trip to the nearest drug store to ask a pharmacist about anemia (they should at least be able to tell you the basics, for God's sake) and what iron pills do. Writers have a responsibility to know what the hell they're talking about if they're going to present their material to a wide audience and expect people to pay for it, and it's negligent to just shrug and figure it's too much effort to find out the facts. At least mention that you've done no research whatsoever. It's just frustrating. It's not like I'm someone with a Ph.D in the history of the Middle Ages bitching about how she screwed up on whether or not lace was popular on expensive Italian garments in a book set during the Renaissance. This is basic stuff. She could have at least checked that she had her facts right considering she clearly has no personal experience with this kind of thing.
 * Seems to just be a case of Did Not Do the Research, especially considering that Nora's anemia only seems to kick in when it's convenient to the plot, and all but is forgotten by Crescendo.
 * It just amazes me that no one caught this before the book was published. Isn't that what editors are for? I also did a search in the Crescendo e-book, and her iron pills are mentioned once. That's it. I did a search for "anemia" and "anemic", and nothing came up. I did a search for "iron", just for good measure, and... nothing but the aforementioned line about iron pills. So it's definitely a health defect of convenience.