Article
Care
Creed
Easter
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1 min read

Understanding the power of blood

From hospitals to hymn books, it's significant for a reason.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A bag of blood connected to a drip.
Give blood.
Aman Chaturvedi on Unsplash.

With one billion molecules of oxygen packed into each of your 30 trillion red blood cells, blood is sometimes known as the red river of life. Countless lives have been saved through blood transfusion, but why, throughout history, across continents and cultures, has there been a special interest in the blood of one man crucified 2,000 years ago, believing it alone to have “wonder-working power”?  

Whether you are a newborn baby with half a pint of blood, or an adult with nearer nine pints, “what is certain is that you are suffused with the stuff”, writes author Bill Bryson in his book, The Body.  

Once thought to ebb and flow in waves like the sea, from the liver to other organs, having been heated in the heart, blood in fact flows in a network of vessels measuring some 60,000 miles, with the heart acting as pump, not heater. Cleverly conserved through a complex system of blood-clotting in the case of injury, blood is a precious resource that needs replacing if lost in large amounts. Victims of road traffic accidents can require up to fifty units of blood; significant amounts are needed for organ transplantation, severe burns or heart surgery. 

The first human blood transfusion in Britain, using blood from a lamb, was performed by Dr Richard Lower in 1667, given not to replace blood loss but to change character: could the old be made young, the shy be made sociable through blood transfusion? Apparently not.  

Safe transfusion awaited the discovery of blood types by Dr Karl Landsteiner in the early 20th century. Today, NHS Blood and Transplant deliver 1.4 million units of red cells to 260 hospitals each year for transfusion; about 85 million units are transfused worldwide, given to replace blood loss after accident, surgery, ulcer, ectopic pregnancy or for anaemia in cancer. Also used to boost blood cell numbers in malaria, sepsis, HIV, leukaemia and sickle cell anaemia, blood transfusion is now amazingly safe. Fatal reactions are extremely rare, “occurring only in one out of nearly two million transfusions”, writes physician Dr Seth Lotterman. “For comparison, the lifetime odds of dying from a lightning strike are about 1 in 161,000,” he adds. The risk of HIV infection has dropped dramatically, to less than one in seven million. 

History tells though of the danger of transmitting disease from the blood donor during transfusion. The World Health Organization recognises risk of infection with HIV, hepatitis, syphilis, malaria, and Chagas disease. The Contaminated Blood Scandal saw an estimated 30,000 people in the UK given blood transfusions and blood products infected with hepatitis C, hepatitis B and HIV. More than 3,000 people died as a result, and thousands more live with on-going health complications. For my final Christmas article for Readers Digest, I wrote on Stephen Christmas, a tireless campaigner for blood safety who lived with haemophilia and died in 1993, having contracted HIV through contaminated blood. 

I was a blood donor. However, I am now unable to donate blood or organs for the rest of my life since there is a possibility that my blood is ‘stained’, possibly with prion disease, after adopting embryos. The Blood Transfusion Service will not accept donations from women who have had various fertility treatments. 

And there’s another uncomfortable truth about blood donation – the NHS does not have enough blood, organs, tissues, platelets, plasma or stem cells to treat everyone who needs it. As a nurse, I remember caring for a man dying of liver cancer. Suffering from sudden, massive melaena (blood loss in black, tarry stools as a result of internal bleeding), he received emergency blood transfusion, with bag after bag of blood being infused, until the consultant called for the treatment to stop, because the bleed was too big – and blood supplies too scarce.  

Struggling to accept the stark reality of stained blood and dangerous shortages, I kept coming back to an old Sunday School song about blood, where absolute abundance and ultimate cleansing are instead promised. 

There is a fountain filled with blood 
   Drawn from Immanuel’s veins; 
And sinners, plunged beneath that flood, 
   Lose all their guilty stains. 

Gruesome and graphic in its imagery, but full of deeper meaning. And as a nurse, I’m accustomed to blood, sometimes lots of it. I’ve seen that man bleed out on the ward that night; I’ve attended a road accident, where a boy lost his leg – but not his life, because towels stemmed the massive flow of blood. I’ve raced a patient to the operating theatre after her aortic aneurysm burst within; I’ve stemmed arterial bleeding from the groin by applying prolonged pressure to the site punctured by a catheter during cardiac stenting. According to the World Health Organization, severe bleeding after childbirth is the leading cause of maternal mortality world-wide. Each year, about 14 million women experience postpartum haemorrhage resulting in about 70,000 maternal deaths globally.  

In the Bible, and in hymns of praise like this one, there is also no getting away from blood. “Like it or not, the Bible is a bloody book,” writes  Kyle Winkler. It runs through the book like a crimson thread. There’s a story of a woman bleeding for twelve years, until she touched the hem of Jesus’ garment and was healed.    

Elsewhere the Bible keeps returning to the idea of blood, shed in sacrifice, used to cleanse, save, and heal in a spiritual sense. In the Old Testament, animal blood was painted on doorposts at Passover as a sign of protection from judgment, and sprinkled ritually on the altar as a sacrifice for human sin, restoring relationship with God.  

On Good Friday, Jesus himself shed (and sweat) his blood, sacrificing his life on the cross to “wash our souls” once and for all. Millions of Christians across the world take a sip of communion wine each Sunday in commemoration of this act. It’s a beautiful gift, coming with a promise that the shed blood will “preserve thy body and soul unto everlasting life”, through the forgiveness of sins. It’s no wonder then that churches love to sing about this blood. “Would you be free from the burden of sin? There's pow'r in the blood, pow'r in the blood,” goes one hymn, while another simply says, “Your blood has washed away my sin, Jesus, thank you”.  

“God’s intention for blood isn’t gory—it’s beautiful! And I’m certainly not offended or scared by it,” writes Kyle. “Rather than question how little blood I can get by with, I’d rather stand under the cross to be covered in all that I can get!” Thank God for the fountain of forgiveness that flows from Good Friday. 

  

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Review
Culture
Film & TV
Trauma
5 min read

This bad TV version of The Last of Us ruins much more than storytelling

Following up the acclaimed video game doesn't deliver prestige viewing.
A pensive looking woman glances to the side.
Ellie, played by Bella Ramsey.
HBO.

What’s the point of the TV adaptation of The Last of Us

Throughout its second series, I’ve been trying to wrap my head around this question. I’m still short of an answer. 

Turning the two The Last of Us video games into prestige TV was always going to be problematic, because those video games already were prestige TV. You just had to press buttons on a controller now and then.  

The first The Last of Us video game is regularly included in lists of the best video games ever, and it’s not because of any ground-breaking gameplay or because of any technological advancements it made. It’s because of its story.  

It is richly character-focussed, gritty, realistic, and utterly human. The Last of Us Part I (as it’s now known) carries the kind of gravitas and emotional complexity you might expect from the likes of The Sopranos, Breaking Bad, Chernobyl, or The West Wing. It’s already prestige TV.  

So, is the TV adaptation simply an attempt to make this same story accessible to people who don’t play video games? Maybe. That would make sense, were it not for its deeply frustrating second series, the finale of which has just aired. 

The Last of Us Part II was massively controversial when it released in 2020. (WARNING: absolutely colossal spoilers ahead, for both the games and the TV show). Joel – the main protagonist of the first game – is abruptly and brutally murdered in its opening act. This leads Ellie – his pseudo-surrogate-daughter – to hunt down those responsible in attempt to enact a reckoning.  

In the video game, most of the story is told over the course of three days. First, from Ellie’s perspective, then from the perspective of Abby, Joel’s killer. In the TV show, the second series covers Ellie’s side of the story before very abruptly shifting to Abby’s side in the final seconds, leaving the viewers with a cliffhanger. Even as someone who’s played the game and knows what’s going to happen, it felt like a bit of a slap in the face. 

But for someone who hasn’t played the games it must be bordering on nonsensical. Even spread over two series, the story is so truncated, and so much is left unsaid. I can’t imagine making sense of this series without having played the video game first. But the TV show is basically just a live action remake of the game. Which again begs the question: what’s the point of the TV adaptation of The Last of Us

I’ve found this series, and the video game it’s based off, hugely frustrating. Because it’s trying to convey an important message. But both the game and the show contrive to undermine their important central ideas through poor storytelling techniques and structures.  

But in making clear what was left unsaid in the game, the power of the moment is undercut. Much is spoken; little is said. 

Let’s take one example. Half-way through the game (or towards the end of series 2), Ellie has tracked down and tortured one of Abby’s friends for information on her whereabouts. Afterwards, she talks to her lover Dina about what happened.  

In the game, it’s harrowing. Ellie is visibly shaken by what she’s just witnessed herself do. “I made her talk.” She says. And then to Dina: “I don’t want to lose you.” “Good,” comes Dina’s reply. And that’s it. Cut to black. Little is spoken; much is said.  

But where the scenes last about 30 seconds in the game, in the TV show it’s over five minutes long. “I made her talk. I thought it would be harder to do, but it wasn’t. It was easy. I just kept hurting her.” So says Ellie, halfway through the conversation. The writers are clearly trying to make explicit Ellie’s fear that she’s losing herself, and Dina by extension, in her thirst for revenge. But in making clear what was left unsaid in the game, the power of the moment is undercut. Much is spoken; little is said. 

“I know writers who use subtext and they’re all cowards,” Garth Marenghi once said. I can only assume he writes for HBO now. 

It’s a shame the scene gets fluffed as badly as it does, because really it’s the centrepiece of the narrative. Faced with unthinkable violence, Ellie chooses to repay the act in kind. But, in hunting down and torturing those responsible, ultimately Ellie finds herself becoming less and less human with each act of revenge. Here, in this conversation with Dina, Ellie begins to glimpse the reality of this. That acts of violence towards others are ultimately also acts of violence towards her own nature.  

This is, as it turns out, a deeply Christian notion. Where other Ancient Near Eastern creation myths depict their gods as creating the world through violent and bloody struggle, in Genesis God merely speaks life into being. Where Jesus’ disciples would violently overthrow their Roman oppressors, he instead says “those who live by the sword, die by the sword.”  

Moreover, Jesus’ death by crucifixion was unspeakably cruel and violent, encompassing protracted public humiliation, sexual abuse, and mutilation. It is here that Christ draws the suffering of the world to himself, that we might be given the opportunity to live free from the ongoing cycle of violence that surrounds us. Not that we might avoid having violence done to us, but that we might find the strength not to be violent in turn.  

And this is the ultimate paradox at the centre of Christianity: that the greatest show of strength the world has ever seen is found in Christ’s being nailed to a tree.  

Violence begets violence begets violence begets violence. That’s the message of The Last of Us Part II; albeit one conveyed in a rather ham-fisted way. While I’m not optimistic, I hope the next series of the TV show manages to fix the game’s wobbly narrative structure to convey this in a way that is nuanced and compelling. Because it’s a message we desperately need to hear. 

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