These days, it is fairly commonplace for reviewers and interviewers to emphasise a writer’s ‘other’ experiences or work as a source of their material, their insight and sensitivity, or their intellect. Their authority to speak on a particular subject is often tied, not to the vividness of their imagination, but to experience. Perhaps this has always been the case, but it seems that the memoir boom of the 90s, and its long slow aftershocks, have had a strong influence on the way reviewers, interviewers, and perhaps readers, approach works of fiction and non-fiction. It is no longer enough to be (just) a writer: one must be a postman-writer, a teacher-writer, a doctor-writer.
One of the most reviewed collections of short stories to be released in Australia last year was Karen Hitchcock’s Little White Slips. Karen Hitchcock is a senior medical registrar at the John Hunter Hospital in Newcastle, and a PhD candidate in English/Creative Arts. She is also the mother of twins, and competes in triathlons. Almost every review that I read of Dr Hitchcock’s book mentioned her medical career and tied her work as a doctor to both her intellectual status and the notion of the good doctor as extraordinary for being able to manage a medical career, postgraduate study, a family, and writing. Reviews frequently cited other doctor-writers (or writer-doctors), and spoke about the particular qualities of empathy, insight, or intelligence that medical practitioners bring to their writing. Many reviews reflected the almost-mythical status that we still accord doctors in our culture: the fear and admiration, awe and terror with which we regard those who work most intimately with the body and its diseases, who know its cavities and flows, its frailties, its potential for recovery, and for failure. Who have the power to heal or harm, who stand at the portals of both life and death.
It is hardly surprising that those who, professionally, are perhaps most intimate with humanity’s frailties and failings, as well as our strengths and possibilities, are also credited with the potential to provide readers with insights into the mystery of being human. For a long time, doctors have been culturally understood as an elevated species – monster-Gods hovering on the borders of humanity, looking in. They are individuals with a unique perspective on the condition of being human. In the famous, satirical novel about medical interns, The House of God, the Fat Man teaches his medical students that "Gomers [patients: an acronym for Get Out of My Emergency Room] are human beings who have lost what goes into being human beings. They want to die, and we will not let them." Doctors, in other words, are charged with helping patients to recover and maintain their humanity. A description that might also – in a more romantic, less practical sense – be applied to writers.
The Pen and the Stethoscope is a collection of short works of both fiction and non-fiction written by doctor-writers. As such, it assumes, or perhaps opens up an exploration of the possibility, that writers who are also doctors offer a unique and particular perspective. The works have been selected by Leah Kaminsky, herself a practicing family physician and writer whose book of poetry – Stitching Things Together – was recently published by Interactive Press. The selections are diverse and engaging, each offering a different perspective and style, though each is strongly narrative – more akin to Creative NonFiction than papers from a medical journal.
The works are all by American and Australian medicos and focus largely on contemporary medical practice, with the notable exception of the extract from Robert Jay Lifton’s The Nazi Doctors: medical killing and the psychology of genocide.
The book is presented in two parts: the first including nine works of non-fiction, and the second six works of fiction, including one by the editor, Kaminsky.
The non-fiction essays and extracts are each fascinating insights into the practice of various aspects of medicine. Atul Gawande’s opening piece ‘The Checklist’ is a short, sharp and engaging story about the incredible improvements in patient outcomes that can – and sometimes are – being achieved through the use of the humble checklist. The piece is concise and gobsmacking, exploring both the awful simplicity of Gawande’s work, and the complex resistance to it. His non-fiction book of the same title tells the same story, in far more detail. For my money, this essay gets it done faster, and more clearly.
Danielle Ofri’s piece ‘Intensive Care’ tells the story of her work as an Emergency Room intern under the challenging tutelage of Dr Sitkin. Like the best of the works in this collection, this piece explores the underlying humanity behind the interactions between patients and doctors, as well as the strong drag of the impulse towards dehumanisation. Dr Sitkin is perhaps typical of the kind of doctors patients most fear encountering: the kind of man who strides past patients in various states of pain and disarray: patients with metastatic oesophageal cancer, metastatic lung cancer, renal failure, liver failure, declaring them “Dead. Dead. Dead. Why are we wasting our time even talking?” And yet, by then end of her essay, Ofri convinces us of his humanity, and perhaps of the necessity of his cool approach.
If there is a consistent emphasis in this collection, it is on the humanity of medical practitioners. The terrible cost of dealing so intimately and constantly with the body at its most debased and debilitated. The necessity for distance, coolness, the long view. The essential humanity, kindness and good intentions of the doctors into whose hands we will all thrust ourselves – willingly or unwillingly – several times during our lives. In her introduction, Kaminsky talks about suffering ‘Tunnel Vision of the Soul’: a condition in which, after six years as a medical student, she emerged “almost totally desensitised to human pain and suffering”. The cure, for Kaminsky, lay at least partly in literature – in both reading and writing – as a way to recover her appreciation for seeing her patients as human beings. In some sense, the non-fiction in this collection inverts those lessons: allowing readers – potential patients – to see their physicians as humans.
Some Famous Writer/Doctors
Jacob M Appel
Arthur Conan Doyle
Oliver Wendell Holmes, Sr.
William Carlos Williams
Adeline Yen Mah
The exceptions are Oliver Sacks’ piece – typical of Sacks in its ability to humanise both doctor and patient – and the compressed extract from Lifton’s work on the Nazi doctors, which examines “the transformation of the physician – of the medical enterprise iself – from healer to killer.” The piece is heart-wrenching; a deeply personal lifting out from Lifton’s book of those sections dealing with the ways in which he came to write his story, and how the research and writing of it affected him. The edited extract focuses on his wrangling with the moral questions thrown up by his examination of Nazi doctors: how, as a Jewish man, to enter into the world of those doctors in order to attempt to understand what they did. As he writes in the afterword: “The logic of my position was clear: only a measure of empathy, however reservedly offered, could help one grasp the psychological components of the anti-empathetic evil in which many of these Nazi doctors had engaged.” This piece is difficult to read – but necessary. I am grateful for having read it, and for being directed towards the larger work from which it is culled, and for the extraordinary work of its author in entering into the world of the ordinary men – the ordinary beasts – who were responsible for so much horror.
The second part of the book includes six works of fiction, by Ethan Canin, Nick Earls, Peter Goldsworthy, Jacinta Halloran, Leah Kaminsky and John Murray. Fiction, with its emphasis on the intimate, personal and subjective, is notably quieter and subtler in its dealing with the moral problems of the doctor-patient relationship. It is, perhaps, surprising that after reading the collection, I was distinctively impressed by the fact that a great deal of the drama and melodrama was located in the non-fiction, rather than the fiction. Non-fiction, perhaps, can more easily accommodate the emotional ballast of heightened drama, while fiction – or, at least, the kind of modest literary fiction presented here – is more concerned with subtlety, delicacy of emotion and action, with small insights, modest failures, with a more human and individual dimension of experience.
If the non-fiction in this collection largely emphasises the humanity (and empathy) of medical practitioners, and the facts and figures of medical practice and research, then the fiction is its mirror twin, focusing on the experiential domain of the patient, and on the grey area between life and death, sickness and health. Of course, not all the pieces are as moribund as this description implies. Peter Goldsworthy’s piece is notable for its comic depiction of a doctor dealing with the death of another passenger on his flight, and Nick Earls’ ‘Dog 1, Dog 2’ is a playful black comedy about the process of dehumanisation. Works such as Ethan Canin’s ‘We Are Nighttime Travellers’ and John Murray’s ‘Communion’, however, are more intimate in nature, quieter, more circumspect examinations of character rather than incident.
This collection of diverse works is a fascinating read: well worth dipping in and out of, celebrating and fleshing out the diverse but strangely cohesive perspective on humanity that emerges out of the works of writers who are also doctors.
n a bourke is the author of The Bone Flute, The True Green of Hope and What The Sky Knows (illustrated by Stella Danalis). She blogs - irregularly - at Lost for Words.
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