Many doctors over the past two centuries have felt moved to write about their profession, and when I first picked up this book and looked at the list of authors on the cover I felt that rather too many of the usual suspects were being wheeled out—Bulgakov, Chekov, Conan Doyle and (a smothered groan) A J Cronin, a practitioner whose sentimental puritanism now seems irretrievably stuck in the interwar era which greeted him with acclaim. But Helman includes some other less classic names, especially from our own time and from the patients' side, and the subject is such a rich one that I would be surprised if any reader, medical or lay, did not find something here which conveys a new insight or a cause to ponder. Ruth Picardie, the young journalist who died of breast cancer four years ago, writing columns for the Observer as she did so, became in her last months a deservedly wellknown voice. But just as worthy of attention is her near-contemporary Rachel Clarke, whose A Long Walk Home was published after her death at 28 from a rare cancer of the nasal sinuses (rhabdomyosarcoma). It has become an obituarist's cliche to label such an odyssey ‘putting up a brave fight’: in fact Rachel's fight, as documented in the section included here, was initially to get the doctors to tell her what was really wrong with her. She was talked at by an evasive consultant who apparently did not want to spell it out, and then by his registrar who assumed in an off-hand way that she already knew—and this, let us note, was as recently as the mid-1990s. Similarly, Clive Sinclair (the writer, not the inventor), a casualty of polycystic kidneys, though properly grateful for a year's dialysis followed by a transplant in 1995, would have liked it if the medical staff in the unit had talked to him rather than across him—‘In their eyes I am not a man, I am a patient. As such I am required to be good-humoured, stoical, dependent, and sexless.’ This may sound like a standard complaint in the Can't-doctors-be-better-trained-in-human-relations? department, but actually it may be something different which modern medicine has made much worse. Cronin and the dynasties of doctors standing behind him, back to the days of the barber-surgeons, may have been patronising and accustomed to talking to patients with little education, but at least they knew that in the midst of life we are in death and that we all go there in the end. It is your present-day practitioner who, instead of helping his patient to get on terms with this fact, is all too likely to camouflage the reality by wittering on about further treatments, possible operations and—that last resort of the craven—going in for more tests. Thus: ‘... instead of the threatening feeling of a fate that will unfold over an indefinite period of time, a structured and fixed timetable of referrals and interventions is established... With this treatment schedule, thoughts of death are postponed time and again.’ This explicit statement of bad faith is quoted from another source by Renate Rubinstein, a Dutch journalist, and she also gives it a name: apparently it is called ‘the system of hope’. I am interested to be told that what I had hitherto supposed to be merely a by-product of medical ineptitude is a deliberate policy, and I would value this little book for this revelation on its own—but I am much disconcerted by the fact that Rubinstein herself seems half to approve of this patient-fooling. Perhaps multiple sclerosis (of which she has subsequently died) has that effect on the mind? Mortality is indeed the constant, background, understated theme of this anthology. Somerset Maugham, who trained and practised briefly as a doctor at the end of the nineteenth century, gets to the heart of the matter with his story Sanatorium (reprinted here), in which it becomes clear that the moral challenge is not to keep patients ‘optimistic’ but to encourage them to accept their fate in the most positive way. I could wish the book were longer, the selection of pieces larger, and the editorial presence rather less—a substantial Introduction and another chapter of his own is Helman-overload. But I applaud him for an energetic attempt on a multiform subject of great importance.
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Mar 1, 2008
S M Kermanshahi + 4
Open Access
