Doctor, doctor


One of the things that has always appealed to me about narrative journalism is how well it can open up for better understanding institutions of power and accepted, often ingrained, ways of thinking about our world. For me, some of the best examples of non-fiction that do just that are the following works on the world of medicine:

Mrs Kelly’s Monster by Jon Franklin (The Baltimore Sun, 1978) is about a brain surgeon fighting to save his patient from the clot on her brain during what amounts to about a five hour procedure. From the get-go, Franklin shows how nervous the skilled surgeon is about what he has to do for the long-suffering Mrs Kelly, while the time descriptions and the electronic beat of the heart rate monitor underscore both the danger of the procedure and the height of the very real tension in the operating theatre.

Franklin’s masterful descriptions and insights helped demystify not just one of the most revered and heavy duty medical procedures, but what was really going on behind the surgeon’s mask. It’s no wonder this article remains one of the first pieces that most students of narrative journalism read.

It’s a classic example of how deep immersion and the psychological interview can help journalists delve behind the armour of scientific authority and show the inner world of the expert.

Dr. Ducker now begins following the Circle of Willis back into the brain, toward the second, and more difficult, aneurysm that swells at the very rear of the Circle, tight against the most sensitive and primitive structure in the head, the brainstem. The brainstem controls vital processes, including breathing and heartbeat.

The going becomes steadily more difficult and bloody. Millimeter, millimeter after treacherous millimeter the tweezers burrow a tunnel through Mrs. Kelly’s mind. Blood flows, the tweezers buzz, the suction slurps. Push and probe. Cauterize. Suction. Push and probe. More blood. Then the tweezers lie quiet.

“I don’t recognize anything,” the surgeon says. He pushes further and quickly finds a landmark.

Then, exhausted, Dr. Ducker disengages himself, backs away, sits down on a stool and stares straight ahead for a long moment. The brainstem is close, close.

“This is a frightening place to be,” whispers the doctor.

In the background the heart monitor goes pop, pop, pop, 70 beats a minute, steady. The smell of ozone and burnt flesh hangs thick in the air. It is 11:05 a.m., the day of the monster.

Mark Kramer’s book length exploration of the world of medicine in  “Invasive Procedures”, (Harper & Rowe, 1983) took a different tack.  Kramer who had felt that having a surgical procedure had altered his life in some way, was, he says at the start,  interested in who surgeons are because they are imbued with so much power.

To find out, Kramer follows his subjects around medical conferences, observes them in social settings with their colleagues and families, examines their childhood experiences, sits in during consultations and watches them during surgery.

He questions among other things, how these doctors insulate themselves against the daily suffering of their patients and the impact of their work on them – after all, it is a role where expectations of a certain level of empathy is the norm.

But how some treat their patients is hard to take. “This is veterinary medicine”, one surgeon says in the operating theatre in front of a nurse and a not-quite-under patient, a grandmother whose obese frame makes the procedure a challenge. Surgery on her the doctor has earlier said would be “like flaying a whale.”

Kramer’s approach reveals what makes the surgeons in his book so extraordinary and at the same time, so very ordinary.

He strides across the waiting room without looking up, heading for the safety of the offices that lie beyond the receptionists desk, his gray tweed sports jacket flapping around him. That is the way most people see their doctors. No one present has trouble recognising him. Many patients seek eye contact, but the surgeon has gone shy, like a waitress who won’t even glance at her charges for fear of being sent off for a glass of ice water

For some people, their level of dependency on their doctors, means they begin to see them in another vein, even think of them in the same way they’d think of the “Pope” Kramer writes. Being a surgeon, he adds “has got to be as wearing as being beautiful, and even more likely to tempt with prospects of power, because there’s more to be had and for longer.”

Kramer’s work is a reminder of how, in a time where we defer everything to scientific expertise, that kind of authority can dominate, usually to the exclusion of everything else. His prodding is necessary. What is the calibre – beyond their expert knowledge – of the people whose hands we place our lives in.

This brings me to The Empathy Exams, by Leslie Jamison (2014) in which Jamison makes pocket money by moonlighting at the local university where she helps out in the assessment of final year medical students. She is one of several actors who have to act out a script in which they have some or other ailment and evaluate how the med student responds.

This is an incredible essay that makes you catch your breath at times. However it goes a great many places and while it obviously illuminates the nature of people who make life and death decisions about us, its central tenor is the nature of empathy itself – something I plan to explore further down the track in this blog.

Once the fifteen-minute encounter has finished, the student leaves the room and I fill out an evaluation. The first part is a checklist: which crucial pieces of information did he/she manage to elicit? The second part of the evaluation covers affect. Checklist item 31 is generally acknowledged as the most important category: ‘Voiced empathy for my situation/problem.’ We are instructed about the importance of this first word, voiced. It’s not enough for someone to have a sympathetic manner or use a caring tone of voice. The students have to say the right words to get credit for compassion.

Other students are all business. They rattle through the clinical checklist for depression like a list of things they need to get at the grocery store: sleep disturbances, changes in appetite, decreased concentration. Some of them get irritated when I obey my script and refuse to make eye contact. They take my averted eyes as a challenge. They never stop seeking my gaze. Wrestling me into eye contact is the way they maintain power – forcing me to acknowledge their requisite display of care.

I grow accustomed to comments that feel aggressive in their formulaic insistence: that must really be hard [to have a dying baby], that must really be hard [to be afraid you’ll have another seizure in the middle of the grocery store], that must really be hard [to carry in your uterus the bacterial evidence of cheating on your husband]. Why not say, I couldn’t even imagine?

Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They don’t want to presume.

Some doctors are for want of a better word, heroes. The doctors and nurses who in the last year took a stand for the well-being of refugee children in detention and the medics  who stay behind when everyone else withdraws from conflict zones, surely embody this.

So, does the one in the next and final article of my post, The Doctor by James Verini (Atavist, 2014).

This is quite a call to make among all the amazing pieces I’ve listed here, but Verini’s piece is my personal favourite – quite simply because his descriptions of the world in which this particularly doctor operates is so finely tuned, I can almost taste it. I’m biased, yes, but I don’t think you need to have spent time in parts of Africa to appreciate how well he has done this.

He asks what indeed would make anyone in so lofty a profession who could go anywhere and have anything, stay in a place like Nuba under circumstances of war.

The prospect of being able to run full tilt towards humanity, I think.

A few days before Mubarak arrived, Catena, who is the only trained surgeon in Nuba, was examining new patients at the intake clinic. A crowd of several dozen sat outside, fanning themselves with their intake cards. (Temperatures in the dry season can reach 120 degrees.) The women, many of them pregnant, wore colorful wraps, the men cheap suit slacks and secondhand T-shirts.

Inside, an examination table, a desk piled with outdated medical journals, and a wooden crucifix left barely enough room for Catena to stand. He had on bronze-frame eyeglasses with large lenses and was wearing scrubs and green Crocs sandals. At 51, Catena owns one pair of non-scrub pants, which he puts on once every other year, when he leaves the hospital to visit the United States. After moving to Nuba, seven years ago, he came to the realization that he needn’t wear socks. This was, he confided to me,an unbelievable moment of clarity.”

I think many people might agree Verini’s work is incredible. His writing has always managed to convey a multiplicity of things: of cultures where celebrations happen even under duress, where as respected as some aspects of western approaches are, it is not the only way for people tired of the way the global north has traditionally treated them.

In the last few weeks I learned about The Nurses by Alexandra Robbins which explores the much overlooked pressure cooker world of nursing. Unfortunately I don’t have a copy yet but I’m looking forward to reading it.

I hope you enjoyed the reads I put up here and hopefully you’ll be inspired to look for copies of the ones not fully accessible on the internet. They’re well worth it.

My next post will look at creative non-fiction pieces on, quite simply, writing. Good writing, bad writing, poetry – and its effects.

In the mean time, however, thanks for stopping by.