Extreme medicine

[Published in current issue of the IHCA magazine, Scope]

As if medical students don’t have enough to be getting on with, I inveigled a few of them to join me and a couple of doctor friends to go to a Russian-made film entitled Morphia, screened in the Light House cinema as part of the Dublin Film Festival. We had used the book upon which the film is based as a text in class a few weeks earlier, so the chance to see a screen adaptation was a happy coincidence.

The students are participating in a programme developed by the School of Medicine, Trinity College Dublin to give first-year medical students the chance to do a six-week long arts & humanities module alongside all their traditional medical science subjects. For the module, they get to choose from a range of options including creative writing, perception, philosophy, ethics, advocacy and history.

In the literature module, we read two texts or extracts every week with some medical angle or other, hear a brief presentation on each from one of the students and then discuss the portrayals of illness, doctors or patients in the texts. It seems to be going very well and I’m getting the sense that the students are going to benefit from this earlier-than-normal exposure through literature to some key issues in the practice of medicine. There’s quite a bit of reading involved, though, so fair play to the ones from the group who on top of all that chose to come along to the cinema as well.

I had warned them that the Film Festival programme suggested bringing along a sick-back for Morphia. This is an adaption of a rather bleak collection of autobiographical stories by the Russian doctor and writer, Mikhail Bulgakov. Set during World War I and the Bolshevik Revolution, the movie tells a story of a just-qualified doctor, Mikhail Alexeivitch Polyakov, who is sent out back-of-beyond to run a small, rural medical facility. While the centre itself is well run and well stocked, the life the young doctor is thrown into is very challenging: adjusting to rural ways of doing things and the people, living up to patients’ and colleagues’ expectations, awkward cases and difficult patients, long hours and no social life.

Polyakov quickly adopts morphine as a way of coping and isn’t long becoming an addict. The movie traces his Train Spotting-like decline from promising young doctor open to the social changes that the revolution promises (“Don’t call me Sir. Call me Doctor, or Alexeivitch Polyakov.”) to a down-and-out criminal casually dismissing all humanity about him in the service of his addiction. This personal story parallels the social disintegration of the times, and the film explores how private weakness can have profound and public impact on those around us. The film’s shocking final scene, set with obvious intent in a crowded cinema, is given additional impact by having the credits roll without the usual soundtrack to help relieve the tension.

To say the style of the film is gritty realism is to understate the case. The graphic nature of the medical scenes, of the doctor’s physical symptoms as he abuses, and of the lives of the people, make US medical dramas seem positively Fisher Price by comparison. “Beyond gratuitous at times,” was how Kerri, one of the medical students I was with, put it.

The Bulgakov original text is a “standard” in reading lists for medical humanities courses. Case after case described so honestly by the Bulgakov character make for great discussion and debate among medical students of many of the issues that will confront them in the future, albeit in a very different country and time. The film blends those cases with the story of morphine addiction to create something very different but still useful in the context of medical education.

Psychiatrist, Aoibhinn Lynch, afterwards told us she felt the early stages of the film in particular were still relevant to today, dealing with issues – both personal and professional – that many newly-qualified doctors still confront when starting out: “moving to a place where you are without the usual social supports; being thrown in at the deep end, as it were; the panic of encountering things that you have only read about in books; the fear that people will think that you are a bad doctor if you don’t know what to do; the difficulties of building new relationships in a small community where the doctor is seen as something of an authority figure.”

Jennifer, a first-year medical student, empathised with the doctor up to a point: “The weight of expectation bearing down on him, and the obvious stress, marginalisation and heartache he was trying to deal with would negatively impact on the best of us, and in any situation like this we must all find a coping mechanism to deal with it.”

“I myself sometimes find the world of medicine to be a daunting one,” Jennifer admits, “with a frightening amount of responsibility, and even at this early stage in my journey towards becoming a doctor I find myself somewhat fearful. Polyakov’s struggle with substance abuse was a slippery slope down which theoretically any of us could fall … but hopefully won’t. Sometimes our own mental health needs to come first.”

Cillian pointed out that “As the film showed, despite common misconceptions, a doctor is like any other person, and can succumb to their demons if the right supports are not in place to help them.” Kerri point to the fact that in a lot of television and film doctors are presented as very moral, clean-living characters, “yet we had a lecture at the start of the year with some fairly shocking statistics on the number of doctors with addiction problems.”

Rather than having particular resonance for a medical student, Daire felt there was more of a universal relevance for any one who can identify their own struggles with those of the young doctor as he progressively turns away from the usual crutches of career, sex, compassion, humanity.

Overall, it was great to be able to see such a superbly made “foreign” film in Dublin and to make practical use of it as food for thought. In the literature module, we’re moving on now to pick up on one of the minor themes of the film: psychiatric treatment. We’re going to use extracts from Sebastian Barry’s novel The Secret Scripture, which in beautiful prose deals with one of the issues that caught Dr Lynch’s attention in particular: “I thought it was interesting and unfortunately typical that the psychiatric hospital where Polyakov was treated was portrayed as the most miserable place – dirty, no privacy, patients subjugated and cowed, literally stripped of their clothes and dignity. This is not an uncommon portrayal of psychiatric treatment in film and the arts – and sadly not one which would encourage anyone to seek treatment”.

Perhaps this next generation of doctors will be better equipped to analyse and do something about such negative portrayals.


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