Doctor narratives


Maeve Binchy:

She sort of knew it was coming, but still, the day it was confirmed it was a shock. The kind man who told her had been a colleague and friend from the very early days when they had all started pre-med together.

“I’ll miss the millennium party,” Nora said. That was her immediate reaction to being told she had six months to live. Nothing about leaving the husband she had loved for years or about not seeing her children grow up and marry, or not knowing her grandchildren.

Read the full story from the Irish Times archive >>>

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The treatments this time around would be tougher to endure, the possibility of a long life more remote. T. S. Eliot once wrote, “But at my back in a cold blast I hear / the rattle of the bones, and chuckle spread from ear to ear.” Neurosurgery would be impossible for a couple of weeks, perhaps months, perhaps forever. But we decided that all of that could wait to be real until Monday. Today was Thursday, and I’d already made tomorrow’s O.R. assignments; I planned on having one last day as a resident.

Excerpt from ‘When Breath Becomes Air’ in the New Yorker here >>>

AND here is an article from Stanford Medicine magazine republished by the Washing Post >>> 

Verb conjugation became muddled. Which was correct? “I am a neurosurgeon,” “I was a neurosurgeon,” “I had been a neurosurgeon before and will be again”? Graham Greene felt life was lived in the first 20 years and the remainder was just reflection. What tense was I living in? Had I proceeded, like a burned-out Greene character, beyond the present tense and into the past perfect? The future tense seemed vacant and, on others’ lips, jarring. I recently celebrated my 15th college reunion; it seemed rude to respond to parting promises from old friends, “We’ll see you at the 25th!” with “Probably not!”

(by beardn)

This is an autobiographical essay, written as a retrospective diary. I am going to discuss this text firstly by discussing the key themes and then by commenting on the style of writing and character of the doctor.

Themes:

The Doctor in the community:

·     The inter-dependent relationship between doctor and society:

This comes across most strongly in this text. She describes her role in the community as one of a ‘family friend’ – suggesting she attains a level of intimacy with her patients, caused by her integral role in the community, over and above the normal. She also assists with transporting goods, during the times of petrol rationing – which is outside of her job criteria but is also vital to the community.

However she also relies on the community at times, in order to complete her work (for example: Men from the quarries helping to dig through the snow – in spite of the adverse conditions).

·     The status of the doctor: Clearly viewed as very important, patients accepting of her, despite her being a woman (unusual to have female doctors in those times). “We did hear that our doctor was ill and had a woman doctor doing his work, but we’ve got to be thankful for anyone these days.”

·     Female role: Unusual for a woman of her time to be college-educated and working as a doctor. Consider how this alters her practice; women found it easier to confide in her, community may comment on her gender, however are happy to accept her care (shows how the status of a doctor can overcome gender discrimination). She is also a mother, how did she manage her work and raising her children (especially when husband was at war)? This text also highlights the importance of women when the men were at war (they took over the men’s roles/jobs) and also how the war highlighted that women were equally able to contribute in the workplace.

Isolation/Remoteness (consider the contribution of the war)

·     Constant references to the harsh weather, lack of facilities, difficulty getting to patients’ homes etc. (“…had to walk along the tops of walls to get to the farm”, “telephones were not plentiful then”, “…I noted the mileage, 53 miles, but I had done only three visits and been out there for three hours”). Creates the idea of a wild, inhospitable countryside that she’s constantly battling with, in order to do her job (“dropped once on top of an embankment and slide down it, carrying all my essentials in a haversack…”).

·     Mentions war, occasionally, this also contributes to the idea of hardship and being cut-off (“petrol rationing”, “driving at night, with only side-lights, as required in war-time”).

Kindness of Community:

·     Helping others (selflessly): Demonstrated by both the community and the doctor (links with the above-mentioned theme).

·     Indomitable Human Spirit: Despite adverse conditions the doctor still does her best to get to her patients and the community will still do their best to help her and each other.

Contrast between medical knowledge of the 1930’s and today:

·     Demonstrated with the treatment of her husband’s back problem – medical management and knowledge of back treatment is much more advanced/effective nowadays. The extreme management of his back demonstrates a severe lack of appropriate knowledge.

The character of the Doctor:

·     She is a very impressive woman; college-educated, strong-willed, successful, also raises her children whilst working and her husband is away at war.

·     However, from this text, I think that she seems more interested in the extra-ordinary that the ordinary (?? Typical of doctors). Her choice of incidents doesn’t give much of a sense of her daily life – lacks meaningful description. I found myself wondering how she managed to raise her children whilst working all day. (more interested in her medical anecdotes than her children). She, instead, dedicates long paragraphs to her husband’s slipped disc and funny/unusual incidents (e.g: “Billy nearly overdid his waiting once”). These anecdotes are interesting, however I think the text would have benefitted from her discussing her daily life as well, as it’s difficult to get a sense of her ‘true’ character and the text subsequently lacks atmosphere. How does a woman cope ? I think this is a key question about her, which she doesn’t really address in this text.

·     She, perhaps, has a certain lack of understanding of her patients’ circumstances, which is demonstrated by her comments about money not being plentiful. The average wage in the 1930’s was around 7/6d/week and so her comments that “fees were very low” doesn’t seem to take into account the equally low wages of people in the community. This observation goes against her general portrayal in the text (one of selflessness, dedication etc.).

Writing style:

·     Lack of meaningful descriptions: Difficult to get a sense of her set-up/life. The image of ‘snow’ is very dominant, however this is only one season – there is a lack of comprehensive descriptions. She portrays a vague idea of a ‘harsh’ landscape, however I found it difficult to build up an idea of her surroundings in my mind. Consider the veterinary books written by James Herriot; he conjures vivid imagery of his setting in just a few sentences.

·     Colorless writing (no spark): Uses short/expressionless sentences (to her detriment) “Are you married”…” “Yes”. Occasionally her expression seems awkward and is difficult to interpret (“…but lacked for volunteer teachers”).

·     However, her story is an interesting one and we must remember that she is a doctor and not an author. One must consider what the point of the text is; to tell her story.

(by macleanm)

Samuel Shem = Pen name

In an interview, there is a funny post about his reasoning for the pseudonym:

Q. It was published under a pseudonym. Did anybody know you’d written it?

A. People in the Boston medical world knew it was me. I was just starting my practice as a psychiatrist and I thought I could prevent my patients from seeing me as this radical, sexy, young guy. But they all found out immediately.

Furthermore, from what I read online, his publishings were bold anti-system workings. A lot of people were unimpressed by his work. From other articles and interviews I read about Bergman, he was not very well liked at first. At the time of his publication, the older generation of doctors really didn’t like him, and numerous schools refused to have him participate in talks or presentations at their school. 3

The author’s real name is Stephen Bergman, he was a practicing psychiatrist, graduated from Harvard medical school. Also, was a recipient of Rhodes scholarship from Oxford.  He’s written a few novels (Mount Misery, FINE). Mount Misery is actually the sequel to “House of God”. Generally these are based on psychotherapy/psychoanalytics. He’s also created plays such as Room for one Woman and Napoleon’s dinner. With his wife Janet Surrey, they are authors of the play Bill W. and Dr. Bob, which is about the 2 gentleman who created Alcoholics Anonymous.

It is said that this novel was based on Beth Israel Hospital, where Bergman did his internship. Essentially, the book is about the treatment of interns at the time (late 60s, early 70s). It’s about the power hierarchy and how low quality of life interns live.

There is an excerpt from an interview with the Boston Globe, on the 35th anniversary of his book, describing his inspiration for the satirical novel:

Q.What inspired you to write “The House of God”?

A. All of my writing is about one thing: the danger of isolation and the healing power of good, mutual connection. If you get isolated, as in “The House of God,” you can go crazy. You can commit suicide. It happens in medicine. To put it very simply, during internship, each of us got isolated. We not only got isolated from each other, we got isolated from our authentic experience of the system itself. You start to think: I’m crazy for thinking this is crazy.2

With the recent ’24 no more’ petition, there is a relevant quote from this same interview:

Q. When you heard about the Libby Zion verdict in 1984 [the result of a successful lawsuit brought by the family of a young woman who died while in the care of trainees] did you think: “Now things will finally change?”

A. I definitely did. My first reaction to the verdict was “Hooray.” There are two sides to it, though. I come down barely on the side of what has come to pass, which is making sure doctors are not so tired that they can’t function.

Q. That’s not what I expected you to say. You barely come down on the side of limiting trainees’ work hours?

A. It allows people to have lives and it allows care to be better. I really do think that. The only thing I’m a little concerned about is that since I believe good connection is essential for good medicine, this kind of fragments it a little bit. On the other hand, connecting with the patient is not only a matter of time. It’s a matter of understanding and awareness. Those old docs just could come in and put a hand on your shoulder and make it so the patient wanted to talk to them. But now we don’t always select the people who know how to do it.

Q. In what way are we not selecting those people?

A. We select the smartest, but so many of the smart guys who rise in these hierarchies have no sechel [the Yiddish word for sense]. I’ve said this for 30 years. Look at “The House of God.” The Fat Man [a wise and irreverent resident] is smart as hell and also intuitive and compassionate. I wish he’d really existed when I was an intern.2

In this story, there is also the presence of sexism. We see subordinate roles filled by women (nurse, sisters in ‘awe’ of their intelligent brother, lack of female interns).

From this story ( chapter) there are a few unwritten rules that can be learned:

  1. Gomers don’t die.
  2. Gomers go to ground.
  3. At a cardiac arrest, the first procedure is to take your own pulse.

REFERENCES:

  1. Samuel Shem, “The House of God”
  2. The Boston Globe Interview, ’35 years later, author reviews House of God’, by Dr. Suzanne Koven  – http://www.bostonglobe.com/lifestyle/health-wellness/2013/09/01/interview-with-samuel-shem/h7tS4bjDlynBYCyddW6a1O/story.html
  3. The Atlantic, Samuel Shem, 34 years after the ‘house of god’, http://www.theatlantic.com/health/archive/2012/11/samuel-shem-34-years-after-the-house-of-god/265675/

http://www.psychiatrygrandrounds.com/podcast/gr081103kj-iPhone-cell-trimmed.mov

The title of Danielle Ofri’s second collection of reflections on her professional life as an attending physician Incidental Findings
comes, as she explains in the prologue to the book, from her own experience of turning up with her husband for a routine antenatal screening in one of NYU’s private clinics, and discovering, to her alarm, that the sonographic image of her baby’s umbilical cord reveals an anomaly. But is it an anomaly which means something? Her colleague tries to put her in the picture.

http://danielleofri.com/wp-content/uploads/2010/12/A-Day-in-the-Clinic-Ofri.pdf

Andy Neil writes about deciding to talk straight with a patient about their cancer >>>

“He thanks me. He thanks me. He thanks me for telling him he has cancer. My eyes fill with tears and I make myself look in his eyes and I make myself hold his hand cause he deserves it and so much more.