Students notes on Vincent Lam’s story ‘Contact Tracing’

(by tsheeha)

The story is set in Toronto, Canada, the year 2003. It describes a time where SARS disease has run rampant worldwide, a disease which effects pulmonary function and leads to eventual death. The story describes how two doctors who have contracted the disease tell stories about pastimes and try to help each other overcome the disease. Two other characters involved in the story are Dolores, the nurse and Dr. Zenkie, who attends to the two patients.

The story is portrayed in two formats – a professional and personal style of writing. Firstly we see Dr. Zenkie’ notes. His dealing, interactions and treatment of the patients. H is informing us of the patient’s condition at the time. He is almost setting the scene. We4 get aspects of the medicine and procedures used to try and treat the disease.

There is also a personal story being told as the author lets us delve into the lives and attitudes of each character, Dr. Chen, Dr. Fitzgerald and Dolores the nurse. We see how SARS  affects their lives on a daily basis and how they cope with the disease.

Early on in the story we get an insight into how a doctor may deal with the disease. It is like the disease is undermining the authority of the doctor. Dr. Fitzgeraald says that he wants to ask the nurse to stop calling him doctor, but when the time comes he is afraid to let go of his identity, perhaps his only chance to find a cure.

The idea of alcoholism is discussed regularly throughout the piece. Dr. Fitzgerald is an alcoholic who miakes light of his struggles with alcoholism by claiming he only has a few or just a night cap to help him sleep. H eis covering up a deeper problem and his denial is not helping his treatment as he refuses to admit to Dr Zenkie that the real reason he is shaking is due to withdraw from alcohol.

Dr. Chen and Dr. Fitzgerald went to medical school together and although they admit that they weren’t very good friends, it is interesting to see how their relationship and new found friendship helps them cope through this disease. They share nostalgic memories of their old friend who died of pancreatic cancer and of their attending ways of practice.

Through their discussions the author is allowed to portray many themes. One such theme is the stress of Doctors. They both tell shocking stories of how their stress got the better of them and they both did things that they may have regretted. Dr. Chen decided not to call a nagging family when their mother died and Dr. Fitzgerald wouldn’t help a junkie who appeared to be in need of CPR. These stories give the reader a somewhat sinister view of potentially likeable characters.

The story also deals with the role of a nurse and perhaps the poor treatment and unfair working conditions. During the SARS epidemic they were offered retirement with no benefits or if a nurse refused to treat a SARS patient she would lose her seniority. We see how one particular nurse. Dolores struggles with the whole situation. She was unhappy when she thought she had to treat SARS patients. Her children were asked to leave playschool in fear that they would contract the disease and spread it to the other children. I believe that the character Dolores epitomizes the common citizen of the time. While the other characters reminisce of their past glories and sufferings, Dolores is portrayed as just trying to make it through day by day, protecting her home and family.

The concept of loneliness and death is talks about throughout the story. Dr. Fitzgerald talks of Ming, a girl he once loves and now Dr. Chens wife. He regrets not starting a relationship with Ming and blames his loneliness by the void she has left in his life. This sense of lone lines is also a major factor in his drinking problem.

Death is a running theme throughout. The patients discuss the death of their friend and also discuss how being a doctor has chamged their attitude to death.  Dr. Chen stating that he now feels oblivious to the feelings that a loss causes emotionally.  Dr. Fitzgerald says hints that he has nothing left to live for and has accepted that his illness will kill him. He does not want to be resuscitated.

The eventual death of Dr. Fitzgerald is a bit of an anti-climax as it is written as a news report and takes away from the heroic act of Dr. Chen trying to save his life.


Student notes on Bulgakov’s ‘Morphine’

(by stefanon)

Written in 1926, Morphine is a short story that’s part of a collection known as “A Country Doctor’s Notebook”, which though not his most prominent work (the Master and Margarita claims this title), serves as a prime example of Bulgakov’s gripping narration and fantastic characterisation.

Upon reading this story, I felt that in order to comprehend the text, we must examine the two protagonists, who stand in stark contrast to each other when juxtaposed, alongside the main themes and issues raised in the text.

Dr. Vladimir Mikhailovich Bomgard
As such, he’s the text’s main hero. Displaying many virtues, he portrays the ideals that we expect in a physician. Passionate, hardworking, diligent. We can see his passion for the art of medicine on several occasions. He admires the town hospital as if it were the most magnificent building he’s seen, exclaiming: “Oh, what a splendid thing a large hospital is, with its smooth, well oiled-machinery! He’s also very eager to read up medical texts and fill gaps in his knowledge, as seen in his mental notes to “read up some psychiatry and his musings about “the mechanism of sleep.

However, this may very well be a sign of the internal inadequacies that Dr. Bomgard feels upon his transfer to the town. During his time in the rural settlement of Gorelovo, he was as such a jack of all trades. With its drawbacks of isolation and lack of personal stimulation, Gorelovo could at least provide Bomgard with a wide variety of medical cases, that required him to keep his mind sharp and his skill set varied. Now however: “for the first time [Bomgard] felt that there was a limit to [his] responsibilities”. As he says:

“My days were wholly taken up with diphtheria and scarlet fever. But only my days. I started sleeping at night, undisturbed by that ominous nocturnal tapping downstairs, which meant that I was likely to be roused and dragged out into the darkness to face danger or whatever fate had in store.

We must ask ourselves- does he maybe feel that his proficiency as a doctor is fading? It’s possible, that with all of the Hospital’s superb facilities and increased opportunities for recreation and socialising, Bomgard’s vision of himself as a multi skilled doctor is fading. Therefore, with all of his attempts to block Gorelovo out of his memory, he keeps revisiting the countryside in his mind before sleep, “fragments of recollection passing through his fading consciousness” .

Yet, it’s not the place that he thinks about but rather, it’s the job that he remembers and now wonders about. Who’s in his place, what are they doing? He cannot let go of the thought of returning to general practice, and it is perhaps for this reason that he hopes to move on even further, past the small town hospital, to
“Moscow.. a clinic.. asphalt, the bright lights” .

He sees the country clinic and the small town hospital as rites of passage as such- steps on his way to Moscow. It is for this reason I believe, that Bomgard is so unnerved upon his receipt of Polyakov’s letter. He sees Gorelovo as an indelible part of his past, yet, it’s a part to which he shall never return, since he’s completed his duty and owes nothing to the place. Therefore, it’s not surprising that upon receiving a letter that calls upon his duty as a physician (A duty to which he strictly adheres to) to return to Gorelovo, Bomgard is furious. “It was an absurd, hysterical letter, enough to give the recipient migraine. There, it was starting: the nerve on my temple was starting to twitch…”

Polyakov’s death by suicide meant next to nothing to Bomgard, however, it does allow him to get a hold of Polyakov’s diary, and brings out Bomgard’s main personal flaw- pride. The diary highlights Polyakov’s weakness, his struggle with addiction and his inability to manage the countryside practice that he took over from Bomgard. As he’s reading it, he must feel increasingly confident in his ability as a physician, which is his overwhelming concern. Personally, my main issue with Bomgard’s personality is highlighted in the closing line. He ponders: “Should I publish the diary which was entrusted to me? I should. Here it is.

We must ask- of what value is publishing the diary to Bomgard, other than highlighting his strength as a physician against Polyakov’s weakness? It cannot act as a discouraging agent as such, since it wasn’t through his own fault that Polyakov became addicted to morphine. And it cannot help overcome the isolation that country doctors feel- rural people still need doctors. Hence, the diary that documents Polyakov’s personal demise, the diary that was entrusted to him, was exploited by Bomgard. It shows, that as a physician, Bomgard overcame the struggle of Gorelovo- he had the strength and determination to. Publishing the diary highlighted Polyakov’s inability to do so, although both physicians had the same starting point. The act of publishing the diary serves to show us a clear divide in physicians’ qualities as doctors and as people- though Bomgard may be a superb clinician, unfortunately, he’s not the most admirable person.

Dr. Sergei Polyakov
As such, his personality is that of an addict. But, he does provide a refreshing view of “the doctor”. In Polyakov, we see that a physician is not necessarily a superhero- he/she is just as vulnerable and flawed as any human. There is a prevalent sense of pity evoked by Polyakov’s writings, which Bulgakov intertwines with elicited feelings of revulsion and perhaps even fury at the doctor’s failure to overcome his inner struggles. After all, we must realise- that Polyakov is at large, a victim of circumstance rather than a free acting agent. For a reason we’re untold of, Amneris leaves Polyakov, leaving him in deep emotional turmoil, struggling to cope with his cruel thoughts: “Did I really want to kill her? Kill her?

He seeks isolation, doesn’t want to see people. It’s probably no coincidence then, that his psychological anguish manifests itself physically, and Polyakov is  “stricken one night with such pain that he starts to writhe all over the bed.
Cue Anna Kirillovna’s morphine injection- one involuntary act which, when combined with Polyakov’s underlying depression leads to his demise. It is morphine that allows him to forget Amneris, his thoughts about her slowly fading, until a month later (15th of Februrary -> 19th of March) he forgets her completely, and openly admits: “I have morphine to thank for that.

His infatuation with Anna Kirillovna, who later becomes his mistress, is also quite fascinating. We must ask ourselves, whether or not the feelings are genuine. As it stands, she’s the only person who currently feeds his addiction. He relies on her to make up his morphine solutions, to revive him upon his cocaine overdose, and to be the external support that he needs. His stint with cocaine is also quite interesting. It’s an attempt to replace morphine, to beat his addiction. Now that his psychological wound has healed, he doesn’t need morphine as an antidepressant anymore, but rather, he needs it because he has become addicted. He’s fully aware of this condition, and is plagued by a sense of shame that stems from it.
He becomes paranoid, afraid that “other people may find out about [his] vice”.

The main fear associated with this would be losing his doctor’s licence. This highlights the fact that Polyakov still sees his personal and professional lives as two different entities- his addiction shouldn’t have an impact on his role as a doctor, although, he’s grateful for his location in his “isolated practice”. It’s precisely the perfect medical setting that allows a doctor to indulge in his personal vices, such as a morphine addiction.

We do feel quite frustrated at Polyakov’s futile attempts to beat addiction. He convinces himself that he can indeed beat it, and that with proper help and treatment he’ll overcome his struggle, but reality begs to differ. He uses the revolution as a pretence to indulge in his addiction, and turns to both lies and theft in order to gain access to the drug.
What’s interesting is his awareness of his actions, which he documents in the diary. He makes notes to himself to
“tear that page out”  when referring to more shameful episodes of theft. He never does this, which leads us to assume that although he does have brief moments of lucidity, his life is now prevalently chaotic, insane, and fluctuating between euphoria and living hell.

He deteriorates both physically and mentally. He now hallucinates even when sober, and grows physically thin and weary. He vomits frequently, his body is covered in abscesses and ulcers. He has become a doctor with no regard for sterility, the crystals of morphine are what he now sees as “life giving”. Bulgakov’s skill as a writer shines through, in the way we can see the diary entries becoming shorter and more abbreviated, as was stated earlier on in the story by Dr. Bomgard. Bulgakov hints at the fact that Polyakov’s suicide may be a pre-meditated act, as he tells Anna that he’ll “leave here by February”.

His diary entries become increasingly shorter, his thoughts increasingly more sporadic and staccato. The thought of staying alive becomes unbearable, and after intending the notebook for Bomgard, Polyakov kills himself by gunshot, having previously stated that he has no fear of rifles after the Muscovite revolution. Ultimately, his addiction won. Whatever the doctorly qualities Polyakov was trying to hang onto were, his personal vices overcame his professional virtues.

Themes and Imagery
The most prevalent theme was addiction, however, I believe that because it’s so confined to the character of Polyakov, examining the character offers more insight than examining the theme specifically does. Therefore, I believe that a much more valuable issue to consider is isolation within medicine. It’s undoubted, that rural areas do require their medics, it’s a simple fact of life. But we must ask- what kind of doctor should work there? As evident, Bomgard hated the rural lifestyle. He  couldn’t wait to get out of Gorelovo. Polyakov on the other side, embraced the isolation, but for all the wrong reasons. The seclusion of a rural landscape allowed him to wallow in his own depression, and was evidently a very unhealthy environment. Therefore, I wonder- is there a type of doctor who’s ideally suited to a life of isolation and disease? Although the era of the story is different, we must still remember, that essentially, medicine is about people serving other people. It’s about interacting with live human beings to the closest extent. Hence, is it even probable, that there even is a type of doctor who would voluntarily give up stimulating social interactions and go work in an area such as Gorelovo?

Image-wise, my absolute favourite image in the story was when Bomgard describes Polyakov’s death. He says “greyish violet shadows, like the shadows cast at sunset, showed more and more clear in the hollows around his nostrils, and a fine sweat, like droplets of mercury, was forming in the shadows.It’s an image that combines the natural world with the human form and with death. The image highlights how death is a process that awaits all of us, and how although it may seem alien and terrifying, it’s a natural progression that follows life. The slipping of Polyakov from this world may indeed be described as a dark shadow at the end of a sunset.

Student notes on Joyce Carol Oates’ Angel of Mercy


‘Angel of Mercy’ by Joyce Carol Oates is one of nine short stories published in the bookThe Female of the Species. This collection of short stories was published in 2005 by Harcourt Books and instantly achieved recognition, acquiring a large collection of positive reviews including features in The New York Times and The Gaurdian. All agree it is the nature of her stories that the public found so addictive. Each of the nine short stories are suspense thriller yet deal with completely different women from completely different walks of life. The primary themes of violence and sex provide thrill and excitement to the tales.

Mercy vs. pity

‘Angel of Mercy’ is no different. In this short story, Oates forces us to confront our own personal ethics and to examine what truly constitutes mercy and what constitutes pity. Though one might consider the two to be similar, upon closer examination we realise that there is in fact a difference. Pity is an emotion. It is not an action. It is the sympathy and kindly sorrow one might show towards another in pain. Mercy however is an act. It is an act of kindness, of sympathy. Of course pity can lead to one showing mercy however the two are very different indeed.

We see that mercy is the physical act of pity.

‘Angel of Mercy’ demonstrates the difference between the two through the characters of Agnes and R-. At the beginning R- is pitiful and sympathetic towards the ‘doomed’ patients of the City of the Damned. Her strong principles keep her on track, and we see her showing pity, not mercy. R- relates to the patients in order to show kindness and compassion regarding them as her grandmother etc. Agnes on the other hand despises pity. After working in the City of the Damned for 8 years she has lost all hope and believes the only way that she can show kindness and compassion to her patients is through the act of mercy.


Character of Marcus Loper

Though the character of Marcus Loper is not given speech nor characteristics at all throughout the story, it is undeniable that his presence is imperative.

I felt that this character serves two purposes.


Upon examining the character of Marcus Loper, one realises that the physical destruction of this young man in the prime of his youth personifies the mental destruction of both Agnes and R-.  Marcus Loper was rich and handsome. His gruesome and untimely death shocked and dominated public culture. The loss of a young man so prosperous and handsome created a kind of tragic sensationalism the public couldn’t resist. However all the while Loper’s physical degradation dominated the public eye, the beauty and richness of the character of R- is being destroyed in a manner equally as gruesome and horrific. R-‘s desperation to find in Marcus the man he had once been correlates with her desperation to rediscover herself – find the woman, the nurse she had once been. “In the City of the Damned, among the daed, catatonic, comatose, Marcus Roper was fascinating.For he is not damned; he’s young. He will survive.”

Roper also personifies the sexual element of this story. This is another aspect that differentiates R- from Agnes at the beginning of the tale. At outset, R- is seen as “striking and attractive”. She appears as almost a beacon in the midst of the desolation and decay of the hospital. Agnes on the other hand is rarely ever viewed as a sexual creature. It is noted that though Agnes dies a virgin she had in fact been kissed. We can only presume this was before she began working in the City of the Damned and lost her herself to the hopelessness and desolation of the place. The stripping of her sexuality serves to almost dehumanise Agnes from the beginning “Male hospital workers took notice of her red hair and ruddy flesh until she passed the age of thirty-two or three, by which time it was difficult to imagine Agnes as a sexual being”. By stripping Agnes of her sexuality and hence her humanity, Oates creates the image of an almost ethereal being further emphasising the sinister nature of the ‘Angel of mercy’.  We see her even refuse her imaginary lover for the sake of her ‘work’ at the hospital. “I mean, thank you for asking me to be your wife, but my work at the hospital is all the life I need.” And this rings true when we see R- stripped of her sexuality towards the climactic point of the tale. D- is unable to continue to be intimate with her due to “that smell” and we are instantly realise that the pungency and decay of the hospital has taken her over.


This story largely centres around the loss of human traits of R-.

Predominant themes of story

Loss of humanity

·     Love welts on skin; first sexual association with work at hospital

·     Recognises patient is no longer person after stroke ‘the body may remain; the “patient” is gone’

·     Has hope that Marcus will recover

·     Gives Roper hope, tries to protect him from reality of situation “Outside the grime flecked window what R- could see of the sky was the hue of a soiled bandage, but Marcus Roper need not know”

·     First realisation of power, control? “for it seemed to her that she held the man’s very heart in her hand”

·     Needs D- to love her in order to feel human “R- silently pleads with D- to love her, that R- will be saved from what R-‘s fate would be if D- does not love her”

·     Can no longer eat meat – feels as though she is eating human “meat nauseau”

·     Father losing his ‘manhood’ – losing his humanity

·     Loses D-

·     Realises Marcus shall never recover can never be the man she wants him to be “R- was stroking the limp stubby penis”

·     By end of story R- has lost notion of time and so we see that the hospital has swallowed her up – tracking of time is a significant human attribute birthdays, seasons etc.


One cannot ignore the hell-like references throughout the story.

Burning river – river styx

Constant death and despair

“In the City of the Damned, the gods Stroke & Tumor reign. Fatherly gods gone bad.”


This short story deals with many themes. It forces us to look at our own personal morals and question societies everprevailing desire to preserve life, no matter how grim the quality is. It also forces us to recognise how quickly a person can become dehumanised due to their environment and surroundings. Both agnes and r- were extremely intelligent and prosperous finishing first in their class. However the hospital swallows them up and spits them out dead like it does everything that enters it doors i.e. Marcus Roper.

Student notes on Lorrie Moore’s story People Like That are the Only People Here


People Like That are the Only People Here

This short story is from a collection called Birds of America by Lorrie Moore, published in 1988. Most of the stories feature characters in some sort of dire situation, which is certainly true of this story. Moore has stated that this story is ‘loosely based’ on her own experience when her son was diagnosed with a similar condition.

Title: I was instantly intrigued by the ambiguous nature of the title of the story. The ‘people like that’ referred to are in fact the other people in the hospital, those maintaining the ‘airy, scripted optimism’ described by the narrator’s friend. The title is almost a direct quote from the lines spoken by the friend: ‘Everyone’s so friendly here. Is there someone in this place who isn’t doing all this airy, scripted optimism – or are people like that the only people here?’ Canonical babblings is the medical term for the stage in child speech development at around six or seven months when babies move from meaningless sounds to attempts at proper words and speech rhythms. Therefore the title could be referring to the fact that the baby is spending this stage of his development, his ‘canonical babbling’ stage, going through the ordeal of cancer treatment. However, I think that it could also reflect the mother’s transition from one who is naïve and ignorant about the world of ‘Peed Onk’ to one who becomes fluent in the language of ‘N-G tubes’ and ‘Hickman catheters’. The ‘Peed Onk’ of the title is the phonetic spelling of the name given to the Paediatric Oncology department where the baby is being treated.

Literary Techniques: Moore makes use of a number of interesting literary devices throughout the story. The first thing I notice was the use of capital letters when referring to certain characters in the story –  the Baby, the Mother, the Husband, the Radiologist, the Surgeon. It was interesting to note that all the characters were described based on their relationship with the mother – for example, the father of the child is referred to as the Husband, and not the Father. I think that this use of capitalisation is an attempt by the mother to show how they have all been thrust into certain roles as a result of the baby’s illness. It is almost as if they are acting out parts in a play. This technique is one way in which the author conveys the mother’s struggle with her sense of identity throughout the course of her child’s treatment.

Moore also uses capitalisation throughout the story in certain phrases- ‘Sixteen Is a Full Life! Let’s Make a Deal! Sympathic Expressions’ my understanding was that these phrases and actions were so clichéd in the world of ‘Peed Onk’, that it was almost as if they were scripted lines the characters had to say/do at some point.





·     Parental struggles with identity during illness of a child

·     Conflict in home caused by illness

·     Conflict between patients and doctors



Parental struggles with identity

The mother, who is also the narrator of the text, undergoes a major internal conflict as a result of her child’s illness. She knows that society expects her to act a certain way. She is a writer, and her husband advises her to ‘Take Notes’ of the experience in case they need money to pay for the baby’s treatment. She finds this idea abhorrent, saying to him: ‘I’m not that good. I can’t do this….. Our baby with cancer? I’m sorry. My stop was two stations back’. Upon their arrival in the ‘Peed Onk’ ward, the mother feels that she will never be able to identify with the other mothers there: ‘The Mother does not know how to be one of those other mothers, with their blond hair and sweatpants and sneakers and determined pleasantness’. On the other hand, the husband throws himself wholeheartedly into the new community of parents. His ‘membership’ of the group is indicated when we are told that ‘he too is wearing sweatpants’, which the mother considers to be the ‘uniform’ of the Peed Onk parents. We also see that some of the parents have come to identify them completely in terms of their child’s illness. For example, Joey’s father gave his job up to devote himself to looking after his son, which he has done for almost 5 years. His marriage broke down, and I couldn’t help but wonder what he would do once Joey eventually succumbed to his disease.


Conflict in home caused by illness

We see that there are times of tension and conflict between the mother and the husband as a result of their child’s illness. One of these is when the husband cannot understand why the mother isn’t taking notes to write about the experience, as they will probably need the money. The mother refuses to, yet the story concludes on the cutting lines ‘There are the notes. Now where is the money?. They also disagree on the course the baby’s treatment should take at the end of the story, with the father finally agreeing to go ahead with the ‘watch and wait’ decision. The mother’s frustration at the husband’s attitude can be seen in the lines ‘Why does he do this, form clubs all the time; why does even this society of suffering soothe him?’ We see that illness has caused strain amongst all the families in the Peed Onk ward – Joey’s father’s marriage broke down, the mother leaving him for a new husband who will never be as ‘maniacally and debilitatingly obsessed’ with Joey’s illness as Frank is. All the other parents discuss the different hospitals they’ve been in ‘as if they were resorts’. The disruption that a child’s illness causes to a whole family can be seen most clearly.


Conflict between patients and doctors

The mother is clearly frustrated with a large majority of her child’s caregivers, probably because they are the only people she can legitimately vent her anger to. From her first encounters with the doctors, they appear to sidestep her concerns and treat her in an apathetic, distant manner. The radiologist sidesteps her questions about her baby’s scan. The surgeon is more interested in the detail of the treatment than comforting the mother after breaking the news to her – ‘the tricky emotional stuff is not to his liking’. The oncologist ‘rattles off some numbers, time frames, risk statistics’. The social worker has no idea how to properly comfort the mother when she is distressed after witnessing the baby go under the anaesthetic. The mother is infuriated when she discovers a problem with her baby’s NG tube and the doctor that is sent to them is a medical student who ‘looks fifteen’. She loses her temper with him, insisting that he fixes the problem. The most startling example of doctor apathy in the story, in my opinion, is when the surgeon calls the mother outside to talk to her. She is terrified that she is going to be given more bad news, feeling that she cannot take any more. The doctor, oblivious to the panic he has caused, asks her to sign a copy of one of her books for him. She has to ask him if her baby will be ok, as he has forgotten to tell her.

Student notes on William Carlos Williams’ Doctor Stories


The Girl With the Pimply Face:

The Girl with the Pimply Face is a short story unlike any other extracts we have read this semester. In my opinion, the main themes presented to us in this story are the themes of compassion and discrimination.

From the very outset we are presented with the theme of discrimination through the druggist’s discriminatory remark ”But they’re foreigners and you know how they are.”  This remark serves to marginalise the sick baby from the very outset. The narrator of this story serves to refute this discrimination however as he personifies the theme of compassion. Although he was “just sitting down to lunch”, he still succeeds in reaching the patient’s house by two-thirty and expresses no anger on discovery that no one is home. What I found interesting about this narrator was his non-judgemental character. Unlike the druggist who seemed rather dismissive, the narrator reserves all judgement regarding the foreign immigrants. He does not look upon the fifteen year old girl with disgust or scepticism but instead retains a high degree of respect for her. “Boy, she was tough and no kidding. I fell for her immediately”.  His sense of compassion is inherent in his ability to recognise her “excellence”- a complete contrast to his wife who later regards her as a “Pimply faced little bitch”. Throughout the story, “The Girl with a Pimply Face” is extremely unhelpful as she seems “indifferent as though it had been no relative of hers instead of her sister” and yet the doctor expresses no frustration and his adulation shines through as he describes her as “A tough little nut finding her own way in the world.” He seems to perfectly encapsulate “the Art of Medicine” as not only does he wish to help the baby, but also expresses concern regarding the young girl’s leg.

Although the doctor seems compassionate and intent on helping his patients, he still harbours pre-conceived notions regarding the immigrant family. This is thrown into relief as he assumes that this baby has been somewhat neglected”No doubt it had been in a bad way before that, improper feeding etc,etc.”.  He is also somewhat short regarding the mother and makes little attempt to comfort her or to even fully explain the situation.

The theme of discrimination is encapsulated in the wife’s reaction upon hearing the narrator’s story. She seems strongly opposed to such “charity work” and is immediately sceptical “Did they pay you.” She seems intent on demonizing the immigrant family as she retells Kate’s story. I feel that this character serves to reflect the discrimination inherent in society. This sense of prejudice is later emphasized as a fellow doctor expresses outright disdain for these Russian immigrants. I feel the author sets up a parallel between the narrator and his more sceptical colleague in an attempt to highlight the narrator’s compassion. The narrator’s compassion is in complete contrast with his colleague’s caustic criticism as he describes the immigrant mother as a “bugger” and the daughter as a “pimply-faced bitch”. The narrator even defends the mother’s actions by describing them as “Natural maternal instinct” to which his colleague replies “Whisky appetite, if you should ask me.”

The story ends with a final visit to the immigrant family. The narrator’s sense compassion is clearly unblemished by his wife’s and colleague’s advice. This is apparent in his unbridled admiration for the fifteen year-old “ A powerful little beast”.  It is obvious that the narrator does not seek monatory reward but is instead content with the sense of satisfaction which comes from helping others”God it is I said. And it was much better.” The story then ends with a sense of hope for the young girl as she returns to school. I feel that this ending seeks to highlight the importance of compassion, especially in healthcare.

The Use of Force

“The use of Force” is somewhat different to “ The Girl with The Pimply Face.” “The Use of Force” by William Carlos Williams addresses the exertion of physical superiority over others, asking the fundamental question: is it ethical to hurt someone for his own good? While “The Girl with the Pimply Face” displays a straightforward kind of compassion, “The Use of Force” shows us that compassion is not always straightforward. From the outset, the doctor displays patience as he tries to coax the young girl to open her mouth. When he realizes the futility of his approach, he gives the child an ultimatum “Will you open it now by yourself or shall we have to open it for you?” Williams’ choice to use interior monologue as a “stream-of-consciousness” tool reflects the narrator’s experience of dialogue and gives insight into the character and his appraisal of the situations he encounters. It is through this “stream-of-consciousness” that we come to realize the assertive nature of this doctor’s actions. This is seen as he steels himself for a battle “I had to do it. I had to have a throat culture for her own protection.” It is obvious then, that this doctor is committed to helping this child and his determination of purpose is untainted by a fear of hurting her. This is in contrast to the child’s father whose fear of hurting her impedes his ability to truly help her. The child’s mother is equally inept at helping her child as she cannot restrain her for fear of hurting her daughter. I feel this is highlighting the doctor’s strength of character, unlike the child’s parents. Williams creates the typical setting of tentative and indulgent parents contrasted by the assertive actions of the doctor and so we realize that doing what is best for someone is not synonymous to what is kindest. As the situation demands the story is told with wit and wry humour: ‘the damned little brat must be protected against her own idiocy, one says to ones self at such times’. The awkwardness of the situation is diffused using this humour: I could have torn the child apart…it was a pleasure to attack her…’. Here Williams presents the theme of the varied life of the doctor; in this case attempting to get a throat swab and having to battle wryly against the odds. It is a wonderful snapshot of a minor incident in the life of a doctor and outlines in a very humorous way the all too human thoughts of the doctor. The story also presents enjoyable cameos of human nature: the uselessness of the indulgent parents, the frustrations of the doctor  who is all too aware of human nature and above all the utter determination of the young girl who stubbornly refuses to co-operate. Embedded in the story is the theme of the life of the doctor entails-for all his glory and knowledge, he is still a mere human and is not immune to human fallibility.

Despite his all too human faults, I feel the story serves to highlight the heroism of this doctor as he understands that what is best is not always what is nicest.



This story is set in the USA during the Depression years in a children’s hospital where children who are the victims of poverty or unfortunate circumstances are nursed. The themes addressed are the issues of poverty, hopelessness and social decay, alongside the plight of a doctor who becomes outwardly cynical and disrespectful while at the same time managing to maintain a sense of duty and determination. The narrator doctor presents themes of poverty and social breakdown alongside the theme of his own personal battle against cynicism and fatalism balanced against his innate professional sense of duty and determination.

The narrator of the story is a battle-worn doctor who sounds overcome by a hopelessness that borders on outright cynicism.( I was taken aback) There are times in the story when the language used by this doctor makes the reader want to cry out at the wanton callousness of his observations. He refers to his child patients as ‘brats’ and observes that one child might grow up to become ‘a cheap prostitute…your country needs you, brat’. The story is masterful however in that beneath this exterior disregard for the dignity of the children under his care this doctor reveals an inner conscience and a determination that shines some light of hope on his desperate and fatalistic pronouncements. This doctor character is used to convey the desperation of the times and the strains that such social breakdown places on the doctor as a professional.

He paints a picture of a society in freefall. Many of the unwanted children in his care come from poverty in minority families – Hungarian gypsies and the Irish are cited. Yet for all the desperation and disregard portrayed through the eyes of the narrator we also glimpse themes of real hope and humanity. The care of the nurses’ shines strong – they care for the children as if they are their own children. One nurse cannot witness the post mortem of a child she has cared for. And despite himself the narrator doctor takes pleasure in the progress baby Jean Beicke makes as she gains weight and sleeps and feeds. He describes her blue eyes and shows real determination in caring for the child. He pesters the ‘ear man’ to inspect the child’s ears and he agonises over the failure to make a clear diagnosis. When all is lost and it becomes clear the child will die he cares enough to organise a post mortem to establish the cause of death and to learn for the future. He is scrupulous enough to call the ‘ear man’ in for the autopsy so that he too can benefit by discovering the real reason of death. In the words of the ‘ear man’ it was ‘a clear miss’. Perhaps the determination of the outwardly cynical narrator may save another child from a similar end.

There is also another theme that saves the narrator doctor from his own outward cynicism – that is his determination to reveal and highlight the social conditions in which people are living. When it becomes clear that baby Jean will die he makes sure to get permission from the child’s aunt to have an autopsy carried out and this is done in a discreet and sensitive way. Furthermore, the narrator of the story is careful to use the character of the aunt to tell the story of the desperation of baby Jean’s mother who is abandoned by her husband. In taking care to tell the full story of people caught in desperate circumstances he informs the reader of the real story of the Depression era and does not simply present a sentimental or judgemental presentation of the themes and issues. Behind the dreadful battle-worn pronouncements of this doctor lies a social conscience – could it be that the fatalistic and disrespectful language this doctor uses is a product of a social conscience that has left him burned-out and mentally bloodied? Bloodied but unbeaten in that he maintains a professional concern and determination to achieve some good and he possesses the humanity to appreciate the loving care of the nurses who he works with and to take real pleasure in a patient’s progress.

This is a masterful and fascinating story in that the language this doctor uses is shocking, downright disrespectful and unacceptable – yet it is this very shock value that conveys the desperation of the social conditions people live in and in this way our narrator doctor goads us into having a social conscience too. ‘Vote the straight Communist ticket’ he announces wryly and sarcastically at the end as if to say when all else fails we can always turn to the Communism! William Carlos Williams is determined in this story to present his themes of social and personal desperation and breakdown in a way that will shock and stir us into empathy, and hopefully action.

Co Louth-born oncologist Austin Duffy wins Francis MacManus short story competition

RTÉ producer and competition organiser, Séamus Hosey, says the story casts new light on “the relationship between medicine and literature, and how a medical practitioner depicts from the inside the harrowing and stark world of a cancer ward”.

Duffy, aged 36, now works as a staff clinician at the National Cancer Unit in Bethesda, Washington DC, where he specialises in the treatment of gastrointestinal cancers.

Extract from Orca by Austin Duffy

Winner of the Francis Mac Manus short story competition 2011, (will be broacast in the first of the Mac Manus Season on Monday, June 6th in The Book On One slot at 11.10pm on RTÉ Radio 1).

‘You can’t beat the feeling of coming to the end of a night on-call. When you’ve got to the morning without anyone dying on account of some vacancy in your medical knowledge. It was close though. All evening there’d been calls about Ruairi. His dressing was seeping with blood at the spot on his hip I’d drilled into earlier that day with a large trocar needle, hand-held like a power drill and bevelled, for bone marrow biopsies. My advice over the phone had been simple. Keep with the pressure dressings and watch the blood pressure. Then around eight, Debra called. She’d just started her night shift. You can see it pumping, she said, you’d be as well to come in. I didn’t argue. Sometimes doing marrows you can be unlucky, hit a small artery. Potentially cause a bleed out. Sort of the opposite to an oil-strike, luckwise. Sure enough, when we peeled back the dressings there was a good trickle coming from the spike hole. Took hours to quell it. His blood pressure started to hover low. Vitamin K and clotting factors did the trick eventually. His mother came up to me afterwards and asked, is this normal with cancer? I told her no, it wasn’t.

I turned the corner by the brewery then crossed the footbridge to the North Mall. At that point you can see the river for some length before it bends into grey walls. A complete moon was over where the open sea would be. Most of the light was coming from streetlamps, hunched over the footpath like lanky tulips. They threw my shadow on the water as I walked under them.

I’d only met Ruairi and his mother a few days previous in outpatients. He came referred after noticing a lump on the side of his nose. Looked like a horse kick. He was into horses. When we did a scan of his lungs there were tumours hanging from his bronchial tree like ripe fruit. Tests showed small round blue cell tumour, which, believe it or not, was the technical term. When the pathologist announced it at the multi-disciplinary conference it was the first time I’d ever heard of it.

A very primitive . . . aggressive tumour, the pathologist said, poorly differentiated . . . hasn’t evolved much . . .

Like a great white shark, someone said.

I suppose so, said the pathologist.

Small round blue cells, Like tiny irises. There was a picture shown, projected from the microscope onto the back wall. It certainly didn’t look like a vicious cancer, lit from the inside by immuno-histochemistry like a stained glass window. The pathologist pointed out the characteristic features with a bright red dot, showing clumps of cells, a bit bloated, suspended in serum, not very blue actually. They looked like the frogspawn I’d dip jamjars into as a child, then place on a windowsill and watch day by day as the tadpoles evolved. Sprouting mini-hindlegs, then weeks later released into the grass at the back of our house.

He kept texting on his mobile phone throughout that first outpatient visit. I kept waiting for his mother to tell him to stop. Will it take long? was the only thing he said. As if cancer was school work. I looked at him severely, thought to myself, one of those immortal teenagers, did he not listen to a word I was saying? Had he never heard of cancer? What he really means doctor, his mother said smiling, is will he be long away from the horses? Hopefully not too long, I said. Forget about the fucken horses was what I was thinking. He wanted to be a jockey but had grown too tall. Hoped now to be a trainer. He prefers horses to people you see, said his mother ruffling his hair.

He looked down and away, red-faced, embarrassed, his thumbs still working away on the phone. Mam!! Ah he’s still my wee pet, she said, my wee fella. Mam will you shut up will ya!