Promises to keep: Doctor-patient interactions

Screen Shot 2018-11-12 at 22.39.17

Forgetting Emilie Pine’s Notes to Self and Maggie O Farrell’s I Am. I Am. I Am. by mistake on the hall table at home, I had to adjust the plan for this class on my way in to Trinity.

We started, as planned, with the opening scene from the film adaptation of Carlo Levi’s non-fiction Christ stopped at Eboli which shows the Levi figure, aged, (“closed off from this world”) contemplating his portrait paintings of the peasants he treated and knew when he was banished to southern Italy for criticising Mussolini’s government. In the clip, we see close ups of the painted faces and hear the voiceover saying “I’ve been unable to keep the promise I made to those peasants upon leaving: that I’d return to them.”

Moving to another poor community in a rural location, namely, Gloucestershire – I then told them about John Berger’s A Fortunate Man, and showed them some of Jean Mohr’s photographs, pointing out that the commission that led to Fionn McCann’s ‘General Practice’ photographs, which hang in the halls around the Biosciences building, was inspired by A Fortunate Man. We read together the short scene early in the book in which a young woman visits the doctor, John Sassall, complaining about nothing in particular (‘You just feel weepy?’). The episode is mostly dialogue, but we discussed Berger’s observation of the patient: that ‘She is nubile in everything except her education and her chances.’ We compared that to Levi’s painterly observations of the peasants of southern Italy. We also analysed the particularly personal level of care that was shown in the consultation, how it reached into the patient’s circumstances, going way beyond physical and even narrowly defined mental health concerns.

We discussed at some length the last few lines of the vignette, another authorial intervention: “After she had turned the corner, he [Sassall] continued to stare at the stone walls on either side of the lane. Once they were dry walls. Now their stones were cemented together.” We identified the poetic nature of it and the possible metaphorical comment it represents in relation to the lives of the local people becoming more restricted.

To stand in for the more negative experiences of doctors that are a feature of some of the encounters in Pine’s Notes and O Farrell’s I Am.., I simply showed them & read from the front page of the Irish Times from 13 September 2018 when the Scally Report was published.

Irish Times frontcover doctor quotes

We then read Kim Caldwell’s personal essay, ‘Life Lessons’ (from CUP’s ‘Palliative & Supportive Care’), about her recollections of dealing with various patients close to or at the time of their death. We discussed why she might have chosen to address those people in the second person singular; and some other aspects of the style of writing, the structuring of the pieces, and the literary nature of some of the writing. We noted how much detail she was able to recall about the lives of these patients, details which she had picked up from spending time with them and consciously listening to them, details which she still recalls and which she consciously shares with the reader, as if challenging the reader to sit with the patient as well and get to know them. We discussed her reasons for going into so much detail, and for wanting to share the accounts with others. (Prompted by one possible reading and the occasional ‘commodification’ of doctors’ experiences that one encounters, we discussed the possibility of there being an element of flexing or trumpeting about such accounts, but the majority of the class felt that this would be an unfair reading to the author in this case whose genuine nature came across very clearly in how much she obviously cared about these people, wanted to remember them as people – not just patients, and how she pointed to her shortcomings and the system’s pressures that prevented this kind of interaction being the norm.) We discussed the pressures on medics to concern themselves with much more than just the science of health, the symptoms, the diagnoses, the treatments. It was pointed out how helpful it was to get this perspective on the patient-doctor relationship.

I gave them – “to go” – a 1977 Irish Times piece written by Maeve Binchy (whose portrait by Maeve McCarthy was one of the paintings chosen to “go with” a poem during our visit last week to the National Gallery), called ‘Anna’s Abortion’, and one of the ‘In Her Shoes’ personal accounts that had some parallels >

(Note: It was our first poetry-free and fiction-free day.)


Student presentation on Carlo Levi’s Christ Stopped at Eboli


This extract from Carlo Levi’s book Christ stopped at Eboli is a memoir of his time exiled in the South of Italy because of political activism against the fascist government in Italy at the time (1935-1936). He is deposited in one of the poorest regions of Italy, rife with poverty and sickness, especially malaria, where people have no love nor loyalty for the fascist regime and dream of a better life.

The main theme present in the extract is class. Levi constantly refers to people as either “the gentry” or “peasants” although he himself seems to have a kinder of view of most peasants than his peers. Levi suggests that the idea of class as “a remnant of feudalism”. His patients are constantly making entreaties to him, as if he is above them, bowing and trying to kiss his hand.
We get a close look at a prominent member of the upper class, the mayor Luigi Magalone, “the youngest and most fascist mayor in the province of Matera”. The mayor seeks to treat the author differently to other political prisoners due to his class. He seems completely detached from the abject poverty and illness of the village saying “the village was healthful and prosperous”.
Levi shows how little difference there is between the classes, the doctors and pharmacists have as little an idea about medicine as the superstitious peasants. Indeed the superstitions are shared by both classes, Dr. Milillo warning the author to beware of love potions in drinks offered to him by peasant women.

The author’s sister’s visit gives us a great insight into the lives of the peasants in the region. We see how much malaria is a part of life in the region through the words of the policeman she talks with. On page 87 the sister describes the abject poverty of the people who live there.
“They had trachoma. I knew that it existed in the south, but to see it against this background of poverty and dirt was something else again.” This view contrasts directly with the view the mayor of the town gives when first talking with the doctor. The author presents a bleak view of life in the Italian countryside, the population filled with apathy, with no hope.

A strong contrast is made between altruism of the author and other doctors. “How was I to resist their pleas?” This is at odds with the bitter resentment of the other doctors towards the patients, they are outraged by the patients’ lack of money to pay for services rendered. The prescription of quinine to remedy problems not satisfying their every need. “There’s no cure for their mulishness.” It’s no wonder that the patients flock to the new doctor in town.

There is also a heavy emphasis on family in the piece. Both the townsfolk and the author place a huge importance on family. The author suggests it is due to their lack of religion or faith in their government “they had little attachment to either religion or the state”. The only time we see any happiness in the townsfolk is when they see the author and his sister. Kinship and family is of the upmost importance to the people of the village.

The role of women is questioned in the piece. We see how women in the region must be in mourning when family dies, contrast with sister’s freedom. Looked upon with respect and interest.

The permeating presence of malaria in the region raises questions about how much power a doctor can actually have to help their patient. In an environment such as this there seems to be little that the doctors or the inhabitants of the region can do to counteract this.

In conclusion Levi’s work is a fascinating insight into the life of common people in rural, Southern Italy at the time, in particular their relationships with medics and disease. The author puts a cross an image of him being benign and friendly with all inhabitants of the region, regardless of class. It seems unlikely that he took a much more equal view of the people in the village than the rest of the gentry in the village.

Doctor in society

On the theme of what the doctor’s relationship is to her community and to society more generally, we read extracts from the following texts:

John Berger’s A Fortunate Man

Carlo Levi’s Christ Stopped At Eboli

Gabriel Garcia Marquez’s Love in the Time of Cholera

JD O’Connor’s “Doctor in the Dales”

The two presentations will shortly be posted here, but in the meantime, those who missed either class and those who didn’t get a chance to formulate their thoughts during the classes, are invited to add “comment” on this post (by clicking on Leave a comment link above).