Medicine and Literature

The Doctor's Companion to the Classics

John Salinsky

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315343341
• Edition: 1
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

'Medicine and Literature' is the doctor's guide to the classics. How can a doctor best understand the emotions and behaviour of his or her patients? An effective and deeply satisfying route is through an appreciation of literature, and the profound understanding its authors have of the human predicament. In this extraordinary and enlightening volume, general practitioner John Salinsky guides the reader through some of the world's finest works. In each chapter he describes a classic novel, short story, play or poem, revealing them to be easily accessible and enjoyable. He shows how parallels can be drawn between characters in literature and in the consulting room. Developed from his long-running column 'Education for Primary care, Dr Salinsky's book give doctors a new perspective on the doctor-patient relationship and provides unique support to communication skills.

1

Introduction: why should doctors read the classics?

When I was at school, my best subjects were English and biology. Biology taught me how living things worked, which interested me greatly because 1 knew it was the first step on the path to becoming a doctor. But, as the narrow sixth form science curriculum began to close around me, I had some regrets that I would no longer be able to learn more about literature – except in my own time and without any help from teachers.

During my years at medical school and as a hospital doctor, the prescribed reading was all firmly focused on biological and clinical science. Nevertheless, I continued reading for pleasure and extending my knowledge of the classics. Some of them I found difficult and perplexing, but with many there was an immediate spark of connection, as if the author was speaking to me directly and we understood each other perfectly. These books gave me great enjoyment and the sense that I had discovered hidden treasure. Their stories were always there for me to revisit and the characters took up residence in my inner world.

When I became a family doctor, I found myself in a world where people were constantly telling me their stories and sharing their feelings with me. Often they reminded me of people in my favourite books, and the fictional characters I read about would remind me of particular patients I had encountered, so that the two worlds would reflect each other. And they still do. A young woman, hopelessly in love with the wrong man will remind me of Anna Karenin; a frightened, anorexic little waif makes me think of Fanny Price from Mansfield Park; a clever but tormented student could be Joyce’s Stephen Dedalus; and the family of three brothers in my practice, of whom the elder two are schizophrenic, always make me think of the Karamazov boys.

Lines and phrases from literature also float into my mind as I listen to the patients: ‘All happy families are alike: but every unhappy family is unhappy in its own way’ – that one comes up a lot. An angry man, incoherently vowing vengeance, conjures up: ‘I shall do such things, I know not yet what they be, but they shall be as the terrors of the earth’ (from King Lear). Someone expressing anguished regret makes me think: ‘agenbite of inwit’ (James Joyce’s wonderful borrowed but freshly applied phrase for the gnawing of conscience). And, when an amiable old fellow launches himself on an apparently pointless digression (as they frequently do), I remember Tristram Shandy declaring that ‘digressions are incontestably the sunshine’. That always helps me to sit back and listen and not worry about the diagnosis, which will come at its own appointed time.

Has all this awareness of literary parallels in the consulting room helped me to be a better doctor? That would be hard to prove. It certainly helps me to see my patients as human beings. And because they resemble my old friends, the characters in my favourite books, I think I am able to regard at least some of them in a more benign, forgiving and tolerant way. I become less impatient with them and more interested in their feelings. I feel sure that there are times when thinking about the classics has helped me to be amused rather than enraged when patients behave in ways which doctors traditionally hate. I am thinking of the ‘trivial complaints’, the ‘inappropriate demands’ and the ‘unnecessary visits’. Even ‘the ingratiating manner’ can give rise to loathing and contempt in the heart of the genial family doctor. But, as soon as I recognise characters in the surgery as belonging to the same human family as my friends from the classics, my anger and frustration dissolve, and a nicer part of my personality is able to emerge. If you were to call all this an enhanced capacity for empathy, I should not disagree. But do I have any greater insight into my patients’ souls? Does the wisdom and insight of the great writers help me to a better understanding of human emotions and behaviour? I hope so and I would certainly maintain that a writer like Tolstoy (when he is writing fiction) can tell you more about what it is to be human and have feelings than any number of textbooks of psychology or handbooks of psychotherapy.

More recently I began to feel the need to share my enjoyment of reading the classics with my colleagues. I requested, and was given (by an enlightened editor), the opportunity to write a regular column on medicine and literature in the quarterly journal Education for Primary Care (formerly Education for General Practice). In each issue, the column consists mainly of an in-depth account of one of my favourite classics. The aim is to invite people who have never read the book to give it a try and to encourage those who read it years ago and remember it vaguely to read it again. I also invite guest writers to contribute articles about their favourite books. These articles have now been collected and published, with some revisions and additions, in the present book.

Do doctors have time to read books for pleasure? When I ask my colleagues and GP registrars I am pleased to find that most of them are quietly reading all sorts of non-medical books. Mostly they read recently published books, and my friends sometimes ask me why I chose only to write about the classics. The answer is that they are so much better written than most other books. Clearly they have shown their quality simply by surviving while numerous others, published at the same time, have vanished without trace. The high quality of the classics is evident in their sheer reliability. If you are going on a long plane journey, choosing a book from the airport book shop is risky: you may end up tossing it aside in irritation after a few pages. But a classic will not let you down. Pack something like War and Peace in your flight bag and, although you may have to work at it a bit to get into the story, you will soon be happily absorbed and oblivious to discomfort, delays and appalling food.

Italo Calvino the Italian writer (whose brilliant novel If on a Winter’s Night, a Traveller is included in my selection) wrote an essay called ‘Why Read the Classics?’ Calvino offers 14 reasons for reading the classics, of which I find number nine the most interesting: ‘Classics are books which, the more we know them through hearsay, the more original, unexpected, and innovative we find them when we actually read them.’ He goes on to say that there has to be ‘a spark’ between reader and book; there is no point in reading the classics out of a sense of duty or respect, we should only read them for love. The exception is reading at school; school has to teach you to know (whether you like it or not) a number of classics, some of which you will later recognise as ‘your classics’.

The books discussed here are, of course, those which are special for me and for my guests. It may surprise you to find that most of them are not about medical subjects. When I mention my interest in the classics to professors of literature, they are, of course, pleased to hear about it, but they tend to assume that I am only concerned with stories about doctors. I have to assure them that this is not the case. It is true that we can learn a great deal from stories about doctors, if only about how badly they can behave. Fictional accounts of doctors and their patients can provide excellent teaching material for students and I shall say something about the place of literature in the medical school a little further on. But I wanted to feel free to include my favourite classics regardless of whether they had doctors as principal characters.

Of course, even when they are not the main focus of attention, doctors have a way of creeping in at the margins of literature: it is difficult to keep them out. When they do appear, I find them fascinating, as I guess all doctors do, and I am happy to spend some time with them. They are colleagues after all: we want to compare our practices with theirs and cheer them on when they do something decent or noble. Unfortunately, most literary doctors show a dismaying lack of moral fibre, decency or even professional competence. The only truly heroic fictional doctors seem to be those who appear in novels written by doctors themselves.

But if you are looking for ordinary, frail, human doctors you will find plenty of them popping up to diagnose and prog-nosticate in the books we talk about here: there is Emily Brontë’s Dr Kenneth, who does his best with some very difficult patients in Wuthering Heights; we have Dr Slop the man-midwife, who makes a botched delivery of the infant Tristram Shandy (breaking his poor little nose in the process); and, talking of obstetrics, we spend an evening in the Dublin Rotunda Hospital in the company of Leopold Bloom and a crowd of drunken medical students. We study the career of young Dr Lydgate (of Middlemarch) in some detail and emerge shaking our heads sadly. And of course, the collection begins with Kafka’s unnamed Country Doctor, who is whirled away by magical horses on the ‘Night Call from Hell’.

As you scan the contents page, you may be wondering how and why these particular works were chosen. You will observe that they are arranged in no particular order, either chronological or thematic. They were chosen because they are favourites with a special meaning for me or for my guests, and because they are classics. They present themselves, more or less, in the order in which they appeared in the Medicine and Literature column. I began with Kafka’s short story A Country Doctor because of a quotation from it which has acquired a special significance for GPs: ‘To write prescriptions is easy, but coming to an understanding with people is hard.’ And also because I thought that a story about a GP would entice a few of my colleagues who ‘have no time for reading’ to give it a try (it is only six pages long). The next piece, on A Midsummer Night’s Dream, was inspired by the need to explain to my group of GP registrars why their course organiser was taking them to see a Shakespeare play. After that came some of the big books which sit beside my bed, ready for me to reread a chapter or two (at random) whenever I feel the need to revisit my friends within. They include Anna Karenin, Mansfield Park, Wuthering Heights and Tess of the d‘Urbervilles. Some of my choices have a reputation for being difficult or obscure. James Joyce’s Ulysses, perhaps the greatest twentieth-century novel in English, seems to put off nearly everyone. So why do I love it so much? I try to explain why and hope that more readers will be encouraged to share in the fun. Another secret delight waiting to be discovered is Laurence Sterne’s Tristram Shandy. Anything written in the eighteenth century may seem very remote to a modern reader, but not this book, which is amazingly modern (or even post-modern) and full of wonderful comic scenes, delightful characters and, of course, digressions.

Not all the books were chosen by me: it is a pleasure to welcome some of my friends and fellow classics readers who have contributed to the column and now the book. Brian Glasser has written about Hemingway’s story Indian Camp, which graphically exposes the non-empathetic doctor and ends so tragically. Oliver Samuel leads us very happily into an appreciation of the sonnets of Shakespeare and Donne; Tim Swanwick celebrates the life and work of Mikhail Bulgakov, a country doctor who also happened to be a literary genius; and Gillie Bolton treats us to an exploration of The Rime of the Ancient Mariner.

All the chapters have been written chiefly with the aim of sharing and spreading the pleasure of reading the classics to our fellow doctors, who work terribly hard and are in desperate need of a little spiritual refreshment. And if one of these books becomes one of ‘your classics’ it will stay with you for life as a constant inner resource whenever you begin to despair of the human race. Will ‘your classics’ help you to be a better doctor? I make no promises and you may already be a better doctor. I don’t insist on the classics earning their living in this way. They are simply there, like the mountains and the stars, to give lasting pleasure to everyone who discovers them.

All the same, if the classics can have a beneficial effect on the professional persona, we should surely be introducing them to students as part of the curriculum. Unhappily, most medical students are still deprived of literature from an early age, as soon as they are segregated into the scientific side of the educational system. But this situation can be remedied. There is now a growing interest in many medical schools in the teaching of the humanities as applied to medicine. Literature, and especially classic literature, has an important part to play in this new curriculum and it is my hope that this book will prove helpful to those of my colleagues who are enthusiastically bringing reading back into medical studies. GP registrars might also benefit from the introduction of some literature into the half-day release course; some courses already include ‘book review’ sessions and I have tried them myself with some encouraging results. In the final chapter of this book, I discuss some of the ways in which the books described here might be used for teaching purposes.

I would like to thank my guest writers for their valuable contribution of voices different from mine; I am also grateful to Alistair Stead for his expert guidance and constructive suggestions. He has also provided three valuable contributions in the form of ‘postscripts’, which shed a different light on the books and gently counterbalance some of my errors and omissions.

I would like to thank the editors of Education for Primary Care, Declan Dwyer and John Pitts, for their encouragement with the original ‘Medicine and Literature’ section of the journal in which these articles first appeared; and everyone who has written to me and told me that they have enjoyed one of my classics as a result of reading an account of it in the journal. It is my hope that all of you will find yourselves heading for the library or the bookshop or perhaps just dusting off a few neglected volumes from your own shelves. I want to see you all, in my imagination, settling down happily with a copy of a classic book and, for a couple of hours, forgetting all the tedious vexations which beset the National Health Service. I feel confident that you will emerge refreshed and invigorated and with smiles on your faces. But what should you read first? In the following pages my friends and I will be happy to offer some suggestions.

Reference

Calvino I (1991) Why Read the Classics? Translation by Martin McLaughlin (1999). Vintage, Random House, London.

2

A Country Doctor

a short story by Franz Kafka

I first came across a reference to Franz Kafka’s story A Country Doctor¹ about 25 years ago, when I was starting out in general practice and thus becoming a ‘country doctor’ myself. I can’t remember the exact context, but I know that it was quoted in an article by Marshall Marinker, one of the pioneers of the New British General Practice of the early 1970s. When I telephoned Marshall to ask him about it, he told me he had first used the quotation as an epigraph on the title page of a book called Treatment or Diagnosis,² of which he was a co-author. The book is an account of a study of the ‘repeat prescription’ patient by one of Michael Balint’s research groups. And the quotation was: ‘To write prescriptions is easy, but to come to an understanding with people is hard.’

Brilliant! I thought, and no doubt lots of other idealistic young GPs thought so too, for I kept hearing the phrase quoted at educational meetings. It was a wise saying from a famous writer, which encapsulated everything we stood for. Our mission as family doctors was (and is) not just to scribble on the pad but to connect with our patients as human beings, experience the spark of empathy and mobilise our resources, both human and medical – and to reach out to them with compassion, insight and wisdom.

A couple of years later, I was wandering around Oxford with Philip Hopkins, who is another pioneer GP and founder of the Balint Society. In the window of a second-hand bookshop, we came across a beautiful edition, illustrated with woodcuts, of A Country Doctor by Franz Kafka. ‘Look there’ I said to Philip, ‘that’s the story with the famous quotation about writing prescriptions being easy. It’s one of general practice’s special books.’ We went inside, examined the book and enquired about the price. I remember that it was in German and that it was very expensive. I decided (foolishly) that I didn’t want it that much. But Philip bought it. I wonder if he still has it.

When I got home I bought a Penguin edition of Kafka’s stories and actually read A Country Doctor myself for the first time. I was knocked out by its power and its vivid dream-like strangeness. I suppose I had been expecting some sort of Czech-Jewish version of Dr Finlay’s Casebook, with a wise old doctor giving an eager youngster the benefit of his experience. I should have known better. I had, after all, read The Trial and Metamorphosis: I knew that Kafka wasn’t like that. So what happens in this famous story? And what does it mean? Does it truly have a take-home message for real-life country doctors like us?

Here’s how it goes. The doctor has received an urgent night call to a patient in a village ten miles away. It is snowing a blizzard and the doctor’s horse has died in the night so he has no means of transport. Striding around his courtyard in ‘confused distress’, he kicks at the door of a disused pigsty. The door flies open to reveal two magnificent horses and a strange groom, who offers to yoke them up and get his gig ready. Unfortunately, this groom also has evil designs on the doctor’s servant girl, Rose. Before he knows what is happening, the doctor finds that the horses are carrying him away in the gig and the last thing he sees is the groom battering down the door of his house in order to get at the terrified Rose, who has locked herself inside. The reader is now, like the doctor, overwhelmed with dismay, carried off by the galloping horses and gazing back in horror. The night call has become a nightmare; how can a doctor concentrate on his patient when frightful things are happening at home which are totally out of his control?

Surprisingly, the journey takes no time at all; the doctor’s courtyard seems to open directly into the patient’s farmyard. The horses are still, the snow has stopped and the scene is bathed in moonlight (thi...