Medics are human!
So hard to remember when they are speaking to you as though you aren’t, or when, godlike, they are fixing you.
Hard for the medics, too, when their much of training and daily grind conspire also to create a wall of (sometimes vital) professionalism between them and us.
When my father-in-law had cancer we did not care one jot about the human skills of the consultant: we just wanted Big Science to come with its battering rams and attack the disease. Later, we were touched by the kindness of the man whose medicine could not save the day, but whose shared humanity lit Dad’s last weeks with loving concern. That loving concern, the exchange of feeling between doctor and patient, human and human, is Sam Guglani’s subject matter, both in this novel and his extra-curricula activities as an oncologist in Cheltenham, and the founder of Medicine Unboxed, which aims to engage health professionals and the public in conversation around medicine, illuminated through the arts (www.medicineunboxed.org).
I saw Sam speak a couple of weeks ago at Gladstone’s Library , partly a reading from the book, partly a talk about the need for medicine and art to meet , particularly literature, more often, and more publicly. As he spoke I remembered some work I’d done with medical students when we had a few years’ experiment with literature modules in the School of Medicine at Liverpool – first, how hard those medical students were willing to work, something some arts students might have profitably learned from. Second, how useful some of them found poetry. Third how distressing some members of some Shared Reading groups found it to have a student doctor in their midst – as if the enemy had shown up in your sanctuary.
It seemed to me that Sam Guglani might help spearhead a movement to change that dynamic, and I was a bit sorry that he was an oncologist: we need him to work in mental health.
Of course, there are many humane, careful, loving people working in the discipline of psychiatry. I know some of them. But not many people I meet through Shared Reading seem to have been in relation to them in many years engagement with Mental Health Services. Hence the distress of some group members when finding ‘doctors’ on placement in Shared Reading groups some years ago.
After he’d finished speaking, Sam read the opening chapter of the novel, which made a great stand alone story, strangely shocking.
I bought the book and read it last week – a set of inter-related stories from hospital; doctors, patients, cleaners, nurses, porters, doctors-as-patients, the voices are woven into a swelling chorale: this is human life in a contemporary hospital, a workplace, the demands of being human often pressured out of kilter by the demands of ordinary organisational any-workplace situations. Anyone at work can find the printer’s broken, IT help-desk not helpful, I haven’t managed to grab any lunch, am worried about home, or am still flustered by what happened before…but here, you are face to face with the next patient, and another test of your often failing humanity:
They’re waiting, someone is always waiting, always wanting something from her, wanting an answer. Even now, looking away from both of them and down at the notes on her lap, Emily feels the couple sitting there tight-lipped and straight-backed, the entitled press of their stares.
She’s been falling in slow motion from the minute she walked in here, apologising but not really meaning it. No, she had meant it, she was sorry, but only just. In a contest of apologies it would be weightless: sorry to keep you waiting, sorry, you’ve months to live; sorry, these days I struggle to feel very much for you, my patients.
She’d sat next door first, hoping to read through the notes and print off a path report. But the printer had crashed again, its red light blinking after brief, hopeful whirrs. She called IT and someone young, some terribly young and relaxed-sounding girl, said it was too late in the day, that they couldn’t possibly fix it now, surely there must be another printer? Then Nancy had arrived, telling her that Freda, their woman on the ward, was set to leave, she wouldn’t stay in for tomorrow’s MRI, that her daughter and husband were with her and they were packing up. This news, this and the sound of the clicking printer, pushed Emily from her chair and propelled her into the consultation, unprepared and flustered.
It’s little moments like that, almost unspottable, that make Sam Guglani such an excellent human diagnostician. That the printer could have pushed you, that the previous patient’s walking out could have propelled you into action with the next patient, like a domino fall, one into the other, with your conscious self scrabbling about behind, trying to self-question. Am I sorry? No? Yes? A bit? He is carefully observing and sescribing humans asked to work in overly demanding and finally inhumane situations, mostly doing their failing best.
Guglani wants to draw attention to the failings as well as the best efforts. He’s angry, often through the non-medical voices ithe book, the porter, the hairdresser, or here, the medical secretary:
Take Munro in our office yesterday, telling us all about Jim. I’ve some bad news everyone, he says. And even then his voice stays hollow. How must that be for a patient? Important words offered as empy sound. I stood at the back of the room and watched him as he talked at us.
‘Important words offered as empty sound… he talked at us’ Of course we all get angry about this, and it is us non-medics perhaps who feel it most. But this isn’t a critique to be applied only to senior doctors. I’ve met it often in professional, highly educated people, women aswell as men, who use it as cover, a kind of armour. As members of a civil society, we have to ask ourselves, why do such people need that armour?
For the medics, the pressure to save lives, to heal, to offer cure is a hard pressure to bear for best among us. For more on that read John Berger’s A Forunate Man. Histories would also sit well with a rereading of Lydgate’s part in Middlemarch. Feel a weekend study group on medics and literature coming on…
With this novel Sam Guglani joins a fine tradition of doctor-writers – he quoted Chekov (much read in Shared Reading groups) at the start of his talk, and I thought as he spoke about William Carlos Williams and Oliver Sacks. I remembered, too, the group of medical students I spent an afternoon with who berated me for thinking they had time to waste on literature – we have blood clots and heart attacks to learn about! People could die!
Cant remember if I have written about this in The Reader magazine? I wrote about it at the time, I know. Will dig it out and post tomorrow.
Human, so human. That’s why many doctors are doctors. Sam’s description of the oncologist could be any one of us all day, any day. The printer doesn’t work, it’s friday so there’s no milk for coffee, you’re running late because it took 40 minutes to admit a patient to hospital and now you’re pushed to get to a joint visit with the district nurse at 1 pm. No lunch. Bladder not emptied since leaving Home. A patient makes racist comments about a colleague. …
And still we rise, do our best.
Thank you so much for this Jane. I’d like to share it with a group of GPs in Shropshire if I may.
You need to be in touch with Sam – you are part of the same movement.