There is a long and noble tradition of doctors who write about medicine. The best of this writing brings to the page powerful insights about what it means to be a human being—the kind of insights that are sparked when the steel of medical science is struck by the flint of medicine’s art. Language is one of the key medical arts, and memoir and essays make wonderful genres for the development of such sparks.
In his memoir, On the Move, neurologist Oliver Sacks speaks of his awareness that he was not born “a medicalizer”, but became one through a rigorous training programme in which he acquired medical knowledge and medical habits of mind. As a doctor, his writing became his way of reconnecting with his pre-medicalised self. “It seems to me,” he commented, “that I discover my thoughts through the act of writing, in the act of writing.” He described himself as “haunted by the density of reality”, and struggled through language to find a way to express the complexity, interdependency and messiness of lived existence. In doing so, his sentences would get away on him: “I may express the same thought in different ways. I can get waylaid by tangential thoughts and associations mid-sentence, and this leads to parentheses, subordinate clauses, sentences of paragraphic length.” Nevertheless, said Sacks, his discursive style of writing (which usually needed extensive pruning before publication) was “a special, indispensable form of talking to myself.”
Neurosurgeon Paul Kalanithi’s memoir, When Breath Becomes Air, reveals a similar driving passion for finding meaning in life. Before embarking on medical training, Kalanithi graduated with degrees in biology and English Literature. Literature, he decided, “provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Kalanithi the brain surgeon became even more aware of the deep and intrinsic relationship between our humanity and language, noting that if the brain’s speech areas are damaged “the patient becomes an isolate, something central to her humanity stolen forever.”
What kind of life exists without language?” – Paul Kalanithi
Kalanithi’s love of literature re-emerged, poignantly, in his mid-thirties, when he became terminally ill with cancer:
Lost in a featureless wasteland of my own mortality, and finding no traction in the reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics, I began reading literature again… I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again… I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.” – Paul Kalanithi
Gavin Francis is an Edinburgh-based GP. His collection of essays, Adventures in Human Being, takes the reader on a journey through the human body, beginning at the head and ending at the feet. Like Sacks, Francis often uses a patient’s condition as his starting point, but where Sacks tends to travel inwards in an attempt to grasp something of the patient’s experience, Francis often journeys outwards, seeking the human body in a wide range of linguistic, cultural and historical contexts. His essay on the face, for example, traverses Leonardo da Vinci, the Greek philosopher Anaxagorus, Shakespeare, and the nineteenth century Edinburgh doctor Charles Bell (for whom Bell’s palsy is named). The essay on the shoulder is an exploration—partly via Homer’s The Iliad—of the ‘dual-use’ of the word arms: “parts of our bodies and weapons of war.”
All of us have landscapes we consider special: places that are charged with meaning, for which we feel affection or reverence. The body has become that sort of landscape for me; every inch of it is familiar and carries powerful memories.” – Gavin Francis
New Zealander Dr David Galler’s memoir is Things That Matter: Stories of Life and Death. A highly skilled and experienced Intensive Care specialist and public health doctor, Galler, like Kalanithi, received an education in the humanities (Classics, Comparative Religion—and, post-graduation, bus driving) before embarking on medical training. The critical thinking skills he honed in this time shine through in his account of his life in medicine: an understanding of cultural and historical perspectives, an appreciation of nuanced differences, and an ability to weigh competing factors so as to make sound decisions in complex cases.
Diagnosis and treatment are as much an art as they are a science, and the final result may not in fact be final because of ongoing changes in how patients respond to their treatment over time. This is the context in which we operate—this is the art of medicine where we know what we know and we apply what we know, see what we get and make adjustments as necessary to get the best for each and every patient.” – David Galler
Galler has spent a large proportion of his working life at the high-tech end of medicine, managing seriously ill patients. He knows the composition of our “biochemical soup” and what needs to be done to restore its balance, but his (many-times invasive and risky) interventions are always steeped in humanity. A philosophy of care emerges which is warm-hearted, clear-headed and underpinned by a commitment to the values of respect and honesty. Galler reminds us to critically examine institutionalised thinking, to create positive change, to deal with “debilitating legacy issues”, and constantly to keep in mind what really matters:
When I look for purpose in my work, it’s about people and life. When I look for purpose in the provision of healthcare services, whether they be to an individual, a family or a population, nothing changes—it’s also about people and life.” – David Galler
So… four doctors, four books, four excellent reads:
- Galler, David. Things That Matter: Stories of Life and Death. Auckland: Allen & Unwin, 2016.
- Francis, Gavin. Adventures in Human Being. London: Profile, 2016.
- Kalanithi, Paul. When Breath Becomes Air. London: The Bodley Head, 2016.
- Sacks, Oliver. On the Move. London: Picador, 2015.
Sue Wootton is co-editor of Corpus.