Magazine article The Spectator

The Pen Is Scarier Than the Scalpel

Magazine article The Spectator

The Pen Is Scarier Than the Scalpel

Article excerpt

As little as a century ago, doctors were our friends.

Summoned by messenger in the middle of the night, they would be welcomed into the home with open arms and plied with a generous snifter. Thus fortified, they would take the patient's history; ask about eating, sleeping and bowel habits; feel the pulse and listen, without the benefit of a stethoscope, to the chest. And that, really, was that.

Decorum prohibited any sort of detailed physical examination. Only after Queen Victoria's death did her physician, Sir James Reid, discover that she had a 'ventral hernia, and a prolapse of the uterus'.

Nowadays, not only is the 'home visit' a rarity, but the doctor-patient relationship has become tense and combative, thanks largely to the internet and the opportunities it affords for self-diagnosis. We want doctors to confirm that we are as ill as we think we are, and to be impressed by our selftaught medical expertise; but we also want them to assure us that nothing is wrong.

These are ludicrous demands, impossible to satisfy. And so we have grown to resent doctors, and their lofty authority, and their calm, detached unknowability.

Thanks to a new publishing trend, however, doctors are currently more knowable than they have been for years. As if frustrated by how little the public understands them and their craft, growing numbers of medical professionals are writing bracingly revealing books whose appeal is a carefully calibrated mix of memoir, confession, philosophical rumination and -- the icing on the cake -- gory case studies. There is much flashing of multidisciplinary credentials.

'Look!' these books shout. 'You might think doctors are unfeeling automata, but I'm not! I can quote Yeats and play the piano!' The acknowledged classic of the genre is Boston-based surgeon Atul Gawande's Complications, published in 2002.

Complications gets the balance exactly right: it snags our attention on the puzzling tale of a shotgun victim with an entry wound in his buttock but a bullet lodged in his upper abdomen (and no major organs or vessels destroyed en route); breaks off to consider the issue of good doctors who, for a variety of reasons, go bad; then tells us what it's like to operate on a woman whose leg has been destroyed by necrotising fasciitis, aka 'flesh-eating bug'. Throughout it all, Gawande's aura of fallibility humanises him. 'Every day, surgeons are faced with uncertainties, ' he writes. 'Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect.' My favourite medical memoirs are by brain specialists, reflecting the fact that the brain has always been the focus of my hypochondriacal anxieties. I didn't sleep for a week after finishing the neuropsychologist Paul Brok's Into the Silent Land (2003);

couldn't stop thinking about Stuart, whose left frontal lobe was mashed when he was driving on a motorway and a bolt snapped off the vehicle in front: 'He told the paramedics he was fine and had better get home now, but they saw the brain stuff gelling his hair and put him in the ambulance.' Brok's interest is in what can happen when the brain's wiring goes even slightly awry, and his case studies are of obscure phenomena like Cotard's syndrome, an especially chilling form of dementia whose victims cease to believe that they exist. …

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