159SPEAKING FOR OURSELVES

Mark Twain’s statement ‘I never let my schooling interfere withmy education’ cannot, and should not be taken too seriously by themedical student. Yet, to ignore it would also be inappropriate. Theusual suspects—surgery, medicine, pathology and other texts—are of course essential. Medicine is a social science as it deals withhuman beings who are sick, ailing and often at their wit’s end. Yet,there is no emphasis, in most curricula, on the humanities. ‘…every illness … comes with a spiritual violation that parallels thephysical ailment. A doctor has to be … a dispenser of cures butalso a minister of healing’ (Abraham Verghese: The TennisPartner).

What, then, should doctors read—and why? It is necessary tocast one’s reading net wide. Sir William Osler had recognized thisa century ago and proposed a bedside library for medical students.Some of these books are now obscure and unlikely to attract manyreaders. Art, religion and philosophy are important but may beesoteric to some. We propose four stories: The Citadel by A. J.Cronin, Heart Sounds by Martha Weizmann Lear, The TennisPartner by Abraham Verghese and The Final Diagnosis byArthur Hailey.

All four are pretty easy reads but the real meat is in the subtext.The Citadel is Cronin’s semi-autobiographical account of medi-cal practice in the 1930s. When we first meet him, the ‘hero’Andrew is a struggling young doctor straight out of medicalschool. We trace his story through early days in basic practice ina Welsh mining town, his marriage to an idealistic small townschoolteacher, his ambitions that drive him to appear and pass theMRCP and that eventually get him to the corrupting influence ofsuccess in Harley Street. Very few of us have anything likeAndrew’s eventful journey but the human drama of his ethicalchoices echoes in all our professional lives. We all need the idealof the shining citadel on a hill as medical practice teeters betweena cut-throat business and a managed care health industry. And thehumanity of Cronin’s medicine means that it is as real as it was 80years ago.

In Heart Sounds, Martha Lear documents her husband’smyocardial infarction and the subsequent decline into terminalrefractory heart failure. At one level it is ‘Love Story’, adult size,as a desperately-in-love middle-aged couple cope with the dis-ease, disability and impending death of one of them. But at anotherlevel, it is an insider’s view of what it is to become a patient.Martha was a journalist and writer of obvious competence and inHoward Lear, she has a senior urologist to tell her what ishappening. She watches as Howard’s colleagues and physiciansfail in empathy. She notes how we often play the blame game withour patients, evading our responsibility for their tribulations. Andyet there is no stridency, just the careful documentation of her owngrief and her husband’s telling of his own story.

What books must a doctor read?

SANJAY A. PAI, ROOP GURSAHANIThe warp and weft of our personal and professional lives

rarely weave well together. In The Tennis Partner, Verghesedocuments the unravelling of his friend and tennis partner,David’s life. David Smith is a medical student in his mid-thirtieswhen Abraham and he meet and the common ground betweenthem, other than medicine, is a shared obsession with tennis.David, in fact, was a tennis pro using the game to finance hismedical education. As Abraham grows to know and understandhim, the other facets of David’s personality become obvious:a cold family, an inability to sustain relationships, a tendencyto denial and the final cut—a recurrent cocaine addiction.Simultaneously, Verghese describes the parallel dissolution ofhis own marriage with a numbing candor. The pressures ofmedicine, albeit at different stages in their career, extract theirtoll on both of them but the difference lies in the outcome.

‘There but for the grace of God, go I.’ Most doctors meet JoePearson of The Final Diagnosis at some stage in their career.Pearson is a senior pathologist at a large hospital, an ageingstrategist in hospital politics who is gradually losing touch withcurrent medicine. Too many of us let our professional competencedeteriorate and are then forced into making the kind of choices thathe makes.

Be warned, the first three are real tear-jerkers. None of themachismo of the catheter jock, just the touchy-feely side ofmedicine that too many of us are unwilling to touch with theproverbial barge-pole.

There are other reasons to read the books. The Tennis Partnerand Heart Sounds are real-life stories while Cronin’s novel isbased on the story of his own life. Indeed, many of the events in TheCitadel are recapitulations of the incidents mentioned in the firsthalf of his autobiography, Adventures in two worlds. Cronin, inboth his books, refers to an incident that took place during anMRCP examination. When asked what he regarded as the mainprinciple or basic idea which he kept before him while exercisingthe practice of the medical profession, the protagonist answers‘…never to take anything for granted’ rather than the usual spielof helping suffering humanity. Verghese’s sidelights on practis-ing medicine in a teaching hospital in the 1990s are impossible toignore for anyone in our profession. He writes, ‘I taught studentsto avoid the augenblick diagnosis, the blink-of-an-eye label, thesnap judgment. But secretly, I trusted my primitive brain, trustedthe animal snout. I listened when it spoke.’

Can mere stories influence physicians where philosophicaltomes have failed—or have been cast aside as relics from a bygoneera—as impractical and difficult to read? Yes, they can. As T. S.Eliot believed, it is ‘just the literature that we read for “amuse-ment” or “purely for pleasure” that may have the greatest and leastsuspected influence upon us.’

Manipal Hospital, 98 Rustom Bagh, Airport Road, Bangalore 560017,Karnataka, India

SANJAY A. PAI Department of PathologyP.D. Hinduja Hospital, Mahim, Mumbai 400016, Maharashtra, IndiaROOP GURSAHANI Department of NeurologyCorrespondence to SANJAY A. PAI; s_pai@vsnl.com

© The National Medical Journal of India 2003

Speaking for Ourselves