Tidying my hard drive, I found a wormseye from earlier this month. So I will put it here, as well:
Worm’s Eye, Mon 2 Oct 06
In the house of an old doctor I found I book called “Patients as people” and settled down to read this alarming heresy. It had been published in 1957, and was a collection of fictionalised case histories, designed to show how diseases arose from the lives around them, and how mind and body were intimately interlinked: a sort of Oliver Sacks for GPs; but in some ways more informative because it was aimed at a readership of doctors. Implicit in every line, and sometimes quite explicit, was the knowledge that case histories almost always end in death.
“Let him go”, says the consultant, finding on his ward an alcoholic salesman, admitted with cirrhosis, at the end of his story; and there’s no doubt what is meant, especially when the landlord of the salesman’s pub pitches up in the same ward, on the same day, with another complication of alcoholism. He, too, is dispatched with the same phrase.
It is taken for granted that doctors tell the truth only among themselves: a patient with very high blood pressure is told, when he worries, that it is “normal for his age”. There were then no medicines that could treat it. Almost all the treatments that were available now seem barbarous: the alcoholic salesman gets antabuse and aversion therapy in the local asylum, but after a while relapses; the depressive editor of a provincial newspaper, my favourite character, is treated with a mixture of sleeping draughts at night and methedrine in the mornings to perk him up.
Sometimes the attitude to drugs is quite literally kill or cure: when the alcoholic is first given one drug, they follow it with a sip of whisky, to show off the aversive effects. It’s a dangerous drug, says the doctor. Sometimes patients die if they drink a whole glass. But that’s better than being an alcoholic. ECT, which the depressive is also subjected to, has almost no side-effects, except that sometimes the fits are so violent that elderly patients can fracture their spines or hips, however firmly they are held down. So nowadays, says the author, they are given a muscle relaxant as well.
That doctors can do little is taken for granted: the depressive has two episodes treated, but in the third, after he has retired, and his depression takes the form of hypochondria and fear of death, nothing more can be done with him. He has a stroke, and then, in hospital, pneumonia starts. No question of treating it with antibiotics.
Yet this brusqueness is not unsympathetic. The book was, in its day, progressive. It was written, I think, to humanise a generation of doctors who had come through the war. The doctor in whose house I found it had landed on one of the D Day beaches two hours after the first troops, and made two further trips across the channel to collect the wounded in the next 24 hours. Later, in Antwerp, he had just left a party in a girlfriend’s house when a V2 landed on it, killing her and everyone else in the apartment. But it was a story he told me from Indonesia that really brought home what war does to doctors.
In 1945, as soon as the Japanese retreated, a fresh war broke out in Indonesia, between nationalist rebels and the Dutch colonial powers, with the British army as guilty bystanders. It was vilely fought on both sides. The doctor was sent up into the hills to rescue “the half-castes” who would otherwise be killed when the Dutch left; his escort were freed Japanese PoWs, re-armed by the allies, who shot everything and everyone in their path. “They had a heavy machine gun, and if they came to a village, they would just fire it right through the grass huts. And if anyone was on there, they were dead.”
On one such expedition, they found an orphan child crawling with a congenitally dislocated hip. The doctor diagnosed her problem, realised he could not treat it, and told his orderlies to shoot her. He looked up at me at this point in the story; a kindly, frail old man with large brown eyes. His orderlies refused the order. “Very well”, he said. “On your own heads be it.” So the orderlies smuggled the child into one of their lorries, and took her back down to the coast, where eventually a dutch surgeon was found who could operate on her.
The doctor who ordered the little girl shot is dying now himself, of heart failure. For the last thirty or forty years, he has been a fervent evangelical Christian, but this autumn, I think, he’s wondering what he will soon find out. It’s always seemed to me an intellectual crime that a man of such gifts and courage should believe such silly things, but now I think I understand how, growing weary of playing god, you might want to believe in him instead.