About the piece:
This was one of several creative readings delivered at our April 2024 Literary Evening with the NBM Lab.
“Conversations with A Fortunate Man”
“Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place. For those who, with the inhabitants, are behind the curtain, landmarks are no longer only geographic but also, biographical and personal.”
These are the beautiful, almost poetic, opening lines of A Fortunate Man: The Story of a Country Doctor by British writer John Berger, first published in 1967. It remains what some general practitioners (GPs), me included, consider to be the greatest book ever written about the work that we do. Over the years I have come to learn that many general practitioners and family doctors have not heard of the book, let alone read it. Even fewer non-physicians are familiar with it.
I first encountered A Fortunate Man towards the end of the first year of my two-year family medicine residency in the early nineteen nineties. It was a critical time in my life as a young doctor. I was waiting for a meeting with the Chair of the department of family medicine to discuss my uncertainties about continuing in family medicine and switching to more specialized training.
My heart and my head were at war. As I moved through the specialty hospital rotations during those first few months, I was repeatedly lured by the siren-song of the hidden curriculum message that the most intellectually gifted medical students choose specialist practice, not family medicine. In my heart I longed to be a comprehensive generalist doctor like the one who cared for my northern English working-class family (and delivered my three younger siblings at home) when I was a boy in Lancashire. In my head, I wanted to avoid being one of the “B-Team,” which is how one specialist teacher referred to the discipline of family medicine.
Outside the office was a small library and as I waited, I scanned the shelves and saw the intriguing title of this slender paperback book. As I took it from the shelf and opened it, I was immediately drawn in by those opening lines and the stark, mysterious, black-and-white photographs by Swiss photographer Jean Mohr. I signed the book out right away.
I cannot recall the conversation with the Chair, but that night, in a little over two hours, I devoured its one hundred and sixty-eight pages whole.
*
In the dramatic opening scene of the book, the doctor rushes to the aid of a woodsman trapped under the weight of a fallen tree:
“A man breathlessly said that a woodman was trapped beneath a tree. The doctor asked the dispenser to find out exactly where: then suddenly picked up his own phone, interrupted her and spoke himself. He must know exactly where. Which was the nearest gate in the nearest field? Whose field? He would need a stretcher. His own stretcher had been left in hospital the day before. He told the dispenser to phone immediately for an ambulance and tell it to wait by the bridge which was the nearest point on the road. At home in the garage there was an old door off its hinges. Blood plasma from the dispensary, door from the garage. As he drove through the lanes he kept his thumb on the horn the whole time, partly to warn oncoming traffic, partly so that the man under the tree might hear it and know that the doctor was coming.”
The doctor arrives, the plasma transfusion is set up, and morphine given for pain. The woodsman and the leg pinned under the fallen tree are both saved.
John Berger and Jean Mohr followed Dr. John Sassall, the eponymous protagonist of the book, for weeks recording in both words and photographs everything from dramatic scenes like this to the more prosaic office visits for common colds and other minor ailments.
One early scene in the book, a house call to woman dying of congestive heart failure, reminded me of the first house call I ever made during my internship year. I was on call for the practice over the weekend. Late on an autumn Friday afternoon just as clinic was finishing, I got the page. It was from an elderly woman in her eighties who lived alone.
She was clearly confused and, as I recall now, the only information I could get from her was that she had been having “trouble with my water.”
By the time I arrived at her second-floor walk-up apartment it was dark and after several loud knocks on the door she finally answered. Before I could register her appearance in the unlit hallway — the greasy, unkempt shoulder length grey hair or the grubby, ankle-length polyester nightshirt — I was overwhelmed by the stench of urine. It was clear that she had been incontinent for days from an untreated bladder infection and her confusion was due to sepsis, a common complication in the elderly.
This was one of my earliest memorable experiences of the invisible suffering of ordinary people that occurs behind closed curtains and closed doors — captured so perfectly in the opening lines of the book.
About the author:
Nick Pimlott is a family physician and writer. He is a Professor in the Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto. Nick is also the Editor of Canadian Family Physician, the official journal of the College of Family Physicians of Canada, and is at work on his first book.