medicine

A Country Doctor’s Notebook

Remember the Netflix show A Young Doctor’s Notebook I mentioned last time? Daniel Radcliffe plays a newly-minted doctor who is chucked into Middle-of-Nowhere, Russia, to run the hospital there. He faces syphilis, gangrene, and boredom and lives to tell the tale. It’s dark, dark humour, friends. Not for the faint of heart.

Well, when I realized that it was based on a real-life memoir (or stories-based-on-real-life, rather) , of course I had to read it. The show got over much too quickly for my liking and I wanted more stories about the horrible doctor Nika.

But- much to my dismay- the memoir was written in earnest by a sincere and competent doctor/author who lived and worked in Russia a hundred years ago. Imagine the guilt. A Country Doctor’s Notebook, by Mikhail Bulgakov is a short book but packs a punch.

A hundred years ago, Mikhail Bulgakov kept a journal about his experiences in a village hospital in Smolensk. In 1920, he published a compilation of short stories based on these years. Bulgakov comes across as an earnest young man, far from the show’s portrayal of him. The simplicity and humility of the narration (courtesy a Russian-English translator) reminded me of RK Narayan.

Unlike Malgudi Days, however, this book did not have me longing for a simpler time. It’s hard to feel nostalgic for the days of poor anaesthesia, disinfectants, and primitive amputations. Oh, and also the Russian Revolution. There is no romance, or comedy- only homesickness and desperation. It’s difficult to say any more about the stories for fear of spoilers, but suffice to say that doctors back then had unimaginable struggles.

I’ll stick to my policy of not rating real-life stories, but be warned that this collection is not especially eventful or entertaining. Interestingly though, its original publication date of 1917 makes it one of the oldest books I’ve ever read (with the possible exception of ‘classics’).

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Man’s search for Meaning

He who has a why to live for can bear almost any how. ~ Friedreich Neitzsche

This post is written in an attempt to review the book, Man’s Search for Meaning, written by Dr. Viktor E. Frankl based on his experiences during the Holocaust. Frankl formulated a theory in psychiatry after he graduated from medical school, which states that value and meaning in one’s life is what keeps one going, so to speak. He devoted much of his life, before the Second World War broke out, to developing this theory. But it was during his time at the Concentration Camps in Auschwitz and Dachau that the theory’s validity was reinforced. After the war, his theory found wide acceptance; and he has even been compared with Freud for his contribution to Psychology.

Scholarship, bordering on devotion to one’s vocation even in the worst of circumstances, during the most horrific times in recent human memory, is laudable in itself. But it’s all the more so for someone like Frankl, who lost everything in the Holocaust. His wife and parents were gassed in the gas chambers of the concentration camps, and all of his life’s work was thrown away and destroyed.

Frankl’s memoir of his time in the concentration camps is, for the most part, a scientific observation of the inmates. While it is not a gauche field study, since he himself is an inmate, it is an attempt to test his theory. By doing so, additionally, he also stays true to a purpose in his life. In the very first page he dispels any misconstrued notion about this book – “This book does not claim to be an account of facts and events but of personal experiences… It is the inside story of a concentration camp, told by one of its survivors.” Still, he restrains himself from sharing too much from a personal perspective. He states, clearly, the purpose of writing this particular book: “it will try to answer this question: How was everyday life in a concentration camp reflected in the mind of the average prisoner?” So, it was to be a venture to further the science of psychiatry.

Frankl discusses the mindset of an inmate in the period following his admission into the camp, the period when he is well entrenched in the camp routine (the most heart wrenching, I thought), and the period following his release and liberation. It’s a thin book with many anecdotes, of other inmates, structured around Frankl’s own experiences. Despite this human element, in numerous places he seems to struggle to detach himself from the present and the past in order to present a somewhat objective view of what was happening, in scientific terms.

Without doubt, this book can change one’s view of life. Frankl provides us brief insights into the life of inmates in concentration camps, who endured the vilest known horrors in recent memory. By doing so, he illustrates to us how the last of human freedoms, which is to choose one’s attitude in any given circumstance, can never be taken away.

On the other hand, the book can also confound the reader with its sprinkling of psychiatry-related terms and concepts. Brevity is, unfortunately, not one of the better virtues of the book, as it concludes. The last few pages of the book attempt to provide an insight to how Frankl uses his theory to found a novel therapy called Logotherapy, wherein he guides people to find meaning and value in their lives. Too much Chicken Soup? That’s what I thought, too. The last few chapters almost undid the book for me. So, my advice, in case you read the book, is to stop when the war is finished and when he describes the behavior and mental framework of the incredulous inmate who is free.

If you’re into self-help books, you’ve probably read variations of Frankl’s ideas already. But this is an original work, and hence worth a read. If you’re not into mushy self-help, you could try the book anyway, for its no-nonsense exploration of human nature in times of terrible adversity. 3.5/5.

What matters in the end

This is my review of Being Mortal, by Atul Gawande.

I have been lucky enough to know my grandparents, and other relatives of their generation. Like most other Indian kids, a sense of respect for the elderly was drilled into my head at a young age. Culture aside, I relied on my grandparents to be more laid back and indulgent than my parents were.

It’s painful, even as a child, to watch someone you love gradually lose their health and dignity to old age. In many cases, this is accompanied by a not insignificant amount of physical suffering. Incontinence, dementia, poor immunity, weakening of bones- the list is endless. I discovered this book on Goodreads, and made a spur of the moment trip to Blossoms to pick it up when a close relative was diagnosed with an untreatable cancer.

Atul Gawande is an Indian origin medical doctor and writer in the USA. I’ve read only one of his other books, Complications. He tries to bring a touch of humanity to medicine, a science that is rapidly becoming about business and profit. When a senior citizen is diagnosed with a terminal illness- usually cancer- the knee-jerk reaction is to fight it head on with poisonous chemotherapy and radiation therapy. Gawande urges doctors to think twice before prescribing painful treatments that are unlikely to work. The role of a doctor, he says, is to improve the quality of life and not merely its quantity.

He substantiates his suggestions with statistics. Apparently, a huge chunk of medical spending in the US can be attributed to people in the last year of their lives. When the treatments aren’t working, Gawande argues, why put patients through painful surgeries and hospital stays? He also puts forth a framework for deciding on treatment paths, especially in the case when the medical decision making falls to a relative of the patient. What does the patient value most in his/her life? Is it physical mobility? Being able to spend time with relatives? Or is it the ability to live independently? Based on the answer to these questions, sometimes it is more appropriate to send a patient to hospice care, or prescribe palliative surgery instead of aggressive treatment.

I give this book a 4/5, because I could relate very well to the issues discussed. Gawande discusses an emotionally charged subject with the right balance of head and heart. I very much hope that you don’t like this book, because that means that you have likely never seen a loved one suffer.