Last year I had the happy experience of going under general anaesthetic and coming out of it again. ‘Won’t be long,’ the orderly said, wheeling me into a dimly lit space resembling a basement, ‘they’re just finishing up on the patient before you.’ Left alone in the sterile gloom, I hauled myself onto my elbows to take note of my surroundings. The room seemed of perfectly square dimensions and covered wall-to-wall with large pale tiles, bare but for a few sinks, trolleys and storage shelves. Concluding that there was nothing interesting enough to justify the exertion of propping myself up, I lay back down again. Then I noticed that, if I strained my neck a bit, I could see two doors with porthole windows to my right, and behind them, the shower-capped heads of surgeons toiling. Later, when the anaesthetist was embarking on the simultaneous tasks of hooking me up and making small talk, I sensed the doors suddenly swing open, and I caught a glimpse of the patient before me, a flash of skin under the bright lights of the operating table. Then the doors swung closed again.
Aside from the vaguely comic aspect of the situation, my feeling of being the first and only person in the queue was comforting—I was a mere matter of business to be attended to in a brisk, workmanlike and presumably competent manner. Yet the small talk, despite its undisguised function to distract, was reassuring too. I’ve long been interested in the workings of the body, and this tension, between recognising the individual and at the same time offering them up to the greater machinery of the system, I find intriguing. Having a body with all its quirks and failings is of course a fundamental part of human experience, and there are vast industries with legions of trained professionals dedicated to its management. So it’s a pity, I think, if not very surprising, that the work of medics is something that is not explored more often in fiction. Thankfully, there is such a thing as a ‘physician writer’—medical practitioners who, miraculously in my opinion, somehow find the time and energy to also engage in creative writing.
Perhaps Stanisław Lem does not entirely count as a physician writer, since he abandoned medicine early—and not unenthusiastically—to write, but he did train as a physician and his first novel, which I’ve just finished, is from the viewpoint of a student doctor. The Hospital of the Transfiguration (Szpital Przemienienial, translated from the Polish by William Brand), refers to a provincial Polish asylum during the early days of the German occupation. The young doctor, Stefan, a somewhat dispassionate and misanthropic fellow, spontaneously accepts a post there, and the story advances—no spoiler here—to the inevitable dilemma the hospital staff must face when the Nazis arrive on the scene to co-opt their institution, and their patients.
Stefan wavers between being humane, curious and concerned with the nature of existence, and being cool and aloof, with the clinical detachment expected of him. Some of the asylum patients are wholly developed characters, while others he views with indifference—they are pitiable creatures without a trace of back story or speculation on the ‘causes’ of their madness. That said, it’s obvious that their insubstantiality is linked to their circumstances, and a subtle condemnation of apathy is threaded finely and with a merciful lack of preachiness through the text. I actually found the novel hugely enjoyable, being gently ferried towards some pretty dispiriting conclusions.
Hospital was written in 1948 but not published until 1955, by which time Poland was beginning the process of de-Stalinisation. So the novel is realist, but not very, and it was definitely not socialist-realist enough for earlier publication…Perhaps too the censor judged that themes of the dehumanising structures of power and bureaucracy leading to horror were, in spite of the presence of barbarian Nazis, a bit too close to home, (though being from a Jewish family Lem was closer than most). In this sense, as well as in its wry tone, Hospital fits nicely into the tradition of black humour, the grotesque and the absurd— that of Gombrowicz, Schulz, Kafka.
This tradition fits just as well talking about the body as it does about power. The body is after all a site of suffering and caprice, and of mechanisms that should work well but often don’t; in medicine the will to progress is constantly pitted against the reality of dealing with the mysterious minds and bodies of others. One scene in Hospital, of the attempt of an imperious surgeon to remove a brain tumour, is engrossing and blood-curdling despite—or perhaps because—it is related almost as a textbook series of actions by a man who holds everyone, patients and fellow doctors alike, under his sway.
I also found Lem’s witty descriptions to be something of a masterclass in succinct characterisation. I wonder if perhaps that sense of detail might be helped by the habit of clinical observation, of attempting to take the immediate measure of a person. In any case, it can’t hurt. And like the fiction of other medically-trained writers, he provides plenty of insight into details of clinical practice around the time he was writing, so the novel functions as something of a historical document too. (Bulgakov was also brilliant for this; I’m thinking especially of Morphine.)
Partly then these details are so fascinating because they reflect attitudes to and practices around the body, giving a sense both of scientific developments and societal shifts. But they’re also fascinating in themselves, in that they describe a world that is largely hidden from us: the world of blood and viscera, of things that pulse and pump. When I was going into surgery I had immense curiosity about what would actually take place. But I also felt immense disappointment, upon awaking (notwithstanding the relief that I had woken at all) that I had missed the most interesting thing to happen to me all year.
A few novels before Lem’s, in one of those weird but not uncommon convergences in reading/thinking, I picked up another book about a physician in wartime, The Land at the End of the World by António Lobo Antunes. (Os Cús de Judas, translated from the Portuguese by Margaret Jull Costa). Antunes is a psychiatrist, and Land draws from his experience of being stationed at an Angolan outpost during the Portuguese colonial wars. It’s set mainly in Lisbon, a few years after the 1974 revolution that toppled the Estado Novo regime, but flashes back to ‘71 and ‘72, when Portugal was still fighting its brutal and doomed battles of Empire.
It’s quite ingenious, certainly one of the best anti-war novels I’ve read. Here the narrator is a surgeon, not a victim of an occupying force but a self-loathing part of one; he witnesses the moral rot of a disintegrating empire and the physical one as well. The body is always compromised, the patient always condemned, and the doctor’s role is mainly palliative. On returning to an unrecognisable Lisbon, and feeling unrecognisable even to himself, the narrator holes himself up in a bar and unravels in a long ruminative rant, a confession minus any hope of salvation. Like the voiceless woman who is the target of his monologue, though, you do feel strangely compelled to stick around.
This is partly because the language is so exciting—eloquent, furious, roiling with contempt but with a melancholy and languorous undertone. I’m not sure how Lobo Antunes does this so well exactly, how he manages to convey such torpor and urgency all at once. And yet all these words spilling out of the narrator are still insufficient to him somehow, as he casts wildly around for similes that become so numerous and elaborate as to border on the ridiculous. I can’t recall a point at which they actually crossed the line into total silliness, though some might disagree. In any case, there’s a kind of vigour to the language that made me want to write, and that’s probably recommendation enough.
Thinking about these two novels together I realise that both are, amongst other things, about failure— failure mainly in reconciling institutions of power with the dignity of individuals. The successes, I suspect, wouldn’t make such great stories, but the mere attempt is where the humanity lies. It’s sometimes said that medicine is a creative application of science, and that reading fiction makes more empathetic doctors. But since medical practitioners are agents in many of the most intimate and important events in our lives, more of them actually writing fiction that reveals something of their singular perspective would be welcome, I think— not just by those of us who like the gory details.
Kyra Giorgi is a writer and researcher. Her collection of short stories, The Circle and Equator, won the 2017 Steele Rudd Award. She has also published a scholarly monograph and other things here and there.