Shelves: modern-lit , sociology Years ago I was at a dinner party, one of the group being a quietly spoken woman who had largely stayed mute. Somebody happened to say that she had a good dentist. Suddenly this woman exploded. Whereas she, it now transpired, was both a Years ago I was at a dinner party, one of the group being a quietly spoken woman who had largely stayed mute.
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In it a GP working in the Forest of Dean in the mids comes to life. We read about his encounters with patients and his struggle to respond to their illnesses and lives. The demanding and fallible humanity of John Sassall, the doctor, is described as clearly as the everyday courage and despair of his patients.
They portray Sassall at work and in conversation, his patients as individuals and in groups, and the ever-changing dialogue between sky and landscape, both beautiful and full of foreboding.
He starts his career thriving on medical emergencies, impatient with non-specific symptoms and the absence of clear-cut physical diagnoses and underlying pathology. He moves gradually towards an empathic listening and companionship with his patients and their families, striving to recognise who they are and the meaning of their illness to them. Physical and psychological intimacy is central to his relationship to his patients.
As a GP, he witnesses and records the lives of his patients, simultaneously standing inside and outside their stories.
Sassall embraces this ambiguity. He is as exacting about applying scientific evidence before evidence-based medicine was a twinkle in the eye of its inventors as he is committed to the fraternal bond that develops over years with his patients. This bond includes sitting with them and their families at the threshold of death. One of the many pictures of John Sassell taken by Jean Mohr. He had done this by becoming unconventional. Yet the unconventional doctor is a traditional figure.
Now, working in inner city Hackney, a different landscape from the Forest of Dean, I still feel that. Long before I had come to know patients and their families, Berger, an art critic and writer, had illuminated the deep potential of medicine, and particularly general practice, to express solidarity with people as they move through their lives. The mixture of darkness and light in the text and the pictures resonate even more in me now, a middle-aged GP academic, then it did 30 years ago.
The archetype of the wounded healer emerges in different forms across cultures and across historical epochs, from the Greek myth of Chiron the wounded centaur , to shamanistic healing in aboriginal societies to the complex figure of Paracelsus in 16th century Europe.
Re-reading this book again, particularly in the light of his subsequent suicide, I think that John Sassall expresses that archetype. His story reminds us all that part of what we have to give to our patients is a reflection of our own weaknesses and failings, although I am not clear how to reconcile this with the onwards and upwards rhetoric of contemporary primary care.
The question remains salient today. It is particularly acute for general practice within the UK, because the possibility of long-term relationships with patients is actively undermined by a government that either does not understand the value of these relationships or does not care enough to sustain them. They will talk about what the book means to them and what it still has to tell us almost four decades after it was first published. Further details on the event and the whole season: www.
Although we are not charging for seats, these need to be booked in advance: Berger J. A Fortunate Man: the story of a country doctor. London: RCGP;
Zenda recomienda: Un hombre afortunado, de John Berger
La vida que no vemos: sobre «Un hombre afortunado» de John Berger