Five Books of doctors

With the Democratic Party “unwavering” in its determination to rebuild American health care from top to bottom, regardless of public opposition and a lack of bipartisan consensus, perhaps it is a good time to escape the frustrations of politics by taking stock of doctors in fiction. Who knows what the medical profession will look like in a generation.

Despite the perennially huge American audience for medical dramas, which seem to have begun in the late ’thirties with the MGM series of films about Young Dr. Kildare, there has never really been a similar demand in literature. Another young doctor, Frank G. Slaughter caught the wave a few years later and rode it to millions of sales, scribbling nearly a score of bestsellers about doctors between 1941 and 1984. Except for Sinclair Lewis in Arrowsmith (1925), however—not a particularly good novel—few men and women have resorted to fiction to explore the realm of medicine.

The obvious medical novels are Der Zauberberg (1924) and La Peste (1947). Yet Mann’s focus is on the patients in a tuberculosis sanatorium in Davos. The medical personnel, including the doctors, remain in the background, faceless institutional functionaries. Not even Hofrat Behrens, the sanatorium’s director and chief of medicine, plays much of a role beyond repeatedly delaying Hans Castorp’s release from the captivity of unending treatment. Camus is far more interested in the thinking and behavior of medical men. Bernard Rieux may be the greatest portrait of a doctor in a medicine—and, not incidentally, he also turns out to be a good writer (or, at least, a good narrator). But it is never possible to forget the political and allegorical dimension of La Peste, which continually threatens to transform Dr. Rieux and his medical colleagues into transparent surfaces.

For a selection of novels about doctors, the Literature, Arts, and Medicine Database at NYU is the place to start. The database is intended to be comprehensive, though, which is its vice as well as virtue. Because it is impartially unselective, chucking together books that merit serious attention with middlebrow potboilers, it offers small advice or direction to anyone who wants to read only the best. Nevertheless, what is surprising is that even so comprehensive a database contains so very few good novels that evince more than a glancing curiosity in the rational habits and moral competitions of medical doctors.

The best of them may be one that is rarely thought of as a doctor’s novel. Middlemarch (1871–72) is such a vast panorama that Tertius Lydgate is easily overlooked. He may be the novel’s most admirable character, though. A medical innovator, he is Eliot’s exemplar of the new sort of level-headed professional reformer and man of learning just coming onto the scene. Although he judges himself a failure in the end, Lydgate was a glimpse into medicine’s future.

Here are five more recent novels about fictional doctors in the Lydgate mold.

(1.) Walker Percy, Love in the Ruins (1971). In a novel set in the near future, Dr. Tom More is a “not very successful psychiatrist” and bad Catholic who is prey to “depressions and elations and morning terrors.” Estranged from orthodox psychiatry, which “promotes adjustment to the environment, or, as I call it without prejudice, bestialism,” he has invented the lapsometer, a device that measures how far a man’s self has falled from itself. His colleagues scoff at him, but with the device More diagnoses not only the ills of the age, but theirs as well.

(2.) Norma Rosen, At the Center (1982). The Bianky Family Planning Center is an abortion clinic established in the memory of a young woman who died in an illegal abortion. Dr. Edgar Bianky and his two partners “preside over death all day,” but are determined to do good. The tension between the cross-purposes dominates their personal and professional lives. As one of them says, they have “let an idea, what was originally for human good, become more important than human good.” Rosen, the mother of the novelist Jonathan Rosen, has not written a tract; the novel is neither pro-abortion nor anti-abortion. Rather, it shows that the contest between high ideals and human realities is at the center of the medical life.

(3.) Penelope Fitzgerald, Innocence (1986). Her sixth novel is set in post-war Italy. As a boy of ten, Salvatore Rossi was taken by his father to meet Antonio Gramsci, who had inspired the older man to become a Communist many years before. Long a political prisoner, Gramsci was by then dying in a Rome clinic. Rossi promises himself two things: to have nothing to do with politics for the rest of his life, and to become a doctor. At thirty, he is a successful neurologist in Florence. Then he meets a girl.

(4.) Ha Jin, Waiting (2000). Lin Kong, said one critic, is “China’s Dr. Zhivago.” Married by arrangement to a woman who will not agree to a divorce, Kong must wait eighteen years to marry the woman he prefers. In the mean time, they are not permitted to show each other any affection or even to take lunchtime walks around the hospital grounds. Married at last, Kong does not find the happiness he had hoped for. He “waited eighteen years just for the sake of waiting.” His long and ultimately disappointing wait is a potent symbol of human experience under Chinese Communism. And the practice of medicine is little different under such conditions, Kong learns.

(5.) Robert Cohen, Inspired Sleep (2001). Ian Ogelvie is a thirtysomething psychiatrist and sleep researcher who is running clinical trials of a revolutionary drug that provides “inspired” REM sleep. Once upon a time he had been brilliantly promising and idealistic: “Over the years all the fat shiny plums of precocity—the internships, the fellowships, the awards, the publications—had fallen off the tree for him on schedule.” Now, however, he is the creature of his own career expectations. Then he meets Bonnie Saks, a fortysomething divorcée who has volunteered for the study because insomnia is preventing her from finishing a dissertation on Thoreau. The two are, in many ways, each other’s last chance. Neither love nor a cure is the final result.

The gaping hole in the fictional representation of medical doctors is their professional training. As Larry McMurtry says in his most recent memoir, almost no American novels have paid any attention to the experience of graduate school—Philip Roth’s Letting Go, his own Moving On—but how much more true of medical school! Except for Arrowsmith and Morton Thompson’s soap-operish Not As a Stranger, another of the big fat socially conscious bestsellers of the ’fifties, there is just no American fiction that undertakes to show how idealistic overachievers are turned into mere doctors.