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HumanitiesCMAJ

The Soul of Medicine: Tales from theBedside

Sherwin B. NulandKaplan Publishing; 2009214 pp $30.95

This collection is arranged into aseries of “tales” in whichauthor Sherwin Nuland offers a

number of perspectives on the ques-tion: “Tell me about your most memo-rable patient.” There are 20 tales in all,arranged according to specialty, mostwith a commentary by the narrator,understood to be Nuland himself, whoalso provides a couple of tales.

The obvious question is whether thestructure, with its direct reference toThe Canterbury Tales, offers someadvantage over, say, a simple collectionof personal essays about clinical experi-ences. The risk of modelling the narra-tives after The Canterbury Tales soexplicitly (even the setting is Canter-bury) is that if it doesn’t work convinc-ingly — by offering the reader someparticular insight, a taste of subversionor irony that serves the content — thewhole endeavour can come off as, atbest, a conceit. At worst, it can trivializethe story. But as an admirer of Nuland’swork — especially his intrepid Mai-monides and his much lauded How WeDie — I entered The Soul of Medicinewith an open mind about the approach.

What I didn’t foresee is that con-structing the stories in this way wouldlead to a particular prose style. Here aresome samples:

“But one day the stratagem did notwork, and thereon hangs the Tale.”

“I have been at several autopsieswhere even death refuses to yield itssecrets to the meticulous probing ofwhich postmortem studies of organs,tissues and fluids consist.”

“With this long prelude involvingmorals on one hand and mayhem on theother … you are, I hope, prepared toread a story like no other, which I havealready claimed this Tale to be.”

Plainly, this is bad writing, verboseand full of affectation, and many of thetales are similarly tainted. Instead offeeling I was being confided to by acolleague, I had a sense of being cor-nered by a raconteur oblivious to howoften I checked my watch — and forthis reason many of the stories, despitesome otherwise very compelling narra-tive, left me unmoved. Perhaps this isthe central critique of the book: Its con-struction entrains a certain tone, whichis not only tiresome, but does an injus-tice to the content.

Some stories do manage to rise abovethese difficulties. “The Cardiologist’sTale” recounts a touching relationshipbetween physician and patient and nicelycaptures the sort of emotional symbiosisthat enriches both lives. As well, Nulandshould be congratulated for his candouron including several tales about physi-cian misbehaviour.

The chapter that sealed my opinionof the book was “The Medical Stu-dent’s Tale,” where a married man isseen in the emergency room for genitalcellulitis after visiting a brothel. Themedical student (accompanied by thenarrator, who makes a cameo in a sus-piciously large number of tales) discov-ers their patient, Peaches Pasqualani,has visited the whorehouse with theknowledge and the consent of his“chubby little wife.” The medical stu-dent, who crows to us that he “consid-ered the sanctity of the family my maingoal in life” is openly disgusted by thisman and his culture that he feels con-dones this sort of behaviour. The stu-dent flies into a rage, but a simple ver-bal humiliation of the patient isn’tenough: “Slashing into Peaches’ fore-skin did not ameliorate my anger, norlessen the thoughts of my wife and twobabies at home. I asked for the respon-sibility of changing the daily dressing.”

The narrative devolves from there:“Those were my favourite times of theday. Morning and evening, I wouldvengefully march into the four-bed roomwhere Peaches was boarded, and he’dturn white on me appearing there.”

I was revolted merely by having totranscribe that passage, not only becausethis is sadism expressing itself through,and corrupting, the medical act, butbecause the story is related more than 40years after it occurred without evidencethat the perpetrator has in the interimacquired any self-awareness of what hehas done. I could find no irony here,only gloating. Unlike other tales whereNuland editorializes on those who havecommitted misdeeds (seven pages ofrebuttal, in one case), no comment isoffered here.

I trust many in Nuland’s medicalreadership can make up their own mindsabout right and wrong, but given the sortof misadventures doctors have histori-cally found themselves caught up in —

CMAJ • NOVEMBER 24, 2009 • 181(11)© 2009 Canadian Medical Association or its licensors

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Previously published at www.cmaj.ca

often in the name of the righteousness— I wanted a word of comment fromNuland about this physician’s motiva-tion and felt the omission deeply. Butmaybe I am being too harsh. Maybe thiswasn’t an act of medical torture after all,just another tale. Still, I like to think thateven in Canterbury they can tell the dif-ference between the board certified andthe water board certified.

Let’s end with the summation of wis-dom from “The Medical Student’s Tale.”“Three days later, the dressings werediscontinued and I lost my status as anavenging angel. But it was a great ridewhile it lasted.”

Actually, maybe it wasn’t such agreat ride. If this is the soul of medi-cine, let me be bereft.

Liam Durcan MDNeurologistMontreal Neurological HospitalMontréal, Que.

CMAJ • NOVEMBER 24, 2009 • 181(11)© 2009 Canadian Medical Association or its licensors

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All afternoon she lay, silent and quiet,her eyes shut.By evening the visitors started to leave,And I was on the brink of going too,But I did return, and whispered into her ear,not expecting a replyA tender farewell“Good-night, my darling. We will see you tomorrow”And she replied,“Good-night my darling. I hope to see you tomorrow, too”

I cannot forget those wordsWhispered in that voice I loved so muchWhich meant she was still alive, and hoping.But alas, she went into a coma soon afterAnd there was not to be another tomorrow for herNor would I see her look for me then,Nor ever again, in this life.

Frank Irwin Jackson MDRadiologistEdmonton, Alta.

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This poem is dedicated to the memory of the author’s wife, Leoné Jackson MD. The author’s poetry is gathered into three volumes including, most recently, Leoné,Sagas of the Red Canary, and other poems (2009).

Dr. Durcan is the author of two books offiction, Garcia’s Heart (2007) and A ShortJourney by Car (2004). He is currentlycompleting his next novel.

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