{"id":37651,"date":"2016-10-20T14:27:08","date_gmt":"2016-10-20T13:27:08","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=37651"},"modified":"2017-08-22T16:57:01","modified_gmt":"2017-08-22T15:57:01","slug":"claire-mcdaniel-and-daniel-marchalik-physicians-and-their-pasts","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2016\/10\/20\/claire-mcdaniel-and-daniel-marchalik-physicians-and-their-pasts\/","title":{"rendered":"Claire McDaniel and Daniel Marchalik: Physicians and their pasts"},"content":{"rendered":"

The Doctor\u2019s Book Club<\/span><\/strong><\/a>
\nRichard Flanagan The Narrow Road to the Deep North<\/em>\u00a0<\/em><\/span><\/strong><\/p>\n

So we beat on, boats against the current, borne back ceaselessly into the past.<\/em><\/p>\n

-F. Scott Fitzgerald, The Great Gatsby<\/em><\/p>\n

It is estimated that almost 13,000 Allied prisoners died building the Burma Railway during the Second World War. Richard Flanagan\u2019s The<\/em> Narrow Road to the Deep North<\/em> weaves together the stories of these men and women, Allied and Japanese, whose lives were forever changed by the experience of working on this 415-kilometer stretch in the deep jungle of Southeast Asia known as the \u201cDeath Railway.\u201d<\/p>\n

The narrative is crafted as a collection of interwoven snapshots of the various characters\u2019 lives. Slowly, these mementos coalesce to form a cohesive story of the perpetual aftershocks of war. By moving through time and space, Flanagan\u2019s work captures the pervasive damage caused by World War II to those who served and who waited for them at home, both during the war and in the years that followed.<\/p>\n

And yet the war itself remains a minor player in the novel. The major wartime developments\u2014the lost battles and the falls of empires\u2014go unmentioned. Instead, Flanagan focuses on the daily experiences of the war prisoners, chronicling their daily struggles, interpersonal relationships, and the unique price all end up paying for serving their country.<\/p>\n

The book focuses on a young doctor named Dorrigo Evans, an Australian officer who rises from abject poverty to celebrated war hero, but who can never escape the weight of the tragedies accumulated through his years in the war. Dorrigo, having just graduated from medical school, is drafted into the armed forces as an army doctor. He is captured almost immediately after joining, and is sent to work on the Death Railway where, due to his position as a physician, Dorrigo becomes the camp\u2019s leader and only physician.<\/p>\n

In unforgiving detail, the novel captures the difficulty and futility of providing medical care in conditions where basic medical supplies did not exist. Indeed, Dorrigo becomes a surgeon around a \u201chospital that was no hospital but a leaking shelter made up of rags hung over bamboo, beds that were not beds but vermin-infested bamboo slats, the floor that was filth\u201d turning him into a \u201cdoctor with almost none of the necessities a doctor needed to cure his patients.\u201d<\/p>\n

However, the novel also captures the unyielding human drive for survival and a physician\u2019s need to heal by any available means. Forced to improvise, Dorigo crafts the lacking necessities out of whatever meager resources can be scavenged. For the malnourished and dehydrated, Dorigo and his orderly \u201cset up a new camp drip\u2014a crude catheter cut out of green bamboo connected to some rubber tubing stolen by Darky Gardiner from the Japanese truck the night before\u2014which ran up to an old bottle filled with a saline solution made from water sterilized in stills fashioned out of kerosene tins and bamboo.\u201d Instead of a scalpel, Dorigo uses \u201ca sharpened Joseph Rodgers pocket knife\u201d to incise a vein and insert the bamboo line.<\/p>\n

The surgical procedures are even more desperately inventive and, as a result, gruesome.\u00a0 In one of the most vivid moments in the novel, an Australian soldier, his leg destroyed by spreading gangrene despite multiple amputations, is taken to the makeshift operating theater. As inch after inch of the leg is wrenched away from the body using a kitchen meat saw and suture \u201cimprovised out of a pig\u2019s intestine casings,\u201d a bent spoon is used as a compressive device to prevent exsanguination. But despite Dorigo\u2019s desperate attempts to save the soldier, he ultimately finds himself operating on a lifeless body, already dead for nearly ten minutes.<\/p>\n

The novel oscillates between such moments of devastation and glimpses of triumph, as many perish and few ultimately manage to survive. But the ghost of the camp never leaves for, as Flanagan notes, \u201cA happy man has no past, while an unhappy man has nothing else.\u201d<\/p>\n

Returning home and numbed by the horrors of war, Dorrigo\u2019s life is marred by dispassion in his personal relationships and indifference in his professional career. The banalities of life as a peacetime surgeon make him feel as if \u201chis spirit [was] sleeping\u2026 though he tried hard to rouse it with\u2026shocks and dangers.\u201d Despite \u201cacts of pointless compassion and reckless surgery,\u201d he finds it impossible to return meaning to daily life.<\/p>\n

The past, it turns out, never truly passes. And for physicians, whose job are often shaped by suffering and a feeling of powerlessness, such a past can take a permanent toll.<\/p>\n

Next Month:<\/u><\/strong><\/p>\n

We will discuss Emma Donoghue\u2019s Room<\/em><\/p>\n

Questions to consider:<\/p>\n

-Can support structures sometime stand in the way of recovery for trauma survivors?<\/p>\n

-What does the novel suggest about the complex nature of trauma?<\/p>\n

-What are the many forms of \u201cvictim blaming\u201d that are described in the novel?<\/p>\n

More articles in this series<\/a><\/p>\n

\"claire_McDaniel\"<\/a>Claire McDaniel<\/strong> is a third year medical student at Georgetown University School of Medicine in Washington, DC, participating in the school\u2019s Literature and Medicine Track. Additionally, she is an MBA candidate at Georgetown University McDonough School of Business.<\/em><\/p>\n

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\"daniel_marchalik3\"Daniel Marchalik<\/strong> is a urologist at MedStar Washington Hospital Center in Washington, DC. He directs the Literature and Medicine Track<\/a> at the Georgetown University School of Medicine and writes a monthly column for <\/em>The Lancet<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The Doctor\u2019s Book Club Richard Flanagan The Narrow Road to the Deep North\u00a0 So we beat on, boats against the current, borne back ceaselessly into the past. -F. Scott Fitzgerald, The Great Gatsby It is estimated that almost 13,000 Allied prisoners died building the Burma Railway during the Second World War. Richard Flanagan\u2019s The Narrow […]<\/p>\n

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