A doctor in the house

A local MD stitches some fine tales of the emergency ward

Book review by Suzanne Alyssa Andrew, Toronto Star
January 22, 2006

hile novels and movies about medics are rare, the success of medical TV dramas (Grey's Anatomy, Nip/Tuck, General Hospital and ER) may be indicative of the episodic, rapidly changing and story-driven lives of medical professionals. Trading scalpel for pen, Vincent Lam, who works in the emergency room at Toronto East General, uses his real-life knowledge to create a worthy fictional montage of the Canadian medical field.

Stories such as "How to Get into Medical School" and "Code Clock" from Lam's debut collection resemble the 20-something medical romance foibles of Grey's Anatomy or the heart-stopping emergency interventions of ER more than they do the literary landscapes of contemporary CanLit. Yet the short story genre allows Lam to explore the darker subtleties and subtexts, the deep interior monologues not supplied by TV drama voiceovers.

Each of these interconnected stories reveal nuances of different pressures — the immense sense of responsibility, sleep disturbances, psychological problems and the failures of imperfection — medical professionals navigate, depicting in detail the human suffering often omitted from MD-TV.

The book's epigraph, "Medicine is a science of uncertainty and an art of probability," attributed to Sir William Osler, is particularly apropos of Lam's story "Eli." An optimistic young ER doctor tries to assist a prisoner who he suspects may be a victim of police abuse, only to become the target of the prisoner's violent tendencies: "Restraining people is an ironic task," Dr. Fitzgerald observes. "The more you restrain them the more they resist and the harder you must hold them still, strap them in."

"Contact Tracing," in which a series of hospital staff succumb to SARS, portrays the acute fear and paralysis faced by medical professionals during a sudden, deadly epidemic. Switching between different characters' points of view as effectively as an Altman film, Lam depicts a Toronto doctor who must now come to terms with being a patient. "He didn't want them to call him doctor," Lam writes of Dr. Fitzgerald's role shift. There were "obligations attached to the word, which he had no energy or ability to live up to."

Lam's writing alternates between direct observation ("There is a delicious freedom in doing something I do not understand, which cures a condition of no importance") and simple, plot-driving narration ("In the morning Sri arrives at the clinic an hour before the first patients are scheduled").

He earns authority as a storyteller, in part, by making medical language accessible. For all the ER fans who've always wanted to know what vee fib means, what bicarb does or the difference between an internist and an intern, Bloodletting and Miraculous Cures includes a handy 11-page back-of-the-book glossary. It's an effective device, allowing Lam to accelerate dramatic pacing without having to slow down and explain medical vocabulary to (im)patient readers.

Occasionally, clunky dialogue ("Can't fly tomorrow, huh? I just got in from Thailand") and non-sequiturs mar otherwise entertaining stories: "This thirst is like the day after a long-distance argument on the telephone with an old friend, when you realize that he is still on the other side of the telephone line, and that what you were fighting about was what you always disagreed about but were never able to say, and you wish that he lived around the corner so you could go out together for a drink. It is that thirst."

As in most debut fiction, some of Lam's stories read better than others. In this case, otherwise compelling stories such as "Night Flight" have a rushed-together feel. "How to Get into Medical School" (Parts I and II) and "Take All of Murphy" are conservative dissections that could have cut further into raw passions.

Hospitals are the epicentres of the most dramatic events of our lives, the locus of births, accidents and deaths. Lam creates vivid characters and circumstances that satiate our morbid curiosities about medicine, from med school corpse dissection to gruesome complications on the maternity ward. While every physician must conclude his or her career with hundreds of stories about misfit patients and strange illnesses, Lam successfully creates medi-fictions that probe philosophical questions, fears and uncertainties not found in textbooks.

Suzanne Alyssa Andrew is books editor of broken pencil magazine.

© Toronto Star 2006