Doctors in Distress

Evan Hughes, New York Times
October 28, 2007

n "Night Flight," one of the best of the linked stories in Vincent Lam's first book, a Toronto physician named Dr. Fitzgerald takes a jet to Guatemala to treat a tourist who's had a stroke. In the middle of the night a local doctor tells Fitzgerald that a recent CT scan and a neurosurgeon were unavailable, and the pair discuss the grave outlook. "We do not say it directly," Lam writes, "but we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact."

After the patient dies on the flight out, his wife asks if the better treatment available at home might have made a difference. Fitzgerald lies to her "with the greatest tenderness I have within me." Later the same day, in the story's closing scene, Fitzgerald sits with his assistants in a hot tub and plays a parlor game in which they ask one another to choose between various hypotheticals, like "being famous and destitute, or rich and anonymous."

That ending could make Fitzgerald seem callous. But by now Lam has fully brought him to sympathetic life. We know, for example, he's the kind of man who'd prefer not to know if his spouse had a one-night affair; and we've learned, a number of stories and years earlier, that he lost his beloved girlfriend, Ming, to an affair he was only too aware of. In a later story, "Contact Tracing," Fitzgerald contracts SARS and ends up in isolation alongside Chen, the doctor who took his girlfriend away.

Lam excels at this kind of steady accumulation of truths, a tangling of action and incident that renders judgment of the characters difficult, and futile besides. The writing is often lovely — Fitzgerald, jilted by Ming, longs "to tip over the meniscus of anger that grew like water perched higher than the rim of a glass" — and generally understated. So subtle is the narration, and so committed is Lam to the primacy of showing over telling, that dramatic potential sometimes goes underrealized. In "Contact Tracing," for example, when Chen breaks through a glass partition to save Fitzgerald when he stops breathing, the scene is recounted through a banal evening news clip, lending an otherwise harrowing story an air of anticlimax.

Lam is better when he emphasizes the inherent strength of his material. He is himself an emergency physician and thus brings to mind Somerset Maugham, William Carlos Williams and Chekhov — the first a former medical student and the others doctors for the whole of their literary careers. But Lam's work fits better among that of nonfiction writers like Jerome Groopman, Sherwin Nuland and Atul Gawande. He writes what is sometimes called "documentary fiction," providing an insider's view of his field, replete with the stark juxtapositions — notably the privilege of the treater with the powerlessness of the treated — and the moral hazards that characterize the profession. Some of the best stories in "Bloodletting & Miraculous Cures" read like journalistic dispatches from the medical front lines, with careful psychological characterization added. As such, Lam's book represents a promising demonstration of fiction's unique power: to bring the news that stays news, in Ezra Pound's formulation, and to allow the reader to see through the eyes of those who experience events firsthand.

In "Eli," a disturbing and unusually raw story, Fitzgerald must treat a raving man who has been arrested and probably brutalized by the police officers who have brought him to the hospital. The patient shakes loose from the cops and bites Fitzgerald, breaking the skin and jolting him into this thought: "Within blood the idea of death can flow." Fitzgerald castigates "Officer 6982" for losing hold, and then we wait to see which way the doctor's sympathies will turn. He attends to the unruly man and, with a biting tone that is, to Lam's credit, hard to interpret, Fitzgerald tells the police what they were waiting to hear: "Multiple bruises consistent with accidental injury." Fitzgerald ends his shift and drives away shaken and exhausted. Seeing a passing police cruiser, he doesn't look to see "the faces of the officers in that car" — a skillful closing line.

In "Night Flight," Fitzgerald notes, from the airplane, a fire below in the Guatemalan fields. Told it's an intentional fire to process the sugar cane out of leaves, his response also provides an apt description of Lam's achievement: "controlled burn."

© New York Times 2007