A Diagnosis for Doctors

Christine Montross, The Washington Post
January 10, 2008

uring my first tentative days as a medical student, a mentor explained the transition into doctorhood this way: "There are suddenly three things that separate you from everyone else: You touch and cut open a dead body; you ask people socially inappropriate questions and they answer you; and you can walk into a room and ask someone to take off his clothes, and he will do it." With that shift, I would learn, came both the power and powerlessness of doctoring: the defiant salvation of a sick or injured life right alongside our helplessness in the face of the body's failings.

The central characters in Vincent Lam's award-winning collection of stories, "Bloodletting & Miraculous Cures," struggle as their identities undergo this very transition. Lam's narratives orbit around four doctors-in-training, two of whom -- Ming and Fitz -- are first introduced to us as undergraduates clamoring for medical school admission. We meet the others, Sri and Chen, when they join Ming beside a cadaver in their first-year gross anatomy class.

As a collection of stories, "Bloodletting & Miraculous Cures" is relatively unencumbered by the need to share with us how this transition takes place. Instead, the book gains power from its leaps between one story and the next. In the earliest tales, the characters are full of the unsettled angst of doctors-to-be. Fitz is a lovelorn and idealistic student who chafes at the regurgitation that his pre-med classes require. Chen, after only his first year in medical school, is called "doctor" by his family and asked to gauge precisely when his terminally ill grandfather will die. As the characters resurface in later stories, their reticence and dissonance have totally gone, and we are struck by how quickly they have become dispassionate and jaded cogwheels in medicine's machinery.

Readers (patients, all of us) who hope to find within these stories glimpses of a sense of altruism that drives doctors to devote their lives to healing will come away disappointed and disillusioned. Ming, Chen, Sri and Fitz are our windows into a side of medicine that is bleak and stained. Their hospital world is fueled by ego and ambition and is incessantly challenged by the fact of death. When the once-idealistic Fitz is bitten by a patient who has a gash on his head, he retaliates by closing the wound with painful and imprecise staples rather than the more appropriate sutures. Chen -- who lovingly describes the quirks of his family members in "A Long Migration," one of the most successful stories in the collection -- is reduced by the book's end to an angry and detached ER doc who delivers a mocking tirade about an obese patient to a consulting physician. In what feels like a mythic exchange, we witness these young doctors lose their own souls as they save their patients' lives.

And yet the transformation of Lam's characters does not make us despise them so much as it makes us recognize and resent the system of medical training we see them straining beneath. Like the real-world doctors they represent (and, in all likelihood, the author himself, an emergency physician in Toronto), Ming, Chen, Sri and Fitz work ridiculous hours at a breakneck pace. They perform heroic acts and save others' lives, but in the process they lose the ability to nourish and sustain themselves. It is as if they spend so much time defying death that they begin to see themselves as impervious to it. As a result, when they leave the hospital, they drive too fast, drink too much, fall asleep at the wheel -- in essence, put at risk the very lives they work all week to save.

This tension -- watching the best and the brightest careen away from humanity and toward self-destruction -- gives "Bloodletting & Miraculous Cures" its unmistakable Hollywood sheen. Lam's dramatic flourishes of plot contribute to this feel. A patient has a fatal heart attack while being serviced by a prostitute. Sri, in his first year of residency, goes to the apartment of a paranoid psychotic patient and arrives just in time to foil a homicide. And Ming performs an emergency C-section on an unanaesthetized patient to save a fetus in distress.

While these crises lure readers with a kind of sensational voyeurism into medicine, the truth is that Lam doesn't need that artifice. There are many quieter moments of lovely writing in the book, often coupled with sharp insight. The most powerful of Lam's stories is "Night Flight," in which the drama of a medevac team lifting a stroke victim out of Guatemala fades behind more compelling questions: How far should one go to preserve a life, especially when the odds of any meaningful success are slim to none? Is a doctor ever entitled to withhold medical details from a patient's family to spare them anguish?

In this collection, Lam deftly illuminates the line physician and patient must walk together -- hope and health on one side, cynicism and sickness on the other. We see in cold light what is at risk when the balance slips too far in either direction. In the end, "Bloodletting & Miraculous Cures" asks how much of death's burden should rest on the shoulders of those we ask to fight against it.

© The Washington Post 2008