Medical Breakthrough

by Neel Mukherjee Time
August 21, 2008

ecause brilliant writing is difficult to sustain, one usually opens a volume of short stories with the expectation that half a dozen of them will be satisfying and workmanlike, and that a couple will be duds, leaving two or three pieces of real quality to carry the book and advance the reputation of the author. But of the entire trove of qualities that distinguish Vincent Lam's first book of short stories, Bloodletting & Miraculous Cures, the most immediately conspicuous is that each and every single story in this book is a flickering, luminous gem.

Lam, 33, is a Canadian doctor of Vietnamese-Chinese origins, and uses his firsthand experience of the world of medicine to underpin the dozen stories in this book. The pieces are interrelated, lightly and adroitly, by the recurrence of four common characters, Fitzgerald, Chen, Ming and Sri, all doctors. In some stories, Lam writes about his characters in the third person; for others, he uses the first. In less adept hands, this technique could easily seem affected. But Lam's handling of the quickly shifting perspectives is deft and gives the collection an agreeable dynamism.

Between them, his stories encapsulate almost the complete spectrum of the medical world — from preparing for medical-school exams to gritty night shifts; from the experience of being a medevac physician to treating an unforeseen, potentially fatal complication during childbirth; from shenanigans with the police in the emergency room to the terrifying first days of the outbreak of SARS.

The opening work, How to Get into Medical School, Part I, is an achingly sweet love story featuring Fitzgerald and Ming, both preparing for entrance to the University of Toronto Medical School. The second installment of their tale — which, in a clever use of pacing, runs not consecutively but as the third story in this volume — charts the melancholy end of their relationship. Ming is now seeing Chen — another student and someone, as we find out later in the collection, whom she will marry — while Fitzgerald is left behind in Ottawa to retake his exams. In the finest story in the book, Night Flight, we see Fitzgerald, now a medevac doctor with an incipient drinking problem, fly to Guatemala to rescue a young man who has had a stroke. Tightly sprung and impeccably paced, the story's devastating ending is followed by a coda of such searing yet sympathetic honesty that you are left feeling winded by its flawed humanity.

A Long Migration, the least clinically themed story in the book, is Chen's delicate, mosaiced account of trying to piece together the story of his grandfather's life — a tale of several marriages, migration and diaspora. In Contact Tracing, another piece that ratchets up the tension, Fitzgerald is dying of SARS, having contracted it while evacuating a patient from Shenzhen. In the respiratory isolation room next to his is Chen, also infected because he treated Fitzgerald in the initial stages. The ending rewrites any kind of expectation that we may have held in our minds, given that these two men were once rivals in love, and gives a depthless generosity to the story. It is also marked by a wry sense of humor: the doctor treating Fitzgerald doesn't know that the patient's tremors are the withdrawal symptoms of an alcoholic so he charts them as an atypical symptom of the new disease.

Those who have had a serious illness or condition will know the great investment of hope in seeing a doctor — that enormous leap of faith and confidence. Here's a ringside view of the other side as it deals with that leap, the side we never get to see. We may not be comfortable with the fact, but from many doctors' perspectives the most obvious issues are exhaustion and overwork. Emergency-room patients are dryly referred to as "volumes" because of "the way they fill our fixed space" and because of "the volume of noise that we actually hear ... the crying of the child, the belligerence of drunkenness, the thin whine of a failed suicide." And there is a jaded professionalism in the med-school lesson recalled by Fitzgerald during a long night shift: "Always sit down with the patient. It makes it seem like you've spent more time and that you care. If you give this impression (this is the subtext) then the patients will do what you say and leave quickly."

This is a rigorously balanced assessment of the achievements and limitations of modern medicine, as well as an atlas of suffering, survival and failure. Emotionally complex and layered, with a preternaturally surefooted negotiation of the human mind and heart, Lam's insanely gripping book is also illuminated by shafts of radiant, beautiful prose. Like all great fiction, it is both the absolute truth and a vehicle for taking us to a place we've never been before. Read it.

© Time 2008