Like what I imagine to be many people’s journey into medical writing, I started with some large, contemporary figures; gaining insight into the physician psyche with Jerome Groopman, and honest appraisals of health systems from Atul Gawande. But I didn’t sit down to read Lewis Thomas until very recently.
Thomas is probably most famous for his essays originally published in the New England Journal of Medicine during the early-70s and collected into a National Book Award winning volume called Lives of a cell: Notes of a biology watcher. But the book I just finished is a memoir entitled The Youngest Science: Notes of a medicine watcher. Memoirs tend to come in two kinds: fascinating and drab. By extending his personal stories into the broader themes of medicine, science and, at times, language, Thomas plants his book firmly in the former. In this way he also manages to make his observations of medical systems and research resonant today. Literally every page is filled with wonderful pearls, so I am going to simply end this with an extended quote that, in poignant and clear prose, demonstrates that the workings of a hospital in 1937 are not so different from one in 2011:
It is an astonishment, which every patient feels from time to time, observing the affairs of a large, complex hospital from the vantage point of his bed, that the whole institution doesn’t fly to pieces. A hospital operates by the constant interplay of powerful forces pulling away at each other in different directions, each force essential for getting necessary things done, but always at odds with each other. The intern staff is an almost irresistible force in itself, learning medicine by doing medicine, assuming all the responsibility within reach, pushing against an immovable attending and administrative staff and frequently at odds with the nurses. The attending physicians are individual entrepreneurs trying to run small cottage industries at each bedside. The diagnostic laboratories are feudal fiefdoms, prospering from the insatiable demands for their services… The medical students are all over the place, learning as best they can and complaining that they are not, as they believe they should be, at the epicenter of every one’s concern. Each individual in the place, from the chiefs of surgery to the dietitians, the ward maids, porters, and elevator operators, lives and works in the conviction that the whole apparatus would come to a standstill without his or her individual contribution, and in one sense or another each of them is right.
And there’s more where that came from. Highly recommended.