All week this week we recommend the very best, A-grade quality, guaranteed good books for Christmas. Today: Elizabeth Smither reviews the medical memoir by Middlemore sawbones Dr David Galler, Things That Matter.
I have a weakness for books written by doctors – medical books, autobiographies, reminiscences that combine medical information and terminologies with the humanity of the doctor. Few of them are voluminous: medicine has made most of these writers practical and to the point. They have about them the atmosphere of approaching dawn when a patient might come through and find himself plugged full of tubes, amid beeping machines. Humanity and science make a great combination. And so does the quality of trained observation, evident throughout Dr David Galler’s memoir.
Every hospital has its own culture and atmosphere. Early in his career Galler was diagnosed as a Middlemore man. It is a speciality which shares an atmosphere with a breaking-fever-at-dawn scene in a painting or a novel. He writes, “At the cottage window the dawn began to steal in – the dawn that is the critical time of all deadly illnesses – and with it again the parents take hope into their hearts, the mother hiding her face to escape giving vent to her emotion, the father laying his hand on the shoulder of his wife in encouragement of the first glimmerings of the joy which is to follow.”
Survivors, like the London bus conductor Galler treated in his training days, typically have no memory of the apocalyptic dramas in which they have starred: “I was young and I was worried. I was worried because if his kidneys failed he would need dialysis and, although we could do that, the risk of him dying was significantly increased. I wanted to give him more fluid but thought that his heart might not stand that and his lung function would worsen. I rang the boss for advice and then began to fiddle. A bit more fluid, a bit more pressure from the ventilator, some drugs to ensure he had decent blood pressure, a dose of frusemide – a diuretic to make him pee – and a few other manoeuvres for good measure.”
Galler was once a trolley bus driver in Wellington – absolute beasts to drive. Power surges, falling poles, broken ropes, polyester uniforms, fear of haemorrhoids and James Smith corner – small wonder Jim (another driver) and Galler applied for medical school. But perhaps something of bus driving lingers: “Was the patient a rusty Skoda or a new Lexus before the disastrous crash?”, he ponders.
To an intensivist (a word reminiscent of sharp scalpel-like teeth), patients in intensive care are in an extraordinarily vulnerable position and at great risk of being harmed by the very people and interventions meant to help them. “A full-blown course of intensive care is gruelling beyond description, the medical equivalent of the invasion of Iraq. Young people who do well in the short term can take months to recover their physical and emotional strength after a critical illness that requires ventilation and organ support.”
For the frail elderly, often suffering multiple illnesses, a line must often be found between treatment and torture. And here something like a Chekhov story might be found. Conversation between practitioner, patient and patient’s family that carries a freight of information. “As we chat among ourselves they also get a sense of who we are as people outside of being a doctor or a nurse.” Not for nothing are so many medical practitioners, when they have an hour or so free from gruelling shifts and manage to drive home safely without crashing their cars, discovered to be gifted writers.
The desire to intervene is strong in human beings. Every child has some plastic figure in his toy box primed to intervene and save the world, smite the invader and lay waste. It must be there in our desire to offer gratuitous advice, to refuse service (like a bureaucrat), to police visiting hours – when Galler was hospitalised as a child his father shinned up a drainpipe to see him – to possess “the arrogance of certainty” once prevalent in medical practice. But there are times when we need it and are grateful for it. The speed of light and then something different. How moving is Galler’s keeping watch over his London bus conductor: “I know I spent most of the night sitting on a stool beside the bus conductor’s bed counting drops of urine as they leaked one by one into his catheter bag, smiling as the drips slowly turned into a trickle and, by morning, into a torrent.”
About a year later, the reward. “I saw him conducting on the number 22 bus that ran from Hackney to the West End. He recognised me and doffed his enormous conductor’s hat in my direction and I returned the doff with a smile.”
When Galler’s own mother, the remarkable Zaza (after a declension of nicknames and a number from Auschwitz) is dying, the two Galler brothers, both intensive care specialists, become her attendants. Zaza continues serving her “divine chicken and spinach crepes”, smoking and drinking wine, disliking doctors and refusing to visit one. There is one terrible final nightmare of the death camp before the end when her doctor sons are out of their depth. But a nightmare cannot destroy a life and the ending is peaceful. “Later that night, she quietly stopped breathing, a smile on her face, in her own home, free at last.”
It’s impossible to read about Zaza without being vividly drawn to her, to rejoice in her courage and style, even her last cigarettes.
Things That Matter: Stories of Life & Death (Allen and Unwin, $35) by Dr David Galler is available at Unity Books.