'Medicine is an adventure' - an exclusive extract from Dr Gavin Francis's new book
An extract from Dr Gavin Francis’s new book
It’s a typical morning in the clinic, my coffee cooling as I look down a list of thirty or forty names on a screen – my patients for the day. Many of the names I know well, but the first on the list is new to me. With a click of the computer his medical records pop up, and at the top-left corner I notice that his date of birth was just last week. He’s only a few days old; our encounter today will be the first entry into medical notes that, all being well, will follow him for the next eight or nine decades. The emptiness of the screen seems to shimmer with all the possibilities that lie ahead of him in life. For his sake, I hope it stays more or less blank.
From the waiting room doorway I call the baby’s name. His mother is cradling the boy to her breast; she hears me and gets gingerly to her feet. She smiles and makes eye contact, then, with the baby in her arms, follows me back to the office.
‘I’m Dr Francis,’ I say, as I show her where to sit. ‘What can I do for you?’
As a child I didn’t want to be a doctor, I wanted to be a geographer. Maps and atlases were a way of exploring the world through images that revealed what was hidden in the landscape, and were also of practical use. I didn’t want to spend my working life in a lab or a library – I wanted to use maps to explore life and life’s possibilities. I imagined that by understanding how the planet was put together I’d reach a greater appreciation of humanity’s place in it, as well as a skill that might earn me a living.
As I grew older that impulse shifted from mapping the world around to the one we carry within; I traded my geographical atlas for an atlas of anatomy. The two didn’t seem so different at first; branching diagrams of blue veins, red arteries and yellow nerves reminded me of the coloured rivers, A-roads and B-roads of my first atlas. There were other similarities: both books reduced the fabulous complexity of the natural world to something comprehensible – something that could be mastered.
The earliest anatomists saw a natural correlation between the human body and the planet that sustains us; the body was even a microcosm – a miniature reflection of the cosmos. The structure of the body mirrored the structure of the earth; the four humours of the body mirrored the four elements of matter. There is sense to this: we are supported by a skeleton of calcium salts, chemically similar to chalk and limestone. Rivers of blood wash into the broad deltas of our hearts. The contours of the skin resemble the rolling surface of the land.
A love for geography never left me; as soon as the demands of medical training lessened I began to explore. Sometimes I found medical work as I travelled, but more often moved just to see each new place for myself – to experience variety in landscapes and peoples, and become acquainted with as much of the planet as I could. When writing about those travels in other books, I’ve tried to convey something of the insights those landscapes have given me, but my work has always brought me back to the body, as my means of making a living, and as the place from which all of us start and end. Learning about the human body is different to learning about anything else: you are the very object of attention, and working with the body has an immediacy and transformational power that is unique.
After medical school I intended to train in emergency medicine, but the brutality of the night shifts and the fleeting contact with patients began to erode my sense of satisfaction with the work. I’ve taken jobs as a paediatrician, an obstetrician, and a physician on a long-stay geriatric ward. I’ve been a trainee surgeon in orthopaedics and neurosurgery. In the Arctic and the Antarctic I’ve been an expedition medic, and in Africa and India I’ve worked in simple community clinics. These roles have all informed the way I understand the body: emergency situations are extreme and offer a heightened awareness of human lives at their most vulnerable, but over the years some of the deepest and most rewarding insights medicine has given me have been from quieter, everyday encounters. Latterly, I’ve worked from a small, inner-city clinic as a family doctor.
Culture continually reshapes the ways we imagine and inhabit the body – even as doctors. Through my encounters with patients I’m often aware of how some of humanity’s finest stories and greatest art have relevance to, and resonance with, modern medical practice. The chapters of Adventures in Human Being look deeper into some of those connections.
Some examples: when assessing someone with a Bell’s palsy, I’m reminded not just of the frustration of being unable to express oneself, but of the age-old difficulty artists have had in accurately portraying expression. When thinking about recovery from breast cancer, I’ve been conscious that perspectives on what constitutes healing are different for each patient. Three-thousand-year-old texts like Homer’s Iliad can give insights about shoulder injuries, both ancient and modern, and the fairy tales we learned in the nursery eloquently explore ideas of illness, coma and transformation. The customs we bring to bear on our bodies are wonderfully diverse, something that struck me when thinking about the ways in which we dispose of the placenta and umbilical cord. Myths of struggle and redemption echo the convalescence stories going on in orthopaedic wards all over the world.
Medicine has been my livelihood, but working as a physician has also delivered me a lexicon of human experience. I’m reminded every day of the frailties and strengths in each of us; the disappointments we carry as well as the celebrations. Beginning a clinic can be like setting out on a journey through the landscape of other people’s lives as well as their bodies. Often the terrain is well known to me, but there are always trails to be broken, and every day I glimpse a new panorama. The practice of medicine is not just a journey through the parts of the body and the stories of others, but an exploration of life’s possibilities: an adventure in human being.
Dr Gavin Francis is a GP and writer based in Edinburgh.
Adventures in Human Being is published by Profile Books and the Wellcome Collection. Earlier this month (1-5 June) it was read on BBC Radio 4 as the Book of the Week.