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The title of Danielle Ofri's second collection of reflections on her professional life as an attending physician Incidental Findings comes, as she explains in the prologue to the book, from her own experience of turning up with her husband for a routine antenatal screening in one of NYU's private clinics, and discovering, to her alarm, that the sonographic image of her baby's umbilical cord reveals an anomaly. But is it an anomaly which means something? Her colleague tries to put her in the picture. ‘The radiologist has already ascertained that I am a doctor and fellow faculty member. “Just one thing,” he says, leaning his torso into the room, “the umbilical cord is missing one artery, but it's probably an incidental finding. The literature says that 20% can have chromosomal abnormalities, but you’ve already done the amnio to check for that, and 20% can have growth retardation, but we’ll be able to check that with another ultrasound in 3 weeks, so it's probably a normal anatomical variant.”’
It is, in many ways, a classic turning of the tables. The white-coated internist loses her cool, her rationalism, the very ability to assess risk — the situation is way too personal. So Dr Ofri sets out, in her explorations of the emotional underbelly of medicine, to show that ‘nothing is incidental’: her stories about the lives of some of the patients who pass through her hands as an attending physician at Bellevue, one of New York's most famous public hospitals, is full of the frustrations and fears which being a patient entails, along with her winsome ability to acknowledge when she runs up against limits either in the system (of which there are many in the US) or her own inability to alter fate. While the need to know, in person, how things are on the other side of the doctor–patient divide has been a conventional and institutional piety since the antimedical critiques of the 1970s, Danielle Ofri's book goes a step further: by finding out how things are in the flesh. It is not out of place to observe that this entirely praiseworthy attitude became a piety only when technology had become so powerful as to jeopardise medicine's traditional reliance on touch, much as the word ‘community’ is now used in settings that have moved beyond anything recognisable as such to traditional societies.
The interest of this kind of life writing (as it is sometimes called) for readers may well be in the spectacle of a doctor ‘dressing down’, or indeed in terms of the powerful if largely unspoken egalitarian impulse which demands that we should be equal in all things, even sickness. But it would be a mistake to see the rawness of the situations presented in Incidental Findings as somehow closer to the truth of life: all writing is bound up with the art of selfpresentation. Indeed, stories that hold an author's strengths and shortcomings up for public scrutiny, especially when they claim to be representative of the profession as a whole, are liable to be charged with many sins, the least of them aesthetic. They cannot afford to be as naked as they appear to be. It is a mode of writing that is hard to bring off. None less than George Eliot, in one of the greatest novels of the 19th century, warned of the dangers of attending too closely to the common suffering of others. The curious thing about Middlemarch is that she does just that herself, amplifying the sounds that lie on the other side of silence. But rest easy, she adds, even the most receptive of us ‘walk about well wadded in stupidity.’
Just how businesslike medicine has to be is told in A Day in the Clinic, which adopts the simple but effective expedient of using a clinic appointment register as a structuring device. If true doctoring means having a more comprehensive vision of patients’ lives than the shorthand that ends up in their medical records then GPs are in the ideal position to provide it. That internists in public hospitals end up fulfilling this role in the urban US is a telling comment on the political priorities of American medicine. And one theme runs through this story: doctors have to learn to be subtly polyglot, even when they only speak a single natural language.
DANIELLE OFRI'S PUBLICATIONS:
Singular Intimacies: Becoming a Doctor at Bellevue (2003).
Incidental Findings: Lessons from My Patients in the Art of Medicine (2005)
See also her website at: www.danielleofri.com
Thanks are due to Beacon Press, Boston (www.beacon.org), who generously allowed us to reprint A Day in the Clinic from Incidental Findings. The book is available from all outlets (0-8070-7266-4, $23.95).