Medicine and Beyond

Ron Elisha
MJA 2000; 173: 635-638

By the time I was ready to enter university, 13 years of schooling had equipped me with little more than a bad haircut, the ability to forge my parents' signatures, and a healthy contempt for anyone called "sir".

Of the world at large, I knew nothing. Women fell wholly within the realm of terra (read as terror) incognita, the unspoken rules by which society actually operates remained a closed book and, never having been required to decide upon anything more momentous than the timing of a bowel action, I remained a total stranger to consequence.

It was with this solid grounding beneath my feet that, on the night before our preferences for university courses were due to be submitted, I reached a spur-of-the-moment decision to opt for medicine. I had no good reason for this, the second most significant choice of my lifetime. Certainly not a rational reason. But, then, rational decisions are made only in retrospect.

Alas, some 30-odd years later, I still have no good reason.

Medicine, like lava, has consumed everything in its path -- time, energy, intellect, memory, even the very compassion from which the desire to practise it first sprang. Nothing can escape the pervasive imperialism of the medical experience. If it were not so, one would hardly be moved to ask the question "Is there life after medicine?", just as one doesn't think to raise the same question in relation to carpentry, hairdressing or pharmacy. Medicine, even now, remains a vocation -- a calling in the same sense as the priesthood -- something that envelops life rather than being contained within it.

Seated behind the desk of the great white healer, held captive before the endless, overwhelming cavalcade of human misery that goes by the polite name of consultation, it is difficult to imagine that there exists within the real world even an atom of contentment, of wisdom or of simple decency. Humanity, it appears, swims within a moral sewer, largely of its own making and always, doggedly, upstream.

While the foregoing is demonstrably an exaggeration, it nevertheless represents the perception, the feeling one gets, day after relentless day, from behind that perpetual, immovable, ineluctable desk. It is this feeling, coupled with the lack of conviction that accompanied my original decision, that impels me to write.

To see, hear and feel what a doctor sees, hears and feels and not to seek explication, exegesis and catharsis through writing defies comprehension. To bear such witness for 80 hours per week and not to need to escape into the world of writing -- where, for a fleeting, illusory moment, chaos gives way to meaning -- defies credibility itself.

Everything I write, regardless of tone, setting or content, is fuelled by the furnace of anger and outrage I feel at what I daily witness as a doctor. Sometimes it is anger directed at the evil that men do, sometimes outrage at the profound sorrow that is intrinsic to human existence, perhaps directed at God or, more precisely, at the self-destructiveness and, ultimately, moral bankruptcy of a human vision that would conceive of a God capable of such infamy.

Everything I write is fuelled by the furnace of anger and outrage I feel at what I daily witness as a doctor.

The brunt of my anger, however, is borne by medicine itself. For the suffering it has inflicted in the name of progress, for its arrogance in masquerading as a science, for its simplistic reduction of the disease paradigm to a battle between a man and a microbe (social context be damned), for its ham-fisted blundering in ignorance, for its overweening paternalism, for its ultimate impotence in the face of real human suffering and the finality of death. For all these things I cannot forgive medicine.

And for its covetousness, its jealousy, its proprietorial imperative, binding its practitioners to a life of servitude at the expense of family, friends, fitness and, at the end of the day, the very writing that might have served as an antidote to its unbending tyranny.

For that is precisely the place to which my first love, writing, has been relegated -- the end of the day. When the patients have been seen, dinner eaten, the children bedded, reports written and journals read, it is that tiny scrag-end of night during which -- to the accompaniment of burning eyes and aching back, and with the brain rapidly descending into slumber -- I allow myself the luxury of literary enterprise. The window of opportunity, however, is painfully small, and days or even weeks may pass without a word being writ -- not for want of the creative spark, but for want of time, energy and, in the end, simple consciousness.

As the years pass, and with the advent of each new medical torture -- vocational registration, accreditation, amalgamation -- the window grows progressively smaller, to the point where each evening is now a blank wall. And there is no hiatus during the day through which I can indulge my other self in rehearsals or meetings or the kind of schmoozing that actually gets a play on. Patients will insist on getting sick. Time waits for no man. And that's not an actor waiting in the wings, but Death itself.

Which means that the only true sense in which there is life beyond medicine is in the sense of the life of the mind, which retains its capacity to traverse the universe even as Mrs Blogg describes the bouquet of her stool.

It is this mind-body dichotomy -- the coexistence of the sublime and the ridiculous within the one, tiny space -- that hones the irony of my work. My real work, that is. The great love of my professional life. My writing.

And it is the terrible irony central to that work which lifts it above the level of mere diversion, imbuing it with what passes for a semblance of meaning, so that when I sit behind my desk, struggling to retain consciousness through endless tales of dysfunctional body cavities, I can almost convince myself that it's all been worth the effort.

Almost.

Ron Elisha graduated in medicine in 1975, and has spent most of his career in full-time general practice. He has written stage plays, radio plays, teleplays, screenplays, children's stories, short stories and feature articles. Many of these have been published or produced, both in Australia and overseas (including the USA, the UK, Canada, New Zealand, Israel, France, Belgium and Poland). He has won four Australian Writers' Guild Awards (AWGIES) for best scripts for works for stage and television, including the Major Award in 1982 for the play Einstein. Other highlights of his writing career have been a US tour of Einstein, a trip to London to work on a screenplay with Istvan Szabo and a trip to Paris as a guest of the Comédie Française.

©MJA 2000
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