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TRENDS

Prescriptions for a classic

With Siddharth Mukherjee winning the Pulitzer for The Emperor of all Maladies, medical writing has caught the popular imagination. Medical books and thrillers succeed because they give us a deep insight about ourselves, about how the mind-body machine works, says Parvathi Nayar.


Within that undecipherable scrawl could lurk the beginnings of a literary masterpiece...


It is a matter of life or death: that's a concept that gets our attention, whether chuckling over it in a B-grade film, or engrossed by it in an A-grade medical book such as this year's Pulitzer Prize winner for nonfiction, The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee.

It isn't hyperbole to call Emperor a literary masterpiece. The Pulitzer citation describes it as, “an elegant inquiry, at once clinical and personal, into the long history of an insidious disease that, despite treatment breakthroughs, still bedevils medical science.”

Delectable prose

“Elegant” is an apposite description of the New York-based oncologist's prose, whether he is rephrasing Tolstoy: “Normal cells are identically normal; malignant cells become unhappily malignant in unique ways”; or explaining the book's provocative title: “This book is a ‘biography' in the truest sense of the word – an attempt to enter the mind of this immortal illness, to understand its personality, to demystify its behaviour”; or extrapolating, from cancer's ability to mutate, into the realm of philosophy: “If we, as a species, are the ultimate product of Darwinian selection, then so, too, is this incredible disease that lurks inside us.”

Mukherjee weaves together multiple stories about medical advances, doctors and scientists, and the patients who teach us something in the living or dying. Emperor is a historical account of cancer; we understand how cancer rose to prominence as a leading cause of death – as a direct result of human beings living longer now, and more likely to develop cancer. A greater understanding of the disease however comes with the caveat, the more you know, the more aware you are of how much you don't know.

Another doctor/author who combines the three key ingredients that make Emperor such an un-putdownable read — medical expertise, literary elegance and the ability to tell a story — is Abraham Verghese. His first two books, My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS and The Tennis Partner are gripping and finely crafted — more, they are candid and compassionate.

In Country, Verghese talks of coming to Tennessee in 1985 as a newly-qualified infectious diseases specialist who gets so engrossed in the unfolding tragedy of the AIDS epidemic that his own marriage breaks up. In the second book, Verghese and his tennis partner, a medical student named David Smith, find comfort in the structure of tennis while trying to cope with a terrible divorce and cocaine addiction, respectively.

Addressing our fears

By dealing with two of the worst monsters of our time, AIDS and addiction, Verghese's books address some of our darkest fears, whether our own demons or those of our loved ones.

A couple of years ago Verghese took the plunge into fiction with Cutting For Stone, which borrowed elements from his personal history to tell the story of a family enmeshed in the world of medicine across multiple lands including India, a mission hospital in Ethiopia and an inner-city hospital in New York City. Verghese has previously written that “to tell a life story [is] to engage in a form of seduction”; no surprise that he has his readers hooked.

Do Indian doctors make good writers? While more research — blind tests, even — would be needed to prove or disprove the assertion, another hyphenate making the bestseller lists is general surgeon and MacArthur fellow Atul Gawande, author of The Checklist Manifesto, Better and Complications.

The Checklist Manifesto is an unusual exploration of the power of the to-do list. The author uses his own experiences to show that surgery today, for example, is far too multifaceted a task to perform without a detailed checklist. We fail, not because we don't have the knowledge, but because we haven't developed a methodical system to use that knowledge.

Doctors aside, medical writers also come from the world of journalism, such as Lisa Sanders. Her claim to fame is that her Diagnosis column for the NY Times was the inspiration for the popular TV drama, HouseMD, for which she serves as technical advisor. Her book, Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis looks at how misdiagnosis can be at the root of medical errors. She suggests that tests/scans can't be the only basis for diagnosis; a doctor needs to employ a full range of techniques from the physical exam to listening to the patient's story.

The doctor's story is worth listening to, as well, hence the popularity of the medical memoir. In Heart Matters: A Memoir of a Female Heart Surgeon, author Kathy Magliato strikes a chord when she describes “the thrill of touching the human heart”. As one of the world's very few female heart surgeons, she offers a different viewpoint on what is largely regarded as a male preserve.

Tales related to surgery, with its inherent drama, has the edge on our medical reading lists, whether it is the no-frills account of orthopaedic surgeon Dr. Michael J. Collins titled Blue Collar, Blue Scrubs: The Making of a Surgeon; or When the Air Hits Your Brain: Tales from Neurosurgery by Frank Vertosick Jr. In My Stroke of Insight, brain scientist Jill Bolte Taylor shares how, while undergoing a massive stroke, she was able to observe the deterioration of her mind, and experience the twin realities of the intuitive right brain and the logical left brain. Some medical books fall into the Self Help category — one of the most successful genres in the publishing world today. While the genre can attract those looking to make a quick buck by peddling to people's insecurities, there are some useful tomes too. Author Tim Parks in Teach Us to Sit Still shares how reading a famous self-help book, A Headache in the Pelvis helped with his chronic pelvic pain syndrome. There's a book out there on pretty much any medical condition you want; for example, while on pelvic pain, you could find a purely woman-centric one on the subject such as Ending Female Pain: A Woman's Manual – The Ultimate Self-Help Guide for Women Suffering from Chronic Pelvic and Sexual Pain by Isa Herrera.

Many medical-themed books get a wider reading when Hollywood turns its media-savvy gaze on them. Russel Crowe's sensitive portrayal gave a boost to Sylvia Nasar's A Beautiful Mind about Nobel Laureate and mathematical genius John Nash's descent into paranoid schizophrenia. While the 1990 Award-nominated “Awakenings”, starring Robin Williams and Robert De Niro gave a new lease of life to Oliver Sacks' 1973 book Awakenings.

If “Awakenings” inspired, the Geneviève Bujold thriller “Coma”, terrorised. The 1977 book by Robin Cook on which it was based was a runaway bestseller. Medical shenanigans plus crime is a potent combination. Cook, the granddaddy of the medical thriller, is still going strong with some 30 novels under his belt and a new one due later this year, Death Benefit.

The medical thriller is a popular genre with authors such as Michael Palmer and Mike Esposito finding wide readership. If you include forensics within the general purview of the medical thriller, the reading list increases to include such popular works as the gruesome but cleverly crafted series by Patricia Cornwell around the medical examiner Kay Scarpetta.

Medical books deal with a subject close to our hearts — us, we, ourselves. Perhaps the ones we are most drawn to – thrillers aside – are those that give us a deeper insight into how the mind-body machine works, why we are sick, how we can get better — and, unhappily, sometimes, why we can't. The doctor-author hyphenates are some of the most talented storytellers in this field; so when you next get a prescription from your doctor, bear in mind that within that undecipherable scrawl could lurk the beginnings of a literary masterpiece.

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