Free A Fortunate Man by John Berger Page B

doctors themselves. Some of their grievances are real enough. But the general tone of them is the result of fear and resentment at the sensed but not fully understood fact that the nineteenth-century status and categories of the medical profession are becoming obsolete.
    Sassall is not really alarmed by this, for he has established his own special position. As a result of this special position, however, he has to face, far more nakedly than many doctors, the suffering of his patients and the frequent inadequacy of his ability to help them.
    It is generally assumed that doctors take a professional view of suffering and that the process of professional insulation begins intheir second year as medical students when they first start dissecting the human body. This is true. But the question is far deeper than overcoming any physical revulsion at the sight of blood or guts. Later, other factors are an aid to their self-protection. Doctors use a second, technical, entirely unemotional language. Frequently, they need to act quickly and to carry out complicated manual tasks which demand exclusive concentration. Increasing specialization encourages an increasingly scientific view of illness. (In the eighteenth century and earlier the doctor was often thought of as a cynic: a cynic is by definition a man who assumes a scientific ‘objectivity’ to which he has no claim.) The sheer number of their cases discourages self-identification with any individual patient.
    Yet, however true this may be, the suffering which certain doctors witness may be more of a strain than is generally admitted. This is so with Sassall. He is a man of extreme self-control. Nevertheless, when he was unaware of my presence, I saw him weep, walking across a field away from a house where a young patient was dying. Perhaps he was blaming himself for things done or left undone. He would transform his pain into a sense of painful responsibility, for that is his character.
    But his sensibility is not just the consequence of his character: it is equally the consequence of his position and the way he practises. He never separates an illness from the total personality of the patient – in this sense, he is the opposite of a specialist. He does not believe in maintaining his imaginative distance: he must come close enough to recognize the patient fully. Although he has about 2,000 patients, he is aware of how they are all interrelated – and not only in the family sense – so that the numbers seldom acquire a statistical objectivity for him. Most important of all, he considers that it is his duty to try to treat at least certain forms of unhappiness. He very seldom sends a patient to mental hospital for he considers it a kind of abandonment.
    What is the effect of facing, trying to understand, hoping to overcome the extreme anguish of other persons five or six times a week? I do not speak now of physical anguish, for that can usually be relieved in a matter of minutes. I speak of the anguish of dying, of loss, of fear, of loneliness, of being desperately beside oneself, of the sense of futility.
    One aspect of the confrontations seems to me to be important and not much discussed, and so the reader must forgive me if I concentrate on this and ignore others.
    Anguish has its own time-scale. What separates the anguished person from the unanguished is a barrier of time: a barrier which intimidates the imagination of the latter.
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    A man or a woman who is sobbing reminds one of a child, but in the most disturbing way. This is partly because of the particular social convention which discourages adults (and particularly men) from breaking into tears but permits children to do so. Yet this is by no means the whole explanation. There is a physical resemblance between a sobbing figure and a child. The ‘bearing’ of the adult falls away and his movements are limited to certain very primitive ones. The centre