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C Helman, 142: Double Storey Books, 2004, pp 224. ISBN 1919930767
The Suburban Shaman is the title of a new book of stories by Cecil Helman, family practitioner, social anthropologist, ex-ship’s doctor, researcher, and published writer. It provides the reader with a wonderful magical, mystery tour of stories from his career thus far. It is only available in South Africa at the moment (www.kalahari.net) but available via the usual easy routes in our global world. I am told publishers are sought in the US (likely) and the UK (perhaps).
The book is composed of three parts and these mark the three phases of Helman’s expansive career. What are these stories and what or who are they for?
The stories are invariably about patients and memories of patients collected over the last 27 years of clinical practice. There are links and resonances with other works—for example, Dostoyevsky—and this juxtaposition works particularly well when they appear.
The chapters, with almost familiar names, such as “The Rusty Ark” and “Deformation Professionelle”, are mostly short and succinct, not pithy but compellingly thought provoking. The ones I liked best are those mired in what is often the daily grind of general practice, the patient with psychosis (Mrs P), or a lady so bitter from a lifetime of disappointment that she is afraid of yellowing “An autumn leaf”. The last and poignant chapter, “The Brass Plaque”, brings the endeavour to a close with the removal of the aforementioned plaque from the front door of his surgery in North London.
It is not all about patients, for example one of the tales is a highly personal tale of the workings of our clinics in the UK. Having fallen, following a hard day’s work the author ends up on the opposite side of the fence and the full force of an under-resourced, underachieving National Health Service (NHS) hospital comes down on him like the proverbial ton of bricks. His insights are devastating, powerful, and rather sad, considering that he is a local general practitioner (GP).
I have been in practice myself now for over 20 years and the revelation to me is that many of the patients in the Suburban Shaman are instantly recognisable. The grumpy but grand old lady who has seen better times in the days of the Raj, the man who has lost touch with reality, and the sad bereaved old woman should be familiar to those in general practice. Is this so amazing I ask myself, or is there something in these stories that the anthropologist/physician can relate to, in a way that is perhaps unique? Or is it that these are archetypal GP/patient interactions and thus are instantly memorable?
Helman’s thematic context is familiar—he has written such narratives before—and the antireductionist, medicine in a crisis flavour is counterbalanced by the wholesome, sometimes utterly real and true to life tales of “Mr G” or just plain “Suzie” and “Gladys”. The question is, are these views consciously overstated or do they represent (his) reality?
If I had one comment it would be that the more management or educational side of doctoring is ignored, since these too have their stories and narratives, perhaps illustrating the complexities of how health systems work or do not as the case may be. Reflection in whatever sphere is no bad thing and this may be key learning from such a book as this. Rather than merely emphasise its educational value, I would rather say that the book is a sheer pleasure and I would recommend a slow, deliberate read, preferably while on holiday with all senses suitably relaxed, dimmed and destressed.
Helman’s book is a strong addition to a body of work by increasingly high calibre authors who write about medicine from the inside. These include Oliver Sacks and Richard Selzer as well as the relatively new kid on the block, Atul Gawande. All these authors chronicle their lives, and those of patients and their families, as doctor, surgeon, parent, carer, trainee, traveller or just plain observer. Helman’s account is always personally deep rooted, intellectual, and instantly understandable.
As I have already stated the book is excellent and will add to the burgeoning (but largely unread?) bookshelf in every medical school labelled “patient narratives” to be used in the mandatory medical humanities modules in years to come. It will enable students to learn that medicine is about stories as much as anything else but it will teach them also that it is the seeing, experiencing or just believing those stories that makes them come alive. The book comes about as close as you can get to real embodied experience without actually being there.
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