Fall 2003, Vol. 10, Issue 3
By Kate Scannell, MD Review by Felice Aull, PhD, MA
Cleis Press, Inc., San Francisco, 1999 Editor-in-chief, Literature, Arts, and Medicine Database
Associate Professor, Physiology and Neuroscience
New York University School of Medicine
Death of the good doctor? Is this a biography - in memoriam - extolling the life while mourning the demise of a beloved physician? Did the physician die of AIDS? Such might be your thoughts when first encountering this title. Yes, the book's author, physician Kate Scannell, did die - a figurative death. Under the medical imperative prevailing when she trained (she entered medical school in 1976), the "good" doctor provided cutting-edge interventions to save lives; a patient's death represented failure. Then came AIDS, a disease that transformed not only those infected but also many of those who treated these patients, who watched their extended sufferings and deaths.
Scannell was one of those transformed. She realized that her version of the "good doctor" as a "seasoned gunfighter, ready for medical challenges" who offered "aggressive, full-service, state-of-the-art care" was simply inappropriate in the face of such prolonged suffering and inevitable death. In one particular case, she ordered all-out heroics, misinterpreting a dying AIDS patient's plea for help - in retrospect, "my unconscious denial of his dying." The next day she was told that the patient had died thanking the night shift doctor who discontinued his intravenous fluids and injected extra morphine. "I have never practiced medicine in the same way since his death," writes Scannell in the prologue to the book. Death of the Good Doctor chronicles how Kate Scannell learned a different way of practicing medicine from her patients. Each chapter tells the story of a particular patient with whom she interacted. At the same time, each chapter reveals a life - her life - fundamentally changed and changing.
Trained in rheumatology and immunology, Scannell in 1985 was attempting to move from an academic career to clinical practice in general internal medicine. Unexpectedly, she found herself in charge of the AIDS ward of a county hospital serving Oakland and Berkeley, California. She began her work there with great ambivalence, wary of drug-addicted patients and fearful of the dying. For five years Scannell took care of the sickest, most stigmatized members of society. Overwhelmed initially by the severity of illness in those for whom she was responsible, she gradually allowed herself to become emotionally connected to them in mutually therapeutic relationships. These remarkable relationships are detailed in the book.
Take for example, the belligerent drug addict, Jay, whose story Scannell relates in "Sleeping with the Fishes." Jay is thoroughly unlikable, abusive to the staff, deceitful and mean. Most disturbing to Scannell was that "I hated the way that I experienced myself in his presence, as somewhat less than fully human, lacking any compassion for him." One fateful day Scannell loses her temper and asks Jay in frustration, "isn't there anyone or anything you have ever cared for besides yourself?" "Fishes," says Jay tearfully. Scannell buys him a bowl of fish. Jay watches the fish from his bed. Scannell doesn't understand what could possibly be of interest in watching fish, but at one point she joins Jay. She finds herself mesmerized, "floating with them, relinquishing to unpredictable currents... I felt peaceful." Jay notices Scannell's reaction, saying to her, "You get it now, don't you?"
This shared experience affects both physician and patient. Jay becomes more considerate and calm; Scannell takes greater notice of her surroundings, of other people - in her personal life as well as at the hospital. "I thought of how my own sense of belonging was expanding, too, through a succession of patients' lives inviting me into the world . . . [a]nd how it was more than that - it was the very trees around my home, the sounds of the forest, the breakers in the bay."
But why would "belonging" be an issue for Kate Scannell? Because, the reader learns gradually, Scannell felt alienated socially and professionally - an alienation she hardly admitted to herself. When she entered medical school, she was one of few women in her class and had never encountered a woman physician. The male medical model, she felt, was one that had no room for empathic, intuitive interactions with patients. There seemed to be no tolerance for human frailty and uncertainty. "And this woman and physician was also a lesbian, someone whose identity was overtly pathologized by the medical profession and represented in psychiatric literature as 'deviant.'" Then, directing the AIDS ward, she slowly gave herself permission to follow her instincts, to become emotionally connected with patients, to tolerate and learn from their (to her) unfamiliar and sometimes quirky lifestyles and behaviors. There was a price to pay, however: most of her patients died. It took five more years before Scannell felt able to revisit that experience and to write about it.
This memoir, then, is a kind of illness narrative - by a physician who suffered from soul sickness, who had been unable to articulate her sense of personal and professional unease, whose life was altered by the dying patients in her care over whom she grieved. Like most narratives, especially illness narratives, the writing of this memoir was a way to make sense of and give meaning to experience. Kate Scannell's poetically rendered vignettes tell a tale of discovery and healing through powerful engagement with patients. At the same time, her book honors the memory of those patients.
in collaboration with
Dartmouth-Hitchcock Medical Center
The opinions expressed in the journal, Lahey Clinic Medical Ethics,
belong to the individual contributors and do not represent the institutional position
of Lahey Clinic on any subject matters discussed.
