Food for the soul

Food for the soul; Doctors afield; Edited by Mary G. McCrea Curnen, Howard Spiro and Deborah St. James; Yale University, New Haven, CT; 1999; 264 pp. US$27.50 (cloth) ISBN 0-300-08020-4

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Nourishment and renewal are the themes of Doctors Afield. The stories in this book are told by an eclectic group of physicians who have excelled in the visual arts, music, literature, astronautics, the spiritual life, government, academia, collecting, and fun and games. The least among the stories are merely informative and the best are masterfully written with powerful messages. Almost all are autobiographical, which gives them relevance and helps the reader see the interplay between medicine and the contributor's parallel endeavour.

There are two biographical sketches that don't fit the model: those of Carlo Levi and Gertrude Stein. Levi practised medicine, under duress, for only a short period long after his graduation. Stein failed obstetrics in her final year at Johns Hopkins and never graduated. Some people should never go into medicine, but this is not the book's message. Thus I would have much preferred that those spots be given to a couple of star physician-writers who could reflect on medicine and creativity. That would have maintained the central theme and provided a much better counterpoint. So, the field in Doctors Afield is a little spotty, but there are some very fertile patches.

Eli Newberger is a pediatrician who does weekly sessions on the tuba with the New Black Eagle Jazz Band. He tells us about creative inspiration, the magic of improvisation and its prospect of mistakes. Mistakes in medicine can destroy lives, but in jazz improvisation they become a platform for new ideas and redemption. Eli's music has the power to transport him into a state that is not, "strictly speaking, a conscious process." We learn that the joy and release of his music enables him to deal in his professional life with issues such as child abuse and family violence.

In "A Prescription for Poetry," internist Rafael Campo provides a window on specific medical problems versus much larger, more complex societal problems. While trying to concentrate on radiographs of a battered woman's facial fractures he finds instead that he hears the soft, impatient tapping of her husband's foot outside in the emergency room. "Poetry is there when the last of our gizmos and gadgets fail us; ... it helps us gauge that which cannot be assayed in the blood, to see what cannot be imagined."

In "The Singing Endocrinologist," Alice Levine tells us that early in her training she observed the energy and efficiency her two careers provided: "diversions made studies easier, not more difficult." Like Anton Chekhov, who saw medicine as his lawful wife and literature as his mistress, Levine likens a career in music to climbing in sand, whereas medicine is always there, reliable. Both careers are about communicating, and she successfully fuses them into a rewarding life.

The section on spirituality is timely, moving and courageous. In the 19th century, Oliver Wendell Holmes argued strongly for a rational base for medicine that excluded religion. Today in Boston, Ray Hammond and Gloria White-Hammond, with a mission to "serve others as we are led by the Holy Spirit," have transcended barriers of class, gender and race to produce a modern-day miracle. Among other things, their coalition adopts gangs. Guess what has happened to the murder rate in Boston? I am sure that Holmes would be impressed.

Alan Mermann, in "Looking for the Red Line," and John Young, in "Priest in the Prison," are equally convincing on the need to appropriately access the soul to sustain the doctor and heal the patient.

There are lessons to be learned from careers in the visual arts. Andrea Baldeck, an anesthesiologist, was so fulfilled by her photography career that medicine lost out. Sir Roy Calne, a pioneer transplant surgeon, used his surgeon's eye for anatomy as a stepping stone into the world of art and then got lessons from one of his patients, a noted Scottish artist. Wayne Southwick discovered the connection between orthopedics and sculpture and used his second career as a successful bridge into his retirement.

"Getting Famous," by Michael LaCombe, an internist from rural Maine, is the piece that I liked best. His journey as a physician-writer has not been smooth and effortless. He reveals this in a wonderfully literate manner and packs in a whole lot of good advice along the way.

Read Doctors Afield. You will be nourished and renewed.