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Reviews Book

A Few Short Notes on Tropical Butterflies

BMJ 2003; 327 doi: (Published 04 September 2003) Cite this as: BMJ 2003;327:568
  1. Iain McClure, consultant child and adolescent psychiatrist (imcclure{at}
  1. Vale of Leven Hospital, Alexandria

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    John Murray

    Viking, £14.99, pp 274 ISBN 0 670 91347 2

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    For anyone still looking for holiday reading and wanting to escape all things medical, this debut collection of short stories may, at first glance, not appeal. Most of them focus on a doctor as the main character, while others have medicine or medics as a brooding background presence. It is no surprise, perhaps, that all of the stories are written by a doctor. If none of these factors puts you off, you may be interested to know that this book is full of dramatic moments, insights, and images that grip, enlighten, and linger in the memory. The stories' medical subject matter reminds us of the privileged access that doctors have into the lives of others. Their achievement also makes me wonder whether being a doctor lends itself, in some unique way, to the practice of creative writing.

    Murray's own medical training is drawn upon to great effect, as he describes his characters' practice with slick and authoritative detail. He also uses anatomising skill to get under the skin of these shifty doctors. He considers why they ended up in their chosen profession, by delving into their secret thoughts, their memories, and their family stories. In doing so, he makes exciting discoveries.

    He presents the discomforting paradox that physicians, who obtain more intimate knowledge of their patients than anyone, cannot easily commit to relationships themselves; or that they approach the relationships they do have with bizarre moments of detachment, because of their professional role. Thus, in the title story, a neurosurgeon daughter operates on her own father because she cannot trust her colleagues to “look after him.”

    Similarly, he presents doctors who take on massive responsibilities for others' lives, but who are in denial about the need to safeguard their own. One such is the nameless narrator of “Watson and the Shark,” who has been posted to a besieged Médecins Sans Frontières trauma unit. In this tense account of danger and fortitude, the young surgeon discovers that he and his European medical colleagues are more lost and rootless than those they have come to help. Only emotional casualties volunteer for such ultimately pointless work. However, Murray then counterbalances such nihilism with the idea that it is this very process of emotional drift that drives these doctors to help their fellow human beings. As one senior surgeon puts it: “Every life saved is a triumph. That is what keeps us human.”

    This more hopeful message is developed in “The Hill Station.” It tells the story of Elizabeth, a 40-something clinical bacteriologist, who has dedicated her working life to the understanding of Vibrio cholerae, but who has never seen an actual clinical case. Her future takes a dramatic turn when she follows an uncharacteristically rash instinct and travels to the slums of Bombay. Elizabeth's emotional detachment is broken down, even “cured,” by the physical reality of a cholera epidemic that she encounters first hand. In turn, her emotional life becomes more available to her.

    Although such direct handling of doctors' lives and their work is undoubtedly one of this book's strengths, Murray also manages to say something about what medicine does to non-medics. In “The Carpenter Who Looked Like a Boxer” we encounter a bereft spouse and his bewildered children who have been abandoned by their psychiatrist mother, with no word of explanation. Murray unpicks their collective mystification with masterly restraint.

    Other important themes are also explored, such as how Western and developing world cultures interconnect and interact. Some of the main characters are of Indian descent, but living in north America. Some have travelled in the opposite direction. Even the contrasting cultural mindsets of the Western doctors, working side by side in stressful conditions, are delineated with great insight.

    Murray explores all of these themes with delicate skill. Mostly he uses his surgeon's instinct to follow the dictum of the great American short story writer Raymond Carver: “Get in and get out fast.” On occasion, I felt that some of the narrative was over-inclusive, but, overall, with this impressive collection, Murray has fulfilled Chekov's definition of good writing: “You feel life as it should be, in addition to life as it is, and you are captivated by it.”

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