Intended for healthcare professionals

Views & Reviews Between the Lines

A telling tale

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2953 (Published 22 July 2009) Cite this as: BMJ 2009;339:b2953
  1. Theodore Dalrymple, writer and retired doctor

    For half a century the Indian author R K Narayan chronicled the everyday life of his fictional town of Malgudi, in reality his home town of Mysore. He had that ability to see (and convey in words) a universe in a grain of sand that is, perhaps, the mark of a great writer.

    The protagonist of his short story “The Doctor’s Word,” published in 1947 in the collection The Astrologer’s Day, is Dr Raman. He is a specialist of sorts: people go or are brought to him only as a last resort. This causes Dr Raman to demand why they did not come to him earlier, exactly the question I used peevishly to ask in a tropical country where I once worked when people were brought to me with paraplegia caused by Pott’s disease of the spine. The answer was that it was only then that they lost faith in the power of magic to effect a cure.

    Dr Raman is respected, however, because of his plain speaking: “He was not a mere doctor expressing an opinion but a judge pronouncing a verdict.” He tells patients when they are dying because “he never believed that agreeable words ever saved lives.”

    His principle of plain speaking is sorely tested, however, when he is called to the bedside of one of his closest friends, Gopal, who is dangerously ill. On asking why he was not called earlier, he receives the reply, “We thought you would be busy and did not wish to trouble you unnecessarily”—precisely the answer I received 30 years later as a locum general practitioner when called to the bedside of an 80 year old man who had become severely anaemic from chronic rectal bleeding.

    Dr Raman operates on Gopal but without expectation of success. Gopal wakes after the operation and asks Dr Raman whether he will survive. Dr Raman finds himself unable to return a straight answer and prevaricates. Gopal then asks him to witness his will, because if he dies intestate the circling human vultures will rob his widow of his rightful estate; and he knows that if Dr Raman agrees to witness the will it means that he believes that he, Gopal, will die.

    Gopal is weak and sleepy after the operation.

    • “Dr Raman called, ‘Gopal, listen.’ This was the first time he was going to do a piece of acting before a patient, simulate a feeling, and conceal his judgment.

    • “He stooped over the patient and said with deliberate emphasis, ‘Don’t worry about the will now. You are going to live.’ The patient asked in a tone of relief, ‘Do you say so? If it comes from your lips, it must be true . . .’”

    Shortly afterwards Dr Raman gives his assistant instructions to ease Gopal’s passing with an injection if the expected death struggle becomes too painful. But in fact Gopal does not die, and the next day Dr Raman says to his assistant, “How he has survived will be a puzzle to me all my life.”

    Only six and a half pages long, it seems to me that “The Doctor’s Word” might serve as a useful starting point for the teaching of medical ethics, for medical practice is to medical ethics what literature is to philosophy.

    Notes

    Cite this as: BMJ 2009;339:b2953

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