Frimbo is an admirable erudite, reminiscent of Sherlock Holmes, while the “closed room” scenario with a handful of characters evokes Agatha Christie. The writing is accessible, the rendering of Harlem accents remarkable, and the accurate references to state-of-the art forensic medicine, using anatomy and chemistry, are engaging. The conversations between Archer and Frimbo explore the nature of science, faith, and psychology. 

Some passages contain philosophical observations: ‘Pure faith in anything is mysticism. Our very faith in reason is a kind of mysticism’ (p. 214).  
 
Fisher was an African-American physician-author whose clever novel contains only African-American characters, including the physician and the detective. Specialized in radiology, he lived most of his life in Harlem, but he had studied medicine at Howard University. The author of many short stories and plays, he was also a gifted musician and composer. He at died at the age of 37 from an abdominal cancer attributed to his work with X-Rays.   

The Conjure-Man Dies: A Mystery Tale of Dark Harlem
Rudolph Fisher  

Miscellaneous Original edition 1932  
Publisher University of Michigan Press 
Place Published Ann Arbor MI 
Edition 1992 
Page Count 316 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.   
Web image by Salah Ait Mokhtar 

Soto explores his uncertain status in relation to his family, and to the larger society in “You’ve Gone Too Far.” Detailing the “evolution” of his siblings and cousins, who “were no longer Mexican rednecks,” but “held down jobs” and “stopped jamming parking meters for free time,” Soto describes how his family nevertheless feels uncomfortable about him. “My family feared that I had evolved too far.” Drunken Christmas horseplay with his brothers reveals their distaste and distrust of his intellectualism and sophisticated clothes. “They tore my book in half, / and stripped me of my Italian belt.” Only when they have succeeded in making him sick/drunk do they accept him (at least temporarily) back into the family fold. The poem illustrates well the difficulties that can arise when one member of a family elects to live life differently from the rest yet wants to maintain a relationship with its members. The situation has resonance for the children of immigrants, for children who are more educated than their parents, or for anyone who has chosen a life unfamiliar to family or friends.  

“TV in Black and White” focuses on the role of television (in the 1950s/1960s) in shaping, reflecting, and failing to reflect American society. Soto remembers his childhood in which “[we] were sentenced to watch / the rich on TV …”. Sitcom characters played golf, ate steak, and dressed fashionably (the Donna Reed Show, Ozzie and Harriet). “While he swung / we hoed / Fields flagged with cotton . . .”  

Now life is for many relatively luxurious, “Piano lessons for this child, / Braces for that one — “ “But if the electricity / fails in this town, / a storefront might / be smashed /” “and if someone steps out / with a black-and-white TV, / it’s because we love you Donna, / we miss you Ozzie.”  

Soto’s critique is still relevant today. The ubiquity of television and streaming, even in low-income households, confers enormous power on the images and narratives presented. Now there are many more options for viewers of different cultural and economic backgrounds. Yet the dominant culture still exerts a major influence. The gap between representation and reality continues to be an important source of social dissatisfaction and unrest. 

Gary Soto 
https://garysoto.com/
https://www.poetryfoundation.org/poets/gary-soto#tab-poems

Mexicans Begin Jogging
Online: https://www.zocalopublicsquare.org/by-gary-soto/  
New and Selected Poems, Chronicle Books, San Francisco, 1995, p. 51

You’ve Gone Too Far 
Published in Junior College, Chronicle Books, San Francisco, 1997, p.24

TV in Black and White 
New and Selected Poems, Chronicle Books, San Francisco, 1995, p.50

Web image by Jr Korpa 

Literature mirrors the general culture. There has been a recent explosion of books in which AI is the central plot device moving the narrative forward to endings that range from a utopian fulfillment of human destiny to the catastrophic collapse of civilization and the annihilation of humankind. But AI infiltrated the literary space several decades ago. Philip Dick imagined a world in Do Androids Dream of Electric Sheep? where cyborgs were being hunted down because of fear that they might take over the world. In 2001: A Space Odyssey by Arthur C. Clarke, a robot named Hal murders nearly all the crew of a spaceship on a planetary mission because of a programming error. 

Speak by Louisa Hall is more recent addition to the AI library. But it was published several years before large language models became a routine tool to plan a vacation or write a letter of recommendation. Is it still worth reading in 2025? 

The novel is a composite narrative centered around five interwoven stories spanning the time period from 1663 to 2040. In the first narrative, a young Puritan girl who finds herself in an unwanted marriage, records her thoughts in a diary that she is writing on a treacherous ocean voyage to America. Fast forward to the 20^th century and we meet Alan Turing who is writing letters to the mother of young man to whom he was emotionally attached and who died prematurely. He is troubled by his inability at times to communicate with people. A decade later we meet Karl and Ruth Dettman, a couple whose families escaped Nazi Germany but under vastly different circumstances. The husband, Karl, is a computer scientist who has developed a program named MARY to enable computers to interact with humans. Ruth, his wife, is a historian who has built a career centered on the publication of old diaries like the one written by the young woman traveling to America. She is trying to convince Karl to expand the memory of his computer program and enrich it with more human material, but Karl stubbornly refuses because he is concerned about the power of his program to overwhelm its users if its database is expanded. Finally, we jump ahead to 2040, and we read the transcripts of the trial of Stephen Chinn, a man who is being prosecuted for the production of robots that are too life-like. Chinn is being accused of causing physical and psychological harm to the people who have used his robots and of weakening normal relationships between people. A young adolescent named Gaby, who was given a doll powered by a version of MARY, is one of his alleged victims. His own personal recollections are folded into the trial proceedings, as he tries to describe his intentions, justify his actions, and make amends for where they may have gone awry. 

Taking stock of our world today, there is clear evidence that AI can improve the day-to-day lot of people, make life more convenient and efficient, and promote better health outcomes. However, much of the current angst that permeates discussions of AI is focused on the potential economic and sociopolitical consequences. There is fear that systematic adoption of AI will lead to widespread loss of jobs and financial distress for people left behind. The generation of false data and uncontrolled dissemination of unfiltered information may, it is feared, foster social unrest and destabilize democratic institutions.  

All of these predictions, for good or for bad, center on the word “intelligence.” If it is defined as the creative use of information towards a specific goal– my definition, to be sure — then it exists along a gradient and there is not an opposing term. In that case, the mixed picture about the future of AI seems accurate. Humans can process information to both noble and destructive ends. If machines are provided information by humans, then it is likely that there will be worthy and flawed outcomes. It is not a reflection of the logical structures or neural networks that are built into us as humans or artificially placed into machines. It simply is the nature of intelligence. Information is agnostic and it can be processed in a limitless number of ways; there is no guarantee of what will happen when it is processed. 

On the other hand, if we center our predictions on the word “artificial,” there is an opposing term, namely “genuine.” Speak looks beyond AI as intelligence and forces us to think about its impact on interpersonal communication and interactions. The design of the robots that are being created in fiction and in our world of 2025 is steadily improving. The voices become more lifelike, the reactions more emotionally appropriate, the reactions more convincing. They display keen intelligence and manifest seeming empathy with their handlers. Like the artificial friend in Klara and the Sun by Kazuo Ishigura, the robots may even appear to have more feelings and awareness of the ever-changing psychological state of their owners than family members and friends. But it will always remain artificial. Speak forces us to ponder whether interactions between human beings have an element that cannot be programmed, that is not simply manipulation of information. It is that piece that accounts for the genuine nature of relationships between people and it is that component that is vital for human growth and maturation. The interconnected stories in Speak raise the concern that reliance on AI, in whatever embodied form it takes, to provide support and companionship may inevitably fail and leave damaged humans in its mechanical wake. The intelligence of AI may not be sufficient for humans to thrive. It remains difficult to put into words exactly what to call this additional component of human interaction. Thankfully, there is literature, and creative novels like Speak, to help us grapple with what it might be and to help us steer a course where AI is developed thoughtfully with full awareness of its limitations and potential for good and harm. 

SPEAK  
Louisa Hall 
EccoPress, New York 2016, 356 pp 
Web image by Medhum.org

Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.    

In Stuck, Dr. Larson makes a strong case that vaccine hesitancy and rejection are widespread and growing global problems. The book is much weaker in proposing effective solutions. It’s clear that simple solutions, based on the premise that resistance will fade away as soon as public health agencies “educate” people, have failed.  Dr. Larson recommends listening more carefully to antivaxxers’ concerns and developing creative pro-vaccine messaging. Since the publication of her book, the massive initiative to vaccinate the American population against Covid has confirmed the extent and multiplicity of antivaccine beliefs in our society. It has also led public health agencies to develop more sensitive and engaging messaging than in the past. Nonetheless, the core problem remains.  

Stuck
Heidi J. Larson 
Oxford University Press, New York, 2020:  155 pages. 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

A precocious young person on a track to success, Wang experiences a manic episode at Yale that leads to her first hospitalization. After a second hospitalization, her college washes its hands of her. Hitting roadblocks time and time again requires her to rebuild her life over and over. This is not a conventional chronological autobiography but rather essays that provide different approaches to the author’s experience of mental illness. The plural “schizophrenias” of the title encompasses the whole schizophrenic spectrum of disorders. As Wang explains, her own diagnosis is “the fucked-up offspring of manic depression and schizophrenia” (p. 10).   

In an essay entitled “High-Functioning” we learn how the author, having been a fashion editor, knows how to pass for normal: “My makeup routine is minimal and consistent. I can dress and daub when psychotic and when not psychotic. I do it with zeal when manic. If I’m depressed, I skip everything but the lipstick. If I skip the lipstick, that means I haven’t even made it to the bathroom mirror” (p.44).   

Later, in “The Choice of Children,” volunteering at a camp for bipolar children makes Wang think about what it would be like to inflict her diagnosis on her own offspring. In “Reality, On-Screen” she attempts to convey the sensation of decompensating to psychosis. And in “Yale Will Not Save You” she considers the failure of universities to accommodate mentally ill students.  

This is a special and rare book. As with Elyn R. Saks in The Center Cannot Hold, Wang’s disability seems not to have robbed her of her cognitive faculties, resulting in a sense of lucidity. Yet, at the same time, we are never far from madness. As a result, the essays glisten like polished jewels while the author’s voice retains the air of authenticity.   

While Wang has understandably had ambivalent experiences, in every case where The Collected Schizophrenias might have lapsed into an anti-psychiatry rant, the author instead considers a range of perspectives. She is devoted to taking her medication, yet she open-mindedly explores alternative therapies, spirituality, and even the notion that her illness might have bestowed talents or some evolutionary advantage on her.   

We should not have to be reminded that once civilians become patients they do not lose their intelligence. Wang writes that “a primary feature of the experience of staying in a psychiatric hospital is that you will not be believed about anything” (p. 98). Indeed, when she is asked how she is doing and she replies she is doing well, she is said to be lacking in insight. At other times, she is advised by certain well-meaning people that given her diagnosis “I should be proud of how coherent I am” (p. 54), and by others “who don’t believe in mental illness… that in other cultures, a person who would be diagnosed with schizophrenia in the West might be lauded as a shaman and a healer…They are likely to be the type who boast about never taking aspirin for a headache” (p. 23).  

There are many insights to be found in this book that should prove eye-opening to mental health practitioners. It should be required reading for anyone who wants to understand the experience of having an illness.   

Publisher Graywolf Press 
Place Published Minneapolis 
Edition 2019 
Page Count 202 

Web image from Wikicommons
An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database. 

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3). While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist. However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.   

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything” (p.1). As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments. Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy.  

The task of wading through more than a hundred pages of treatment notes induces a feeling of helplessness. This gives us a taste of the author’s own experience of his illness. He often seems to get better or worse without rhyme or reason. Diagnoses come and go. At various times he has been called borderline, obsessive-compulsive, narcissistic or schizoid. He himself questions the literary quality of the notes, considering them “anti-writing” (p.7). Nevertheless, persevering through the material does yield insights for the reader.   

For one thing, the notes document changes in psychiatry over the past half century. The early note takers took their time, and their writing is thoughtful and descriptive. Later notes are comparatively terse and center on the patient’s response to medication. The author suggests that the change reflects a greater fear of litigation. The reality is multifactorial. Less attention is devoted nowadays to understanding a patient’s psychodynamics. Insurance companies pay for symptom relief and want documented results.  

Any sense of tedium the reader might feel from reading the author’s mental health records is made up for by his “tips.” Scialabba gives practical suggestions about pharmaceuticals, what to eat, and how to sleep. Sufferers of depression will be pleased to hear about these things not from a doctor, but from someone who has been through the same ordeal.  

In short, How To Be Depressed is a self-help book that is somewhat out of the ordinary, and whose flippant title belies its serious content. It provides an intellectual perspective on a devastating and common disease. 

Publisher University of Pennsylvania Press 
Place Published Philadelphia 
Edition 2020 
Page Count 146 

Web image created by Medhum.org
An earlier version of this review was published in the NYU Literature, Arts and Medicine Database. 

I have been involved in the field of health humanities for more than seventeen years. The field initially focused on medicine but later expanded to involve other health disciplines. I started teaching medical students but have also been involved with nursing and dental students. I have also facilitated sessions for faculty members. My perspective on and comprehension of the practice of medicine have expanded because of this interaction.  

My interest in the field dates to 2007, when I enrolled in the PSGFAIMER Institute’s health professions education fellowship program (https://apply.faimer.org/prog/psg/) in Coimbatore, India. This fellowship comprised creating and carrying out a curricular innovation project (CIP) at my home institution in addition to participating in on-site sessions at the Institute. Combining my passions for teaching, literature, and the arts, I chose to create a medical humanities (MH) module for my CIP. I began by providing undergraduate medical students at Pokhara, Nepal with a voluntary program on medical humanities, which quickly became an area of emphasis for me. My colleague and I also provided a program for all first-year students at a brand-new medical school in Lalitpur, Nepal. I also led workshops on the subject at several Indian universities in 2020, right before the COVID-19 pandemic. We exchanged knowledge, and I learned about the many projects being carried out in Indian colleges. Traditional teaching and learning methods were of course then upended by COVID-19, which also gave online education a boost.  

 In developing nations there are fewer interactions between the ‘traditional’ humanities and the health humanities. Health humanities (HH) is still a developing discipline in India, where most states/provinces have specialized health universities with which colleges offering health courses are affiliated and involvement of humanities faculty in teaching the health humanities is low. In India, the former Medical Council of India developed an attitude, ethics and communication module that has now been taken up by the National Medical Commission. This module has created interest in the humanities among faculty of medical colleges, and there is now greater awareness of the discipline. A retired English teacher, Dr Radha Ramaswamy, and her team created the Centre for Community Dialogue and Change in Bengaluru, India. This organization offers Theatre of the Oppressed workshops for breaking patterns and creating change. They have facilitated workshops at several institutions in India and even in other countries. Workshops have also been offered in medical colleges. The organization offers periodic training-the-trainers’ workshops. Some medical college faculty who have been trained in these training workshops also facilitate Theatre of the Oppressed workshops. Online webinars and conferences have become more common.  

In Aruba, in the Dutch Caribbean, I began teaching medical students through films, and for the past ten years, I have been concentrating on this. We have presented seminars on this topic at various health professions education conferences in collaboration with others. I have written a few articles on the topic, and I recently worked on a module that used films to help undergraduate dental students develop empathy. 

The last two decades have seen a steady growth in health humanities in South and Southeast Asia and in other regions of the continent. Modules and sessions are being offered to undergraduate and postgraduate students. A few institutions are also offering electives in this area for medical and other healthcare students. HH has several benefits in the education of future health professionals. Health is inherently psychological, social, and related to history and culture. Modern medicine is dominated by technology, and the health system is inherently complex. Methods from the humanities and the social sciences using an interdisciplinary approach are required to promote sustainable interventions that can address the complexity of health and disease that may have origins in social, economic and other factors. HH can develop students’ capacity for critical reading and reflection, and they can then examine health and medicine in society, practice and their own lives; it may also inoculate students against the hidden curriculum (a set of norms, values and beliefs that are not explicitly taught but are learned at the institution) and loss of empathy that may occur in medicine. Doctors and other health professionals engage in a social contract to serve society. Health humanities can help to introduce the contract to students, encourage its exploration, and also introduce ethical issues and dilemmas.  

I have gained a deeper understanding of HH and its connection both to medicine and to the general humanities. A year and a half ago I became a member of an online global network for the health humanities, and the group in addition to health professions educators also has individuals from the arts and the humanities. I have realized that like medicine and the health sciences, the humanities have their own terms and descriptors, theories and concepts, and these may be difficult for health professionals to comprehend. The opposite is also true, as humanities scholars struggle with medical jargon. An open mindset and greater effort are required to address the gaps. In the developing world, the humanities and the health sciences diverge right after ten years of schooling and are mostly in physically distinct locations, yet many health care professionals still have a personal interest in the art of medicine.  

A variety of factors must be considered to treat illnesses and maintain health. The physical and genetic makeup of the individual, the socioeconomic status, social determinants of health, access to good quality healthcare, rational use of medicines, cost of healthcare and preserving the power of antibiotics are among these. Through my research and teaching in the health humanities I believe I have gained a more holistic understanding of a human being and of health and illness situated in culture, society, family and moral values. Today we have wearables and other devices that provide a constant stream of data that must be interpreted and converted to actionable insights. However, we have a responsibility to make sure that the essential humanity of our patients does not get lost in a sea of data. The humanities and the sciences can, should, and must work together to improve health and well-being.   

Web image by Giuliano Gabella on Unsplash

The place: a nondescript, ramshackle medical clinic located on the second floor of a large Chinese mall, located in the suburbs of Toronto, just north of the city, circa 2008. 

Our narrator, the protagonist, is a newly minted family physician, a Chinese Canadian who grew up not far from this neighbourhood. 

On this otherwise nondescript morning, I get into the office and find that the first patient of the day is already waiting for me. 

On my way into exam room eight, I grab the large patient file that sits in the file holder just outside the door. Many of these files are for longstanding patients of the clinic, and even though I’ve only been working at the clinic for just over a year now, I’ve basically inherited them and their problems from the doctors who worked shifts here before me. 

Inside the room are two middle aged Chinese men. One is a stocky, heavy built man in work clothes. Next to him is a clean-shaven man wearing a dress shirt and slacks. I vaguely recognize the larger man. I’ve definitely seen him before. I’m not sure who his friend is. 

The two men greet me enthusiastically. 

“Good morning doctor,” says the man I recognize. 

“Here, we bought you a cup of coffee,” says the other man. He points at a styrofoam cup of Chinese mall coffee that is sitting on my desk. 

I nod and smile. It occurs to me that it is odd that they are so friendly. But it won’t be the last odd thing to happen to me on this day. 

“What brings you in today?” I ask in Mandarin. I’ve gotten used to speaking Mandarin during the majority of my patient encounters at this clinic. In fact, I’ve spoken more Mandarin since I started this job than I have in the preceding ten years, maybe since childhood when I spent a year living in Taiwan. 

The man in the dress shirt speaks. “Do you remember filling out a life insurance application for him recently?” 

As he speaks, I open the manila folder and start flipping through the chart to orient myself. I do remember this chart. The patient, the blue-collar worker, is not a regular patient of mine. I’ve only seen him once or twice in the past over the last few months, for prescription refills, and a discussion about his hypertension. Most of the chart, years and years of doctor visits, predates me. 

A month or two earlier, a request came in from an insurance company, asking me to provide a letter documenting the patient’s medical record. Insurance companies use these records to determine if a patient should qualify for life insurance, or how much of a premium they should pay based on their pre-existing medical conditions. 

“Yes. I do remember filling this out for you.” It is starting to dawn on me what the purpose of this visit is. The problem here is that the patient has a long history of high blood pressure, and he’s been consistently noncompliant with his treatment. I flip further back through the chart. There are multiple records of high blood pressure readings over the years, and lists of medications that were prescribed that he never ended up taking. 

All of this was documented in the note that I sent back to the insurance company last month when they asked me for a record of the patient’s medical history. 

Now it’s the patient’s turn to speak. “I don’t understand why I didn’t qualify for insurance. I have no health problems. What did you write on the insurance application?” 

I brace myself. I know he won’t like the answer. “I didn’t write anything special. I just told them what happened at your doctor visits based on what is written in the chart.” 

“You told them that I have high blood pressure?” 

“You did have high blood pressure at the last visit.” I turn the notes to the page from the last visit. “Your blood pressure was 154/96 at the last visit.” 

“I don’t have high blood pressure. I feel fine.” 

Of course, the patient feels fine. Hypertension is a silent disease. Patients usually don’t feel anything. 

“Why don’t you check my blood pressure now? I’ll prove to you that I’m fine.” 

I can feel myself start to tense up. I’m not really sure how to extricate myself from this situation. I agree to check his blood pressure as a way to buy myself some time. 

I put his arm inside the blood pressure cuff and pump the cuff. I use the silence to think about what I should do next but there isn’t enough time. Nothing comes to me. 

Not surprisingly, the reading is elevated.  

“160/100” I report. I try not to sound too triumphant. “It’s still high.” 

The patient ponders this for a moment. 

The friend decides to try a different tack. “Doctor, my friend here is trying to apply for health insurance. Can you please help us out? “ 

“I’m not sure how I can help.” As I say this, I look up and notice once again, the styrofoam cup of coffee. Now I see the gift for what it is. A payout or a bribe. Either way, something dirty. 

“If you can just write a letter explaining that he is healthy and he doesn’t have these issues, we can take it to the insurance company. Please help us out.” 

I have to choose my words carefully here. It’s harder for me to do this in Mandarin and I wish I could speak English here. “I can’t do that. It’s in the file. I can’t change the record.” I open the file and show the two men. The patient has a long history of high blood pressure. It isn’t one reading, or one visit, but a pattern of high readings over many years. I try to explain this in as simple Mandarin as I can. 

“Really? All we need is just a letter, explaining that he is healthy.” 

For a moment, I’m tempted to write them a letter, just to get them out the door. But what purpose would it serve? There’s no way around the fact that the insurance company has already received my prior correspondence clearly documenting the high blood pressure readings. I can’t lie to them. I think about my medical license, my career, and the prospect of losing it all over a two-dollar styrofoam cup of coffee. 

I shake my head. “I can’t do it.” 

In medical school, we attend classes on how to conduct patient interviews. We’re taught ways to de-escalate angry patients who are upset about things like having waited too long in the waiting room. For patient visits that are spiraling out of control, we’re taught the importance of body language. If a visit is going nowhere, we’re taught to stand up and move towards the door. This will suggest to the patient that this discussion is coming to an end. So this is what I do. I get up and move towards the door. 

The patient and his friend look offended. “Why are you getting up? We’re not done talking.” 

I’m now feeling very edgy. Medical school didn’t teach me what to do in this situation. A pit is forming in the bottom of my stomach. My sympathetic nervous system has kicked into overdrive. 

“I don’t have anything more to say.” I manage to force out this sentence in slow, stilted Mandarin, but my stomach is churning. 

“Why can’t you help us?” 

“I didn’t say I can’t help you. But you’re asking me to do something I can’t do.” 

“You’re a doctor. A doctor is supposed to help people.” 

I’m lost for words now. I stare back at the patient, the gears in my brain spinning frantically but to no avail. 

“You call yourself a doctor? What kind of doctor are you?” 

In our training, we’re taught a formula of what to say to patients in this type of situation. If a total breakdown in communication with a patient occurs (I’m pretty sure when a patient is pressuring the doctor to do something illegal and unethical, this would be grounds for a total breakdown), we’re taught to say something along the lines of “I feel like we’re having a breakdown in the patient-physician relationship, and we cannot continue this way. It might be best if you find another doctor to try to help you.” Right. You try translating that sentence into Mandarin. You try translating that sentence when a large, Mandarin-speaking man is breathing down your neck and asking you what kind of doctor are you? 

I try to come up with that sentence, but all my years of spoken Mandarin at the dinner table with my parents, and two years of university level Chinese fail me in that moment. 

I’m trying to say that our relationship is breaking down, but what actually comes out of my mouth is this sentence: 

我不喜欢你的态度  

This translates roughly into “I do not like your attitude.” In hindsight, maybe the sentence sounds too much like how a parent might lecture their teenage son when said son refuses to take off his headphones to hear whatever lecture the parent is offering. Or maybe it’s simpler than that, that maybe nobody likes being told that they have an attitude problem. Or maybe it was just the moment. I’ll never know for sure. 

In the next instant, the patient leaps up and charges at me. 

Terrified, I bolt out of the room. Luckily, I am already at the door of the exam room and in an instant, I am down the corridor, with the patient hot on my heels. Near the end of the hall, a friend of mine, another doctor in the clinic, comes out of his room to see what the commotion is about, and manages to get between the patient and myself, giving me a moment to flee to the relative safety of the computer room in the back of the clinic. I shut the door behind me. 

Outside, I hear the ruckus continue. My friend and one of the receptionists are trying to talk the patient off the ledge while the patient is hurling epithets at me in Mandarin. As I stand there, my entire future career flashes before my eyes. I tell myself this: if he makes it into the room, do not throw the first punch under any circumstances. But if he throws the first punch, then what? 

Over the years, I’ve been asked many times what it’s like working almost entirely with Chinese patients in a language that isn’t my native tongue. I’ve even given talks to the Medical Mandarin club at the University of Toronto about how to conduct medical interviews in Mandarin, and I have a few prepared answers for the students. But the full truth is too hard to explain. Only this incident can explain it. 

The truth is that I speak Mandarin well for a Chinese-born Canadian but compared to a native speaker, I am only just getting by. I can order food at a restaurant. I can understand television dramas from China and Taiwan. I can even haggle with a salesperson over the price of a speaker system if need be. 

In time, my medical Mandarin has improved too. When I started, I only knew a few medical catchphrases that my parents spoke at home. I knew how to say, “Hepatitis B” and “cholesterol” and “blood sugar.” The rest of the terms, I gradually learned from my patients over the years, as we talked about erectile dysfunction, menopause, thyroids, and everything else under the sun. 

All of this is great for my vocabulary, but the truth is that anyone can order dishes off a menu if they practice enough times, and the rote conversations that fill Mandarin textbooks and audio Mandarin lessons can be memorized and rehearsed until one can fool most people into thinking one is proficient. What I’ve learned about languages from medicine, and most specifically, through this incident, is that true mastery of a language should also include being able to nimbly think up an intelligent, appropriate response when one is under emotional pressure. 

Thankfully, this scenario doesn’t occur that often. In the years since, I’ve had to teach myself to be very, very careful when having emotionally charged conversations. And over time, I learned a technique that I could deploy now if necessary. If a situation like this encounter were to recur in the future, I would stick to English to avoid miscommunication and to retain control of the conversation.  

Fortunately, the office manager managed to talk the patient into calming down and the door to the computer room was not barged through, and there were no fisticuffs. It was, to date, the closest I’ve ever come to physical blows in my adult life. The patient had initially demanded that I come out and apologize, and insisted they would wait outside the office until I reappeared. But eventually, the manager explained to the patient that if he kept on threatening the office, we might just have to call the police. 

As for me, for a few weeks thereafter, I thought twice about walking down the long corridor to the underground parking lot alone, but time passed and eventually this incident moved out of the forefront of my mind and life went on. I never saw the patient or his friend again. 

Web Image by Brando Makes Branding

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours 

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