On the one hand, if the doctor is physically unable to treat, then he is not responsible for withholding treatment. On the other hand, by being rendered professionally helpless, perhaps he is being punished for not taking a moral stance against his patient. This interpretation seems to have validity because the last line recalls Psalm 137, which warns, “If I forget thee O Jerusalem, let my right hand forget her cunning.” 

For drawing attention to the biblical reference, I am grateful to Dr. Danielle Ofri (clinical professor) and Lara DeLong (Class of 2001), both at NYU School of Medicine. Dannie Abse (1923-2014) was a practicing physician and poet. 

Reading by Dannie Abse

Case History
‘Most Welshmen are worthless,
an inferior breed, doctor.’
He did not know I was Welsh.
Then he praised the architects
of the German death-camps–
did not know I was a Jew.
He called liberals, ‘White blacks’,
and continued to invent curses.

When I palpated his liver
I felt the soft liver of Goering;
when I lifted my stethoscope
I heard the heartbeats of Himmler;
when I read his encephalograph
I thought, ‘Sieg heil, mein Fuhrer.’

In the clinic’s dispensary
red berry of black bryony,
cowbane, deadly nightshade, deathcap.
Yet I prescribed for him
as if he were my brother.

Later that night I must have slept
on my arm: momentarily
my right hand lost its cunning.

Commentary

“Sometimes it’s very difficult to like some patients. Patients imagine that they’re always likable, but in fact there are some one has great difficulty with, I think. And indeed there was one patient that bugged me so sufficiently that I wrote two poems about him.”

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

This eloquent statement against the madness of war is the first novel in a trilogy that includes The Eye in the Door (1993) and finally The Ghost Road (1995), which was awarded the Booker prize. The story is closely based on the publications and annotated literary papers of three real men who met at Craiglockhart in 1917: psychiatrist W.H.R. Rivers (1864-1922) and two poets: Siegfried Sassoon (1886-1967) and Wilfred Owen (1893-1918). Owen wrote some of the most moving war poetry and the knowledge that he would be killed in action at age 25 simply adds to the poignant sense of futility.  

Pat Barker (b. 1943) probed the tenacious role of class within the military hierarchy, while the society, which the military purports to defend, is rapidly being transformed by the converging lives of domestic servants and aristocrats. Her descriptions are powerful: the yellow skin of women who work in the munitions factory; the surgeon who can no longer bear the sight of blood; the young soldier who cannot eat because his nose and mouth had once been filled with rotting flesh when he was hoist by a grenade into the decomposing belly of a dead German. Rivers helps the men to recall and to understand the origins of their ailments by gentle, patient conversation–a treatment that he described in Lancet, 2 Feb 1918. 

Regeneration
Pat Barker
London: Viking Press
New York: Plume
1991, 256 pages)

From the Vault: In these times, certain works of literature seem to be as relevant to us now as when they were published — possibly more relevant than the times that they depict. From the vault of the now closed Literature, Arts and Medicine Database, we will pluck a few items for their power and timeliness. 

Web image by  National Library of Medicine

From the closest bus stop, the shift in focus is immediately apparent. A walk along the Avenue de la Paix (Peace) takes one past sculptor Daniel Berset’s monumental broken chair statue, conceived to encourage a multi-national ban on anti-personnel mines and cluster munitions. In the background, stands the European headquarters of the United Nations in the beautiful Palais des Nations (originally built in 1929 to house the League of Nations). A bit farther on, a statue of Gandhi greets passers-by, adorned one recent day with tributes to the late Russian political activist and prisoner, Alexei Navalny.  

The Red Cross/Red Crescent museum itself sits at the foot of the International Committee of the Red Cross (ICRC) headquarters, a large white building atop a hill. A modern glass and steel structure houses the collection where visitors are invited to learn more about the organization’s origins, as well as the long-standing alliance between individual Red Cross and Red Crescent national societies that provide humanitarian relief around the world. 

While the organization of exhibits in the museum’s permanent collection is not strictly chronological, a sculptor’s dramatic all-white rendering of Henri Dunant seated at a desk—and accompanying text—explains the Geneva resident’s role in the founding in 1863 of what is now the International Red Cross. Dunant, who was first inspired to create a relief effort to alleviate the suffering of soldiers after witnessing the 1859 battle of Solferino, Italy, also participated in the framing of the original Geneva Convention of 1864. On display in a nearby case, copies of that document contain language that reflects the authors’ optimism, “Ambulances and military hospitals shall be recognized as neutral…Wounded or sick combatants, to whatever nation they may belong, shall be collected and cared for.” Subsequent versions that expanded on the protections outlined—thereafter referred to as the Geneva Conventions—were drafted respectively in 1906, 1929, and 1949, with the lattermost document still remaining in effect.  

To safeguard both those providing care and wounded soldiers, the Convention “established a universally protective symbol: a red cross on a white background.” (There has been some debate about whether the white cross on the emblem was intended to carry religious significance or was simply chosen as a readily recognizable symbol, i.e., the inverse of the Swiss flag.) A little more than a decade later, use of the red crescent—a symbol more readily recognizable to Muslim soldiers—was initiated, with formal adoption of this symbol in 1929. Today, the red crystal emblem is used by allied societies in regions where the population does not identify with the cross or the crescent.  

Throughout the museum, the response of the Red Cross and the Red Crescent to humanitarian crises around the world is documented through a variety of materials including photographs, artifacts, and facsimiles of official records. The experiences of survivors in more recent conflicts and natural disasters are brought to life through additional media, including music, graphic representation, and recorded testimony. A striking example is found in the Hall of Witnesses where visitors can sit face-to-face with greater-than-life-size videos of survivors describing their experiences—among them, a former child soldier, a civilian who lost his legs but now works with other amputees, and a woman who experienced multiple displacements from her home country. 

The youngest victims of conflict come into focus in a haunting display of photographs posted along the wall of a nearby room; the accompanying text explains that the children portrayed are survivors of the 1994 Rwanda Genocide. Separated from their relatives at such an early age many did not know their family identities, or even their own names, making reunification difficult and sometimes impossible.  

Fortunately, there is hope to be found as well. In the Restoring Family Links section of the museum, more testimony may be viewed and heard, describing instances in which families separated by conflict have been reunited by the Red Cross and Red Crescent. Stories of recovery and resilience, even among individuals who might have given in to despair, amaze and inspire. 

In another gallery, a display of artwork crafted by prisoners and made primarily from found materials serves as testament to the desire for creative expression among those who have yet to attain their freedom. Among these works: a locomotive made by a French prisoner in Germany in 1941; a set of playing cards drawn by a Moroccan prisoner held by the Polisario Front (a group seeking independence in the Western Sahara) in 1998; and a miniature palace put together by Lebanese prisoners in Israel in 1999. (A book of this artwork is available in the museum shop.) 

With not all threats to human dignity stemming from civil wars, nationalist movements, repressive governments and militia, the Red Cross and Red Crescent also work to prepare vulnerable populations for natural disasters. A small area of the museum is devoted to this work, while a newer threat, cybersecurity is addressed at the Data Detox bar, where a pick-and-choose your own cocktail metaphor is used to provide “…steps you can take to control your digital privacy, security, and wellbeing”; cards that summarize this information are available to take home. 

Leaving the exhibits behind, in the lobby of the museum, the departing visitor is reminded of the power of literature and art to communicate our moral obligation to alleviate human suffering, as well as our capacity to do so. A quote from Dostoevsky that runs along one wall recalls our universal responsibility to one another, while nearby, observers are invited to add their own bit of weaving to artist Zahrasadit Hakim’s tapestry-in-progress, an example of how the cumulative efforts of many changes, supports and enhances the whole. 

The Museum of the International Red Cross and Red Crescent
https://redcrossmuseum.ch/
Av. de la Paix 17, 1202 Genève, Switzerland.  

Photo of the Red Cross/Red Crescent museum from wikicommons

Ingrid (played by Julianne Moore) finds out that her good friend from long ago has terminal cancer. Martha (played by Tilda Swinton) still lives near enough that Ingrid can visit her in short order, and she does. For Martha, Ingrid’s visit is welcome and well-timed; she is looking for someone to accompany her on her journey to her last breath. The plan is set. On the day that seems right to her, Martha will ingest a drug that will release her from a cancerous life promising more suffering. She asks Ingrid to be the one accompanying her, and only asks that she be in the room next door. Ingrid agrees. 

They decamp to a place in the hills Martha rents. Ingrid takes a room downstairs instead of the room next to Martha’s, perhaps as the first visible sign of some pressure on the relationship and the idea. While many days pass when Martha is not ready, Ingrid does what she can to put Martha and herself at ease by maintaining some activities of daily living. They respond to each other as close friends do. Nevertheless, tensions threaten the facade of normality. Ingrid seeks activities away from the house, further yet from the room next door, and a friend warns about dangers she could encounter from her involvement in Martha’s death. The way they talk and respond to each other gets more stilted and wary up to the day Martha finally takes the pill, a day Ingrid is not in the room next door, or in the room downstairs, or in the house.  

That’s not the end, though. Ingrid returns not long after Martha dies, spends time with and offers succor to her daughter, and then defends Martha and herself to the police at great risk. The answer to Almodóvar’s question could be that these reconstituted relationships can endure, however bumpy and sad they may become along the way.  

The Room Next Door
Director: Pedro Almodóvar 
Cast: Julianne Moore, Tilda Swinton 
Sony Pictures Classics: 2024
RT: 1hr 47minutes 
Web image from Sony Picture Classics

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 

01.12.26 551

From Tigers to Otaku

09.16.25 1362

The Happiest Couple

07.28.25 1143

The Things We Don’t Talk About When We Talk About Dying 

05.13.25 1723

One Patient, Two Systems 

02.24.25 2355