Doctor-Patient Relationship – medhum.org https://medhum.org Cultivating empathy & critical thinking in health, culture & the arts Sun, 05 Jul 2026 00:05:17 +0000 en hourly 1 https://wordpress.org/?v=7.0.3 https://medhum.org/wp-content/uploads/2024/05/cropped-medhum-logo-300-e1715809791117-32x32.png Doctor-Patient Relationship – medhum.org https://medhum.org 32 32 Meet the MedHum Team: Dr. Steven Field  https://medhum.org/interview/practitioner-interview/dave_hsu/meet-the-medhum-team-dr-steven-field/ https://medhum.org/interview/practitioner-interview/dave_hsu/meet-the-medhum-team-dr-steven-field/#respond Tue, 26 May 2026 22:29:57 +0000 https://medhum.org/?p=14543 The Guts of it All 
David Hsu sits down to talk with Medhum editor Dr. Steven Field. Steve is a gastroenterologist, though retired from clinical practice. He is Clinical Assistant Professor of Medicine in the New York University School of Medicine. He has also received certification in Bioethics and Medical Humanities, as well as Psychodynamic Psychotherapy of Adults. 

DAVID HSU: Why do you think medical humanities is important in today’s world?

Steven Field 

STEVEN FIELD: I think it’s important because it’s a way of getting back to the heart and soul of clinical medicine, or at least, I hope it is. I was in practice for 35 years, and I think that medicine has moved towards a different concept than the concept that I grew up in professionally. I like the idea of well-rounded physicians. I think people should know things other than just medicine. Reading novels gives you an appreciation for the way that people interact, not necessarily just in medical illness, but also outside of illness, which then you can extrapolate back [from].

But I admit I’m biased. I was a liberal arts major in college. I started in English, and my degree is in history. What was your area?

I did a double major in biology and history. Most of my classes were 20th Century American history.

My senior essay was on Puritan and colonial town planning theorems in New England and the middle Atlantic states, nothing I’ve used ever since. And my junior essay was on witchcraft.

Witchcraft is a little bit closer to medicine.

True. I actually was looking at the sociopolitical ramifications of witchcraft in Tudor-Stuart England and France under Richelieu. So, while it wasn’t wars and treaties history, more social/cultural history, it was history nonetheless.

I come from that liberal arts background, so I have a leaning towards medical humanities. I think it’s really helpful to ground people who are in the field, and I think it’s an often incredibly helpful way to relate to patients on so many levels. You might not be amazed, but many people would be, to know how many times the doctor-patient relationship is either forged or strengthened over a shared interest, literary or otherwise. I don’t mean sharing at the same time, but something that somebody else has read, or a movie, or a play you’ve seen. The reason I think medical humanities has assumed more importance is because the period of time that doctors have to spend with patients in the encounter has gotten smaller and smaller. There’s this thing that in some offices a new patient visit should take 20 minutes and follow-ups should take seven minutes. I retired from practice in 2011, and I would never be able to function under this system now, because I’m a schmoozer, you know? I like to talk to patients.

And you’re a gastroenterologist, is that right?

I am a gastroenterologist, although I had a large proportion of my practice in general internal medicine. Along the way, I also got a certificate in psychodynamic psychotherapy, which I found very useful, not only in the practice of medicine — mind and body are linked, of course — but in two other places as well. I had a small psychotherapy practice, in addition to my medical practice, so it clearly helped there. And I work in clinical ethics now, and understanding family dynamics is really helpful when you are dealing with patients and families in conflict. I think that psychiatry especially — not so much psychopharmacology, but psychotherapy — is kind of the closest to medical humanities, in some ways.

That’s interesting. I read your bio and it talked about dynamic psychotherapy, but I didn’t know what that meant. I didn’t realize it refers to inter-family dynamics.

Psychodynamic refers to treatment basically anchored in Freudian theory. So it’s not cognitive behavioral therapy. It’s the old standard, you know? You talk about childhood, ego, super ego, all that stuff.

So you see that medical appointments are getting shorter and shorter, and there’s more and more use of technology, and like you’ve mentioned, the humanities could be a bit of a buffer against that. It would help us navigate that world. Can you be a bit more specific on how you see that relationship unfolding?

Just to be clear, it’s not really a buffer against technology per se, but rather, against the depersonalization of medicine that can result from increased technology and decreased time. I’ll tell you the truth. It’s tough for me to answer that question, because I’ve never functioned in this 20-minute visit environment, right? When I was last in practice, a new patient got an hour and a follow-up got a half an hour. That’s much harder to do today. So there was time to talk to them and sort of develop the relationship – the medical side as well as the interpersonal side.

I think that it’s a good question. I think medical humanities could have two different functions. It hopefully heightens physician sensitivity to the human condition, to what patients are feeling and going through. In addition, I believe that for many physicians it acts as a counterweight to the immersion in medicine and illness, and as a source of personal fulfillment. Of course, that second sense may not be true for everyone; people find fulfillment in life in many different ways.

Let’s talk a bit more about the tie-in with psychiatry because I’m really curious about this. You reviewed the book The Third Reich of Dreams. How do dreams and the subconscious relate to medicine?

Freudian theory has gotten a bit of a bad name over the years, and psychiatry has moved very much to psychopharmacology. But psychiatrists classically loved to analyze dreams, because a dream brings in not only what the immediate concerns are, but also all the things that you draw on in your background. So it’s a very interesting way to approach things. For some people. Others don’t dream, or they dream, but they don’t remember them.

And it’s not only dreams. I noticed many times in patient interactions in my medical practice, that people re-enact things from their childhood or early adulthood. Their mother didn’t love them, so they choose somebody who reminds them of their mother, because they think they’re going to fix it this time. That’s almost a cliche. But that sort of stuff happens a lot, and I think that’s really interesting.

I had sort of a subspecialty in inflammatory bowel disease, so a lot of Crohn’s and ulcerative colitis patients. And I had one young woman, not so young actually, who had very severe Crohn’s, and she wasn’t getting that much better. And I talked to her about putting her in the hospital and putting her on TPN (total parenteral nutrition) because she was losing so much weight, and she didn’t want to do that. And she said “I don’t want to go to the hospital. I’ll try, Dr Field. I’ll really try, because I’m telling you, I really don’t want to gain any more weight.” And then she said “I mean, I don’t want to lose any more weight.” And I just said, ”Well, that’s an interesting slip, right? What do you think that’s about?” And she paused, then she burst into tears. And then I got the whole story about her difficult relationship with her mother, and how her mother was always making nasty comments about her weight. This was all coming out; there was a whole huge story behind it. And there’s stories behind lots of people’s stuff, and I’m not saying her Crohn’s was due to that, not at all, but there are lots of patients who have this kind of thing in their background. You know, life story and narrative, and so that’s what I think Medical Humanities is about, the human narrative behind the patient and their illness. I think having some knowledge and experience, some background, that isn’t just medical but also is humanities-oriented can sometimes give you common ground with patients, or even just make you curious about them. All it took was saying, “that’s an interesting slip. What do you think about that?” And it was a whole other side of this patient. Medicine is about people, and people are not just their disease. They’re people with a disease. Sometimes you have to have that sort of global look. And I think the interaction with the humanities is helpful in that regard.

What’s your Gestalt sense of the relationship between our mental well-being and physical illness?

I have always felt that the two things influence each other, and it’s not necessarily a sharp line between them. I would certainly not go so far as to say that my patient’s experience with her mother caused her Crohn’s disease, but I think psychological states can certainly exacerbate symptoms. I mean, the gut, specifically, has its own extensive immune system. It has its own nervous system, responsive to inputs from the central nervous system, and the enteric nervous and immune systems are interrelated. And much of that has been well worked out, there’s this whole field of neurogastroenterology that deals with this.

So I think that’s recognized, clearly, that one’s psychological state can influence illness and sometimes worsen symptomatology. Many times I’ve seen “intractable” symptoms abate when a patient retires from a stressful job, for example. So I think stress has a very significant role in the production of symptomatology and perhaps in the pathophysiology, actually, in certain cases.

How about today? In 2025, it seems like the world of medicine is facing a lot of stress. There’s a lot of vaccine skepticism. People are antagonistic towards public health. COVID certainly didn’t help things. How do you see medical humanities being part of that landscape?

Well, I imagine that landscape is prominent in the United States in large part related to political developments.

I guess I’m influenced by my subscriptions to the New York Times, but Canada is the same. I mean, I feel like before COVID there were a few people that were skeptical of vaccines, but now everyone seems entitled to have an opinion about it and voice it readily. I’ve worked with mostly Chinese patients. I hear this from them all the time, but they’re generally a little bit more “toe the line” regarding what their government says they should do. But I think now people are more emboldened with some of these ideas.

One thing about the United States is that, as opposed to most of the northern European countries and Canada, the US has a very strong libertarian streak. Individuals. “Don’t tell me what to do.” We rebelled against England, settled the frontier, dispossessing everybody who was there in the process. So there’s this real idea of the right to be left alone. So the question is: does that feed the problem?

The reason I have a little question with the role of the humanities is when you look at people who are involved in medical humanities — and this may only be my impression — I think they tend to sort of cluster closer to the left. And more of them are the people who will take vaccines and things like that. But I don’t know that. I wish there were a larger role for medical humanities in smoothing over these political differences and polarization. I think it would be nice if there were. For example, people talk about book clubs and reading groups. I’m a big believer in them, and they’re very popular, but most of the time, book clubs are self-assorting entities, right? Go with people in your club. The people in your reading group are often people who probably feel somewhat the way you do. It would be great to have reading groups with multiple viewpoints represented, as long as their discussions don’t devolve into chaos. These days, that’s a real risk. A big problem in America is that we’re becoming more and more polarized.

The trick is to bridge that divide somehow.

A big problem is that in so many cases, there is no trust. When everyone has their own facts, it’s the end of the idea of an absolute truth. Each side has its own truth. You have your facts; I have my facts.

I guess, as a historian, we are taught gradually that truth is kind of like that, right? One thing I remember learning in university is this idea that facts can be a subjective experience for people.

That’s true. The subjective interpretation will vary and can color the way history is written. And history is written by the victors, right? But facts are facts.

Given that that’s the landscape, what would you like to see MedHum evolve into over time?

Well, It was set up originally as a Medical Humanities Resource. That is, it originally came out of the Literature, Arts and Medicine database, right? So I still like to look at it as a resource. But I’d also like it to be a place where people go for well-written and insightful writing, commenting on aspects of the interface of health, wellness, current events, and literature and the arts. I think it should exist, as the mission statement indicates, at the nexus of medicine and the wider society, and comment on the interactions there. MedHum is brand new, so you have to see how it develops. I’d like it to be a source of good writing, good insightful and perhaps incisive commentary.

I was going to ask you about what you thought about the relationship of technology in medicine. A lot of the time when people talk about humanities and the liberal arts education — like history and English majors — one thing they don’t spend a lot of time on is cutting edge technology. A lot of these studies go back to things that occurred decades ago. But medical humanities is a little bit different, because it wrestles with these things that are happening right now. There’s a certain degree of urgency. And in medicine, new things are coming out every couple of years. As soon as AI comes out, we adopt it for some medical purpose. So we’re constantly trying to push that boundary. Where do you see that going as a person with a humanities background?

One of the things about all the technology is it’s very important to ask the questions about what you’re going to do with the technology. Where it’s going to go, how we can protect things like privacy and vulnerable people. I mean, bioethics has a lot to say about technology like AI and big data and privacy. It also has a huge amount to say about other technologies, like reproductive technologies, transplantation, and the like. But I think you’re talking about two different things. The time-honored majors in university, English and history, the number of people who are electing to major in these is dropping, while the number of people majoring in the STEM fields is rising. So that’s a process that’s happening, and it’s going to continue to happen, just because that’s where things are going. I think that a role for medical humanities in that mix is that of humanizing the processes which technology facilitates and also asking important questions about technology. In terms of AI, since you brought it up, what does it mean to be human? As the machines get better and better, and given that we often use cognition as an indicator of life — ‘sentient beings” — where then is the line? When you can get psychotherapy from a chat bot what does it actually say about interpersonal interaction, what does it actually mean to interact as a human being? Where does this logically end up? No one knows. So I think thinking and writing from a humanities point of view about technology brings a new perspective to the subject. It may be the best way to contextualize our progress and at the same time create guardrails where needed. Because they will be needed.

And there’s just been so much in the news about the use of AI to write fiction. To write college essays. When a chatbot is creating, can it be said to have an imagination? To employ metaphor, or allegory, or irony? And ultimately, how will technology limit our adeptness with basic human interaction? There’s lots of dystopian fiction written about this kind of thing.

If AI continues to evolve and people start to use it as doctors, where do you see a medical encounter in the future? What does it turn into? What does it look like?

There are studies that show that AI is comparable to or better than most radiologists looking for breast lesions. And there’s lots and lots of ways that AI can help in medicine, including increasing diagnostic accuracy across a number of areas, screening potential drug candidates, personalizing treatment plans, and the like. Interestingly, there is a suggestion that the use of AI-assisted technology may lead to a subtle loss of the physician’s native ability to evaluate, what is referred to as “de-skilling.” An interesting and sobering thought. Overall, though, I think AI can be a huge help in medicine, with its potential only beginning to be appreciated. But I would hope that AI would never replace doctors, because AI can’t empathize, can’t engage in a meaningful relationship with a patient, even if it can create the words. I, for one, would always know that it was a machine interacting with me, and that would color my response.

For diagnostic purposes, it will weigh the relative possibilities, but some of that diagnostic process — especially in terms of general medicine — is intuition. There are some areas where AI is less helpful. AI can screen data and suggest diagnoses and investigations, but sometimes patients would come in, and the doctor will think “something just doesn’t smell right here. There’s something not hanging together about this” or “this is somebody who doesn’t normally complain, and now they’re complaining, and that’s different. What’s going on here now?” AI may, may evolve to be able to catch up to that too, because my understanding is that it’s just becoming better and better. But it’s certainly a useful adjunct. I know in our medical school curriculum there’s a whole session on how to engage with AI and how to use it. And I think that’s good. It’s a tool, and it’s really helpful.

One more change of gears. How did you go from the liberal arts background into medical school? Was there a transition, or was that something you always wanted to do? Or was the liberal arts a bit of a detour? How did that evolve?

I always wanted to be a doctor, but I also always knew that I wasn’t going to spend four years at a college that was very strong in liberal arts and spend it doing biology or some other concentration in the sciences. There were just too many other things that I liked. I had a bunch of AP credits coming out of high school, so I didn’t have to take many science courses — and I didn’t — but I took enough, and the rest of the time it was English, history and other humanities courses. I thought that was important before I went to medical school. And I generally think that it’s important.

Where did you get that idea as a 17 or 18-year-old?

Probably simply from the fact that I was too interested in so many things. I was fascinated by medicine, but I always read a lot, and I was much more attracted to humanities in college, knowing that I was going to go to medical school afterwards. I knew I’d be spending the rest of my professional life in medicine, so I wanted to explore non-medical areas in college.

When you went into medicine, did you think that you were leaving the humanities part behind, or did you always think the two would stay entwined?

I always thought the two would stay entwined. At one point I actually thought of doing psychiatry — as I said earlier, that always seemed to me to be the specialty most intertwined with the humanities — but I decided not to. But no, I didn’t leave the humanities behind.

One thing I’ve always appreciated about the United States is their undergraduate education is much more permissive of people pursuing other things and then going to medical school later. In other countries, like in Canada, undergraduate learning is very much more pre-defined. If you want to become a doctor, you have to do life science, and life science leads into medicine. It’s technically not written anywhere, but everyone does it this way, and I think you miss out on a lot of stuff that you could learn that might help you later, but in a more abstract way.

I think a four-year general undergraduate curriculum can certainly broaden your horizons. Medical school was four years of really hard work; College was the last time, at least for the next four years, that I could do something else in depth with the other side of my brain.

Or even if we just say those four years exist for themselves. It’s a great four years. It doesn’t matter if it affects you later, necessarily. We could die tomorrow. You enjoyed your college years. Let’s circle back. Why is medical humanities important in today’s world?

I feel like medical humanities is important because I just think it makes us broader and deeper and hopefully more empathic human beings. And that’s always a good thing, and I think patients benefit from that. I hear a lot of complaints from family and friends about medical care these days (because let’s face it, I’m at the age where my contemporaries all talk about their medical care) and often their biggest complaint is that the doctor’s visit was very short or they felt rushed. Unfortunately, a number of people are unhappy with the nature of doctor-patient interactions these days. But I don’t know that the humanities alone are going to make that better. So much of it is driven by insurance companies, reimbursements, and documentation needs — all things that are beyond our control.

Thank you very much for your time.

Web photo by Medhum.

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]]> https://medhum.org/interview/practitioner-interview/dave_hsu/meet-the-medhum-team-dr-steven-field/feed/ 0 Tell Her Everything by Mirza Waheed https://medhum.org/review/book-review/tony_miksanek/tell-her-everything-by-mirza-waheed/ https://medhum.org/review/book-review/tony_miksanek/tell-her-everything-by-mirza-waheed/#respond Mon, 20 Oct 2025 13:07:21 +0000 https://medhum.org/?p=12384 The narrator – a melancholic, retired Indian physician now living in London – rehearses his life story and its secrets that he plans on telling his adult daughter when she visits him from America. Dr. Kaiser Shah (sometimes called “Dr. K”) sent his only child, young Sara to a boarding school in America after her mother, Atiya died of cardiac arrest. Since then, father and daughter have rarely seen one another.  

For more than twenty years, Dr. K worked in a hot town in the Middle East yet never got to know or understand its people. His only friend was a troubled hospital anesthetist, Biju. Dr. K was employed by the local hospital and assigned to the Accident and Emergency department. The hospital administrator, Sir Farhad (a man Dr. K feared and revered) was an enigmatic figure of authority. Dr. K was obsessed with accumulating wealth. When Farhad offered him an opportunity to earn extra money, Dr. K had no qualms accepting the new part-time position: punishment-surgeon. He would supervise criminal sentences requiring physical mutilation that were imposed by a judge. 

Biju sarcastically told his friend, “You are at the cutting edge of your profession, Dr. K” (111). Yet there was no humor or humanity at presiding over the amputation of the hands of a father-son team of thieves or a maid convicted of stealing jewelry who underwent a similar clinical maiming. The hospital routinely accepted these “punishment cases” referred from the Corrections department and constructed a special operating theatre on the top floor for these “special ops.” Over a decade, Dr. K figured his involvement in this injurious punishment amounted to at least twenty cases.  

Raucous Biju gets accused and convicted of stealing drugs from the hospital. His penalty was removal of a hand. Dr. K pleaded on behalf of Biju with the hospital administrator but to no avail. Dr. K was not convinced of Biju’s guilt and would not participate in the amputation of his friend’s hand. Dr. K resigned his post as punishment-surgeon and eventually settled in England with plenty of money for a comfortable albeit lonely life.  

This disturbing and at times dastardly story displays more than a slight hint of Franz Kafka’s influence including the brutal application of “justice” and a byzantine bureaucracy. Even the physician-narrator’s nickname, Dr. K, appears to be a nod to Kafka.  

The novel illustrates the personal and professional downward spiral that can occur when empathy and morality are subjugated to the pursuit of wealth and status. The story raises troubling questions about the participation of doctors in the legal system’s punishment of criminals.  

The reliability of the narrator is tenuous. He may be in denial or perhaps his memory has grown fragile and corrupted. Remorse seems mostly absent. The story warns of the preponderance of lies we tell – to oneself and to others. Dr. K will not be mistaken for a model doctor or a good man. He has participated in hideous acts of cruelty, been an absent father, and placed the acquisition of money as his main priority. The opening line of the novel is a blunt confession and a succinct conclusion: “I did it for money” (3).

Tell Her Everything
Mirza Waheed
Melville House, Brooklyn, NY, 2022: 234 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database. 
Web image by Medhum.org

Book Launch at the Lahore Literary Festival: 
]]> https://medhum.org/review/book-review/tony_miksanek/tell-her-everything-by-mirza-waheed/feed/ 0 The Collected Schizophrenias by Esmé Weijun Wang  https://medhum.org/review/book-review/guy_glass/the-collected-schizophrenias-by-esme-weijun-wang/ https://medhum.org/review/book-review/guy_glass/the-collected-schizophrenias-by-esme-weijun-wang/#respond Tue, 16 Sep 2025 02:18:00 +0000 https://medhum.org/?p=11712 Esmé Weijun Wang is a novelist who has been diagnosed with Schizoaffective Disorder. The Collected Schizophrenias is a book of personal essays that was the 2016 winner of the Graywolf Press Nonfiction Prize.  

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. 

]]> https://medhum.org/review/book-review/guy_glass/the-collected-schizophrenias-by-esme-weijun-wang/feed/ 0 How To Be Depressed by George Scialabba https://medhum.org/review/book-review/guy_glass/how-to-be-depressed-by-george-scialabba/ https://medhum.org/review/book-review/guy_glass/how-to-be-depressed-by-george-scialabba/#respond Tue, 16 Sep 2025 02:18:00 +0000 https://medhum.org/?p=11698 How To Be Depressed is a book with a most unusual structure. It is introduced by an essay entitled “Intake” that was previously published in a literary magazine. The bulk of the book, “Documentia,” is taken up by an edited selection of the author’s psychiatric records from 1969 to 2016. It is rounded out by an interview with the author and by his “Tips for the Depressed.”  

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. 

]]> https://medhum.org/review/book-review/guy_glass/how-to-be-depressed-by-george-scialabba/feed/ 0 Inside The Pitt: Medicine Meets Drama https://medhum.org/multimedia/podcast/dave_hsu/inside-the-pit-medicine-meets-drama/ https://medhum.org/multimedia/podcast/dave_hsu/inside-the-pit-medicine-meets-drama/#respond Wed, 03 Sep 2025 11:20:07 +0000 https://medhum.org/?p=11517

Apollo On Call

This month on Apollo On Call, I sit down once again with our pop culture expert, Dr. Stuart Harman, to discuss our impressions at the completion of season 1 of HBO Max’s medical drama, The PITT. Some of you may remember that Stu and I did a discussion about The PITT a few months back, shortly after the show premiered. At that time, we had only watched about half of the episodes. Now, having completed the entire first season of the show, we are ready to discuss the entire season of the show, with spoilers. 

So, if you still haven’t seen The PITT and you’re the type that doesn’t like to have plot developments spoiled, stop right here, go back and watch the show before you listen. For everybody else, enjoy the show! 

READ TRANSCRIPT FROM THIS EPISODE

This is a lightly edited transcript of Apollo on Call 

00:19 

Welcome to Apollo on call, the podcast of medhumb.org 

00:23 

I’m your host. Dr, David Hsu, hope you enjoy the show. 

DAVID HSU 00:33 

All right, we are back here for Apollo on Call. I have been rejoined by the guru of pop culture, Dr Stuart Harman, the pediatric emergency medicine physician and director of the pediatrics residency training program at the University of Ottawa, and most importantly, our expert on all things The Pitt. Because we are here to have our follow up discussion about possibly the greatest medical television drama ever made, and this time, we’re gonna do it with spoilers. Stu, welcome back to Apollo. 

STUART HARMAN 01:09 

Thanks for having me back. I get invited to do a fair number of things, but I don’t always get invited back after I showed up once. 

DAVID HSU 01:17 

Well, the first episode was so fun, and we managed to make it fun, even though we didn’t spoil anything, right? So anyone who’s listening to this show, if you haven’t seen The Pitt yet, and you haven’t heard the first episode of our discussion on The Pitt, go back and listen to that one. This one is only for people who have seen the show or who have decided for some reason they don’t want to watch the show. They just want to listen to hear us talk about it. Spoiler alert. Either way, you’ve been warned. 

STUART HARMAN 01:39 

Spoiler alert. You’ve been warned. 

DAVID HSU 01:42 

All right. Now we have both finished season one of The Pitt. Where it stands is, apparently there is going to be Season Two, but we’ve finished Season One, and we’re willing to talk about every detail of the show, whatever comes up. We won’t hold back today. But the first question, the question that everyone asks, is, how realistic is the show? We dealt with this issue in the first discussion, and we came away from it saying The Pitt is very realistic. Not in the sense so much that everything is perfectly representative of a regular day in the life of an emergency room doctor, but the way they cram everything together makes it feel realistic to the audience. So even for us as physicians, watching it, the show brings out the feeling of what it would be like to be in the hospital after one of these long shifts or during these difficult cases.  

STUART HARMAN 02:39 

I think that’s what I said last time, that there are a lot of scenes where you’re saying no, objectively speaking, that doesn’t really happen, but that sure feels like what’s happening.  

DAVID HSU 02:49 

Correct. Now, having said that, I think we should talk about the same issue, because this issue comes up all the time when people talk about The Pitt is, how realistic is it? And this time, we can actually go into some of the details. What did you think the show did really well in terms of depicting that it was real? 

STUART HARMAN 03:11 

On a very superficial level, a lot of the procedures that they show them demonstrating, I’ve got to give credit to the special effects and makeup people, a lot of that stuff looked fairly real, not all of it, but some of it. 

DAVID HSU 03:26 

Right. And the actual medical sequence, you know, like a patient comes in, they have a pneumothorax, what’s the next thing to do? They really got their money’s worth with whichever medical experts they paid. Because it seemed to be very, very accurate, right? 

STUART HARMAN 03:42 

Yes, 

DAVID HSU 03:44 

And I know this, because I was watching the show with my wife, and she’d be calling out, “they need a Blakemore. Get the Blakemore”. Meanwhile, I’m sitting in the background, like, what’s a Blakemore? I don’t really know. And I’m not asking my wife, because I can’t admit to her that I don’t even know what the next thing in the sequence is. But she had trained as an internist, so she had seen a lot of these things in real life. It was really astounding to see that the show was being very, very realistic. And even the things that I did understand, like a lot of the psychosocial Family Medicine stuff, okay, this is pretty accurate. Pretty close to how we’d be handling things in real life, with a few little exceptions. 

STUART HARMAN 04:17 

Yeah, I found it fun, perhaps, when I was watching some of the pediatric cases to guess what the answer was going to be. And in none of them did I feel like, Oh, that’s a cheat. That’s not right. It’s like, oh, you know what, for what you presented beforehand, that diagnosis makes sense. Although I think I mentioned before that there are a few diagnoses that I guess were less based on the medicine, and more based on what would be an interesting case to put on a TV show.  

DAVID HSU 04:48 

Now, since you’re the pediatrics guy, I’m gonna ask you about this. There’s a big case in the show where a girl drowns, right? And I have never actually seen a small child die in the emergency room or on the wards. As a family medicine trainee, you only get so much exposure. And fortunately, these things don’t happen every day in an emergency room. But I have heard people talk about it, and my wife has also talked about it a few times. They saw some younger patients, although she didn’t work with actual children, but in her case, it would be maybe young adults, the 20 year old, 21 year old. 

Even those cases, as a physician, you just feel gutted, because these people have their whole life ahead of them. So for these things to happen, it’s such a tragedy, and The Pitt drags you through this with a young girl who drowns and drowns saving her sister because in a swimming pool accident. Now, you’ve dealt with this kind of thing in real life. How accurate was the representation of this case? 

STUART HARMAN 05:50 

I think it’s fairly accurate in terms of just the medicine side of when someone’s drowned. You hear these stories about falling through the ice, freezing, cold water, drowning, where you warm them up and actually you bring them back. And I think the easy route to take on a TV show might have been to do that. Might have been to say, Oh, she’s cold. We warm her up and she’s back to normal. But that isn’t realistic in the case of somebody who’s drowning in not really freezing water. Really that person just wasn’t getting oxygen, and so if you don’t have oxygen, eventually everything shuts down, including your heart, and then you’re gone. And if I’m not mistaken, that is the case where the child — it goes to what you call asystole, right? They completely flatline, right? I think that’s the part of the show where the parent is saying, okay, well, you can shock her now, like do the thing with the paddles. And talking to a lot of my friends who’ve watched the show, when they talk about what sets this show apart from maybe some other less researched medical dramas, or even just TV shows in general, they really liked that part. They really liked how in real life, when you have a flat line like that, you can try to treat it by giving them epinephrine medication to make the heart beat. But that flat line represents that the heart is doing nothing, and the heart is not a battery that just runs out of electricity that you can shock it, put in more electricity, and it starts back up again. The electricity is to reset the rhythm of the heart when the rhythm is not compatible with life’s rhythm. But if there’s no rhythm at all, the heart’s not beating at all, and you’re flat lined like that, you can’t shock them back. And I’ve definitely seen movies and shows where they did shock somebody from a flat line and the heart comes back, or they did chest compressions, and it went from a heart not beating to the resumption of normal heart activity. So that part was realistic. And even that extra element of having the parent sort of saying, can’t you do this is a little over dramatized in my experience. But definitely, I’ve had parents who are sort of aware of something they’ve seen on TV, and they’re wondering, well, can’t you just try this? Can’t you just try it? So I thought they captured that well. 

DAVID HSU 08:06 

Now you and I have talked about medicine on the air on Medical Dads. We’ve talked about life in private for years, but I’ve never asked you this question. How often do these cases really happen where you see a case that you’re really gutted by because you are on the front lines of this in the peds ER. How often does it happen, is my first question, and then I’ll ask you my second question after you answer this. 

STUART HARMAN 08:32 

So, I mean, drowning, specifically, in my city, we have a couple of drownings a year, and most of them don’t actually make it to the emergency department, because the person’s found, you know, significantly after the time that they’ve drowned. So they happen. They happen enough that we still have —  

DAVID HSU 08:49 

How about, not necessarily a drowning, but like a tragic, senseless death of a child. 

STUART HARMAN 08:54 

Any child that died — well, are we just talking about, how often do we see children die in the emergency department, or die somewhat unexpectedly in the emergency department? 

DAVID HSU 09:03 

I think that’s what the show is trying to hit with this. That’s the note the show is trying to hit on this case. 

STUART HARMAN 09:08 

I would say those happen, those happen several times a year. It’s not every day, it’s not every week, even. Sometimes it’s not every month. And then you’ll have a month where it happens twice. 

DAVID HSU 09:23 

This is to you, or just to the department, because you’re not there every hour. 

STUART HARMAN 09:27 

I’m talking about the department on the whole. To me, it happens enough times, but not so many times that I can’t — I was going to say not so many times that I can’t remember the cases. But actually, that’s not — that’s not exactly true. It’s happened enough times that there are ones that I wouldn’t remember unless somebody reminded me. But I would say, well, once every couple of years, I’ll personally be the person there. For a case where we don’t bring them back, non-survival in the emergency department setting. 

DAVID HSU 10:06 

So this is my second question, and I’m very curious about this, going beyond The Pitt, because The Pitt is just focusing on what’s happening in the halls of the hospital for that shift. How do you handle this as a medical doctor, when you go home after you’ve had these things happen. They’re super emotional, draining. Are you able to process it in some way? Are you compartmentalizing it and not talking about it with your family or do you bring it up at dinner? What happens to you, Dr Harmon, when you go home after a case like this? 

STUART HARMAN 10:43 

I don’t think they addressed this on the show The Pitt, but there is this element of you see some of these terrible things, and it’s not always a death, right? Sometimes you see some things related to child abuse or just catastrophic injuries, where the person survives, but you know that their outcome afterwards, it’s not gonna be great. I’m a pediatric emergency doctor, so it’s all children. So there is definitely this real life aspect of not really being able to go home and just talk about that with your spouse. Just unload all that stuff all the time. Because, my wife, she definitely signed up for better or for worse. You know, sickness, health, richness, poorness, all that, but not specifically to be my therapist, where I can come and put so much stuff on her that now she is going to have her own trauma, right? So that people ask my wife, how do you deal with having to deal with hearing about all the horrible things? 

DAVID HSU 11:45 

Well, she’s also, she’s not a physician, right? So she would be, she’d be facing it with a different perspective. She’s a teacher, so it would give her a different perspective. And it might be, it’s not good or bad. It’s just, it would be different. 

STUART HARMAN 11:58 

That’s a good point. People listening to this podcast, as opposed to the one you and I usually do together, don’t know that my wife is a teacher. And you know, people choose their careers based on the type of things that they like to do, expect to do, what they handle well, what they don’t handle well. So you wouldn’t expect people who don’t go into medicine to necessarily be well equipped to hear about that type of death, those types of tragedies, all the time. So there is this element of when I go home, I can talk a bit to my wife, but I consciously try not to overdo it. So how else do we deal with it? How else does a physician — how else do I process these things? 

DAVID HSU 12:45 

I mean, you strike me as being a very jovial guy in general. I’m sure most of their regular listeners to medical dads would agree. And even the people who are going to hear us on Apollo on Call will agree. You’re pretty jovial. It’s hard to imagine you simmering or stewing, for lack of a better word about a case that happens, but I’m sure that this job is difficult, right, and your job in many ways is more intense than my job. As a family doctor, things do happen. A lot of times they’re not happening directly under my supervision. And even then, I’m sometimes just like — feels like a huge thing has hit me on the head, and I need a week or two to slowly, pace my way through it. But the stuff you’re seeing and the stuff The Pitt people are seeing is a whole different level. That’s why I’m curious. 

STUART HARMAN 13:33 

You know what I think, what aspect of this is for a lot of people, when something, when a tragedy, just happens, simply being aware of it or witnessing it doesn’t necessarily affect you in an unshakable way, compared to if you feel that there’s some element of that that’s your fault, right? Some element of that, well, it’s your responsibility, and you could have done more. So it’s not every time I have a bad case that I have a long process that I have to go through to get through it and move on. But from time to time, there are going to be those cases where there is some sense of what could have been done differently. What more could I have done that day? Or if only this thing had happened or lined up just right? Those can sort of rob you of sleep a little bit. Plus, there’s a whole other element that you’re accountable for some of these things, right? So you never know if somebody is going to launch a complaint or a lawsuit or something along those lines. And I think actually for a lot of physicians, that sometimes robs them of more sleep than the actual case itself. Sometimes even a case that went well and you did everything right can rob you of a lot of sleep if other people don’t think you did it right. But so, yeah, that’s a little bit of a peek behind the curtain for old Dr Harmon here. Sometimes there are some of those that you have a sense of responsibility about it, that affects you a bit. But I do feel like I have a fairly good outlook on all of that. You know, I think I’ve come to grips with the limitations of being a human being and just the fact that, for me, if I often look at it, okay, some terrible thing happened, somebody was in a car accident, or someone had something really horrible happened to them, and if I wasn’t there, that thing would have happened anyway. So me being there, I’m exposed, I’m aware of something, but it’s not like being aware changed anything. And at least I could try to help in some kind of a way. I think that that outlook has helped me manage quite a bit of this. 

DAVID HSU 15:59 

Not a bad way to think your way through it. I think I hear what you’re saying. A lot of times these bad things happen. And sure, sometimes it’s like, you know, as a physician, we made a mistake. And so you’re kind of thinking, okay, could I have done better? A lot of times there’s nothing obviously that you did wrong, but it’s just, could I have done things a little bit differently? Maybe we could have achieved an even better outcome than whatever outcome we had, right? And so that kind of thing, it’s hard to let that go as human beings, if we care at all about our patients, right? And a lot of times these things are out of our control, but we kind of wish that it was still within our control. And you do see elements of this playing out on the show, right? Like the older doctor, Dr Robby, he’s seen all this stuff before. So for him, he’s seen good and the bad, and he has to balance it. And these younger people who are coming through and training and seeing things for the first time, they’re getting caught up in stuff like, oh, I had a patient die, right? Like, this happens to Whitaker a lot on the show at the beginning, it’s almost like a comedy at the beginning, right? Everything he touches goes bad for a while. He’s like, maybe I’m just not cut out for this kind of thing. But you realize that’s also part of being a doctor, right? That you have to learn that you can’t save everybody. A lot of it’s out of your control. You do your best, and then you move on to the next one, because the system needs you to keep functioning. 

STUART HARMAN 17:19 

 In the show, I noticed that they did try to do some debriefs. You saw that with some of the cases where they get everybody together and try to do what we call a debrief. We do that. We do that at my hospital, if somebody dies, certainly. 

DAVID HSU 17:32 

And you have, like, a moment of silence and stuff. I’ve never actually seen that in real life. 

STUART HARMAN 17:36 

The moment of silence, I would say that is not routine. We don’t always do a moment of silence, but what we do is something where we get everybody who is involved in the case together after the case is over, you give people five to ten minutes to go and sort of clear their head, try to get everybody back together, not in the same room where the case happened, where everybody’s looking at it, but in a different room. And you go through this debrief, where you try to find out from people, first of all, does everybody understand what happened? You go through the medicine of the case, describe what happened. Then you give people an opportunity to ask questions, or to say, well, how come we didn’t do this? Or should we have done that? And then you get a chance to talk through that. And then there’s an emotional part to it too, where you just like, give people a chance to express what they’re feeling and acknowledge that and talk through that. And like what you were saying, after you’ve been around for a while, you see certain things. It’s very different than when you first start out. So often with these debriefs for children who’ve died by time they’ve got to the emergency department or in the emergency department, I’ll start off by setting that stage for everybody, since some of the people in the room this is the first time they’ve lost a patient, and explaining that on TV, or what we are often led to expect is that when someone needs to be resuscitated where their heart stops, or something like that, that 80% of the time, if we do everything right, we’re going to bring them back. Whereas that, that’s not the expectation of the statistics, right? For some of these cases, they’re coming in with less than a 30% expectation, 30% chance, that you could actually bring them back from that, sometimes less, right? Sometimes the patients come in and they’re gone. And so I’m often explaining that to the group, that there was no real, real hope. It would have been a bit of a miracle. And sometimes we do pull off miracles, but just so that they understand that. 

DAVID HSU 19:26 

So you’re telling me that when you do the debrief, you actually reference television. 

STUART HARMAN 19:31 

No, no, I won’t say, I won’t say, oh, you know, if you’ve been watching a lot of television, you think we’d bring this back. But I’ll say it more along the lines of, what we have to keep in mind here is that although it can feel like or people may come into this with the expectation that we’re going be able to reverse this, most of the time, that’s not what it is for this case, this patient actually came in asystole. 

DAVID HSU 19:53 

This was actually a known thing on the original ER. When ER came out, people would watch the show and track how often they got out the paddles and charged it, and people survived, right? And, wow, 80% of the people on the show survive, right, and it would create this false expectation for patients. You’re just like, oh, beep, okay, get out the paddles. We can bring them back, right? And, and it makes for great television drama, but it’s not realistic, right? I think in this show we have a bit more of a realistic view of it. A lot of the patients are dying, and it’s gut wrenching to watch, but I think they did a pretty good job of balancing that. The doctors on this show are — they’re heroic, right? And we can talk a bit about this, but they’re tempered by the reality of their limitations as physicians. 

STUART HARMAN 20:43 

One thing that I worry about what this show might do that’s going to create a false impression. There were so many times over the course of this one season where one character is doing some kind of medical procedure and other characters are telling them, Don’t. Stop. That’s dangerous. You’re going to kill the patient. And the person will be saying something along the lines of, this is unconventional, I read a case report once. They’re treating it like it’s fine to do these Maverick moves, right? And it always works out, even if it’s the Junior trainee trying something that’s way out there. It never fails, and that, I think in real life, that’s not how that goes. Not to say that people can’t do — I do feel a little bit like the emergency department in particular could — that type of work in the field of medicine can potentially attract a certain type of personality, right? Because people have different ways of how they react under stress. I don’t just mean when you’re stressed, but when you have something critical happen. There are people who, their natural instinct is to sort of slow down, stop, go inward and think through things, which sometimes is the right approach, but sometimes you miss the opportunity to make a quick decision that you should be doing. But then there are the other people who are faced with any kind of pressure situation, their thing is to act, and they don’t necessarily slow down to think. That’s their instinct, is to act. And they have to fight that instinct to slow down and think. And if I was going to generalize the stereotype, I would say for some the quick acting is what can be attract them to emergency medicine, and I would hate for people to watch this show and get the impression that, like, yes, that’s the way I should behave when I get into medicine. And there’s going to be lots of opportunities for me to do that and be rewarded for it. 

DAVID HSU 22:32 

Right. This is something that the show is spinning a little bit, and because they’re making the pace of the show so fast that you have to be problem solving that way. And emergency medicine is faster than most other forms of medicine that are practiced. But this is a really, really extreme way of portraying it. 

STUART HARMAN 22:49 

Yeah, and it would be more collaborative in my hospital, at least. Even if you do need to do this crazy procedure that’s a Hail Mary toss, it wouldn’t be with your supervisor or with somebody from some other service, because apparently the surgeons in this show like to come down to the emergency department and tell you what not to do. But it wouldn’t be with some other service on the sidelines saying, don’t do that. I’m going to bring that patient to the operating room instead but you do it anyway. And then they say, oh —  

DAVID HSU 23:15 

All’s well that ends well, that’s repeatedly on the show. 

STUART HARMAN 23:20 

That’s the theme of the show, all’s well that ends well. 

DAVID HSU 23:23 

Now, here’s a case that a lot of people have talked about and written about. It’s the case of the Advanced Directives. There’s an old man right in the middle part of the season. He gets brought in. He’s having difficulty breathing. He’s already got pretty advanced dementia. There’s a son and a daughter. They’re arguing about what they should do, because dad has already said he doesn’t want to be hooked up to a ventilator. He doesn’t want any heroic measures taken. And then the son says he’s in agreement with dad’s plans. The daughter says, we want to keep him alive. I haven’t spent enough time with dad yet, right? And they’re having an argument about this, this specific case, did you feel this was realistic or not from what you’ve seen? 

STUART HARMAN 24:10 

I was going to ask you the question, because in pediatrics, these advanced directives are something that are made with the parents. I’ve had cases where we didn’t have an Advanced Directive, and the parents had to make the children — adult children of grown up parents — had to make a decision. So I remember distinctly one of these cases when I was in medical school, we’re really not sure. So are we starting chest compressions and resuscitation, or are we not? And the family, we were waiting for the family to make that decision. And in pediatrics, we’ve had cases certainly where the parents were not in the head space, where anybody was able to get them to agree to an Advanced Directive, and so we’ve had to make this decision on the spot. But I was going to ask you, is that actually legal in Canada that you could be an elderly person who has written an Advanced Directive stating what your wishes are, and that goes out the window? 

DAVID HSU 25:06 

To the best of my knowledge, what happens in real life is not so cut and dry. So just because you have an Advanced Directive and you’ve indicated what your wishes are, when you actually get into the hospital in that moment, my experience of it is, the family can still go against the advanced directives. There was a case that was a family that I knew pretty well. I had looked after the elderly parents, both of them for many years, and unfortunately, it was a very strange case, because the lady had developed Creutzfeldt–Jakob dementia, like mad cow disease, which is a really, really severe form of dementia. Actually, backtrack. The lady had just developed really, really severe dementia over a couple years, and she got admitted to hospital with some other sort of, like must have been a broken leg or something, and there was this whole dilemma about, should they do any measures to prolong this lady’s life? Her quality of life was already very, very, very poor. It was very severe dementia. The children, the children that were living in Canada, were all on board with, you know, no heroic measures. Do Not Resuscitate, right? And then suddenly there was another child who wasn’t even in Canada. It was a long-lost son or someone from China, calls long distance to the hospital and says absolutely not. We must do everything for mom and dad, right? And in this case, the family had already agreed there was a plan, and I think the husband was on board with the plan, and he would have been the substantive decision maker. The children were in agreement with the plan, but they couldn’t get 100% consensus, right? There was this other voice, and as soon as the hospital heard that there’s this other voice, they’re like, whoa, we’re gonna back off. We can’t execute this because there could be legal ramifications later. So it was almost to the point of whether legally that written document or the substantive decision maker document held water or not, didn’t matter anymore. It was we need to get everyone on board. And I’m not even sure that’s the right thing to do, but that was actually what ended up happening in real life. So they ended up prolonging this lady’s life for x more months/years and it was very interesting to me to watch this happen. A lot of times, we’ve seen these things happening in real time. You and I can debrief about the show in detail and break down, what’s the law, what’s the ethics? Right? We can teach a whole course on it, ask all our students to write an essay about what they saw. But in real life, you have five minutes, right? The person’s about to code, do we do this or not? And you get this phone call from China, and it’s like, okay, everyone, we can’t decide now, right? We’re in a log jam. 

STUART HARMAN 27:57 

 I had looked it up at one point after that show, because I was so curious as to what the law is in Canada. It seems it’s not exactly the same in every province. So province to province, there’s differences, but the general consensus seems to be that if you have an advanced directive that’s written at the time, when you, as the person writing it, are competent, then that’s legally binding, and other people can’t overturn that unless they are petitioning to say that you weren’t in your right mind when you wrote it, or that you’re you know, they would otherwise say it’s invalid. But that situation of two adult children coming in and saying, oh, we’re not following dad’s advance, I don’t, I don’t think that that’s the way that’s supposed to work here. 

DAVID HSU 28:35 

Right. But in real life, I think what’s happening is the doctors want the family to feel like they’re getting heard, right? So they’re giving the daughter the option, which I guess is what’s happening in my patient’s case, right? They’re allowing this child who isn’t even present to be heard and let them sort it out as a family. Because otherwise, if we just let, you know, the brother decide, and then the sister doesn’t get any say in it, this is going to become a huge issue for them afterwards. So it’s almost better to let them work work through this thing as a family, which is the approach of the show. I think that probably is the best option, honestly. We’ve gotten into discussions about things like advance directives, and it gets really complicated. It’s an Advance Directive. It was written. It was scribbled on a piece of paper, right, and the date is wrong. Is it still valid? Like, these issues appear all the time, right? If you look up, what do you need to indicate your will? All you need is a piece of paper that you wrote down what you want done, and you sign it right? And that can be a will. But will it hold up in court? Will it hold up after you die, when people examine it under a microscope? No one really knows, right? So it’s very, very complicated. 

STUART HARMAN 29:47 

But if anything good came out of that episode of the show, or if something good could come out of people listening to the podcast and listeners talk about it, hopefully it would be that someone listening or someone watching would be motivated to say, okay, let’s actually set up advanced directives for our family members and talk about it now, instead of at the time, this analogy that’s often made of, you know, if you’re on an airplane and the plane is crashing, that’s not the best time to be going over instructions for what you’re going to do with an oxygen mask, and that is tough, right? Better to do that before it happens, when everything is safe and when everyone’s thinking clearly 

DAVID HSU 30:26 

Except before it happens, you don’t really know what it would actually feel like to be in that situation, right? Today, if you ask me about advanced directives, I have a certain opinion about it, but when I’m actually facing life and death, right? I might have a slightly different answer at that point. 

STUART HARMAN 30:45 

I think what Dr Hsu is saying is that, before the plane takes off, put the child’s oxygen mask on, after you put your oxygen mask on. I agree with that concept, but when that plane is crashing, in that moment, he might change his mind to be like, You know what? Both oxygen masks. I want them all. 

DAVID HSU 31:01 

Save yourself. Man, physician, you cannot heal other people if you cannot heal thyself first. Now, here’s the question about that case, though, so the brother and the sister have this long, emotional conversation guided by the doctors, where they eventually explain why it is that the sister isn’t ready to let Dad go, and it’s because she didn’t have a great relationship with dad, and they have this long, teary, emotional conversation, and this type of conversation I’ve had with my patients in the family doctor office, because these patients, because I know these people so well. I’ve known them for years. So then when something happens to their family, they come in and it’s also not happening at the moment. So then they come in later, and then we have a talk, and it’s kind of like a debrief and they can explain why their marriage is struggling, or why their relationship with their son isn’t what it should be, and so forth. And that’s the coolest part of family medicine for me, but I’m wondering, because as I was watching the show, I don’t know, I’ve never been in your shoes, or not much, right, in an emergency room setting, and I feel like there, this is a bit forced. If I was in the emergency room, I don’t think I’d blab out all this stuff to the doctor who I just met, right? I’d probably be more inclined to go back and talk about it with my GP or my buddies, right? But with this in the emergency room, in the moment of, just like unloading all the stuff about my childhood, Is that realistic? 

STUART HARMAN 32:35 

That’s exaggerated, but not completely unrealistic. 

DAVID HSU 32:37 

Okay, so it does happen. 

STUART HARMAN 32:39 

Yeah, you’d be surprised in the emergency department, how often we find ourselves using up a fair amount of time on some of these things that are more probably appropriately addressed elsewhere. But this is just where they’re coming up. So this is where we’re going to talk about it, where sometimes you’re trying to get somebody on board with what to do, or what the next step is to take, and you find yourself spending a lot of time doing that, and some physicians are more willing to do that than others, and some physicians are more naturally inclined to that than others. I think in peds emerge people are maybe more inclined to do that just by nature of being drawn to working with families and children in that way, but it does touch on this character of Slow Mo that they have on the show. 

DAVID HSU 33:24 

Right. So this character is the trainee who spends too much time with her patients, so everything is getting backlogged because she’s not seeing patients quickly enough. 

STUART HARMAN 33:37 

There definitely are trainees and sometimes even staff physicians who can be a bit like that. And the show makes it seem very noble that they all are the same. Well, I guess the show isn’t saying that they’re all the same, but this show presents a very noble version of that, where it’s just because I care so much about these patients and giving them the positive experience that I get drawn into doing these things. But it is true that by the time you’re now having just chit chat and conversation with the families, that actually is becoming a bit of a detriment to the other patients in the department that you need to be spending time with. But I feel there are also sometimes situations where people are spending too much time with the patient, maybe because they enjoy that part more than they enjoy going to see the next patient whose problem might be more challenging, or sometimes the easiest part is the part that’s just building rapport. And actually, I’ve certainly met patients who it doesn’t matter how much rapport you build with them, if you can’t also nail the medicine part, then none of that rapport is going to mean a thing. 

DAVID HSU 34:48 

Well, ideally you should do both. But that gets into this whole art of medicine. I thought it was interesting that the show actually addressed this, right? That the doctors can work at different speeds and the different speeds do affect how the system runs on a whole. It also affects the quality of the medical care, right? So there are patients who are getting brushed by, right, like they’re coming in with issues, and the doctors don’t even have time to deal with it, that if they spent a little more time, they might unearth something. And so we see both sides of this on the show. It’s quite interesting, because it gets into the whole business of medicine being a human-being endeavor, and that means it comes with a lot of variability, right? You have the slow doctor, the thoughtful doctor, you have the fast-thinking doctor, you have the doctor who’s not so good with patients. And there’s always two people in the room, right? It’s not just the Doctor, the patient is also part of this interaction and affecting it. So I liked how the show presented this issue to us. 

STUART HARMAN 35:46 

I also liked that the show didn’t give us an answer or didn’t tell us what’s right and what’s wrong. They had that character slow mo, and they did show that actually sometimes that being slow is causing an issue, and the element of the staff physician actually trying to teach that you can’t just be slow because you’re not confident enough to make a final decision, or that you’re always afraid you’re going to miss something, because that is not a good type of slow to be, that you’re doing unnecessary tests, spending unnecessary time because you’re afraid of what you’re going to miss. But then, on the flip side, they also had it where that character realizes the patient has mercury poisoning because she took the extra time to connect with the patient and to look into it. 

DAVID HSU 36:27 

There is also a scene, if you remember, Collins comes up to her and is like you’re doing a good job, so don’t listen to all the doubters, and you keep on doing you, which I think is a really good message too. There’s no right answer the way that the show presents it, which I thought was quite true. That really is the thing. I feel like I’ve experienced this as a teacher in family medicine, where sometimes these students come through and they’re a little bit slower, and it’s like, wow, a lot of the people in the department are really piling on this person. They feel like they should be faster, and they’re missing the point that actually this person is really honest, and they’re very good with the patients, and maybe the level of expectation for what we have for each individual person doesn’t need to be exactly the same. It certainly isn’t, when they’re actually working. 

STUART HARMAN 37:14 

I feel though the reality of what should be done is quite nuanced, or is in between this, because definitely you’ll have trainees who can be slow enough. People just keep telling them, you do you. And if people sell the narrative that this is actually the best possible care, right? Because that patient is going to be so satisfied the more time you spend with them, you could spend an entire shift with one family, right? That could definitely happen. So — 

DAVID HSU 37:41 

That would not be good medicine. Basically, is what you’re saying. 

STUART HARMAN 37:43 

That would not be good medicine. But then you also do reach a certain point where you do actually have to say, I gotta do me. I gotta be comfortable with what my approach is. And there are some doctors who I’ve known, who’ve been great doctors, who get great patient feedback, who do spend more time — are a bit slower, but I wouldn’t tell them to change. I don’t think I could make them change, and I don’t think they would be better by trying to be faster. 

DAVID HSU 38:13 

I mean, it gets into this question where, what do you think is a good doctor for you. If you were the patient and you walked into the Pitt because you had some injury, which doctor would you want to treat you? And everyone might have a different answer. So maybe you tell me which out of all those people, who would you want to treat you? 

STUART HARMAN 38:38 

Honestly, what you want is the doctor who is the best at getting the diagnosis. 

DAVID HSU 38:41 

You think so? 

STUART HARMAN 38:42 

Yeah. I mean, I think pretty much universally, if the person at the end of the day gave you the right answer and treated you and you got better, then that’s the doctor you would want, even if their bedside manner was slop, even if they were terrible. 

DAVID HSU 39:03 

I don’t think that’s true.  

STUART HARMAN 39:06 

I think it’s true if you actually do get better.  

DAVID HSU 39:10 

That’s only if you think of medicine as a purely zero sum or a binary thing, where there’s a right answer and a wrong answer, right? Which it’s not. It’s a human being thing. 

STUART HARMAN 39:19 

Well, I mean, everybody wants it all, right? Everybody wants the doctor that’s got great bedside manner and the right diagnosis. But if we posed it as a question of you can get a doctor who’s super nice to you, but you don’t get the right diagnosis, would you rather have that or a doctor who’s terrible bedside manner, but definitely you’ll get better? 

DAVID HSU 39:37 

Okay, but let’s talk about The Pitt, all right? You’re not allowed to pick Dr Robby, because I think we would all pick Dr Robby. He seems to have it all at the beginning of the shift, but clearly he’s a flawed character as the shift goes on. But okay, maybe you can include Dr Robby out of all these people you walk into the emergency room during that 15 hour shift, which of the doctors would you be glad to see the most? 

STUART HARMAN 39:58 

Yeah? You know that doctor, Dr Robby, he does have that kind of thing where all his flaws are the things that are self-destructive. He burns himself up for the job. So most patients would definitely like the doctor who’s got all these great qualities and yeah, but at the end of the day, the doctor himself is — 

DAVID HSU 40:15 

All right. I feel like you and I could talk about The Pitt endlessly, yeah, but we must. move forward a little bit here. 

STUART HARMAN 40:22 

We should just have a whole other podcast series on the show. We’ll call it the Bottomless Pitt, where we come up with endless things to say about this show. 

DAVID HSU 40:30 

Now, just thinking broadly from a medical humanities standpoint, because this is Apollo on Call. What do you think about the show overall? Like a meta thing in terms of medical humanities? 

STUART HARMAN 40:43 

I think the show is actually not a bad thing for physicians and even for non-physicians to watch and take home talking points from some of the various scenarios that they put in the show. The scenario of sickle cell disease patients, the scenario of the end-of-life discussions, even the scenario where it’s just a throwaway thing, I kind of wondered why they put it in there, because they didn’t follow up on the plot thread. But there’s a character who misses a urinary tract infection and a patient who comes back, and another character who makes a suggestion, are you sure it’s not because she’s obese that you just biased against obese people, that you fat shamed her and so somehow missed the diagnosis. And the character who otherwise seems very understanding of people, is sort of saying, oh, I don’t think so, but I will reflect on that. I thought it was weird in the show, but for people watching from a medical humanities point of view, it’s a good talking point, a good starting point. Hey, do we think that we have unconscious bias against the obese that maybe affects the way we treat them medically. 

DAVID HSU 41:46 

I thought overall, that the show does a really good job of championing medicine and portraying doctors as heroes, and I don’t think we get enough of that anymore in a way that really hits home. Maybe I’m just jaded from working as a physician. I feel like in this day and age, and I’m talking about doctors themselves — this show doesn’t talk about this — but I think maybe we should talk about it a bit. There’s a lot of this talk in medicine about how doctors are not paid enough. There’s not enough money in medicine. There isn’t a single character in this show that is portrayed as being in it for the money. But you and I went to med school, we did our training. There are many people around us that are in it for the money. Right? That character is missing on the show, and I think they deliberately omitted it, yeah, because they want us to see the heroism part of being a doctor again, which I think is actually a cool thing, because we don’t hear this enough anymore. 

STUART HARMAN 42:51 

It’s true. I mean, I will reflect that this show is taking place in an American hospital. So maybe nobody’s saying anything about money, because they’re being paid so much more than we are here in Canada. 

DAVID HSU 43:01 

Well, they’re all residents and trainees. So they actually are not. One of the students, Whitaker, has nowhere to live. He’s slumming it in an empty ward in the hospital. 

STUART HARMAN 43:12 

That’s true. All the all the doctors and residents complaining about their salary on this show are all hiding out together with all the other sub specialists and specialists that should be showing up to the ER to see patients apparently don’t on the show, since the only characters we see outside of the emergency are surgeons and the odd other person that wanders through when, in real life, there are other people in hospital coming to the emergency departments besides the emergency docs. 

DAVID HSU 43:36 

Right. So it does seem like we’re painting a picture of people who ultimately, for better or worse, no matter what personality type they have, they are in the job because it is their calling. And that’s not completely accurate in real life, but it does reflect well. I think people need to see this. And I think you talked about this in the first episode we did. This is not a bad show to watch for doctors to remind you of why you got into medicine. You know, because we lose sight of that during the day-to-day grind of a long career. For sure, we lose that.  

STUART HARMAN 44:09 

Yeah, this wasn’t lost on me either watching the show. I reflect on how lots of physicians I’ve talked to about the show have told me that they didn’t make it through the first couple episodes, that they just saw it and it’s too overwhelming, or it’s just too intense. And the show does have a bit of a weird intensity, where at the beginning, people are having scalpels dropped in their foot. I kept expecting some main character to have some weird death in the show, but that said, I watched the show to completion because you told me to, because we were going to talk about this podcast. So I knew from the beginning, I’m pushing through. And one thing I thought the show had some serious value in that the characters don’t quit, right? They’re going through all this crazy stuff, and they have this thing of I’m doing this. And I felt a bit inspired by that, or at least I felt a little bit like, yeah, like in every other area of my life that I’m trying to use television to emulate what I should be, this too. I should try to be more like Dr Robby. 

DAVID HSU 45:09 

I definitely got that feeling. Like at the end of the season, I was like, Screw it. We should just all go back and do our jobs. I got to stop podcasting all the time and get back to the core thing that I do, right? And then I went back to work, and I was like, yeah, I could kind of see why I need to do more podcasts. Now. Season Two of The Pitt is coming. It is going to be a real thing, right? And I’m not sure how they’re going to structure it. What does Apollo on Call want to see out of Season Two of The Pitt, if we had any say in it at all? 

STUART HARMAN 45:43 

I think I said on the previous podcast my spiel about how I thought it actually exists perfectly as a singular entity, but aside from the fact that maybe there shouldn’t be a Season Two at all, what do I want to see? Well, there’s a few plot threads that we’re all dying to see how it plays out, right? So what does happen with this doctor who’s using drugs because the show — that aspect is a bit unrealistic — like the way the staff person just exploded on him, the actual medical system treats those doctors as patients. A doctor with a drug addiction is treated as a person with an illness, and the medical system is actually quite supportive of those doctors and helps them to get recovery if they’re willing to admit they have a problem. So now that he’s been forced into that situation, will we see him come back? Will he be allowed to work in an emergency department, or will he come back as a family doctor with a thriving practice, but who’s not allowed to have access to drugs. 

DAVID HSU 46:44 

Will Dr Robby even call him out for it officially, it seemed kind of ambiguous, right? Because he took Langdon’s pills, it looked like he was about to flush them down the toilet. So maybe he wasn’t going to mention the thing to anyone. He deliberately didn’t tell any other people about what was actually going on. So it’s possible that he even buries this issue and allows his prodigy student to continue. But I’m not sure where they’re going to go with it. There’s a lot of ways this thing could play out. 

STUART HARMAN 47:11 

Especially because they have that other character who knows, I forget what her name is, Santos. So Santos knows, and I don’t think her character would let it drop if they had Season Two, so maybe there’d be that. Also, we need to find out what happens with Gloria, the charge nurse. After getting punched in the face and her saying that she’s not coming back, they really kind of left it a little bit like Robby thinks she’s coming back. 

DAVID HSU 47:40 

In real life, that character definitely comes back. In real life, that’s just a bad day. She might need a month off. You know she’ll be back. This job is in her blood and also, the actress that gives that performance, this character is actually one of the best characters on the show. There’s no way she’s not coming back. 

STUART HARMAN 47:58 

Maybe that character doesn’t need the paycheck, but that actress definitely needs the paycheck and won’t walk away from that money. 

DAVID HSU 48:05 

Now, if you were doing this Season Two, and one thing about Season One is they did this whole one hour, is a one hour of real time — 

STUART HARMAN 48:15 

 which I think only partly worked. After a while, they were a bit constrained by that gimmick 

DAVID HSU 48:22 

Right. Now, most likely they would continue that gimmick. I don’t see them changing that because it’s such an important part of the show’s description, right? So how do they top this? Like, how do they do a Season Two? The reason a regular eight hour shift, or a 12 hour shift stretches in the 15 hours is right at the 12 hour mark, this mass casualty event happens. So are we going to jump forward a year in Pittsburgh when another crazy mass casualty event happens? What plot line could they possibly put into this thing for next season? 

STUART HARMAN 48:58 

I would imagine it’s just a regular 12 hour shift, and then they extend it with three hours of them doing the paperwork that piles up so you have a 12 hour shift. 

DAVID HSU 49:06 

This is why you’re not writing television, right? You would want to go for uber realism, like we want the medicine to be totally true to life. 

STUART HARMAN 49:17 

Well, I mean, you haven’t read my exciting fan fiction that I wrote about that other doctor coming to grips with her bias against fat people. 

DAVID HSU 49:26 

Hour 15, Dr Harmon goes home, but is unable to talk to his family about all the crazy things he sees, and just goes and takes a nap. In this show, we don’t really see that. We see these people — they are soldiers, right? Literally, right? The mass casualty event happens, and these people are drawing their own blood and pouring it back into the patients. 

STUART HARMAN 49:47 

Never done that, I’ll tell people. I’ve never done that. 

DAVID HSU 49:51 

So this show tells us that people are thinking of medicine as their whole life. This is a calling beyond the calling, which, on the one hand, earlier, I said it’s kind of nice that we get this heroic portrayal. On the other hand, it’s kind of unrealistic, and maybe we need a bit of a reality check also. 

STUART HARMAN 50:08 

Yeah, that’s an insightful answer. Too bad listeners will never be able to hear it, because we’re going to have to edit that in such a way that none of your patients think they’re going to lose their family doctor in the next 10 years. 

DAVID HSU 50:17 

I don’t know. If I was in charge of Season Two, I feel they don’t necessarily need a mass casualty event, but I actually wanted to see more of some of the night shift doctors, so I thought maybe they could start the season with a little bit of an overlap the first couple hours with the doctors from the night shift, like the Asian doctor, because I definitely felt like I could have used a little bit more Asian representation on the show, and that guy that was sipping on the cappuccinos, he was the man. 

STUART HARMAN 50:43 

What about Santos? I thought she was the Asian represented by that show. 

DAVID HSU 50:47 

Well, that’s true. Santos is also there, but her character is a bit of a train wreck. So you were saying, like, which doctor would you want as your physician?  

STUART HARMAN 50:55 

Not her. 

DAVID HSU 50:57 

Definitely not her. But I could imagine season eight of The Pitt, by then, she’s going to be an attending, and this whole place is going to fall apart. 

STUART HARMAN 51:04 

Actually, you know maybe the doctor I would want is Dr Abbott. He seemed to have his act together. You know, when he’s not at the edge of the roof. 

DAVID HSU 51:12 

He’s a nut job. Also, he knows his medicine the most. So I guess that makes sense, because that’s what you’re looking for. But this guy, if you recall, he had threatened to jump off the building at the beginning of season one, right? The show opens with him about to jump off the building. 12 hours later, he comes in. I heard about the mass casualty event on the police scanner. Like, he goes home, he’s listening on his shortwave radio for the next time he’s going to get called in. Like, yeah, this is definitely the guy you want as a doctor. 

STUART HARMAN 51:44 

As long as he could treat me before his shift is over. Then, all right. 

DAVID HSU 51:49 

All right. Well, at the very least, we both really enjoyed watching The Pitt, but moreover, we really enjoyed talking about The Pitt, which is why we have these two very long episodes about this show. We hope that our audience has caught some of our love for the show, our passion for The Pitt. And you have plenty of time. You’ve got maybe half a year to catch up on this thing, and then Dr Harmon and I will see you when it’s time to roll out The Pitt Season Two discussion on Apollo on Call. 

STUART HARMAN 52:22 

Do you have some kind of way for people to discuss back their insights or things that they’ve learned from listening to the podcast or watching the show?  

DAVID HSU 52:29 

Yeah, you can put comments on MedHum, feel free. You can send us little notes about our discussion if you want. 

STUART HARMAN 52:43 

I’d love to hear what people thought of our take on the show and what their take on the show was. 

DAVID HSU 52:49 

Until then, until the next time we discover some medical humanities, pop culture thing that we need, Dr Harmon, we will bid adios. 

STUART HARMAN 52:59 

See you in Season Two, folks. 


Web image by John Johnson from HBO Pressroom

]]> https://medhum.org/multimedia/podcast/dave_hsu/inside-the-pit-medicine-meets-drama/feed/ 0 Miracle Mile, a Play by Clark Middleton https://medhum.org/multimedia/video/felice_aull/miracle-mile-by-clark-middleton/ https://medhum.org/multimedia/video/felice_aull/miracle-mile-by-clark-middleton/#respond Tue, 17 Jun 2025 13:20:57 +0000 https://medhum.org/?p=10754

Actor Clark Middleton wrote this autobiographical dramatic monologue in collaboration with Robert Knopf. Stricken with juvenile rheumatoid arthritis at age four, Middleton enacts his early painful experience — painful physically and emotionally. He takes us through an adolescence complicated by physical difference, his interaction with medical professionals over the years, and his craving to become an actor. Middleton struggles with the medical establishment, the pain and humor of coming-of-age, and ultimate self acceptance. Eventually, he was able to have both hip replacement surgery and a career in theater and film. The play is funny, poignant, and instructive.

Miracle Mile was performed in New York City in Fall, 1997 at Theater Row. The New York Times review called the play, “an enriching chronicle of a man who refuses to let the world take him at face value.” Middleton performed his monologue at New York University School of Medicine and at other institutions. Clips of a videotape of the theater performance are available at this web site.

Archive Videos from the Play
Juvenile Rheumatoid Arthritis
Move through the pain!
Tucson! Tucson!
My right hip slipped out of its socket…
That’s really being alive
The pain just won’t go away…
When you’re down on your knees…
…no one with hips that bad!
A conference exam is like an audition.
I am standing … alone!

Actor Information
Clark Middleton (actor/author) performed MIRACLE MILE Off-Broadway in the fall of 1997. He has appeared in Sam Shephard’s CURSE OF THE STARVING CLASS as well as Mr. Shephard’s CHICAGO at the Signature Theatre Company. Clark was in William Hoffman’s AFTER THE ORCHARD and performed MIRACLE MILE at the Invaluable Cape Cod Theater Project. He began his professional career performing with the late Geraldine Page in productions of THE MADWOMAN OF CHAILLOT, PARADISE LOST, and VIVAT VIVAT REGINA. Since that time he has appeared in more than 40 NYC productions, most notably at the New York Shakespeare Festival, The Public Theatre, LaMaMa and Circle Rep, where he appeared with Olympia Dukakis in THE HOPE ZONE. In NYC Clark has directed LONE STAR, OUR DALY BREAD, DOMINO COURTS, CALL IT CLOVER and KIDNAPPED. He also directed MARVIN’S ROOM at The Wayside Theatre in Virginia. Clark can be seen in the films BAIL JUMPER, STORIES FROM NEW YORK, THE CONTENDERS and DON’T SHOOT DARLING. Clark plays the forensics expert Ellis on NBC-TV’s LAW & ORDER. He is a native of Tucson, Arizona and a member of both the Lab Theater Company and the 42nd Street Workshop.

Clark died on October 4, 2020. He was 63 years old.

Director Michael Warren Powell
Leading Actors Clark Middleton
Video Courtesy of Michelle Bouchard
Original Date of Entry 07/12/06

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

Web Photo by Alex Radelich 

]]> https://medhum.org/multimedia/video/felice_aull/miracle-mile-by-clark-middleton/feed/ 0 A Doctor’s Visit  by Anton Chekhov  https://medhum.org/review/book-review/jack_coulehan/a-doctors-visit-by-anton-chekhov/ https://medhum.org/review/book-review/jack_coulehan/a-doctors-visit-by-anton-chekhov/#respond Tue, 11 Mar 2025 14:40:22 +0000 https://medhum.org/?p=11336
Chekhov 1898 by Osip Braz

A junior doctor goes to visit the daughter of a wealthy factory owner. (The professor was too busy to go.) The daughter had been ill for a long time and had just suffered “heart palpitations” the previous night. At first the doctor finds nothing wrong with her heart and says that her “nerves must have been playing pranks” on her. 

The patient’s family presses the doctor to stay for the night. During the evening, he reflects on the oppression of the dreary factory town and relates the sense of loneliness and confinement (“like a prison”) to his patient’s condition. Later, in conversing with the young woman, he actually listens to her empathically, rather than just focusing on her symptoms or the function of her heart. He is then able to respond empathically to the young woman’s plight. 

The Lady with the Dog and Other Stories 
Anton Chekhov 
Publisher Ecco 
Edition 1984 
Place Published New York 
Alternate Source Chekhov’s Doctors 
Alternate Publisher Kent State Univ. Press 
Alternate Edition 2003 
Alternate Editors Jack Coulehan 
Place Published Kent, Ohio & London 
Miscellaneous First published: 1898. Translated by Constance Garnett.  

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image by Europeana

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]]> https://medhum.org/review/book-review/jack_coulehan/a-doctors-visit-by-anton-chekhov/feed/ 0 Enemies by Anton Chekhov https://medhum.org/review/book-review/jack_coulehan/enemies-by-anton-chekhov/ https://medhum.org/review/book-review/jack_coulehan/enemies-by-anton-chekhov/#respond Sat, 11 Jan 2025 15:40:22 +0000 https://medhum.org/?p=11348
Chekhov by Osip Braz

Kirilov is the district doctor. His six-year-old son has just this moment died of diphtheria. He stands watching his wife caress the body as the doorbell rings. It is a wealthy stranger (Abogin) who begs the Doctor to come treat his wife who is in great pain. Kirilov says that he cannot possibly leave his wife at this time. Abogin insists, however, claiming that the doctor must know how terrible it is to witness the illness of a loved one and that his home is close-by. Kirilov relents.

But when they arrive at Abogin’s house, his wife is not home. She has pretended to be ill so that her husband would leave the house allowing her to run away with her lover. Abogin is crushed and begins to complain to Kirilov. Kirilov is fiercely angry that he has been dragged from his son’s death-bed to hear Abogin’s love troubles. They scream at one another, and the doctor returns home, with a firm and undying conviction that all those with money deserve his hatred.

Chekhov suggests that grief and misery do not bring people together to share, but force them apart. Pain is egotistic. The story also reflects on the status of doctors. When Abogin tries to lure the Doctor from his house, he speaks of the noble, self-sacrificing profession of medicine. However, he has so little respect for Kirilov as to hound him, then offer him money to absolve the insult. Kirilov, meanwhile, unjustly forms a prejudice against the rich that will never leave him.

Original Source: The Tales of Chekhov, Vol. 11: The Schoolmaster and Other Stories
Publisher: Ecco, 1986 | First published in 1887
Alternate Source: Chekhov’s Doctors, edited by Jack Coulehan
Publisher: Kent State University Press, 2003
Translated by: Constance Garnett
Places Published: New York; Kent, Ohio & London

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

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