The greatest works of fiction afford a glimpse into human nature, into its dark secrets, pettiness, and callowness, as well as into moments of true magnanimity. Conflict and misunderstanding between individuals is another core ingredient in the best of fiction. The best writers have an innate grasp of what makes up the human creature, and have a fluency in psychological analysis that comes only from keen natural intuition. Yet even the most subtle grasp of human nature alone is insufficient material for the creation of great fiction; for the successful author must also be able to draw from a rich backdrop of life experience.
Medicine, like few other professions, provides such a backdrop and as such it is likely not coincidental that there exists a glorious intersection between the fields of writing and medicine. A physician, in the course of his daily work regularly comes across the themes that most people encounter only infrequently-fear, illness, suffering, and death, as well as hope, courage, and perseverance. These titanic forces flush out the essence of human nature, and the physician who is so inclined is provided with boundless material for the exploration of humanity through fiction.
Anton Chekhov (1860-1904), the great Russian author and playwright, was a physician by trade. Chekhov draws abundantly on his experience in medicine in his fiction and drama, and this is brought out in a recently published compilation of Chekhov's medically-related short stories.
In this volume of stories, Chekhov imposes a frank-almost brutal-examination of human nature, and a critical look at the practice of medicine and at those who practice it. The themes in his stories are apparently timeless; any practicing physician will recognize the cynicism, politics, burnout, and overwork that is described by Chekhov. In one story of a beleaguered, overworked rural doctor in the employ of the state, Chekhov even provides a glimpse into what must have been a nineteenth century Russian version of the frustrations of working in a managed care environment. In the story, the physician is forced to care for a large, impoverished population in a clinic over which he exercises no executive authority. Not only is he powerless under the system to fire his incompetent, corrupt, and drunken support staff, but in his prescriptions is at the mercy of a central power that determines the source of pharmaceuticals.
Another story traces the devolution of an earnest, ideological young physician into a money grubbing, lazy, and cynical doctor who treats his patients like objects. This same doctor, who possesses abundant theoretical knowledge of pathology and the practice of medicine, is utterly unable to apply his wisdom to heal patients because of his stifling arrogance and lack of empathy for his patients.
Some of Chekhov's physicians struggle to strike a balance between adequate time for their own lives and families and availability to their patients. This conflict is starkly illustrated by a story in which a physician is forced to choose between attending the deathbed of his only child and responding to an emergency call.
Chekhov also examines the proper role of professional objectivity and distance in medicine. At what point does the curtain that every physician draws between himself and his patient in order to facilitate detached, objective thinking become a mighty bulkhead constructed primarily for self defense? Several stories explore this question, and Chekhov seems to conclude that the answer lies in a happy medium.
All is not dark, however, in the world of Chekhov's doctors. Even amidst the burnout, substance abuse, and money-worship of some of his characters, there are the redeeming qualities of absolute dedication, devotion to the pursuit of medical knowledge, and perseverance even under very unfavorable circumstances. The doctors in his stories are complex, and some of these redeeming qualities even coexist with the uglier traits in some of Chekhov's characters.
Chekhov's Doctors is a well-edited volume that arranges stories in an inviting and readable sequence, (saving lengthier, heavier stories for later in the volume). Dr. Coulehan, the editor, also places Chekhov's stories in historical context, providing the reader with, for example, an ample yet not overwhelming background of Chekhov's relationship with Tolstoy (whose titan influence was difficult for any contemporary Russian author to escape). Of particular interest is a series of commentary in the back of the volume that provides a brief analysis of each story from the author's perspective as a medical doctor.