Cecil Helman - Suburban Shaman: tales from medicines frontline

I come from a family of 13 doctors and not a few hypochondriacs. Among my relatives I can also count a medical librarian, a medical researcher, a medical secretary, a medical social worker, and a technician in a medical laboratory. In fact, the family connection with medicine goes back even farther in time: all the way back to a village practitioner who lived almost 200 years ago.

Most of my adult life I have tried hard to escape from the gravitational pull of this family history, but mostly Ive been unsuccessful. When I think back on it, my struggle to create an individual orbit around medicine (and sometimes to escape from it) began even before I qualified as a doctor from the University of Cape Town in 1967. And in a way, it still continues today.

Growing up in South Africa in such an overwhelmingly medical environment was always a mixed blessing. For one thing, it introduced me early on to an exotic, inverted world unknown to most people outside it in which the usually grotesque and shocking all seemed to have become familiar and domesticated. It was the type of world where suffering and death were close acquaintances and not the usual distant strangers, and where the talk around the dinner table, or the barbecue, was often all about Interesting Cases, with their bizarre symptoms, gross swellings, unusual cures or inexplicable deaths.

This background also taught me that medicine is not just about science. Its also all about stories, and about the mingling of narratives among doctors, and between them and their patients. As Dr Foster, the general practitioner in Arthur Conan Doyles story A Medical Document, puts it: Theres no need for fiction in medicine, for the facts will always beat anything you can fancy. In fact, the art of medicine is a literary art. It requires of the practitioner the ability to listen in a particular way, to empathise and also to imagine to try to feel what it must be like to be that other person lying in the sickbed, or sitting across the desk from you; to understand the storyteller, as well as the story.

Suburban Shaman is about medicine, and about many of the different types of medical practice. It is written from the perspective of a doctor who is also an anthropologist. Its a view from the inside, from the other side of the doctors desk, and is based on the 27 years I spent in family practice, before taking early retirement some time ago in order to concentrate on teaching and writing.

This book is not an autobiography. Its a mosaic of memories rather than a single story. It aims to take the reader along on a series of journeys that Ive been privileged to make through the various different worlds of doctors and patients from medical school in South Africa during the darkest days of apartheid, via ships doctoring in the Mediterranean, to a spell doing research at Harvard Medical School in the USA, to medical aid programmes in the Third World and encounters with shamans and folk healers in different countries, and finally, to the practice of family medicine in various parts of London and surrounding towns. Along the way, each of these different worlds has taught me a specific lesson about the nature of healing and of medical care. Those lessons form the basis of this book.

Much of what follows is a defence of old-style family practice, and a celebration of it. Its a type of medicine that people often take for granted, or even ignore except when disasters happen. In Britain, the local National Health Service general practitioner or family doctor is still the first point of call for the vast majority of people who seek medical help. In its quiet and unassuming way, and every day of the week, family medicine is still at the very frontline of human suffering.

My own professional life has been spent mainly at this less glamorous end of medicine, in suburban family practice, far from the great fluorescent laboratories of the medical schools and the teaching hospitals, far indeed from the newspaper headlines about the latest wonder drug, or the latest tanned and white-coated celebrity surgeon. Family practice in Britain is a rushed, unglamorous life and the effects of its heavy workload can be grinding and corrosive. Yet, for all of this, I think theres a quiet and unacknowledged heroism about it all. And it may well be one of the last survivors (though not the only one) of a long tradition of real medicine, the type of holistic approach to health care that has always tried to treat the person as well as their disease, and to do this within the context of their own home, their family and their community.

What fascinates me particularly about it are the extraordinary human situations into which people (doctors as well as patients) find themselves propelled by illness, especially sudden, unexpected illness. Medical life provides endless examples of these situations, and they supply some of the tales that follow: brief glimpses through the half-opened doorways of many thousands of lives, revealing moments of drama that are poignant, tragic, bizarre or even comic.