I like to read books that explore the ways that doctors balance their idealism, their selfishness, and their need for emotional numbness. Some of the best of such books are by doctors like Anton Chekhov or William Carlos Williams or Samuel Shem. Others are by patients or family members, books like Philip Roth’s Patrimony, Anotole Broyard’s Intoxicated By My Illness, or Arthur Frank’s At The Will of the Body.
I was intrigued to come across a novel by Booker Prize winning South African author Damon Galgut called The Good Doctor. I was even more intrigued when I saw that the epigraph was from a Chekhov short story. A novel about a good doctor by a novelist quoting one of the best doctor-writers ever. Ok, I wanted to see where it would go.
Galgut sets his novel in a hospital that is falling into ruin in a town that seems abandoned, in one of the former homelands of South Africa, a place where Blacks had been banished by the apartheid government to strip them of citizenship and political rights. In the years after apartheid, Blacks have left the homelands and the government no longer wants to support the hospital. But it would be politically unpopular to shut it down. So it limps along, understaffed, poorly equipped, and probably doing more harm than good.
There are three doctors. Two of them meet on the first page. Frank Ellhof has been there for years. He was hired with the promise that he would become the new director of the hospital. That job fell through. He might have left. But he was at a low point in his life. His marriage had fallen apart after his wife had an affair with his best friend. He is passive about his life. Things happen. He lets them. He is tormented by the memory of his part in carrying out acts of torture during his army service, another time when his passivity led to his complicity in immoral acts.
Into his life comes a young and idealistic doctor, Laurence Waters, who is also on the run from his past. Waters is a generation younger than Ellhof. He has chosen to come to the remote hospital for idealistic reasons. He thinks that the hospital should develop programs to provide needed services to the people living in the surrounding villages. He works with the hospital director and the village elders. He has hope for the new post-apartheid South Africa and seems naively unaware of the country’s bitter history. Ellhof, at one point, looks at him and asks, "Where do you come from, Laurence? What country are you living in?"
Laurence seems to be the “good doctor” of the novel’s title. He is full of idealistic zeal. He is an activist in the mold of Virchow or Kouchner or Geiger, a man who sees health care as a right and advocacy as an obligation. He devotes his life to improving the medical provided to the people in the poor villages in the hinterland that the government has forgotten.
Galgut’s does not admire Laurence is not straightforward. The Chekhov quote comes from a short story that is a devastating critique of naïve idealism. In that story, the jaded narrator, a landscape painter, criticizes an idealistic young woman who, like Laurence, wants to bring better health care to the peasants, “If you come to their assistance with hospitals and schools, you enslave them even more. They will have to pay for their drugs and, therefore, to work harder than ever.”
Galgut’s South Africa resembles Chekhov’s Russia in many ways. As another physician-writer, Sidhartha Mukerjee noted, in his appreciation of Chekhov, “Tsarist Russia in the eighteen-eighties was suffused with moral and economic depravity. It was a society overrun by corruption, bribery, and nepotism. Censorship abounded. The news was frequently manipulated and false. Political dissidents were kidnapped, assassinated, or packed off to prison. The élites ensconced themselves in grotesquely opulent homes while poverty, violence, illness, and incipient famine haunted parts of the land.”
Galgut writes in ways that reflect Virginia Woolf’s appreciation of the Russian physician-writer. “Our first impressions of Tchekov are not of simplicity but of bewilderment. What is the point of it, and why does he make a story out of this. The stories are inconclusive, we say, and proceed to frame a criticism based on the assumption that stories ought to conclude in a way that we recognize. Men are at the same time villains and saints; their acts are at once beautiful and despicable. We love and we hate at the same time. There is not of that precise division between good and bad to which we are used. Often those for whom we feel most affection are the greatest criminals, and the most abject sinners more us to the strongest admiration as well as love.”
We think we know what makes a good doctor, a good person, a good society. But then life happens. We are forced to question our deeply held beliefs. Galgut struggled with these issues in his own life. In an interview, he says, “We grew up in a system that was patently abnormal but that was taught to everybody as the way things are. And this system felt as if it was never going to shift, or unravel, or change. It just felt too strong and too deeply rooted. And yet it also seemingly - I know it didn’t but seemingly - changed overnight. Laws that had been in place for decades and decades were suddenly different laws now. And that reflected, I think, a major leap across the generations, a generational jump, a complete gap of being, another way of seeing the world.”
As these doctors try to make sense of a South Africa undergoing radical change, there are echoes of Faulkner’s obsessive inquiries into the effects of the past on the present and the future. In Absolom, Absolom, Faulkner sends his most famous protagonist, Quentin Compson, north, to Harvard, to try to first understand and then deal with the awful past. How, he wonders, did God allow us to lose the war? And how do the effects of the past shape each succeeding generation? Each must come to understand the hold of the past.
Both Frank and Laurence are vying for the favor of the hospital director, Dr. Ruth Ngema (“ngema” means “good” in Swahili.) She is a Black woman who is hoping to get promoted, to get a job in a bigger, better hospital. She is a cautious administrator, unwilling to make needed changes but willing to go along with them if she can do so in way that will allow her to take credit if the work but avoid blame if they do not.
The Good Doctor offers no real denouement, no clear idea of who is or is not a good doctor. At the end, Laurence is dead, Ruth has left, and Frank finally has gotten the job of Director. The government is trying to close the hospital. Frank writes, “The hospital is in trouble and it is my job to save it.” He spends time explaining how the hospital is doing vital work. As evidence, he cites Laurence’s outreach clinics, even though, with Laurence gone, the clinics no longer exist. Nevertheless, Frank feels energized. “I feel, somehow, that I have come into my own.” We look at Frank and see him, alone in his Director's office, and see that he, too, has died.
Medicine is a microcosm and a metaphor, a potent mix of myth and magic, a vehicle for both altruism and exploitation. Galgut, like Chekhov, finds in his mediations about medicine an important way to interrogate the souls of his doctors and to ask us, as readers, to examine ourselves honestly and mercilessly.
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