It was not exactly the opening sentence in Turgenev’s ‘District Doctor’ but it was close:
Strange things happen on this earth: you can live a long while with someone and be on the friendliest terms, and yet you’ll never talk openly with him, from the depths of your soul; whilst with someone else you may scarcely have met, at one glance, whether you to him or he to you, just as in a confessional, you’ll blurt out the story of your life.
In a clinical encounter, the very best I mean, often the other person, the so-called patient, unburdens himself and renders what is superficially intractable, tractable from the depths of his soul. The man who has never felt loved by his mother or anyone else for that matter, now in his twilight years, in between gulps for air and the throaty overwhelmed voice, recounts an aridity of spirit built on a grim childhood. Or, it can be a woman whose inner sanctity was preserved against repeated assaults against the body, freezing lust and love, imprisoning innocence behind silence and leaving joy in an unreachable sanctum.
The voices then flow, uncorked and powerfully emerging from the private and solitary space of being. Yet, this is usually only the beginning, a prow leading into secrecy, for beyond the private is the secret, and beyond that, the barely knowable.
In Turgenev’s story, paradoxically, it is the doctor who turns to the patient, the narrator and unburdens himself. Quite the reverse of what is expected. It is a story of clinical failure, of the limits of medicine and, the fallibility of doctors. There’s the sheer impotence of not having the requisite clinical answer to a mortal question and then too, there’s the shame and despair of failure. But foremost, it is the inappropriate love between a dying girl/woman and the attending doctor, a love that’s doomed to failure.
I’ll tell you in all honesty I don’t know how I didn’t go mad that night. I felt that my sick girl was driving herself crazy. I could see she wasn’t in her right mind and I realized that if she hadn’t thought herself about to die she wouldn’t have given me a single thought. You know, like it or not, it’s horrible to be dying at twenty-five years of age without ever having loved someone – and that’s what was driving her crazy, that’s why, out of desperation, she’d chosen me…Do you see now what I mean? Well, she wouldn’t let me out of her arms.
But, what’s unsaid, what is only implied is that the doctor too loved desperately, that the doctor ached to be loved in a deep and unique manner, that the ache of loving and being loved in return like an ague afflicted him, beseeched him even. And that this momentous, brief but yet too real love, marked him and that he kept it all locked away until his encounter with the narrator whose presence was restorative, insofar as it gave the space for unburdening.
And if I might end by drawing attention to the fact that it was the narrative structure, the storytelling, the capacity to re-imagine oneself in the storyline, to give impetus to the events and actions, to re-purpose the emotions as agents of colour, and the back and forth of empathy and perspective, that worked the miracle of healing.
So, in a story, so in life and definitely so in the clinical encounter.
Photos by Jan Oyebode
MindReadings 
Femi thanks. a million for something to reflect on
I will say this happens not only between a doctor and a patient but also between a teacher and his//her students . With time the teacher/students can become vulnerable and if emotions are not controlled may lead to what is not expected
I am sure you must have heard stories like this before
Prof, I love reading your blog. I’m especially moved by Turgenev’s District Doctor, where the physician becomes the patient, becomes vulnerable, inept in a sense. In this way, he becomes more human and more in need of our empathy and understanding.
The young who loves the physician in this story, reminds me of Asya, a young gymnast about to have a mastectomy for her breakfast cancer. Faced with the inevitability of the surgeon’s blade, she asks a fellow member of the ward, Dyoma, an amputee, to caress and kiss her bosom one final time before it ceases to exist. Wonder if Solzhenitsyn got inspiration from Turgenev?
The doctor becomes the patient, becomes vulnerable, and I daresay a bit more human. He deserves some sympathy, I would say, rather than outright condemnation.
Solzhenitsyn’s Cancer Ward presents a not too dissimilar scenario, where Asya, a young gymnast about to HD e a mastectomy for breast cancer, pleads with her fellow Ward mate, Dyoma, an amputee, to kiss and caress the cancerous bosom before it ceases to exist. Perhaps Dyoma, having already experienced amputated himself, may be best placed to console and commiserate with her; perhaps the chasm created by his own dismemberment can be temporarily filled by the outpouring of her own despair.
In all this, I see a love story, a human story, a striving for clarity when all that’s there is disappointment and disillusion.
Thank you, prof. It was such a joy to read this.
Uzodibia
Thanks for your enlightening comments. I must go back and re-read Cancer Ward. There’s a link to Ruth Picard’s account of her experience of breast cancer- her husband’s postscript refers to the disfigurement consequent on mastectomy in a similar way.
Femi
This breaching of the boundaries happened with between a psychiatrist my father knew, Frederick Duhl, and his patient, the poet Anne Sexton. I am not breaching confidentiality by telling you this since it has long been in the public domain. Your words “Yet, this is usually only the beginning, a prow leading into secrecy, for beyond the private is the secret, and beyond that, the barely knowable.” are redolent of the beauty and the sorrow of the lines we draw between ourselves and others, because of fear of shame or of giving another person power over us by knowing our most intimate selves. Another exquisite juxtaposition of literature and psychiatry.
Carolyn
I didn’t know that about Sexton even though I’ve taught her poems for years now. I forgot to add that the barely knowable is accompanied by the unspeakable- twin guardians of the true self.
Thanks as ever for your comments.
Femi
Thanks Prof for this. I recently started psychiatry specialist training in Ife(OAUTHC, Nigeria) and I’m finding that last part true day by day— And if I might end by drawing attention to the fact that it was the narrative structure, the storytelling, the capacity to re-imagine oneself in the storyline, to give impetus to the events and actions, to re-purpose the emotions as agents of colour, and the back and forth of empathy and perspective, that worked the miracle of healing. So, in a story, so in life and definitely so in the clinical encounter.
I hope to perfect that art of empathy, the capacity to enter into another life or allow others see into one’s and initiate a deeply human and helpful intercourse.
Ayomipo
Thanks for your comments. Very best wishes for your career in psychiatry.
Femi