There was a zen master who observed “When a bird flies in the sky, beasts do not even dream of finding or following its trace. . . . But a bird can see traces of hundreds and thousands of birds having passed in flocks.’ He said Buddhas are like this, able to see the traces of passage, where we see only empty space.
I’m no Buddha, but it sometimes feels as if I see the traces of the passage of people through places I’ve known well, and the traces of my former self. Life doesn’t move in circles, but it does move in spirals. The Earth spirals around our moving sun as it wheels around the heart of The Milky Way, which is also in motion. Life’s great consolation and its frustration is that everything changes, yet the promise of medicine is that we can influence that change for the better. I don’t know about life after death, but every action we make changes the world, and will go on changing the world in some way, long after we are gone, and in that our lives touch immortality. All lives move in spirals, but one of the most unexpected returns for me has been the orbit that has brought me back here, to what I can’t help but think of as the ‘surgical corridor’ of the old building where I trained to be a doctor.
In October 1993 I walked from Sciennes across the Meadows and up to Teviot Place for my first day of medical school. The Futures Institute was the ‘surgical corridor’, and ambulances were queued up onto Lauriston Place. For the years of pre-clinical training we came here only for brief, tantalising glimpses of clinical life. We first had to learn Anatomy, Physiology, Biochemistry, Microbiology, Pathology, Endocrinology – all taught in the labyrinth of corridors between Forrest Road and George Square.
Some complained that we didn’t encounter enough patients in those first two years – it was all lectures and laboratories – but I didn’t mind waiting. Part of me sensed that some emotional maturation was necessary before I could withstand the seismic pressures of hospital work. Some life needed living before I could confront death. But in due course I came here for clinical training, under a series of mentors, some of them on this very corridor: I remember MacGregor, Siriwardena and Paterson-Brown, shadowing Mr Lee’s clinic, which is now the author’s area for this festival; we followed in their wake like goslings after ganders, watching and learning a system, a ritualised approach to suffering. Its protocols had been honed over 300 years of bedside teaching, designed as much to protect us from emotional overwhelm as they were to prevent us omitting some crucial diagnostic clue.
By today’s standards there were many failures in the way we were trained, failures in particular of humility and of kindness. But the surgeons and the nurses who stalked this corridor were masters of a particular art, and I was their apprentice; I needed to learn how to flourish in a steeply hierarchical world at the top of which stood not the professor, nor the patient, but death.
It was years until I began to see that the work of medicine is only tangentially about postponing death – its primary purpose has always been and should always be the relief of suffering. Where possible it can go further, and try to help people to flourish in their lives. Medicine in its best manifestations should be the alliance of science with kindness. A simple idea, but the work itself is complex, so complex, which is why it takes so many years to learn it. And in the UK at least, in the context of the NHS, it relies on a shared sense of priorities – that, as sociologist TH Marshall said of the NHS ‘illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.’ The golden calligraphy on the plaques up and down the walls of this building are relics of a different time, when access to healthcare was a matter of luck, charity, and patronage. Last year I wrote a book in defence of our crumbling NHS, called ‘Free For All – Why the NHS is Worth Saving’, because I believe we’re in danger, now, of returning to the world that made those plaques and bequests necessary. A world in which your baby might live or die on the generous whim of a millionaire, where a cancer diagnosis means having to sell your house to pay for treatment.
Around the time I was learning here, the literary critic Anatole Broyard, who had prostate cancer, wrote of one of the doctors he turned to: ‘from the beginning, I had negative feelings about this doctor. He was such an innocuous-looking man that he didn’t seem intense enough or wilful enough to prevail over something powerful and demonic like illness.’ Illness, then, was powerful and demonic; it was accepted that the apprenticeship to gather the strength to counter it would be demanding physically, intellectually, emotionally. That was one of the meanings of this building for me.
Four years after starting on the wards I took up a job in A&E, tempered in some way by the furnace of ward-based teaching, prepared at least for assessing, if not healing, the most catastrophic failures and injuries, of the human body and of mind. At least those frequently suffered by the people of Edinburgh. But nothing prepared me for the effect of the shift rota. We alternated three days of 14-hour night shifts with four days of 10-hour day shifts, or vice versa, 3 days off in every ten, and for all the time I worked there I reversed my body clock entirely from day to night, two or three times a month. I concede that I learned a lot in that job, much that I still use today as a GP, but it almost destroyed my love of medicine.
That department is a restaurant now, a café, and recently my graduating year, class of ’99, had our 25th anniversary celebration inside. I wondered what a zen master would have seen in that place, if they were able to see traces of passage of human lives. So many people died in those rooms, and so many were saved. The writer Geoff Dyer says somewhere that buildings don’t remember – they have no loyalty – but I remember – and every square yard of that space is dense with memories. I went into the job feeling I needed to gain confidence in managing trauma and in that I succeeded, but I hadn’t counted on the relentlessness of the cavalcade of human suffering through those rooms. It was almost twenty-five years ago, but I still see them: the suicides brought in too late, too broken, or too poisoned to survive. The pregnant woman haemorrhaging pints of blood. The ruptured aortas, the stab wounds, psychoses, traumatic amputations. There’s a corner in the café that I can’t see without remembering holding a man, raving and struggling against me and three nurses, while I pushed a plunger of sedative into his veins as he slumped slowly – too slowly – to the floor. But there are other, more heartening, celebratory memories too, not just of camaraderie with my colleagues – of which there was much – but of glad patients, cured or relieved of pain. The elderly man with a stroke, surrounded by his three daughters – they must have been the age I am now – all smiling as I said ‘of course they can stay’. The young woman in an evening gown, an expert on her own tachycardia, who strode in announcing: ‘Just bring me a basin of ice water and I’ll get out of your department and back to my party’, she said, and sure enough, after dunking her face into basin, her heart was back in rhythm, and she went on her way. The man who walked in holding his head very still in his hands, stating with great composure ‘I think I’ve broken my neck’, and he was right. Instead of being paralysed, he was fixed. Those too are the meanings of this place – restoration, restitution, recovery.
The earth, and our lives, move in spirals, not circles, and we can’t go back, only forward. This building will now have a new life, generating new memories and new meanings – its interdisciplinary academic work is needed more now than ever. The galaxy is turning, our planet following its path through an immensity of nothing. But we are not nothing – we are full of love and memories; we create our own meaning as we spiral through the possibilities of life, grabbing at some opportunities, squandering others. This is the place from which I took my first steps into learning how to use science and kindness to ease suffering, from my patients as much as from the consultants. But it’s also the place where I began to draw meaning from the limitless possibilities offered by our all too brief, wholly precious human lives.