|Genre||Memoir (407 pp.)|
|Keywords||Anatomy, Anesthesia, Catastrophe, Colonialism, Cross-Cultural Issues, Death and Dying, Developing Countries, Disability, Disease and Health, Doctor-Patient Relationship, Drug Addiction, Empathy, Epidemics, Euthanasia, Freedom, Grief, Human Worth, Individuality, Infectious Disease, Loneliness, Medical Ethics, Medical Research, Occupational Disease, Pain, Parasitic Disease, Physical Examination, Physician Experience, Poverty, Power Relations, Public Health, Society, Suffering, Surgery, Survival, Trauma, Tuberculosis, Urban Violence, War and Medicine|
This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.
Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.
This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.
After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.
Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.
Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.
The brutality of people against people is starkly portrayed in this book. Be prepared for an eloquent narrative of suffering and dislocation. Perhaps because of this backdrop, the suffering of the author was particularly poignant for me. He is no lilywhite do-gooder--his altruism is fierce, hard-won and at times bitter.
At one point he returns to England and regular hospital surgical practice, but finds himself depressed: "I missed the exhilaration, that free-fall rush into unpredictability." (p. 169) After his flying doctor stint he prefaces his return to refugee medicine with "I might have hoped that it would be possible to take a holiday from war--even to have lost interest in it entirely--but war, as Lenin had warned, remained interested in me." (p. 277)
Kaplan may call himself a surgeon some of the time, but he is a physician all of the time--even when a journalist or filmmaker. He is profoundly dedicated to his patients, and patients can crop up anywhere for him. His identity is wrapped in doctoring. And even, or perhaps especially, in the war zone, he "brandish[es]" his stethoscope.
|Place Published||New York|
|Annotated by||Shafer, Audrey|
|Date of Entry||08/07/02|