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The body: the broken bits

Dr Gavin Francis has had a varied medical career; he was once a trainee surgeon in orthopaedics, then neurosurgery, and finally intended to train in emergency medicine, but is now a GP in a small inner city clinic. He has worked in Africa and India in community medicine and says he has taken jobs as a paediatrician, obstetrician, and geriatric physician (minus the relevant degrees, one assumes). Dr Francis has served as a doctor to an Arctic mission, and once wanted to be a geographer. One senses that he has failed to find his niche in medicine and I suspect he aspires to be a writer. He has written previously on his arctic adventures, winning prizes for his scripts.

His book Human Being has been enthusiastically lauded in The Times and in The Economist. This book has not been written for a medical audience but for the public.

Dr Francis writes well from human head to little toe of anecdotal experiences during his 15-year wandering medical career since graduating in Edinburgh with honours. The text is 250 pages long and the images are of variable quality. He intersperses his case histories with historical allusions, physiological explanations, and artistic interludes. As Ed O’Loughlin (The Irish Times) succinctly puts it: “It is difficult to decide whether Gavin Francis is a travel writer who moonlights as a doctor, or a doctor who travels and writes on the side.”

And so to the anatomy department and a selective medical journey from cerebral neurons to our lowest print, that of our foot. The first chapter covers the brain superficially, focusing on a neurosurgical procedure to remove a portion of the brain causing intractable, drug-unresponsive epilepsy. Then, in chapter two, to a spiel on psychiatry, with a long dissertation on the pros and cons of electroconvulsive therapy. Dr Francis alludes to One Flew Over the Cuckoo’s Nest and to the ‘tortured’ Sylvia Plath. 

The eye chapter opens with a pithy quotation from James Joyce: “Of all the things that have happened to me, I think the least important was being blind.” A wise man with a mind full of images, memories, and visions. Then follows a historical, philosophical treatise on vision and blindness and a description of cataract surgery, which makes the world a brighter place and 200 yard drives visible for so many. Dr Francis tells us that one of his tutors wanted him to become an ophthalmologist (career path number?).

The chapter on the face is perhaps the best, with intimate descriptions of our multiple Latin-named amazing facial muscles, which allow us to express our innermost and outermost feelings. Leonardo da Vinci was the best exponent of faces according to Dr Francis. I must confess to finding Mona Lisa bland and boring and much prefer Caravaggio’s and Rembrandt’s faces.

The ear chapter is largely about benign paroxysmal positional vertigo (BPPV), which affected golfer Jason Day during the US Open last year. Dr Francis is very enthused about the Epley manoeuvre – I must consult my ENT and GP colleagues and Google Scholar on its efficacy.   

I fell out with Dr Francis during the chest chapter, with particular reference to chest auscultation. He states that one teacher encouraged palpatation, auscultation, percussion, etc, whilst another (Dr Francis’s favourite) recommended: “This is how you examine the chest. With X-rays.” Why does Dr Francis pose with a stethoscope around his neck on the back cover  – for impression or effect? Babies with bronchiolitis can be very distressed, very dyspnoeac, chests full of wheezes and crepitations, with virtually clear CXRs. Dr Francis seems to like to use the stethoscope for heart examination.

Dr Francis is at his best in his descriptions of real life patients with whom he has been involved – the kidney transplant, the acute liver failure secondary to sepsis, the rectal ketchup bottle, the woman dying at home from uterine carcinoma, the little old lady with a fractured hip. 

I remain in awe as a physician at the power of surgery to cure. Physicians dialyse and keep people going; surgeons implant new kidneys and restore full health. I will never forget the skill and artistry of Dr David Hickey in the middle of the night taking a frozen pale kidney, putting it in the pelvis, suturing the vessels, removing the clamps, and this cold kidney turned grey, then blue, then pink and warm, and urine flowed. Success. Goodbye dialysis. Hello life. Home to bed.

Finally, a few further remarks from the department of corrections. There are minor discrepancies in Dr Francis’s descriptions of paediatric hip problems.  

Overall, an interesting, informative, well written, and referenced book. Somewhat selective in its topics. I would award Dr Francis a fail for his disparagement of pulmonary clinical skills, a good pass for his clinical care and commitment, and honours for melding medicine and the humanities. He has written a book more for the layman than the medical man.

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