The Outlandish Companion

by Diana Gabaldon

  However, thoughtful people do look back now and then, and thus innovation rediscovers tradition. More things are known in heaven and earth than are dreamt of by many Horatios, and the metaphysical aspects of medicine are returning, with a wholly modern emphasis on “holistic” methods. In fact, the echo between Claire’s methods and the present-day interest in holistic and natural healing techniques is purely fortuitous, but it was… er … timely.

  “Metaphysical!” is one of those entertaining words with multiple definitions and shades of meaning, but as used in this context, it generally means “of, or relating to, what is perceived as transcendant, supersensible, or transcendental“ or ”neither analytic nor subject to empiric verification.“ What one colleague of mine helpfully refers to as ”woo-woo stuff.”

  Modern medicine now generally accepts the notion that there is a strong interrelationship between mind and body, even though the precise nature of its operation is unknown—i.e., metaphysical. Since it is unknown, there exists an area of mystery in the realm of healing, which in some cultures is called “magic” or “shamanism”—but which is nonetheless an important component of the art of healing, regardless of the forms involved.

  For example, a modern doctor may under some circumstances dispense treatment that he or she knows has relatively little therapeutic value, but that nonetheless makes the patient feel better or recover more quickly, owing to the placebo effect—that is, there is a beneficial effect connected with the simple act of treating illness, regardless of the actual physical effects of the treatment. (“Treatment” being loosely defined here, to cover everything from simple attention to the administration of substances or invasive procedures.) By exactly the same token, a person from a shamanistic culture will often be improved by a healing ceremony, whether the ceremony has any directly apparent physical effect or not.

  In other words, there is a magical aspect to the practice of medicine, and always has been, though this aspect was decried and ignored for some time, in the excitement (fully justified, by the way; the Germ Theory is no small thing) of scientific discovery.

  Given the circumstances of Claire’s story—her disappearance through standing stones—there was plainly going to be an air of mystery and magic about it. What occupation could be more appropriate than that of healer—an occupation that has about it the same air of mystery and hint of magic? What better choice of occupation for a time-traveler, whose life itself turns back—and back again—upon itself, with new truths revealed by each change of perspective?

  The processes of the body are both intensely personal and highly cryptic, which gives us the sense of significance and mystery that we call “magic.” The same mixture of significance and mystery underlies religious feeling, and it is no coincidence that most healers in primitive societies are also priests. Religion and science lie at opposite ends of the spectrum of rationality, with medicine balanced somewhere in the middle. The important thing to note is that it is a spectrum; ergo, the elements of it are all connected, even though the extremities may seem so different as to bear no relation to each other.

  In fact, healing is an art, and has always been understood as such—at least until the very recent past, when the advent of sophisticated technology has given us the delusion that the miracles of the body are all both explicable and controllable. Many are—but not all. Not yet, anyway!

  Consequently, there are echoes throughout all the Outlander books—superstition and magic resonating through the practice of rational medicine—that exemplify the unique attitudes of the second half of the eighteenth century. The Age of Enlightenment was a period of transformation, in terms of culture, society, and thought— magic, if you will, brought about by the power of reason.

  Claire, with her peculiar perspectives, personifies the practice of medicine, mingling the rational and the metaphysical, the traditional and the modern, in pursuit of the ancient goals of the healing arts: the preservation and restoration of health. Modern as she is, she is herself an echo of the Age of Enlightenment, with its odd mixtures of alchemy and chemistry, its hold on tradition, and its search for innovation. She is, in fact, the Return of the Leech.

  WHITE LADIES

  If one is looking for entertaining accidents of history, it’s worth noting that nurses in modern days have most often been “women in white.” Whether chosen for its evident “purity” (and hence the implication of antisepsis), or because blood shows up on it really well, the white uniform worn by many modern nurses evokes the image of earlier “white ladies.”4

  The White Lady is a figure of Celtic myth, known (in varying manifestations) in all Celtic countries, including not only Ireland and Scotland, but Brittany as well (hence the knowledge of “La Dame Blanche” among the rapists Claire meets in the Rue du Faubourg St.-Honoré). Generally speaking, the White Lady is the dryad of death; she is often identified with Macha, Queen of the Dead, and sometimes as the Crone aspect of the Goddess (the Goddess is said to have three forms: Maiden, Mother, Crone—which signify the chief phases of female life).

  Looking more particularly, though, legends of “white ladies” don’t always portray these as figures of death and destruction— though this depiction is common—but in some places as figures of healing and sorcery. Macha, one of the mythic figures identified as the White Lady, is also the Mother of Life and Death—she (and all lesser white ladies, presumably) presides over both birth and death—which, it struck me, was pretty much what a doctor does.

  Given Claire’s naturally pale complexion, her healing arts (and the ruthlessness which is a natural part of them), and her supernatural connections (both real and perceived), it seemed only reasonable to endow her—via Jamie’s fertile imagination and familiarity with Celtic myth—with the title of “La Dame Blanche.”5

  WHY WORLD WAR II?

  The decision to make Claire a healer dictated the time period from which she came. There were two reasons for choosing the period right after World War II: one, antibiotics, and two, technology.

  World War II marked the emergence of truly “modern” medicine, with the advent of antibiotics—sulfa drugs were put into common usage on the battlefields and in the medical hospitals of World War II, and while penicillin was discovered in 1929, no use was made of it until 1941, when the incidence of wartime injuries and infections made its development both economically feasible and socially imperative.

  Prior to this time—and in fact, during a good part of the early days of the war— medical procedures were still very old-fashioned. While techniques such as bleeding and purging had been abandoned, many older techniques—wound-dressing and surgical practices—were still in common use. Therefore, a nurse who had worked under combat conditions in World War II would not find the conditions of the eighteenth-century Highlands to be nearly as strange or unusual as would a more modern medical practitioner. She would be quite accustomed to “hands-on” work, and have no great dependence on modern amenities like indoor plumbing.

  The second reason for the choice of World War II is a corollary of the first and a result of the time-travel premise—technology.

  Were I to have used a professional healer from contemporary times (the 1980s or 1990s, say), she would have been accustomed to the use of sophisticated equipment and procedures, and—if written with psychological plausibility—would have been missing the use of these acutely, at least in the early stages of exposure to the past.

  While Claire is appalled at the lack of hygiene, the ignorance of nutrition, the crudity of surgical procedures, and so on—these are all matters of general medical knowledge that the modern reader also shares. Therefore, a person reading of Claire’s perceptions and adventures— bone-setting, wound-stitching, curing fevers—would feel herself (or himself) very much in her shoes. This sympathetic identification would be less if she were constantly thinking how much she’d like to put an epileptic child through an MRI scanner or what a pity it was that she couldn’t manage peritoneal dialysis or genetic engineering to correc
t inborn errors of metabolism.

  A third factor in my choice of Claire’s time period was the “forward factor.” That is, when dealing with time travel, any writer must make decisions as to exactly how the process will be defined; does a traveler age? If a traveler returns to his own time, will he arrive at the same temporal point of departure (i.e., the same hour, day, etc., as when he left), or will some time (spent in the past) have elapsed?

  Now, the evolution of the Gabaldon Theory of Time Travel was quite gradual, and in fact is still not yet completely explicated.6 However, it seemed to me, while writing Cross Stitch/Outlander, that time is linear and progressive for an individual; a person is living his or her life in a normal manner, and thus does age normally, no matter which time period he or she occupies while doing so.

  That being so, if I ever meant Claire to return from the past (and I didn’t know whether I did or not, but it struck me as a distinct possibility), she would return to a time farther in the future than the point at which she left it. This in turn meant that if I made her contemporary with myself— set the story in the 1980s or 1990s, that is—her return to the future could well put her in my future—she could start in 1990, spend twenty years in the past, and return to 2010—all this in a book that might be published in 1995! (Had I realized at the time how slowly I write, I might have worried less about this.)

  I didn’t want the books to become dated or seem overtly “wrong” in 2010—as might easily be the case if I tried to project Claire’s medical career and daily life in a time later than my own. Looking backward, then, I hit upon World War II as a suitable time period. For one thing, this particular war was the time in which antibiotics were first introduced on a wide scale—the third of the great advances that form the foundation of modern medicine (the first being the notion of asepsis; the second, anesthesia).7 This was a very important modern medical advance, and one with which most modern readers could identify, but without the need for any technological explanation. Also, if Claire had been a combat nurse, she would naturally be accustomed to hardship—and thus would not find the eighteenth century nearly so much a shock as might the average debutante—and would likewise be independent, self-reliant, and resourceful. Since these were qualities I had already discerned in her, my job was only to supply a reasonable explanation as to why she had them. Further, wartime conditions in Britain and France were difficult, austere, and often dangerous. A woman who had lived through nearly a decade of such conditions would not be fazed by the lack of modern amenities—and might be less daunted by the prospect of giving up such things permanently.

  And finally, the eighteenth century was rather a violent time. For Claire to be able to deal emotionally and effectively with common conditions—whether she accepted the social basis for them or not—it seemed useful for her to come from a violent time herself. She is—as her daughter notes, considerably ex post facto—capable of ruthlessness and great strength in the service of her own ideals. These are not personality traits fostered by soft living.

  I didn’t realize it consciously at the time, but there was another reason for the choice of World War II as Claire’s original time— that being the “echo” between the Jacobite Rising and the Second World War, in terms of the effect of these conflicts on society.

  The ’45 put an end to the feudal system of the Highland clans, and—as a side effect—threw a large number of Scottish immigrants out into the New World, where they contributed extensively to the development of what would become America. In a similar way, the disruptions and displacements of World War II resulted in a much larger wave of immigrants, who in their turn altered American society and contributed greatly to its modern form.

  A side effect of wars is social disruption, and while this is usually unfortunate in individual terms, it not infrequently has unexpectedly beneficial side effects. One result of the Jacobite disaster was the emigration to the New World of numerous Scottish Highlanders—who then contributed greatly to the growth and prosperity of their newly founded country. Results of World War II included the development of the military-industrial complex, which has led to such benefits as space exploration, the development of computers, and the concomitant technological explosion that has transformed modern life.

  Major wars invariably lead to rapid developments in medicine—for obvious reasons. The linkage of Claire’s occupation to a wartime background, once suggested, became inevitable—and that linkage in turn led to the development of her character and personal history.

  MEDICAL BACKGROUND

  Where did I get Claire’s medical background? Well, that was yet another accident.

  As a graduate student, I was fortunate enough to have a full scholarship, and therefore was not given a position as a teaching assistant (a common way for university departments to help students earn their way), the university reasonably feeling that these positions should be reserved for students who needed the income. However, my advisory committee was concerned that I should have at least some slight experience with teaching, since it was likely that I would teach at some point in the future.

  In consequence, the university awarded me one-eighth of a teaching assistantship; I taught one lab class per week, for which I earned the princely sum of twenty dollars—the low point of my working life, in terms of income. The only class available for me to teach was the lab portion of a class in human anatomy and physiology— and so I taught human anatomy and physiology, in spite of the fact that this class had nothing to do with my own scientific background or aspirations.

  Well, time marched on and so did I—to Philadelphia, where my husband was getting an MBA at the Wharton School of Business, and I was trying to find a job so we wouldn’t starve. In fact, I found two jobs: The first was a postdoctoral appointment at University of Pennsylvania, where I raised ringdoves and butchered seabirds for a living (this was the low point of my working life in terms of occupational conditions. I couldn’t eat fried chicken for nearly a year). The second was a part-time job at Philadelphia Community College, where my “experience” in teaching human anatomy and physiology landed me a job teaching … human anatomy and physiology.

  This job in turn led to my teaching the same class to nursing students at Temple University, and ultimately, to my teaching the same class—good old human anatomy and physiology—to science students at Arizona State, when I was asked to substitute for a faculty member on sabbatical. In other words, I taught human anatomy and physiology repeatedly, in spite of the fact that none of my degrees or research interests had anything whatever to do with that particular subject.

  Since the course was designed for nursing students and for students taking a science elective, the material dealt extensively with clinical medicine—and I thus inadvertently came away with most of what I needed to know to equip Claire Randall to deal with the medical conditions of the eighteenth century.8

  Beyond this accidental preparation, of course, I undertook considerable library research (see Part Twelve: Bibliography), and I began to ask questions of one or two doctors whom I had met online.

  I’m greatly indebted to Drs. Gary Hoff and Ellen Mandell, among others—not only for their help and advice in describing and dealing with assorted medical conditions, but particularly for their honesty and openness in letting me see a small part of what it means to be a healer, with all the compassion, dedication, and occasional heartbreak that entails.

  (MEDICAL) CONDITIONS AND (PLOT) COMPLICATIONS

  One of the plot complications of the first book, of course, revolves around Colum MacKenzie’s rather interesting medical condition. People always ask writers, “Where do you get your ideas?” One writer of my acquaintance replies courteously that he orders them in bulk from the Sears catalog, but my own much less imaginative answer is, “Everywhere!” In the case of Colum MacKenzie, I got the idea off the wall of my university office.

  At the time, I had a small room in a condemned building on the ASU campus, with crumbling plaster and an ancient air condit
ioner, which shook like a reducing machine and caused thousands of panic-stricken crickets (who evidently found the crevices of the thing an ideal breeding ground) to leap out into the room whenever I turned it on. To add visual interest to this hole, I fetched in a packet of very cheap cardboard reproductions of Great Paintings, and applied them lavishly to the walls and doors of my sanctum. Each Great Painting had on the back of it a small notice, this containing a brief biography of the artist.

  And … well, when I sat at my desk, talking on the phone, the painting on the wall directly in front of me was one by Toulouse-Lautrec, that’s all. The symptoms of his peculiar disease, including the tendency to impotence and sterility, were included in the biographical note on the back.

  You take ideas where you find them.

  I picked up Jamie’s dislocated shoulder—and the method of putting back a joint—from a memory of one of Dick Francis’s early racing novels (I don’t remember which one), in which a jockey described in vivid terms both the pain of the injury and its immediate relief.

  The descriptions of several common medical conditions and contemporary treatment methods came from the medical research—the contents of Davie Beaton’s surgery was taken from a listing of common medicaments that I found in H. G. Graham’s The Social Life of Scotland in the Eighteenth Century. The descriptions of procedures in L’Hôpital des Anges in Dragonfly in Amber were based on the colorful variety of medical procedures (urinoscopists, truss fitters, bonesetters, maîtresses sage-femme) described in Professional and Popular Medicine in France, 1770—1830 (Ramsey).