A Fortunate Man: The Story of a Country Doctor

by John Berger

  Sassall’s desire to be universal cannot therefore be dismissed as a purely personal form of megalomania. He has an appetite for experience which keeps pace with his imagination and which has not been suppressed. It is the knowledge of the impossibility of satisfying any such appetite for new experience which kills the imagination of most people over thirty in our society.

  Sassall is a fortunate exception and it is this which makes him seem in spirit – though not in appearance – much younger than he is. There are superficial aspects of him which are still like a student. For example, he enjoys dressing up in ‘uniforms’ for different activities and wearing them with all the casualness of the third-year expert: a sweater and stocking cap for working on the land in winter: a deer-stalker and laced leather leggings for shooting with his dog: an umbrella and homburg for funerals. When he has to read notes at a public meeting he deliberately looks over his glasses like a schoolmaster. If you met him outside his area, on neutral ground, and if he didn’t begin talking, you might for one moment suppose that he was an actor.

  He might have been one. In this way too he would have played many roles. The desire to proliferate the self into many selves may initially grow from a tendency to exhibitionism. But for Sassall as the doctor he is now, the motive is entirely transformed. There can be no audience. It is only he who can judge his own ‘exhibition’. The motive now is knowledge: knowledge almost in the Faustian sense.

  The passion for knowledge is described by Browning in his poem about Paracelsus – whose life story was one of the tributaries to the later Faust legend.

  I cannot feed on beauty for the sake

  Of beauty only, nor can drink in balm

  From lovely objects for their loveliness;

  My nature cannot lose her first imprint;

  I still must board and heap and class all truths

  With one ulterior purpose: I must know!

  Would God translate me to his throne, believe

  That I should only listen to his word

  To further my own aim!

  Sassall, unlike Paracelsus, is neither a theosophist nor a Magus; he believes more in the science than in the art of medicine.

  ‘When people talk about doctors being artists, it’s nearly always due to the shortcomings of society. In a better society, in a juster one, the doctor would be much more of a pure scientist.’

  Or:

  ‘The essential tragedy of the human situation is not knowing. Not knowing what we are or why we are – for certain. But this doesn’t lead me to religion. Religion doesn’t answer it.’

  Yet this difference of emphasis is mostly an historical one. At the time of Paracelsus sickness was thought of as the scourge of God: and yet was welcomed as a warning because it was finite whereas hell was eternal. Suffering was the condition of the earthly life: the only true relief was the life to come. There is a striking contrast in medieval art between the way animals and human beings are depicted. The animals are free to be themselves, sometimes horrific, sometimes beautiful. The human beings are restrained and anxious. The animals celebrate the present. The humans are all waiting – waiting for the judgement which will decide the nature of their immortality. At times it seems that some of the artists envied the animals their mortality: with that mortality went a freedom from the closed system which reduced life here and now to a metaphor. Medicine, such as it was, was also metaphorical. When autopsies were performed and actually revealed to the eye the false teachings of Galenic medicine, the evidence was dismissed as accidental or exceptional. Such was the strength of the system’s metaphors – and the impossibility, the irrelevance of any medical science. Medicine was a branch of theology. Little wonder that Paracelsus who came from such a system and then challenged it in the name of independent observation resorted sometimes to mumbo-jumbo! Partly to give himself confidence, partly for protection.

  I am not, of course, implying that Sassall is an historically comparable figure to Paracelsus. But I suspect that he is in the same vocational tradition. There are doctors who are craftsmen, who are politicians, who are laboratory researchers, who are ministers of mercy, who are businessmen, who are hypnotists, etc. But there are also doctors who – like certain Master Mariners – want to experience all that is possible, who are driven by curiosity. But ‘curiosity’ is too small a word and ‘the spirit of enquiry’ is too institutionalized. They are driven by the need to know. The patient is their material. Yet to them, more than to any doctor in any of the other categories, the patient, in his totality, is for that very reason sacred.

  When patients are describing their conditions or worries to Sassall, instead of nodding his head or murmuring ‘yes’, he says again and again ‘I know’, ‘I know’. He says it with genuine sympathy. Yet it is what he says whilst he is waiting to know more. He already knows what it is like to be this patient in a certain condition: but he does not yet know the full explanation of that condition, nor the extent of his own power.

  In fact no answer to these open questions will ever satisfy him. Part of him is always waiting to know more – at every surgery, on every visit, every time the telephone rings. Like any Faust without the aid of the devil, he is a man who suffers frequently from a sense of anti-climax.

  This is why he exaggerates when he tells stories about himself. In these stories he is nearly always in an absurd position: trying to take a film on deck when the waves break over him; getting lost in a city he doesn’t know; letting a pneumatic drill run away with him. He stresses the disenchantment and deliberately makes himself a comic little man. Disguised in this way and forearmed against disappointment, he can then re-approach reality once more with the entirely un-comic purposes of mastering it, of understanding further. You can see this in the difference between his two eyes: his right eye knows what to expect – it can laugh, sympathize, be stern, mock itself, take aim: his left eye scarcely ever ceases considering the distant evidence and searching.

  I say scarcely ever, but there is one exception. This is when he is occupied with some relatively minor surgical task. He may be setting a fracture in his surgery, or attending to one of his patients in the local hospital. On these occasions both eyes concentrate on the task in hand and a look of relief comes over his face. As soon as he takes his coat off, rolls up his sleeves, washes his hands, puts on gloves or a mask, this relief is apparent. It is as though his mind is wiped clean (hence the relief) in order to concentrate exclusively on the limited operation in hand. For a moment there is certainty. The job can be done well or badly: the distinction between the two is beyond dispute: and it must be done well.

  I saw a similar expression on the face of a farmer who lives only a few miles from Sassall. This farmer is mad about flying and owns a six-cylinder open-cockpit Czech plane. His farm is not a large or particularly prosperous one. Nor is he part of the gentry. He lives by himself and likes speed. He keeps the plane under an oak-tree in one of his fields. When we had driven the sheep to the other end of the field, and I had turned the prop and he and Jean Mohr were settled and the engine was warm, he signalled to me to let go of the tip of the wing – I was holding it for the plane had no brakes – and at that moment, just before they took off, although there was a gusty wind blowing and the field was very rough and the take-off was liable to be quite tricky, I saw exactly the same look of relief pass over the farmer’s unshaved, chunky, middle-aged face. The problems now were limited to aerodynamics and the functioning of a small internal-combustion engine: the problem of prices, mortgages, Monday’s market, relations, reputation, would all in a moment be beneath them.

  The difference between the farmer and Sassall is that the farmer would like to be able to spend all his life blithely flying and gliding – or anyway believes that he would; whereas Sassall needs his unsatisfied quest for certainty and his uneasy sense of unlimited responsibility.

  So far I have tried to describe something of Sassall’s relationship with his patients. I have tried to show why he is thought of as a good doc
tor, and how being ‘a good doctor’ answers some of his own needs. I have suggested something of the mechanism by which he cures others to cure himself. But all this has been on an individual basis. We must now consider his relationship to the local community as a whole. What do his patients expect of him publicly when they are not ill? And how does this relate to their barely formulated expectations of fraternity within the privacy of illness?

  Sassall lives in one of the larger houses of the village. He is well dressed. He drives a Land Rover for his practice, and another car for his private use. His children go to the local grammar school. Without any doubt at all the part allotted him is that of gentleman.

  The area as a whole is economically depressed. There are only a few large farms and no large-scale industries. Fewer than half the men work on the land. Most earn their living in small workshops, quarries, a wood-processing factory, a jam factory, a brickworks. They form neither a proletariat nor a traditional rural community. They belong to the Forest and in the surrounding districts they are invariably known as ‘the foresters’. They are suspicious, independent, tough, poorly educated, low church. They have something of the character once associated with wandering traders like tinkers.

  Sassall has done his best to modify the part of gentleman allotted him, and has partly succeeded. He leads almost no social life of his own – except in the village with the villagers. It is when he is talking with his few middle-class neighbours that one is most aware of his own class background. This is because they assume in conversation and attitude that he shares their prejudices. With the ‘foresters’ he seems like a foreigner who has become, by request, the clerk of their own records.

  Let me try to explain what I mean by ‘the clerk of the foresters’ records’.

  ‘Where you’re different Doc is I know I can say Fuck You to your face if I want to.’ Yet the speaker never has said Fuck You to Sassall.

  ‘You’re the laziest bitch I’ve ever come across,’ says Sassall to the middle-aged woman draper whose day is now made. Yet only he can say this to her.

  ‘What have you got on?’ he asks about a menu at a factory canteen.

  ‘Do you want to start at the top,’ answers the girl at the counter pointing to her breasts, ‘or at the bottom?’ lifting her skirts up high. Yet she knows she is safe with the doctor.

  Sassall has to a large extent liberated himself and the image of himself in the eyes of his patients from the conventions of social etiquette. He has done this by becoming unconventional. Yet the unconventional doctor is a traditional figure. Where Sassall perhaps is different is that traditionally the unconventionality has only allowed the doctor to swear at and shock his patients instead of vice versa. Sassall would like to think that anybody can say anything to him. But insofar as this is true, it confirms rather than denies his position of privilege. To your equals you cannot say anything: you learn very precisely the form and area of their tolerance. The theoretical freedom of address towards Sassall implies his authority, his special ‘exemption’, precisely because theoretically it is total. In practice anything unconventional which he says or which is said to him in public is a gesture – no more – against the idea that his authority is backed by the authority of society. It is the form of personal recognition he demands of his patients in exchange for the very different recognition he offers them.

  In the village there is a medieval castle with a wide, deep moat round it. This moat was used as a kind of unofficial dump. It was overgrown with trees, bushes, weeds, and full of stones, old wood, muck, gravel. Five years ago Sassall had the idea of turning it into a garden for the village. Tens of thousands of man-hours of work would be involved. He formed a ‘society’ to occupy itself with the task and he was elected chairman. The work was to be done in the summer evenings and at week-ends whenever the men of the village were free. Farmers lent their machinery and tractors; a roadmaker brought his bull-dozer along; somebody borrowed a crane.

  Sassall himself worked hard on the project. If he was not in the surgery and not out on a call, he could be found in the moat most summer evenings. Now the moat is a lawned garden with a fountain, roses, shrubs and seats to sit on.

  ‘Nearly all the planning of the work in the moat,’ says Sassall, ‘was done by Ted, Harry, Stan, John, etc., etc. I don’t mean they were better at doing the work, better with their hands – they were that – but they also had better ideas.’

  Sassall was constantly involved in technical discussion of these ideas with the men of the village. The conversations over the weeks continued for hours. As a result a social – as distinct from medical – intimacy was established.

  This might seem to be the obvious result of just getting on with a job together. But it is not as simple or as superficial as that. The job offers the possibility of talking together, and finally the talk transcends the job.

  The inarticulateness of the English is the subject of many jokes and is often explained in terms of puritanism, shyness as a national characteristic, etc. This tends to obscure a more serious development. There are large sections of the English working and middle class who are inarticulate as the result of wholesale cultural deprivation. They are deprived of the means of translating what they know into thoughts which they can think.4 They have no examples to follow in which words clarify experience. Their spoken proverbial traditions have long been destroyed: and, although they are literate in the strictly technical sense, they have not had the opportunity of discovering the existence of a written cultural heritage.

  Yet it is more than a question of literature. Any general culture acts as a mirror which enables the individual to recognize himself – or at least to recognize those parts of himself which are socially permissible. The culturally deprived have far fewer ways of recognizing themselves. A great deal of their experience – especially emotional and introspective experience – has to remain unnamed for them. Their chief means of self-expression is consequently through action: this is one of the reasons why the English have so many ‘do-it-yourself’ hobbies. The garden or the work bench becomes the nearest they have to a means of satisfactory introspection.

  The easiest – and sometimes the only possible – form of conversation is that which concerns or describes action: that is to say action considered as technique or as procedure. It is then not the experience of the speakers which is discussed but the nature of an entirely exterior mechanism or event – a motor-car engine, a football match, a draining system or the workings of some committee. Such subjects, which preclude anything directly personal, supply the content of most of the conversations being carried on by men over twenty-five at any given moment in England today. (In the case of the young, the force of their own appetites saves them from such depersonalization.)

  Yet there is warmth in such conversation and friendships can be made and sustained by it. The very intricacy of the subjects seems to bring the speakers close together. It is as though the speakers bend over the subject to examine it in precise detail, until, bending over it, their heads touch. Their shared expertise becomes a symbol of shared experience. When friends recall another friend who is dead or absent, they recall how he always maintained that a front-wheel drive was safer: and in their memory this now acquires the value of an intimacy.

  The area in which Sassall practises is one of extreme cultural deprivation, even by English standards. And it was only by working with many of the men of the village and coming to understand something of their techniques that he could qualify for their conversation. They then came to share a language which was a metaphor for the rest of their common experience.

  Sassall would like to believe that the metaphor implies that they talk as equals: the more so because within the range of the language the villagers mostly know far more than he. Yet they do not talk as equals.

  Sassall is accepted by the villagers and foresters as a man who, in the full sense of the term, lives with them. Face to face with him, whatever the circumstances, there is no need for shame or complex
explanations: he will understand even when their own community as a whole will not or cannot. (Most unmarried girls who become pregnant come to him straightway without any prevarication.) Insofar as he is feared at all, it is by a few older patients in whom a little of the traditional fear of the doctor still persists. (This traditional fear, apart from being a rational fear of the consequences of illness, is also an irrational fear of the consequences of making their secret but outrageous and insistent demand for fraternity to doctors who always behave and are treated as their superiors.)

  In general his patients think of Sassall as ‘belonging’ to their community. He represents no outside interest – in such an area any outside interest suggests exploitation. He is trusted. Yet this is not the same thing as saying that he is thought of or treated as an equal.

  It is evident to everybody that he is privileged. This is accepted as a matter of course: nobody resents or questions it. It is part of his being the kind of doctor he is. The privilege does not concern his income, his car or his house: these are merely amenities which make it possible for him to do his job. And if through them he enjoys a little more comfort than the average, it is still not a question of privilege, for certainly he has earned a right to that comfort.

  He is privileged because of the way he can think and can talk. If the estimate of his privilege was strictly logical, it would include the fact of his education and his medical training. But that was a long time ago, whereas the evidence of the way he thinks – not purely medically but in general – is there every time he is there. It is why the villagers talk to him, why they tell him the local news, why they listen, why they wonder whether his unusual views are right, why some say ‘He’s a wonderful doctor but not what you’d expect’, and why some middle-class neighbours call him a crack-pot.