‘Adventures in Human Being’ by Gavin Francis (Profile Books, 2015)
Gavin Francis’ Adventures in Human Being is a compelling collection of essays that takes the reader on a metaphorical journey through the human body from the point of view of a practising doctor. It is a mesmerizing and fascinating journey through the intertwined landscapes of the human body, layered with history, art and literature.
Francis currently works as GP in Edinburgh but, perhaps most importantly, he is part of a line of doctor-writers, including such distinguished contributors as Chekhov and Bulgakov. This line has in recent years developed into a successful genre and include, amongst others, the neurosurgeon Henry Marsh, the surgeon Atul Gawande and the oncologist Siddartha Mukherjee, whose 2011 book, The Emperor of All Maladies, won the Pulitzer prize.
The author divides the book into the areas of the body, including sections on the brain, head, chest, upper limbs, abdomen, pelvis and lower limbs. In each section, he brilliantly interlaces his own personal experiences as a GP with the history of medicine and works of art and literature. In doing so, Francis accompanies readers through an adventurous journey across the human body in the discovery of complex patterns in an otherwise fragmented discipline. These patterns unravel through narratives that are situated in the present, but are deeply anchored in the history of discovery.
The (often metaphorical) theme of a journey is accompanied by analogies between body and nature (see p. 38), and runs throughout the book. This approach allows the author to highlight along the way the ephemeral character of the body, in all its fragility and complexity. This ephemerality is also reflected in the structure of the book itself, which, as the author reveals, is composed of a series of essays or “attempts” to explore each part of the body, but culminates in the final acknowledgment of the impossibility of a task wanting to accept it all (p. 3).
A particularly enjoyable quality of Francis’ narrative is his ability to describe his feelings on meeting people as patients, so that readers are able to get an almost tangible appreciation, through his words, of the hidden beauty, the sacred character of illness seen through the eyes of a physician: ‘the first time I saw someone collapse with a fit, convulse, then drift off to sleep, it was as if I’d watched a process of possession, catharsis and sanctification’ (p. 19). But, readers can also perceive the emotional burden of care, which is often hidden in the clinical language, in that expression of ‘detached efficiency’ which, as Francis highlights, is in fact full of emotional transactions (p. 93).
The caring side of healthcare is indeed an important part of this book. Francis beautifully connects the art and the science of anatomy with the affective domain. He does so in many ways: for example by describing how Leonardo da Vinci’s aim to ‘comprehend every aspect of human being’ brought him to minutely study the facial muscles in order to ‘come close to understanding the divine source of emotions themselves’ (p. 47). Additionally, Francis introduces the reader to the lesser known works of Charles Darwin, who in his work, The expression of the emotions in man and animals, said: ‘He who gives way to violent gestures will increase his rage; he who does not control the signs of fear will experience fear in a greater degree’ (p. 59). This fascinating idea that what we show on the “outside” can change what we feel on the “inside” led Francis to observe closely the faces of his patients at his clinics, guided by both the aforementioned reflections and his “privileged” opportunity to look literally inside people’s faces (p. 45). Francis remarks that time is limited; a close detailed observation may help the physician to discover more about what is going on inside the patient. However, one of the many merits of this book is to prove how turning to the humanities can provide ‘a lesson to take back into […] medical practice’ (p. 98), a precious tool to understand patients better.
Francis uses his medicine for his writing, to provide nourishment to his intimate and close observation of humanity: ‘Training in emergency medicine often felt like being awash in a sea of humanity; my pocket textbook a pilot-book for mariners’ (p. 103). The author exquisitely portrays this humanity, and with his sensitive and beautiful accounts opens the doors for us to begin to understand it, almost implicitly emulating the role of literature in a physician’s life first beautifully recited by Chekhov (1888): ‘I feel more confident and more satisfied with myself when I reflect that I have two professions and not one. Medicine is my lawful wife, and literature is my mistress’. It might seem like a flippant comment but it is particularly important as it highlights how Checkhov is in a way precursor, and it clearly shows an historical continuity in medicine and the humanities that we are now seeing in Gavin’s work.
It is for all these reasons that we think Adventures in Human Being should be especially read by health professionals, both experienced consultants and trainees, and by medical students. This book has the right attributes to inspire, but also to help cultivate deep reflections that should be the essence of medical practice. Paraphrasing Michael Baum (2002), it is indeed through the teaching of the arts and the humanities that doctors can enhance their understanding of science and improve their communication skills, and thus become better doctors. However, this book should also be read by patients and the general public, albeit not only for the reasons highlighted above but also because it opens a window onto what the medical professionals often experience in their daily jobs and could therefore nurture a much needed mutual understanding amongst these groups.
Medicine has been defined ‘an uncertain science’ (Mukherjee 2015). At its core is human frailty and uncertainty, and Gavin Francis’ book is a testament to what makes medicine an art, to what makes medicine, with all its enormous advances, still rooted in human frailty. It leads us, the traveller, through the human body; to discover how medicine comes not only from science but also from the Hippocratic tradition, where the iatros practised the art of care.
Reviewed by Annalisa Manca and Jonathan McFarland.
Annalisa is a medical educationalist at the University of Dundee Medical School, with a strong interest in medical humanities and the emotional well-being of healthcare professionals. She is also interested in the collaborative, dialogical and cognitive processes happening in social learning environments and the educational features related to the social dimension of knowledge. Annalisa regularly runs workshops at international medical education conferences and blogs about technology and education in healthcare professions.
Correspondence to Annalisa Manca
Annalisa can be followed on Twitter: @AnnalisaManca
Jonathan is an expert in Medical English. He mainly works for Ibsalut, the local Health Authority for the Balearic Islands but he is also very interested in International communication in Medicine, and is currently collaborating with Sechenov Medical University in Moscow (curiously enough where Anton Chekhov studied medicine). He is President of the Medical Humanities Association for Mallorca, and is also studying a Masters in Medical Education at Dundee University. He regularly presents at International conferences on the topics of Medical English, Communication and Humanities.
Jonathan can be followed on Twitter: @Medicalenglishb
Baum, M. 2002. Teaching the humanities to medical students. Clinical Medicine, 2: 246-9.
Chekhov, A. 1888. Letter to A. S. Suverin, September 11, 1888, in: Complete Works of Anton Chekhov. Delphi Classics (2014).
Mukherjee, S. 2011. The Emperor of All Maladies: a Biography of Cancer. Scribner.
.2015. The Laws of Medicine: Field notes from an Uncertain Science. Simon & Schuster UK.