Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.
One shouldn’t judge a book by its cover, of course, nor by its title; but when 200,000 books are published each year, this is the counsel of perfection, and you have to judge by something. Some titles are more intriguing than others; recently, for example, I came across one that seemed to sum up the human predicament pretty succinctly: Until Further Notice, I Am Alive.
This was a quotation from an e-mail that Tom Lubbock, the author of the book and former art critic of a major newspaper, sent to a friend on learning, in 2008, that he had a neuroblastoma multiforme and that his expectation of life, with treatment, was only two years. Prognosis is an imperfect art, but in this case proved accurate. Diagnosed in October 2008, he died in January 2011.
Dr Johnson said that when a man knew that he was to be hanged in a fortnight it concentrated his mind wonderfully. But what about when he knew that he would die in two years, with the possibility of the dissolution of his mind before that of his body? The site and growth of the author’s tumour gave him increasing difficulties with language; the last entries in the diary of his illness, three months before he died, are short and fragmentary.
Lubbock quotes the French writer, Charles Péguy: “A word is not the same with one writer as with another. One tears it from his guts. The other pulls it out of his overcoat pocket.” Although the mystery of where our words and thoughts come from is perennial, we seldom think about it; but for Lubbock the problem became an almost physical one, as he struggled to pull words from, and form thoughts, somewhere in his mind.
He is complimentary on the whole about the medical profession, but he meets an arrogant neurosurgical registrar who, mistaking him for someone else, asks him whether he still experiences strange smells (he never experienced strange smells). There is nothing like being mistaken for another patient to make you feel small and insignificant; and the registrar also tells him he is lucky to have any speech left at all.
Lucky? What does the word “luck” mean here? Naturally the author asks himself why he should have a rare fatal disease, and the only answer he can find is that, if the disease exists, someone must have it. But was he lucky that it was initially operable, that it gave him no pain, that it preserved his intellect nearly until the end? Perhaps what the registrar meant was “Most people with a tumour such as yours in the same position in their brain would not be able to speak, therefore you are lucky.” This is a very restricted and inhuman notion of luck. How easy it is for a doctor to wound with a few thoughtless words! Let us all read, mark and inwardly digest.
Lubbock had a son eighteen months before he was diagnosed, the child of his heart; the author’s knowledge that this much-loved boy would remember nothing of him in his later life is poignantly expressed, and is all the more poignant because it is obvious to the reader that he would have been a very good father.
On the whole, I do not like memoirs of illness as a genre; I had a surfeit of them when a magazine once sent me seven of them for review. But at the end of this slender book, I felt a real sense of loss, almost of grief, as if I had known the author personally.