Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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.
Patrick McGrath (born 1950), the distinguished novelist, is the son of Dr Patrick McGrath (1916 – 1994), Physician Superintendent of Broadmoor Hospital between 1957 and 1981. Alas the latter, though he led a dramatic and varied life, committed very little to paper: not more, he said, than a few occasional medical papers and some letters to The Times. His life story would have been the stuff of legend.
In the first third of his novel Asylum, McGrath gives a lyrical picture of what it was like to grow up in the precincts of an institution for the criminally insane as the son of the superintendent, an upbringing half-prelapsarian and half-sinister. There may be better contemporary prose than this account, but if so I do not know it.
Though not a doctor himself, McGrath junior was clearly marked by the medical environment in which he grew up and absorbed the medical atmosphere for later use in his work. The protagonist of his novel Dr Haggard’s Death is a young registrar in surgery at a London teaching hospital just before the outbreak of the war (when McGrath’s father qualified) who fails to make the grade. His irascible boss, Vincent Cushing, does not think much of him; on one occasion he, Haggard, makes a hash of an appendectomy.
Dr Haggard has a passionate affair with the beautiful wife of the chief pathologist, the arrogant and unsimpático Dr Ratcliff Vaughan, who never manages – or even tries – to rid himself of the smell of cadavers and formalin. When Vaughan discovers the affair, he strikes Haggard across the face at the head of the hospital stairs, down which Vaughan falls and breaks his hip. He cannot reveal what Vaughan has done because to do so would harm his lover. In those days, neither adultery nor divorce were as lightly-regarded as they are now.
Dr Haggard remains in traction for three months: a Smith-Petersen nail is inserted into his femur by his boss, Cushing, who then dismisses him from his service. At the same time Mrs Vaughan brings the affair, the one great love-affair of Haggard’s life, to an end. He has lost everything, and knows that he will never recover from it. Nothing remains to him but general practice in a dispiriting seaside town on the South Coast, where senior civil servants and retired professionals go to die.
Haggard gives a name to the metal rod in his femur: Spike. Spike gives him trouble when the weather is damp and cold, or when disagreeable emotions and memories come to the fore in Haggard’s mind. He then injects himself with morphine; investigated by the Home Office for the practice’s high usage of narcotics, he succeeds in persuading the inspector that it is because of the nature of his patients, who are mostly decrepit or close to death.
On one occasion Haggard tries to defeat the habit by abstention, and there follows the usual exaggerated literary depiction of withdrawal effects from morphine; yet it is only too plausible that Haggard should himself be a victim of the mythology of withdrawal. Altogether, the novel is a sensitive depiction of loss and failure, so much more interesting than that of unbroken success: and more frequently encountered, too.
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