Eric Trump
Everything but the Medicine: A doctor’s tale by Lucy O’Hagan (Massey University Press, 2025), 288pp, $40; A Physician’s Journey: A memoir by Eric Espiner (Quentin Wilson, 2025), 244pp, $35
Almost thirty years ago, the American physician and writer Rita Charon coined the term narrative medicine and launched a genre. It is animated by the belief that patients and physicians have stories to tell and that these are vital to an understanding of the medical encounter. Through narrative, either fiction or non-fiction, patients and physicians are meant to create empathic bonds with each other and their audiences in order to extract meaning from suffering. Narrative medicine finds its way into medical humanities seminars, with medical students reading, say, Charon’s Narrative Medicine: Honoring the stories of illness or Virginia Woolf’s On Being Ill. These students may, in turn, keep a journal about their encounters with patients—patients who may be taking notes for their own memoirs.
Dr Lucy O’Hagan’s memoir, Everything but the Medicine: A doctor’s tale, grew out of the narrative medicine tradition. For her, story is linked to care, and she duly pays tribute to the powers of narrative: ‘Stories are how we make sense of things and each other. When we tell a story, we tell who we are, what is important to us, and we attribute meanings to happenings.’ The ideal physician, she says, combines attributes of the ‘medical doctor’, who embodies medical science and fixes bodies, and the ‘story doctor’, who attends to the ‘illness that resides in a person’s life story’. Medicine cures; story heals.
O’Hagan, an accomplished physician who has worked for decades in a wide variety of contexts in New Zealand, has many stories to tell about her patients and herself, and how to care for both. She is a general practitioner. GPs are the plankton of the medical system, often overlooked but essential to its functioning. As she puts it in ‘GP in a small town’, a self-deprecating poem included in her memoir: ‘I have saved lives / but mostly I just watch lives / … I mainly give out tissues and condoms and tend the wounded.’ In chapters ranging from fragments to fully fleshed accounts to the shredded prose of free verse, we learn about her brother’s death, her son’s epilepsy, her marriage’s dissolution and her professional burnout. She also tells us about patients who refuse medication, who live out of their cars, whose bodies bear the scars of cutting, whose lifeless bodies—belonging to Freda, Bert or Maggie, people she’s known for years—need to be confirmed as dead.
These sometimes compelling stories are unfortunately studded with pat conclusions reminiscent of the inspirational signs you might find at your auntie’s bach: ‘Home is a kind of somewhere. A somewhere we long for’; ‘Keep off high horses’; ‘Be yourself’; ‘Don’t be a dick’. Young doctors are advised to ‘laugh’ and ‘learn to love’ because, she concludes, quoting English physician and academic Ian McWhinney, ‘In the end … we are healed by love.’
Anyone who was saved and healed by surgery and pharmaceuticals, as I was (twice), might disagree. But that’s the problem with slogans: they don’t invite dialogue but bury it under generalisations. At times, O’Hagan’s book reads like a vade mecum written by Patch Adams. At others, the cuteness goes too far, as when she compares her patients to dogs who enter her office with tails between their legs, snarling. If you pat them enough, they relax. Conclusion, with a dash of condescension: ‘Make your patients’ tails wag.’
These slogans point to the book’s more troubling feature, namely, the caricatures O’Hagan makes of the ‘colonising flag of Western medicine’ and Māori conceptions of health and illness, which embody a ‘language for the spirit’. She wonders whether she is a ‘lazy Pākehā’ with an ‘ungainly Pākehā tongue’; but a wharenui she visits embodies ‘our relationship with an earth mother’, where ‘We can say love and medicine in the same sentence’. Western doctors are ‘health colonisers’ and ‘Suited Professionals’ who ‘decide who is sick and who is not’. A Māori elder ‘reminds us to look at the sea, honour the wai, marvel at the flight of the manu, listen for the tupuna.’
O’Hagan comes perilously close to opposing the stereotype of the Magical Māori to that of modern medicine, which is merely the ‘realm of the white man’. (This itself is an empty cliché, since more women than men now graduate medical school in New Zealand.) Her heart is in the right place: talking and listening are vital to medicine, and not all patients can be treated the same way. However, by pitting two rigidly stereotyped visions of care against one another, she creates a morally schematic world that precludes the bicultural communication she calls for.
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Dr Eric Espiner might have titled his memoir ‘Everything but the Physician’. What T.S. Eliot said about poetry goes for A Physician’s Journey: it is not the expression of personality but an escape from it. While we learn in often anaesthetising detail about his groundbreaking decades of research, very little of the man himself—apart from a handful of biographical details—breaks through. Unlike O’Hagan, he’s produced an impersonal memoir, a document rich in tables and diagrams and written more for his fellow researchers and future historians of endocrinology than for the uninitiated reader. Unlike O’Hagan, Espiner is indifferent to emotion or the exposure of secrets.
Espiner, who graduated from the University of Otago Medical School in 1957, actually does expose secrets, but they are of the hormonal kind. His subject and the focus of his long and fruitful career is endocrinology, the science of how hormones regulate such bodily functions as growth, reproduction and metabolism. Hormonal imbalances can have serious, existential effects. Novelist Hilary Mantel, who suffered from endometriosis, writes that if you are subjected to ‘hormonal caprice’, you lose ‘the pathways to self … When endocrine patterns change, it alters the way you think and feel.’
In austere prose marked by a steady rain of acronyms, Espiner takes us into his highly productive labs to ‘describe how hormones … can be used or manipulated’ to improve patient health. His memoir is composed of case studies built around the endocrinal puzzles he and his team worked on. Perhaps their greatest discovery is that the heart is an endocrine gland that secretes hormones (ANP and BNP) to maintain circulation. A blood test can now detect a failing heart. These same cardiac hormones are also involved in skeletal development and neurological problems such as Parkinson’s disease. Espiner and his team’s other important research includes studying the pituitary gland’s role in regulating adrenal function, the role of renin in controlling the secretion of aldosterone and developing tests for Conn’s syndrome. Along the way, he stresses the need for sustained funding from New Zealand agencies for significant research and the importance of collaboration and communication across disciplines and national boundaries, for teamwork is vital in his line of work.
No doubt Espiner is passionate about his research, but this passion may stand in the way of a compelling story. He breathlessly reports the results of an important test on the presence of a peptide hormone called CNP (C-type natriuretic peptide) in cerebrospinal fluid. See if you can follow along:
… human concentrations of both CNP and NT-proCNP in CSF were higher than concurrent levels in plasma. The ratio of NT-proCNP to CNP in CSF was much higher (144) than that found in plasma in these subjects (31), suggesting that degradation of the bioactive form was enhanced by tissues of the CNS compared to those outside the blood–brain barrier.
Here, he endeavours to explain how the pioneering heart medication Captopril works:
Captopril was the first of several generations of drugs inhibiting the conversion of angiotensin (produced by actions of renin on a liver protein, angiotensinogen) to the highly active vasoconstrictor angiotensin II (see Fig 7). It did so by binding to the angiotensin-converting enzyme (ACE) in tissues of the lung, preventing the conversion of the angiotensin I precursor to angiotensin II.
His excitement is evident in these sentences, but for many readers the result will be bafflement. Much of Espiner’s memoir reads this way: science and internationally significant discoveries told from a clinical distance with unforgiving terminology. A few snatches of dialogue, a vivid summary like Hilary Mantel’s, a bit of scene-setting—any of these would have gone a long way to making Espiner’s book palatable to a general readership. As it stands, this book will probably find its way into the hands of fellow physicians and researchers. That the memoir ends with twenty-nine pages of citations to Espiner’s published academic articles and book chapters is perhaps another indication of this book’s intended readers.
O’Hagan’s and Espiner’s memoirs are testaments to how they have improved and saved lives during their careers so far. Their love of medicine and research is palpable. Their skills and discoveries have helped legions to live better lives. Both, despite their very different narrative styles, call for sustained communication and collaboration, either between patients and physicians or researchers and their partners in other institutions.
But, as journalist Patrick Smith says of memoir, it ‘represents the democratisation of the written word, because everyone has a story and, as with the harmonica, anyone can make a noise’. Editors sometimes need to step in to make music of the noise. I wonder why, in Dr O’Hagan’s book, no one drew a red line through comparing patients to dogs or challenged her generalisations or emended the bibliography’s citation from ‘Arthur Franks’ to the correct ‘Arthur Frank’. And in Dr Espiner’s book, why didn’t an editor dig deeper for a narrative spine or break the logjam of acronyms or, indeed, democratise the written word? Perhaps editors and writers need to communicate and collaborate better, too.
ERIC TRUMP is a writer and reviewer who lives in Ōtepoti Dunedin. He teaches medical humanities at the University of Otago.
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