A Fortunate Man: The Story of a Country Doctor

by John Berger

  Yet why should time seem to change its pace? What is the difference between a child and an adult in this respect? Sartre in his first novel5 offers a clue. The book as a whole is partly concerned with a similar and parallel problem: how to achieve a sense of adventure given a full awareness of the nature of time. This is how he describes the habitual life of the adult.

  When you are living, nothing happens. The settings change, people come in and go out, that’s all. There are never any beginnings. Days are tacked on to days without rhyme or reason, it is an endless, monotonous addition. Now and then you do a partial sum: you say: I’ve been travelling for three years, I’ve been at Bouville for three years. There isn’t any end either: you never leave a woman, a friend, a town in one go. And then everything is like everything else: Shanghai, Moscow, Algiers, are all the same after a couple of weeks. Occasionally – not very often – you take bearings, you realize that you’re living with a woman, mixed up in some dirty business. Just for an instant. After that, the procession starts again, you begin adding up the hours and days once more. Monday, Tuesday, Wednesday. April, May, June. 1924, 1925, 1926.

  Sartre contrasts this ‘living’ with the occasional ‘feeling of adventure’. This feeling need have nothing to do with exciting events. It is a form of heightened awareness giving a sensation of order – and therefore of meaning – to the very fact and limitations of existence.

  This feeling of adventure definitely doesn’t come from events: I have proved that. It’s rather the way in which moments are linked together. This, I think, is what happens: all of a sudden you feel that time is passing, that each moment leads to another moment, this one to yet another and so on; that each moment destroys itself and that it’s no use trying to hold back, etc., etc., and then you attribute this property to the events which appear to you in the moments; you extend to the contents what appertains to the form …

  If I remember rightly, they call that the irreversibility of time. The feeling of adventure would simply be that of the irreversibility of time. But why don’t we always have it?

  The irreversibility of time is something that young children are well aware of, although the concept could mean nothing to them. They live with it. There are no inevitable repetitions in childhood. ‘Monday, Tuesday, Wednesday. April, May, June. 1924, 1925, 1926’ represents the antithesis of their experience. Nothing is bound to repeat itself. Which, incidentally, is one of the reasons why children ask to be reassured that some things will be repeated. ‘And tomorrow I will get up and have breakfast?’ Gradually after the age of about six, they can answer the question for themselves and they begin to expect and depend upon cycles of events; but even then their unit of measurement is so small – their impatience, if you wish to call it that, is so great – that the foreseen still seems too far off to qualify the present to any important degree: their attention still remains on the present in which things constantly appear for the first time and are constantly being lost for ever.

  One of the most widespread adult illusions is the belief in second chances. Children, until they are otherwise persuaded or bribed by adults, know that they do not exist. Their necessary self-abandonment to experience makes it impossible for them to entertain such an idea. The adult belief in them is a double buffer against experience. Not only is everyone given countless second chances, but the uniqueness of every event is blurred over, if not destroyed. And so, as time goes on, or rather fails to go on, we can tentatively propose that the world has become familiar with us, even that the world on the basis of past events is our debtor. Children have no need for such protection.

  They have no need for it because their own opportunities seem to stretch further than they can imagine. Their own time is endless. They are constantly experiencing a sense of loss: it is the prerequisite, as Sartre points out, of a sense of adventure. Every parting, however trivial, the end of any game or event, represents a final loss which no repetition will mend. Sometimes they need to protest: then they cry out in the hope that the loss can be postponed, or in true regret for what has gone. I say true regret because it is the thing lost which remains the centre of their attention: not, as frequently with adults, their own imagined state of deprivation in the future. Their sense of loss is bounded by the next event or interest. Young children have an almost insatiable appetite for ‘the next thing’. The next is needed to take the place of what has irrevocably gone.

  There is another reason why young children recover from total loss so quickly. Nothing fortuitous happens in a child’s world. There are no accidents. Everything is connected with everything else and everything can be explained by everything else.6 (The structure of their world is similar to that of magic.) Thus for a young child a loss is never meaningless, absurd – and, above all, unnecessary. For a young child everything that happens is a necessity.

  When we suffer anguish we return to early childhood because that is the period in which we first learnt to suffer the experience of total loss. It was more than that. It was the period in which we suffered more total losses than in all the rest of our life put together. Even supposing that no neurotic pattern still forces us to react as we once reacted on some forgotten but terrible occasion as a child, we are bound to refer ourselves back to that period, for in the intervening years we have only rarely and perhaps never grasped, as we had to grasp continually as children, the iron irreversibility of events.

  And yet we are not children even when we suffer again in this way. Above all, we can be aware, as children cannot, of the arbitrariness of our condition. What Sartre calls its gratuitousness.

  I mean that, by definition, existence is not necessity. To exist is simply to be there; what exists appears, lets itself be encountered, but you can never deduce it. There are people, I believe, who have understood that. Only they have tried to overcome this contingency by inventing a necessary, casual being. But no necessary being can explain existence: contingency is not an illusion, an appearance which can be dissipated; it is absolute, and consequently perfect gratuitousness. Everything is gratuitous, that park, this town, and myself. When you realize that, it turns your stomach over and everything starts floating about, as it did the other evening at the Rendez-vous Des Cheminots; that is the Nausea…

  A depressed or bereaved forester obviously does not think like a professional philosopher. But he can see the forest, or the gas-stove in the downstairs room, or the newspapers piled under the dresser in the same light as Sartre describes here. It is almost a question of the light – or rather of how the mind interprets the light. It is a light which objectifies everything and confirms nothing. No child ever sees such a light. It is as different from the light in which a child sees the forest or the kitchen as is darkness.

  I wonder whether I begin to make myself clear. Anguish arises from a sense of irreparable loss. (The loss may be real or imaginary.) This loss is added to all the other losses sustained during one’s life: these other losses represent the absence of what one might otherwise have turned to for consolation on the occasion of this one, the most recent and final of all. Most of these other losses were suffered in childhood – for that is the nature of childhood. Thus the experience of loss tends to return, redeliver one to one’s childhood. If the experience is partly or wholly neurotic, the return to childhood is actually part of the experience. If the experience is not neurotic, it is the sense of helplessness which leads one back. This helplessness – equally present in neurotic cases – changes one’s sense of time. It is a helplessness in face of the real or imagined irreversibility of what has happened. Such awareness of irreversibility slows down time. Moments can ‘seem like years’ because, like a child, one feels that everything has changed for ever. The notion of repetition is suddenly removed from the reality of time. In the case of young children this can amount to a form of heightened awareness and is indeed the secret of much of their sense of adventure. But this is because they are able to explain and justify – at least on one level – everything that happens, every lo
ss included. By contrast the anguished adult suffers the conviction that what has happened is absurd; or at the best, is without sufficient meaning. That is to say the meaning which remains cannot possibly balance what has been lost. Consequently the man or woman in anguish is trapped in the time-scale of childhood without a child’s protection, suffering a uniquely adult agony.

  Sassall meets anguished patients on his rounds – the close relatives of the dying, those who are ill and want to die, the immobilized who are made desperate by a kind of claustrophobic fear of their own bodies, the insanely jealous, the lonely who try to kill themselves, the hysterics; sometimes he is able to reach them: sometimes it is obvious that he never will. In the evenings after supper he has long appointments lasting an hour with patients whom he believes he can help through psychotherapy. They suffer their crises with him and these crises too can mount to the pitch of anguish.

  The psychologist G. M. Carstairs, writing from the comparatively detached point of view of a teaching professor, in no way underestimates the stress of such encounters.

  To encounter a fellow human being in a state of despair compels one to share, at least in imagination, his elemental problems: Is there any meaning in life? Is there any point in his staying alive?

  I believe, however, that the questions tend to present themselves to Sassall in terms of the experience of time. The elemental problem becomes: What is the value of the moment?

  It is as though time became the equivalent of Conrad’s sea: the sickness the equivalent of the weather. It is time which can promise ‘the peace of God’ and which can lash and destroy with ‘unimaginable’ fury. Again I am forced to use what may be a clumsy metaphor in the attempt to define a hidden, subjective experience – the generalized impact on a doctor’s imagination of the suffering which he meets almost daily and which cannot be settled by writing prescriptions.

  Sassall attends all the midwifery cases in his practice – is present at almost every birth. He is also present at most deaths. He is continually being reminded of how much difference a moment can make and of how irreversible, how carefully prepared the process which leads up to that moment is. To some degree he can interfere with the process. He can speed it up, he can slow it down, he can ‘play for time’. But he cannot turn the sea into dry land.

  Patients, when their illness has been given a name, usually ask next: And how long will it take? How long will it be before …? How long? How long? And the doctor replies that he cannot promise but … He can appear to be the controller of time, as, on occasions, the mariner appears to rule the sea. But both doctor and mariner know this to be an illusion.

  All doctors are more than usually aware of death – though some do their best to hide the metaphysical fact by thinking only in terms of the physiological stages of dying. In the human imagination death and the passing of time are indissolubly linked: each moment that passes brings us nearer to our death: and our death, if it can be measured at all, is measured by that apparent eternity of existence which must continue after and without us.

  This may help to explain Sassall’s preoccupation with time. What is the value of the moment sub specie aeternitatis? But the confrontation with anguish is even more important. The anguished are trapped in a moment which is born of all that has happened to them. Faced with the rigid irreversibility of events – so terrible for all who are unprepared, and none can be fully prepared – it is their experience which bends in a circle: unable to catch time by the tail, they chase their own, revolving in one moment blindly through all their life. How much then can a moment contain?

  And how can one moment be compared to another person’s experience of the same moment? Often it seems almost incredible that Sassall putting out a hand to touch a patient finds the patient there, coexisting.

  The objective co-ordinates of time and space, which are necessary to fix a presence, are relatively stable. But the subjective experience of time is liable to be so grossly distorted – above all by suffering – that it becomes, both to the sufferer and to any person partially identifying himself with the sufferer, extremely difficult to correlate with time proper.

  Sassall not only has to make this correlation, he also has to correlate the patient’s subjective experience of time with his own subjective experience. When he has left the patient and is turning the Land Rover round, preparing to drive off, he may suddenly glimpse out of the corner of his mind’s eye the comparative emptiness of that present moment for him, and this emptiness can terrify.

  Sassall, except when involved in the actual treatment of patients, is the most impatient man I know. He is incapable of waiting and doing nothing. He is incapable of resting. He sleeps easily but, at heart, he welcomes being called out at night. He finds it extremely hard to accept as normal the normal content of a day, an hour, a minute. His passion for knowledge is a passion for constructive experience with which to so fill his time that subjectively it becomes comparable with the ‘time’ of those in anguish. It is of course an impossible aim: to construct, to relieve, to cure, to understand, to discover with the same intensity per minute as those in anguish are suffering. Sometimes the aim, as it were, releases Sassall; but mostly he is its slave.

  Unrealizable aims possess many men – all artists, for example. The special stress under which Sassall lives is the result of his isolation and his responsibility. He cannot, like artists, give himself up to his visions. He must remain observant, precise, patient, attentive. And, at the same time, he must face alone all the shocks and confusion which have led to the aim. If he were working with colleagues he would never ask them: What is the value of a moment? Nor could any of them reply, if he did. But the question would present itself far less persistently. Their presence would automatically supply the professional context in which the implications of medical cases are strictly limited. As it is, the implications for Sassall can be almost limitless. What is the value of a moment?

  I said that the price which Sassall pays for the achievement of his somewhat special position is that he has to face more nakedly than many other doctors the suffering of his patients and the sense of his own inadequacy. I want now to examine his sense of inadequacy.

  There are occasions when any doctor may feel helpless: faced with a tragic incurable disease; faced with obstinacy and prejudice maintaining the very situation which has created the illness or unhappiness; faced with certain housing conditions; faced with poverty.

  On most such occasions Sassall is better placed than the average. He cannot cure the incurable. But because of his comparative intimacy with patients, and because the relations of a patient are also likely to be his patients, he is well placed to challenge family obstinacy and prejudice. Likewise, because of the hegemony he enjoys within his district, his views tend to carry weight with housing committees, national assistance officers, etc. He can intercede for his patients on both a personal and a bureaucratic level.

  He is probably more aware of making mistakes in diagnosis and treatment than most doctors. This is not because he makes more mistakes, but because he counts as mistakes what many doctors would – perhaps justifiably – call unfortunate complications. However, to balance such self-criticism he has the satisfaction of his reputation which brings him ‘difficult’ cases from far outside his own area. He suffers the doubts and enjoys the reputation of a professional idealist.

  Yet his sense of inadequacy does not arise from this – although it may sometimes be prompted by an exaggerated sense of failure concerning a particular case. His sense of inadequacy is larger than the professional.

  Do his patients deserve the lives they lead, or do they deserve better? Are they what they could be or are they suffering continual diminution? Do they ever have the opportunity to develop the potentialities which he has observed in them at certain moments? Are there not some who secretly wish to live in a sense that is impossible given the conditions of their actual lives? And facing this impossibility do they not then secretly wish to die?

  Sassall bel
ieves that adversity can temper character. But can their groping and sometimes blind unhappiness be called adversity?

  What is the cause of boredom? Is boredom anything less than the sense of one’s faculties slowly dying? Why do they have more virtues than talents? Who can deny that a culturally deprived community offers far fewer possibilities through sublimation than a culturally advanced one?

  How much right have we to go on being always patient on behalf of others?

  It is from questions such as these – and a hundred others that force their way up through the pauses between these questions – that the disquiet, which finally leads to Sassall’s sense of inadequacy, first arises.

  He argues with himself in an attempt to maintain his peace of mind. The foresters are not subject to the same frantic pressures as millions keeping up appearances in the suburbs. Families are less fragmented: appetites less insatiable: the standard of living of the foresters is lower but they have a greater sense of continuity. They may lack cultural opportunities individually: but collectively they have their Parish Council, their Moat Society, their Dart Teams, etc. These all encourage a sense of community. There is less loneliness in the Forest than in many cities. They are, as they might answer themselves, as happy as can be expected.

  He refers the question back to his former self – the surgeon, the doctor of stark emergency, who tried to transform the foresters into Greek peasants. The foresters have no illusions about life, he says, only a small minority complain. Mostly they proceed with the business of living undaunted. They do not allow themselves – they cannot afford it – to be governed by their sensibilities. The notion of endurance is fundamentally far more important than happiness.

  Abandoning his former self, Sassall now takes a realistic view of the world we live in and its brute indifference. It is the nature of this world that good wishes and noble protests seldom mitigate between the blow and the pain. For most of those who suffer, there is no appeal. The Vietnamese villages are burned alive though nine-tenths of the world condemns the crime. Those who rot in prison serving inhuman sentences which the jurists of the world declare unjust, rot nevertheless. Most crying wrongs cry until there are no more victims to suffer them. When once the blow is aimed at a man, little can come between it and the pain. There is a strict frontier between moral examples and the use of force. Once pushed over that frontier, survival depends upon chance. All those who have never been pushed that far are, by definition, fortunate and will question the truth of the world’s brute indifference. All who have been forced across the frontier – even if they survive and return – recognize different functions, different substances in the most basic materials – in metal, wood, earth, stone, as also in the human mind and body. Do not become too subtle. The privilege of being subtle is the distinction between the fortunate and the unfortunate.