Introduction A Fortunate Man is a masterpiece of witness; a three-way meditation on humanity, society and the value of healing. First published in 1967 it remains strikingly original, blending John Berger’s text with Jean Mohr’s photographs in a series of superb reflections on the doctor’s role, the roots of cultural and intellectual deprivation, and the motivations that drive medical practice. The subject of the book, John ‘Sassall’, emerges as an individual deeply committed to inner reflection as well as to his vocation as a physician. When I was working as a newly qualified doctor it became my habit to give copies as gifts. For years it’s been out of print and increasingly scarce; the habit was becoming expensive. When asked how to approach his own work, Berger has often replied, ‘I’m a story-teller.’ ‘Even when I was writing on art,’ he said in 1984, ‘it was really a way of story-telling – story-tellers lose their identity and are open to the lives of other people.’* When I went to meet Berger, to ask him how he and Mohr came to create A Fortunate Man, he began by telling me a story. It started in London, in the early 1950s, when Berger was a commentator on art for the New Statesman. His essays and reviews were unconventional as well as controversial; he had to fight to keep his job. ‘We received a marvellous essay from an Indian writer called Victor Anant,’ he told me, ‘called “An English Christmas”. On the back of the envelope was the return address: “Left Luggage Office, Paddington Station”. I jumped on my motorbike and drove over to meet him. He’d not long arrived from Bombay, and this was the first job he’d found.’ * Interview in Marxism Today, December 1984, with Geoff Dyer.
420LL_TXT.indd 9
12/8/15 10:38 AM
10
Anant, like Berger, distrusted established power; in India he had been imprisoned by the Raj. The two men became friends and, several years later when Berger was living in rural Gloucestershire, Anant and his Pakistani wife were drawn to live nearby. Sassall was the single-handed general practitioner who attended the two men at that time. ‘I became friends with Sassall after going to him with some minor medical problem,’ Berger explained. ‘He cured me, and we became friends. I used to meet regularly with him and with Anant to play bridge.’ The two writers recognised in Sassall an outstanding physician as well as the enthusiast of an unfashionable ideal – the Renaissance dream of aspiring to universal knowledge and experience. As a doctor who sought daily to empathise with others, though they be of very different backgrounds and perspectives, they perceived that Sassall came closer to attaining this ideal than most men or women ever could. By the mid 1960s Berger had moved to Geneva, but both he and Anant were still in touch with Sassall. One day, Anant suggested that Berger write a book about their friend, his medical practice, and his determined pursuit of the universal. Berger again: ‘“You know, this man is really remarkable,” Anant told me, “but one day no one will know of him. His goodness will have consequences, of course, but unless you write about him, the specifics of his life and his attitude may not be preserved.”’ Jean Mohr was at that time also living in Geneva; a photojournalist with the Red Cross and the United Nations who had done some of his finest work documenting the stateless experience of Palestinian refugees. ‘Jean is one of the truly great photographers,’ Berger told me, ‘utterly invisible, blending into the background like a lamp-stand – the perfect man to sit in on medical consultations.’ Sassall invited Berger and Mohr to live with him and his family for six weeks and, with his patients’ permission, join him night and day in the clinic and on emergency visits.
420LL_TXT.indd 10
8/21/15 9:00 AM
11
Afterwards the two men returned to Geneva and worked in isolation from one another for just a month – Berger recalls the text flowing fairly quickly. ‘When we got together again, and compared what I’d written with the photographs Jean had chosen, we found we’d replicated one another’s work entirely,’ he said. ‘They were tautologous – as if my text was a series of captions to his images. We had both tried to write the book on our own. That’s not what we wanted at all, so we reworked it so that the words and pictures were like a conversation; building on, rather than mirroring, one another.’ Sassall checked the manuscript and made some minor corrections – ‘medical terminology, technical comments, that sort of thing’ – but was otherwise happy with it. In April 1967 the book was published. The Guardian carried an early review by Tom Maschler, the celebrated editor at Jonathan Cape, placed between a photograph of a Vietnamese baby scarred with napalm and an advertisement for woollen mini-dresses. ‘It is a beautiful book’, Maschler wrote, ‘John Berger writes with a passion, with an intensity that few writers could achieve.’ He is particularly entranced by the way Sassall, as portrayed by Berger, has an insatiable appetite for human experience, and imaginatively enters the minds of his patients. He closes with the lament that many reviewers feel when confronted by such a visionary and transformative work, but few have the courage to articulate: ‘I only wish I could do justice in a few words to the richness that makes this book so compelling.’ Philip Toynbee, writing in the Observer a few days later, called it ‘a series of brilliant descriptive sketches . . . a genuine tour de force, and the admirable photographs of the local countryside and its inhabitants match and illuminate the text with an unusual degree of sympathetic understanding’. Toynbee felt particularly well-qualified to comment on the accuracy of Berger’s portrayal of the physician: the book’s subject happened to be his own doctor.
420LL_TXT.indd 11
8/21/15 9:00 AM
12
‘The Sassall who emerges from these pages – both from the text and from the photographs – is indeed the man that I myself have known, liked, and admired for several years. But he is more than the man I know, not because Berger has romanticised him or enlarged him, but because Berger knows him better than I do and has thought about him harder.’ A Fortunate Man is a memorial not just to this exceptional individual but to a way of practising medicine that has almost disappeared. Sassall’s approach to his practice is all-consuming – in today’s culture of working-time-directives and the commercialisation of disease it would be almost impossible to sustain. Sassall has made a Faustian pact: he is rewarded with endless opportunities for experiencing the possibilities inherent in human lives, but at the cost of being subject to immense, and at times unbearable pressures. These pressures manifest themselves as episodes of profound depression, periods during which he is overwhelmed by ‘the suffering of his own patients and his own sense of inadequacy’. The book opens with a series of ‘case studies’, though the term is too clinical and doesn’t reflect either the emotional subtlety of Berger’s word-sketches or the versatility of Sassall’s responsiveness to his patients. They are glimpses of the situations Sassall responds to every day, recognisable to any doctor, but they convey the extraordinary depth of Sassall’s commitment to his patients. They tell of the struggles of those patients, and also show how powerful an influence the landscape exerts on the community and its stories. As Berger writes in the opening pages: ‘Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.’ Within that landscape the community looks to Sassall as a ‘clerk of records’; the figure to whom they tell their stories: ‘He keeps the records so that, from time to time, they can consult them themselves.’
420LL_TXT.indd 12
8/21/15 9:00 AM
13
Berger and Mohr follow Sassall through these parallel landscapes – the physical landscape of rural England and the metaphorical one of his patients’ lives. The moral possibilities of medical practice are drawn out, without shying away from the risks that doctors like Sassall run in identifying so closely with those suffering mental and physical pain. The myth of Faust, the life of Paracelsus, the works of Conrad, and the dream of the universal are each examined for the ways they illuminate aspects of Sassall’s motivation. He is compared to one of Conrad’s Master Mariners who sets out to compass not the globe, but the totality of human experience. Towards the end Berger tries to make an assessment of Sassall’s contribution to society and his community, but finds that he cannot. A society that doesn’t know how to value the lives of its people can’t adequately account for the value of easing their pain. ‘What is the social value of a pain eased?’ Berger asks, ‘What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but extremely difficult diagnosis compare with painting a great canvas?’ The absurdity of the questions reveals just how far we have to go in appreciating the value not just of art, but of life. In the years after publication Berger moved to Haute Savoie, a remote Alpine district in the south-east of France close to the Swiss and Italian borders, in order to live closely with people who worked the land. ‘I didn’t go to university,’ he told me, ‘the peasants were my university professors.’ Like Sassall in rural Gloucestershire, Berger became a ‘clerk of records’ for the people he came to live amongst. He poured his reflections on their lives into his trilogy Into Their Labours, as well as works such as The Seventh Man: his exposition, again with Mohr, of Europe’s exploitation of peasant migrant labour. As a story-teller, Berger wishes to lose his identity in that of his subject and his readers, just as Sassall sought to lose his identity in those of his patients. His
420LL_TXT.indd 13
8/21/15 9:00 AM
14
assessment of Sassall could stand for an assessment of his own life and work: ‘Like an artist or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.’ A few years after A Fortunate Man was written Sassall’s wife died unexpectedly. At the end of his Observer review, Philip Toynbee confessed to a ‘quarrel’ with Berger for leaving her out of the narrative, though the book is dedicated in part to her: ‘this racked and pain-haunted man would have collapsed long ago, and perhaps irretrievably, if it hadn’t been for his wife,’ Toynbee wrote, ‘Her role is as archetypal as his.’ Following her death Sassall left the Gloucestershire practice and travelled for some time in China, learning the ways of the barefoot doctors who were then the main providers of medical care in rural China. His death in 1982, alluded to in Berger’s own postscript, deepens the enigma of his life. A careful reading of A Fortunate Man reveals its title to be a paradox; fitting for a study of a man whose very openness to experience – his gift to the world – may also have been his undoing. A Fortunate Man is almost fifty years old, but remains fresh, urgent and relevant; a reminder for physicians and patients alike of the essence of medical practice – of the differences between healing and medicating. It is a text with resonance for anyone who admires Sassall’s pursuit of the universal. Like all great works it is many things: a celebration of a way of medicine that we have all but lost, a ground-breaking exercise in photo-documentary, a literaryphotographic creation of lasting beauty and a personal study of a man who aspired to an impossible ideal. Sassall’s goal was an intimate appreciation of what it means to be human; medicine was just the vehicle he chose to reach it. In my own work as a general practitioner his kindness and imaginative empathy are an inspiration, but at the same time he stands as a warning of what
420LL_TXT.indd 14
8/21/15 9:00 AM
15
can happen when boundaries between a physician and his or her patients breaks down. In trying to assess Sassall’s qualities as a physician Berger wrote ‘he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity’. This quest for recognition, and for a sense of fraternity, has rarely been articulated so beautifully. Back in 1967, Tom Maschler concluded his Guardian review of A Fortunate Man saying simply: ‘I am grateful for it.’ I too am grateful: to Victor Anant for suggesting the book in the first place, to John Berger and Jean Mohr for crafting such a masterpiece, and of course to Sassall, and his family, for permitting the intimate details of his life and attitudes to be set down. Through this new edition I hope many more readers come to know that gratitude. Gavin Francis
420LL_TXT.indd 15
8/21/15 9:00 AM
23
One of them shouted a warning, but it was too late. The leaves brushed him down almost delicately. The small branches encaged him. And then the tree and the whole hill crushed him together. A man breathlessly said that a woodman was trapped beneath a tree. The doctor asked the dispenser to find out exactly where: then suddenly picked up his own phone, interrupted her and spoke himself. He must know exactly where. Which was the nearest gate in the nearest field? Whose field? He would need a stretcher. His own stretcher had been left in hospital the day before. He told the dispenser to phone immediately for an ambulance and tell it to wait by the bridge which was the nearest point on the road. At home in the garage there was an old door off its hinges. Blood plasma from the dispensary, door from the garage. As he drove through the lanes he kept his thumb on the horn the whole time, partly to warn oncoming traffic, partly so that the man under the tree might hear it and know that the doctor was coming. After five minutes he turned off the road and drove uphill, into the mist. As often up there above the river, it was a very white mist, a mist that seemed to deny all weight and solidity. He had to stop twice to open gates. The third gate was already slightly open, so he drove through it without stopping. It swung back and crashed against the rear of the Land Rover. Some sheep, startled, appeared and disappeared into the mist. All the while he had his thumb on the horn for the woodman to hear. After one more field he saw a figure waving behind the mist – as if he were trying to wipe clean a vast steamed-up window. When the doctor reached him the man said: ‘He’s been screaming ever since. He’s suffering something terrible doctor.’ The man would tell the story many times, and the first would be tonight in the village. But it was not yet a story. The advent of the doctor brought the conclusion much nearer, but the accident was not yet over: the wounded man was still screaming at the
420LL_TXT.indd 23
8/21/15 9:00 AM
24
other two men who were hammering in wedges preparatory to lifting the tree. ‘Christ let me alone.’ As he cried ‘alone’ the doctor was beside him. The wounded man recognized the doctor; his eyes focused. For him too the conclusion was nearer and this gave him the courage to be quieter. Suddenly it was silent. The men had stopped hammering but were still kneeling on the ground. They knelt and looked at the doctor. His hands are at home on a body. Even these new wounds which had not existed twenty minutes before were familiar to him. Within seconds of being beside the man he injected morphine. The three onlookers were relieved by the doctor’s presence. But now his very sureness made it seem to them that he was part of the accident: almost its accomplice. ‘He had a chance,’ said one of the kneeling men, ‘when Harry here shouted but he went and turned about the wrong way.’ The doctor set up the plasma for a transfusion into the arm. As he moved around, he explained what he was doing to try to reassure the others. ‘I shouted at him,’ said Harry, ‘he could have got clear if he’d looked sharp.’ ‘He would have got clear like that,’ said the third. As the morphine worked, the wounded man’s face relaxed and his eyes closed. It was then as though the relief he felt was so intense that it reached the others. ‘He’s lucky to be alive,’ said Harry. ‘He could have got clear like that,’ said the third. The doctor asked them if they could shift the tree. ‘I reckon we can if we are three now.’ Nobody was kneeling any longer. The three woodsmen were standing, impatient to begin. The mist was getting whiter. The moisture was condensing on the half-empty bottle of plasma. The doctor noticed that this fractionally changed its colour, making it look yellower than normal.
420LL_TXT.indd 24
8/21/15 9:00 AM
25
‘I want you to lift,’ he said, ‘while I put a splint on his leg.’ When the wounded man felt the reverberations in the tree as they levered it, he began to moan again. ‘We could injure him worse than ever,’ said Harry, ‘getting him out.’ He could see the crushed leg underneath like a dog killed on the road. ‘Just hold it steady,’ said the doctor. Again the doctor, whom they knew so well, seemed the accomplice of disaster as he worked under the tree on the leg the fourth of them would lose. ‘We’d never believed you’d got here so quick, doc,’ said the third. ‘You know Sleepy Joe?’ asked the doctor. ‘He was trapped under a tree for twelve hours before any help came.’ He gave instructions on how to lift the wounded man on to the door and then into the back of the Land Rover. ‘You’ll be all right now Jack,’ said one of them to the wounded man whose face was as damp and pallid as the mist. The third touched his shoulder. The ambulance was waiting at the bridge. When it had driven off, Harry turned to the doctor confidentially. ‘He’s lost his leg,’ he said, ‘hasn’t he?’ ‘No, he won’t lose his leg,’ said the doctor. The woodman walked slowly back up to the forest. As he climbed he put a hand on each thigh. He told the other two what the doctor had told him. As they worked there during the day stripping the tree, they noticed again and again the hollow in the ground where he had been trapped. The fallen leaves there were so dark and wet that it was impossible to distinguish the blood. But every time they noticed the place they questioned whether the doctor could be right.
420LL_TXT.indd 25
8/21/15 9:00 AM
She is a woman of about thirty-seven. There is just still about her the air of a schoolgirl: one of the less bright girls who is physically more developed than the others but whose physical maturity has already made her slow and maternal rather than shifting and sexy. There is just the last trace of this air about her. In two years it will have vanished. She looks after her mother and it is now for the mother rather than the daughter that the doctor usually visits the cottage. He first saw the daughter ten years ago. She had a cold and cough and complained that she felt weak. Her chest X-ray was normal. He had the impression that she wanted to talk about something. She would never look at him directly but kept casting him quick anxious glances as though somehow by these to bring him closer. He questioned her but could not gain her confidence. A few months later she was suffering from insomnia and then asthma. All the tests for allergy proved negative. The asthma got worse. Now when he saw her, she smiled at him through her illness. Her eyes were round like a rabbit’s. She was timid of anything outside the cage of her illness. If anybody approached too near her eyes twitched like the skin round a rabbit’s nose. But her face was quite unlined. He was convinced
420LL_TXT.indd 26
8/21/15 9:00 AM
27
that her condition was the result of extreme emotional stress. Both she and her mother insisted, however, that she had no worries. Two years later he discovered the explanation by chance. He was out on a maternity case in the middle of the night. There were three women neighbours in attendance. Whilst waiting he had a cup of tea with them in the kitchen. One of them worked in a large mechanized dairy in the nearest railway town. The girl with asthma had once worked there too. And it turned out that the manager – who was in the Salvation Army – had had an affair with her. Evidently he had promised to marry her. Then he was overcome by remorse and religious scruples and had abandoned her. Was it even an affair – or did he only once, one evening, lead her by the hand out of the creamery up to his leather-chaired office? The doctor once again questioned the girl’s mother. Had her daughter been happy when she worked at that dairy? Yes, perfectly. He asked the girl if she had been happy there. She smiled in her cage and nodded her head. Then he asked her outright if the manager had ever made a pass at her. She froze – like an animal who realizes that it is impossible to bolt. Her hands stopped moving. Her head remained averted. Her breathing became inaudible. She never answered him. Her asthma continued and caused structural deterioration of the lungs. She now survives on steroids. Her face is moon-shaped. The expression of her large eyes is placid. But her brows and eyelids and the skin pulled tight over her cheekbones twitch at every movement and sound which might constitute a warning of the unexpected. She looks after her mother, but very seldom leaves the cottage. When she sees the doctor, she smiles at him as now she would probably smile at the soldier of the Salvation Army. Before, the water was deep. Then the torrent of God and the
420LL_TXT.indd 27
8/21/15 9:00 AM
28
man. And afterwards the shallows, clear but constantly disturbed, endlessly irritated by their very shallowness as though by an allergy. There is a bend in the river which often reminds the doctor of his failure.
420LL_TXT.indd 28
8/21/15 9:00 AM