Stephanie A Nixon: ac. Part-time writer and full-time emergency-room physician in Toronto, Vincent Lam paints a three-dimensional portrait of physicians grappling with inner struggles, ethical dilemmas and hospital-room obscurities. The collection follows four Toronto doctors — Ming, Sri, Fitzgerald, and Chen — from hopeful undergrads to medical trainees to seasoned physicians. The doctors in Bloodletting practice medicine; they do not perfect it.
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Stephanie A Nixon: ac. Part-time writer and full-time emergency-room physician in Toronto, Vincent Lam paints a three-dimensional portrait of physicians grappling with inner struggles, ethical dilemmas and hospital-room obscurities. The collection follows four Toronto doctors — Ming, Sri, Fitzgerald, and Chen — from hopeful undergrads to medical trainees to seasoned physicians.
The doctors in Bloodletting practice medicine; they do not perfect it. They guess at the effects of their actions. They try to interpret symptoms, reach infallible conclusions, maintain their authority, and care for their patients. But they make mistakes. They argue. Sometimes they hate their work. It is that recognition of the difficulties of providing health care that makes this collection enjoyable and important. Bloodletting succeeds because it challenges the myth that doctors are omnipotent and medicine is objective.
Instead, this book offers a complex rendition of hospital life, one that is simultaneously valuable for its literary merits and relevant to the field of bioethics. For instance, in "How to Get into Medical School, Part 1", we are introduced to Ming, a no-nonsense and meticulous undergraduate student. She has finished her molecular biology exam characteristically early but is lingering to time her exit from the classroom with Fitzgerald, the artistic study partner with whom she has shared many late nights in the library.
In "Take All of Murphy", we enter the anatomy cadaver dissection lab, which Lam describes as the "first rite of medical school". Here, our medical students are confronted with the first of many ethical dilemmas presented throughout the stories. In this case, the students argue over whether or not to cut through the biblical scripture text tattooed on their cadaver. This is the first of many instances whereby cut-and-dry rules collide with nebulous real-world situations. By the seventh story, "Eli", our characters are now physicians.
Fitzgerald is a trauma doctor juggling a chaotic emergency room when two police officers arrive with their arrested suspect, Eli. He requires medical care for a head wound that is likely the result of police brutality.
In this story, Fitzgerald, who was gentle and sincere as a medical student, has transformed into a shrewd and forthright adversary within a system of power struggles. Eli is a physical threat, but it is the police officers whom Fitzgerald approaches with the most cunning and suspicion. Once again, Lam removes the crisp white lab coat from the profession and gives us a view of medicine as marred and, to some extent, unheroic.
By the time we reach "Night Flight" near the end of the collection, Fitzgerald has developed a substance addiction. As a result, he has been forced to leave his position at the hospital and is now employed as a travel physician, a line of work in which he can keep his addiction hidden.
Additionally, we are introduced to conflicts between public and private health insurers, rich and poor country medical capacities, and hurtful truth-telling versus compassionate lying. Bloodletting in cultural and literary context Throughout these and his other stories, Lam paints a picture of physicians as well-intentioned, partly-competent masters of illusion. They are men and women who hold the pose of confidence and certainty without always possessing it.
Their authority, knowledge, and apparent control of the situation are often manufactured to serve professional and, occasionally, personal ends. After a tiring and frantic night shift in the emergency room, Chen returns home to a darkened bedroom: "The light through the blinds falls diagonally in fat stripes on the floor, and is warm on the carpet whose stains are highlighted and made attractive, important.
This version of medical science and its practitioners is crucial and sets it apart from other contemporary renditions that celebrate doctors as infallible knights in shining white-lab-coat armour and science as completely reliable and failsafe. In short, Bloodletting is the anti-CSI. Whereas the TV-series CSI Crime Scene Investigation presents science as unambiguous, unquestionable and objective, Bloodletting reminds us repeatedly that medicine is an inexact science full of guesses that go wrong, messes that are beyond cleaning and problems that cannot be solved with a quick stitch or pill.
Lam foreshadows this idea with the quotation that introduces his collection — "Medicine is a science of uncertainty and an art of probability" — and reinforces it with a glossary of over one hundred medical phrases at the end of the book.
Readers unfamiliar with these technical terms may find that their regular reference to this glossary through his early stories fades away as such details become unimportant to the actual challenges being faced by Ming, Fitzgerald, Sri and Chen.
The more that we view these medical tools and diagnostics as irrelevant, the more we encounter physicians who are illusionists drawing on a very different set of talents with which to manage scenarios.
The glossary thus becomes ironic, signifying not the possibility of full and complete knowledge, but rather its absence and elusiveness.
In the context of popular versions of medicine or science, therefore, the collection is new and exciting. Bloodletting as a tool for bioethics training Along with its literary contribution, Bloodletting also has relevance for academic training.
While there are clear-cut right and wrong answers to some questions, much of bioethics involves the search for solutions that are most right or least wrong, positions that can change with a shifting point of view. The initial step in ethical decision making is recognition and articulation of issues as moral dilemmas in the first place.
Each of his short stories is embedded with ethical quandaries that could act as a springboard for such bioethics teaching. In "Code Clock", for instance, we see our medical resident responding to a "code blue" for a hospital in-patient with a cardiac arrest.
His failing confidence and capacity will prompt many readers to consider avoiding teaching hospitals in the future. However, Lam has hit on a real and central challenge in medical training: how to balance the inevitable need to learn new skills with the dire risks associated with incompetence. This story points a spotlight on the medical school mantra of "watch one, do one, teach one", prompting critical reflection on the process of becoming a proficient practitioner.
The story is also imbued with counterproductive power dynamics amongst the various physicians and nurses at the scene, providing yet another starting point for ethics discussion with health care trainees.
In "Winston", Lam presents Sri as a medical trainee providing a psychiatric consultation for a young man who believes he has been poisoned. Readers join Sri in his journey from clarity of purpose at the start of the encounter to self-doubt about what is real and what is right by the end of the exchange. Lam gives bioethicists much fodder for discussion. Second, in this story and others, he encourages us to question what constitutes appropriate supervision of medical trainees from their overseeing physicians who may be distracted, disinterested or themselves ill-informed.
Most important, however, is the issue of boundaries in medicine and the lengths to which health care providers can and should go to provide appropriate care. Supported by World Health Organization press releases and fictitious medical chart entries, Lam presents the experiences of a range of physicians and nurses as they struggle through this devastating experience.
His characters suffer the stigmatization of quarantine, the dehumanization of isolation and the sequelae of SARS itself. Like much of this book, "Contact Tracing" is accessible to all but will have a unique impact on those who can associate with the experience — in this instance, a health care response during an infectious outbreak.
Accuracy, objectivity and precision are also crucial, but in this collection they, too, are elusive. Bloodletting and Miraculous Cures offers a refreshing, entertaining and sometimes disturbing view of doctors and doctoring that is satisfying to both readers unacquainted with the challenges of medicine and those all too aware of the messy reality of the practice.
It is a credit to Lam who uses his imagination and, no doubt, his experience as an emergency room physician to cut beneath the surface and present a collection of stories that brings to light the everyday quandaries faced by health care providers.
Full Cast & Crew
One character is hired by an insurance company that sends planes into foreign countries to bring back the injured, the dead, or the nearly dead. As in any collection, some parts shine less brightly than others. The stories Lam sets in the ER feel weakest. Television has already fully milked the frenzy of the ER, and a recent book by Texan physician Frank Huyler, The Blood of Strangers, broke the experience into fragments of lyricism and understated poetry. He presents an interconnected web of patients and doctors — the damaged and those barely keeping it together to care for them.
Bloodletting & Miraculous Cures
The seventh in the set, entitled Eli, heavily explores the theme of deception. At the same time, Lam has also incorporated elements that show the risks doctors face every day while trying to save others. Eli centers around Dr. Fitzgerald as he treats a patient Eli who has been brought in by police officers. Though the officers claim Eli simply fell while in custody, the patient argues that it was the police themselves who brutalized him. Regardless, Fitz reluctantly treats Eli.
Bloodletting & Miraculous Cures
A practicing ER physician, Vincent Lam delivers a precise and intimate portrait of the medical profession in his fiction debut. These twelve interwoven stories follow a group of young doctors as they move from the challenges of medical school to the intense world of emergency rooms, evacuation missions, and terrifying new viruses. They fall in love as they study for their exams, face moral dilemmas as they split open cadavers, confront police who rough up their patients, and treat schizophrenics with pathologies similar to their own. In one harrowing story set amidst the SARS crisis, which the author witnessed firsthand, two of these doctors suddenly become the patients.