An Amazing Murmur of the Heart

Ways of bringing doctors to heal


By Cecil Helman
Hammersmith Books, £12.99

Cecil Helman, who died in 2009, was a South African-born, Jewish, London GP and anthropologist, recognised for his textbook, Culture, Health and Illness, and particularly for his autobiographical volume, Suburban Shaman, published in 2006. This new, posthumously published book is a companion to Suburban Shaman and a fitting tribute to Helman.

Its title, An Amazing Murmur of the Heart, is neatly yet also movingly ambiguous. On one side of the story is the tendency of medicine to reduce the patient to a malfunctioning piece of machinery. "Do have a listen to that amazing heart murmur just across the ward," says the senior doctor to the medical students, "straight out of a textbook."

On the other side, stands the physician as healer rather than as "techno-doctor", the one who sees the patient as a person, and whose own heart murmurs in response to the other's suffering.

Helman (pictured below) asks a simple question early on in the book in reaction to the technology and what he instructively terms "paper-patients", those charts and print-outs and mechanical beeps and computer screens that keep hospital staff busy and enthralled, and that now dominate the GP surgery as well. This question is, "where has the patient gone?" This is a question that has often been asked, but it is a good question nonetheless and Helman's book is a rather beautiful attempt to investigate it.

Technology can obscure the reality of human suffering

This does not mean to answer it because, in truth, we all know the answer: the patient has disappeared behind the technology of medicine, which - brilliant and life-saving though it is - obscures much of the reality of human suffering and allows doctors to defend themselves against what they come up against.

An Amazing Murmur of the Heart instead tries to reinstate the patient through a process of story-telling and personal encounter, making the connection between patient and doctor one that is meaningful and from which both can learn.

Helman's anthropological eye is an acute one, as he places everyday tales of medicine in the context of social and cultural ways of being. I have only one quibble, which is with the final three paragraphs of the whole book.

Reflecting on the idea of the doctor as "wounded healer", Helman asks "who can heal the wounded healer" and answers: "Only the healer himself". Yet it seems to me that, in this answer, he reverts to a kind of medical omnipotence in which the doctor stands superior to everyone else as the one who manages everything.

The rest of the book shows how this is not the case, how much the doctor needs to learn from the patient if the murmuring of the heart is to be appreciated in its complexity and human significance.

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