The Yale Journal for Humanities in Medicine

Book Review

Secrets from the Black Bag
by Susan Woldenberg Butler.
Royal College of General Practitioners, London, 2005.
Paper $29.49.
Reviewed by Howard Spiro (howard.spiro@yale.edu).

This remarkable collection tells the first-person stories of physicians, largely general practitioners from the United Kingdom, or rather more properly, the British Empire (because they have about them something of the pink tinge of early 20th century maps).

Henry James explained somewhere that adventures happen to those who can tell them. Doubtless the physicians here inscribed are generously enlarged by the boundless perspective of the author, Susan Woldenberg Butler, who says as much in her preface: "on top of whose testimony I’ve constructed fiction."

But that is as it should be. Years ago in a collection of physicians’ stories of their own illnesses, When Doctors Get Sick, I was struck by the matter-of-fact way in which doctors told about their own troubles: few expressed emotion, fear, or wonder. Only the psychiatrists had the imagination, or maybe the leisure or the professional experience, to dwell on what it is like for a doctor to turn into a patient.

In this engaging collection, however, that is what Susan Butler has done. Medical readers will go over her stories with nostalgia and even envy at the freedom that physicians have lost. No one in this book runs the risk of being a module, either patient or physician. "Patients are the material of experience driven by the spirit of inquiry, which makes them sacred," writes "Tommy MacDonald" in telling why he left working in the suburbs to travel by boat or plane to care for the aborigines in outback Australia.

But here the patients are not all industrious and hard-working folk, there are scoundrels and drunks in equal measure. Sometimes a baby dies from misadventure, sometimes a wife gets gonorrhea from her husband, and alas sometimes doctors make mistakes and patients die. I liked the advice of eponymous "Zoltan Nagy": "We do not always know why people come to us. They give us an edited version … to summon up the courage to bear their souls … Many patients do not want to discuss the past, especially if it includes suffering and sorrow." And he warns that such patients may not return if they feel they have spilled their guts.

There is much wisdom in this book: "Someone will pay the price for secrets, concealed or revealed." Susan Butler’s book deserves wide celebration. It is the kind of book physicians will want to leave on the table by their bed, to read in the hope of dreaming.

Published: December 6, 2006