I’m fond of referring, in talks and in discussions about medical professionalism, to the midnight meal. It’s a metaphor that I borrow from Dr Jerome Lowenstein, a friend and colleague who wrote an essay of the same name. In that essay he recalls a time when the medical team would meet in the hospital restaurant, in the middle of the night, to deal with the emotional leftovers of the day. With shift working, and an increasingly busy and technological approach to medicine, there is all too often neither time nor space for a midnight meal. He suggests that medical humanities might offer an alternative way, create an alternative space, to pick over the remains of the day and so be ready to face another day.
The essay is simply and beautifully written, and so I was pleased to be given a copy of Dr Lowenstein’s first novel, Henderson’s Equation, to read. Pleased but also a little daunted, because I have to admit that physiology was never my strong point. Not so of course the author who, in addition to being a clinician and teacher has also spent a lifetime researching acid-base physiology. As a result his book offers an informed portrayal of Henderson’s intellectual insights and the creative leaps of imagination that inspired and drove his research. Henderson’s Equation is however about much more than this. Instead, set against the backdrop of World War I, the rise of fascism, the Sacco-Vanzetti trial, and growing anti-Semitism at Harvard and elsewhere, this is a story that is as much about the nature of friendship as it is about medicine.
Because although they have much in common, the main protagonists- Lawrence J Henderson and his assistant Aaron Weiss-come from very different worlds, with different expectations and constraints moulding the men they become and what they value in their lives and in others. For Henderson his research is all-consuming, whereas for Aaron there is a constant struggle to find the right balance between embracing all that medical science has to offer whilst not losing sight of what makes him, and his patients, human. Over the course of Aaron’s career he and Henderson continue to collaborate until social and political differences result in a painful and damaging rift. Forced to choose between caring for patients and pursuing an academic career Aaron chooses his patients. Forced to choose between his principles and his friendship for Henderson he finally finds room for both.
This book is a delight to read, not least because of a rich sub-plot involving a master craftsman called DePodesta. DePodesta teaches Aaron about the importance of friendship, creativity and patience. As Aaron matures it is these qualities that he learns to offer to his patients. Come to think of it, a midnight meal with Aaron and DePodesta may be just what the doctor ordered.