What I learned from Terry Pratchett

I’ve been thinking about this for quite a long time now, and this seems like a good time. I’ve spoken about this any number of times with students in clinic, and with doctors in training.  The thing is, as soon as they hear me mention Terry Pratchett, I get the judgement. Or, to be more fair, I get the social profiling.  The disguise I wear as a moderately competent 46 year old paediatrician with greying (OK, grey) hair and comfort in my surroundings slips away and there he is – the awkward, spotty, 14 year old.  Actually, I didn’t come to Terry Pratchett until my university years but that’s almost too trivial to mention.  The main point is that the stereotype is probably fair.  This was an author with tremendous reach but with a core readership of the awkward, the geeky, the clever but, well, those with limited life skills.

So, I go on to try to explain why it is that I thought (and think) Terry Pratchett a genius.  I illustrate it with a scene from one of his books.  I’ll share it with you, but throughout this I want you to remember the readership.

The scene I’m interested in involves Granny Weatherwax, one of the recurring characters on Discworld.  Granny Weatherwax is a witch – and here many people’s eyes glaze over.   The book in question is called Lords and Ladies, and in this scene Granny is attending a terrible accident; in a very rural setting an expectant mother has been kicked by a cow.  The local midwife, Mrs Patternoster, has learned mostly from animal craft and tradition.  She is out of her depth, which is why she’s called for Granny.  Very quickly it becomes clear to Granny – and to us the reader – that either the mother or unborn child is going to die, and maybe both.

(Once again, I remind you.  Spotty, geeky 14 year olds.  Spotty geeky 14 year olds.)

Mrs Patternoster wants to involve the father in the decision around which life should be saved.  Granny decides not to.  Instead she dispatches Mrs Patternoster to comfort the father.  Some time passes; Death – another of Pratchett’s recurrent characters – passes through with dignity, and a little while later the midwife returns to find the expectant mother alive, the baby dead.  Pratchett handles this scene a good deal more delicately than I’m capable of, and have done here, but that’s the blunt truth of it.  Granny has also busied herself in discovering why the cow was behaving as it was – there was a thorn in its flanks.  Noting Mrs Patternoster’s disapproval of  Granny’s failure to involve the father in the decisions, Granny asks “You don’t like him?  You think he’s a bad man?”  “No!”.  “Then what’s he ever done to me, that I should hurt him so?”

And that’s it.  We hear no more from any of these characters – except Granny and Death.  There is no further discussion.  And there’s the genius.  Into a book about witches, and vampires, and elves and trolls, he’s slipped something which reveals important things to think about in regard to compassion, paternalism, honesty, bravery.  You can go further – you can think about the twin burden and privilege of delivering health care.  If you want to, you could even work in root cause analysis.  You don’t have to agree with Granny – but you can’t be neutral about what she’s done.  You have to think about it.  You have to be a spotty 14 year old geek thinking about issues like this.

Isn’t that amazing?

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