Domhnall MacAuley: Of melancholy, despair and, Dr Gachet

Domhnall MacauleyDr Gachet has the world weary look of a country GP. His portrait, which hangs in the Musée d’Orsay, always spoke to me louder than Van Gogh’s sunflowers or other celebrated paintings with their vibrant colours and, almost childlike, optimism. It has a depth of feeling, concern yet distance, and an overwhelming sadness. Unlike other famous medical works of art, it attracts little attention in the medical narrative. Perhaps, because is it strangely disquieting. Dr Gachet’s face shows sympathy and understanding but, he is a man with troubles of his own. In it, I always saw two patients –a reflection on Van Gogh, the artist in whose place we stand, and the doctor himself. Tired and battered by relentless care. I sensed the worn out emptiness of a burnt out family doctor.

“Beyond the silence” was just another book on my desk-one of many sent for review. Idly flicking over the cover, I found the author, himself a GP, took his inspiration from this same Dr Gachet portrait. As the first few lines begin with Dr Gachet in consultation, like any GP, I just had to read on. The book, described as a novel, links two narratives; the partly imagined story of Dr Gachet and his relationship with Van Gogh in the village of Auvers-sur-Oise and, the life of a contemporary GP in Worcestershire. Although, we already know the ending, Chapman tells a sensitive and gripping story of Van Gogh’s relationship with his doctor; of love and loss, of sadness and alienation, and his ultimate disintegration with bipolar disorder. Intertwined is the heart rending narrative of the life of an ordinary British GP, his consultant wife, practice manager and partners. But, if van Gogh’s life can be read as a novel with the safety of time and distance, the contemporary story is real, palpable and unsettling.

Deeply troubling, you share every step of his stumbling decline from his early humiliation while still a medical student, the dysfunctional practice partnership, his over sensitivity to the needs of patients which eventually becomes overwhelming. For any doctor reader, it is disturbing in its everyday normality. The feelings, anxieties, and deep insecurities as we see our colleague gradually begin to lose control of his life, are so close to the daily reality of our work that this could be any family doctor. We follow his journey into the darkness every night, share the consultation when he sees his own GP, and his eventual meeting with his psychiatrist. Watching these two stories unwind, and knowing of Van Gogh’s suicide, the pages are haunted by inevitability. And, as I read this book deep into the small hours of the morning, I shared his despair and loneliness as he sank deeper and deeper. More disquieting, however, was the sense that much of this story is built on truth, not fiction. If it is autobiographical in any part, I feel a great admiration for the author, for baring the dark parts of his soul, and sympathy for the terrible journey he must has travelled. It is a poignant, difficult and unsettling story.

Is it possible that we are all partly responsible? Could we share some responsibility for the damage caused by the rhetoric of the early days of general practice training- the privilege of providing personal care, the sense of duty, the primacy of the relationship with the patients, the core values of continuity of care? These are admirable aspirations and greatly valued by our patients, but could they be partly to blame for the wreckage of lives torn apart; casualties of the burden of responsibility. The relentless demands of general practice, where every patient leaves their burden at the doctor’s door, do take their toll. I see it etched on the worn faces of so many colleagues. Its not just a novel.

“Beyond the silence” Andrew Chapman. Pilrig Publishing PO Box 174. Tewkesbury. 2010.