Claire McDaniel and Daniel Marchalik: Physicians and their pasts

The Doctor’s Book Club
Richard Flanagan The Narrow Road to the Deep North 

So we beat on, boats against the current, borne back ceaselessly into the past.

-F. Scott Fitzgerald, The Great Gatsby

It is estimated that almost 13,000 Allied prisoners died building the Burma Railway during the Second World War. Richard Flanagan’s The Narrow Road to the Deep North weaves together the stories of these men and women, Allied and Japanese, whose lives were forever changed by the experience of working on this 415-kilometer stretch in the deep jungle of Southeast Asia known as the “Death Railway.”

The narrative is crafted as a collection of interwoven snapshots of the various characters’ lives. Slowly, these mementos coalesce to form a cohesive story of the perpetual aftershocks of war. By moving through time and space, Flanagan’s work captures the pervasive damage caused by World War II to those who served and who waited for them at home, both during the war and in the years that followed.

And yet the war itself remains a minor player in the novel. The major wartime developments—the lost battles and the falls of empires—go unmentioned. Instead, Flanagan focuses on the daily experiences of the war prisoners, chronicling their daily struggles, interpersonal relationships, and the unique price all end up paying for serving their country.

The book focuses on a young doctor named Dorrigo Evans, an Australian officer who rises from abject poverty to celebrated war hero, but who can never escape the weight of the tragedies accumulated through his years in the war. Dorrigo, having just graduated from medical school, is drafted into the armed forces as an army doctor. He is captured almost immediately after joining, and is sent to work on the Death Railway where, due to his position as a physician, Dorrigo becomes the camp’s leader and only physician.

In unforgiving detail, the novel captures the difficulty and futility of providing medical care in conditions where basic medical supplies did not exist. Indeed, Dorrigo becomes a surgeon around a “hospital that was no hospital but a leaking shelter made up of rags hung over bamboo, beds that were not beds but vermin-infested bamboo slats, the floor that was filth” turning him into a “doctor with almost none of the necessities a doctor needed to cure his patients.”

However, the novel also captures the unyielding human drive for survival and a physician’s need to heal by any available means. Forced to improvise, Dorigo crafts the lacking necessities out of whatever meager resources can be scavenged. For the malnourished and dehydrated, Dorigo and his orderly “set up a new camp drip—a crude catheter cut out of green bamboo connected to some rubber tubing stolen by Darky Gardiner from the Japanese truck the night before—which ran up to an old bottle filled with a saline solution made from water sterilized in stills fashioned out of kerosene tins and bamboo.” Instead of a scalpel, Dorigo uses “a sharpened Joseph Rodgers pocket knife” to incise a vein and insert the bamboo line.

The surgical procedures are even more desperately inventive and, as a result, gruesome.  In one of the most vivid moments in the novel, an Australian soldier, his leg destroyed by spreading gangrene despite multiple amputations, is taken to the makeshift operating theater. As inch after inch of the leg is wrenched away from the body using a kitchen meat saw and suture “improvised out of a pig’s intestine casings,” a bent spoon is used as a compressive device to prevent exsanguination. But despite Dorigo’s desperate attempts to save the soldier, he ultimately finds himself operating on a lifeless body, already dead for nearly ten minutes.

The novel oscillates between such moments of devastation and glimpses of triumph, as many perish and few ultimately manage to survive. But the ghost of the camp never leaves for, as Flanagan notes, “A happy man has no past, while an unhappy man has nothing else.”

Returning home and numbed by the horrors of war, Dorrigo’s life is marred by dispassion in his personal relationships and indifference in his professional career. The banalities of life as a peacetime surgeon make him feel as if “his spirit [was] sleeping… though he tried hard to rouse it with…shocks and dangers.” Despite “acts of pointless compassion and reckless surgery,” he finds it impossible to return meaning to daily life.

The past, it turns out, never truly passes. And for physicians, whose job are often shaped by suffering and a feeling of powerlessness, such a past can take a permanent toll.

Next Month:

We will discuss Emma Donoghue’s Room

Questions to consider:

-Can support structures sometime stand in the way of recovery for trauma survivors?

-What does the novel suggest about the complex nature of trauma?

-What are the many forms of “victim blaming” that are described in the novel?

More articles in this series

claire_McDanielClaire McDaniel is a third year medical student at Georgetown University School of Medicine in Washington, DC, participating in the school’s Literature and Medicine Track. Additionally, she is an MBA candidate at Georgetown University McDonough School of Business.





daniel_marchalik3Daniel Marchalik is a urologist at MedStar Washington Hospital Center in Washington, DC. He directs the Literature and Medicine Track at the Georgetown University School of Medicine and writes a monthly column for The Lancet.