{"id":39160,"date":"2017-05-11T14:04:20","date_gmt":"2017-05-11T13:04:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=39160"},"modified":"2017-08-22T16:53:56","modified_gmt":"2017-08-22T15:53:56","slug":"claire-mcdaniel-and-daniel-marchalik-medicine-from-fiction-to-today","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/05\/11\/claire-mcdaniel-and-daniel-marchalik-medicine-from-fiction-to-today\/","title":{"rendered":"Claire McDaniel and Daniel Marchalik: Medicine, from fiction to today"},"content":{"rendered":"

\"\"<\/a>The Doctor\u2019s Book Club<\/a><\/u><\/strong>
\nBen Winters Underground Airlines<\/em><\/u><\/strong><\/p>\n

My country tis of thee,
\nLate land of slavery,
\nOf thee I sing.
\nLand where my father\u2019s pride
\nSlept where my mother died,
\nFrom every mountain side
\nLet freedom ring!\u00a0<\/em><\/p>\n

W E B Du Bois My Country \u2018Tis of Thee<\/em><\/p>\n

 <\/p>\n

Ben Winters\u2019s\u00a0Underground Airlines <\/em>begins with a mysterious search party. Victor, an undercover bounty hunter, is on a mission to track down a runaway slave named Jackdaw. A federal contractor and a former slave himself, Victor is exceptionally good at his job, with 209 captures under his belt. His search begins in Indiana around the turn of the century\u2014the 21st<\/sup> century.<\/p>\n

In Victor\u2019s world, President Lincoln was assassinated before the American Civil War took place. In the hopes of avoiding a national conflict, Congress enacted the Crittenden Compromise: six amendments and four resolutions that permanently solidified slavery in four southern states, while barring it from spreading to the north. A conflict was avoided, but the US\u2014the only modern slaveholding nation\u2014became internationally isolated, shunned by the United Nations and all democratic governments.<\/p>\n

Victor lives in two Americas, each governed by two sets of realities and experiences. But this problem is neither ancient, nor farfetched. As Du Bois observed, \u201cthe problem of the 20th\u00a0century is the problem of the color line.\u201d Underground Airlines <\/em>asks if this may be the problem of the 21st<\/sup> century as well\u2014both in Victor\u2019s world and in ours.<\/p>\n

Winters\u2019s description of the healthcare system in this alternative world is particularly intriguing as it exposes the fact that the system, even in the free north, is still plagued by segregation and inequality. It is a reality that is all too familiar to Victor\u2014a knowledge he uses to his advantage in his work. Because Victor knows that Jackdaw would require medical attention after\u00a0his complicated and violent escape, he searches for the type of doctor who would be willing to see a black, uninsured, and undocumented patient. Those, he knows, are a rare find.<\/p>\n

He easily locates Dr Elizabeta Venezia-Karbach because she, unlike most other physicians, \u201caccepted all health plans and dedicated one third of her appointment slots to the uninsured,\u201d stating that healthcare \u201cis a basic human right.\u201d She is, in this way, an anomaly, choosing to close \u201ca thriving suburban practice to open a storefront clinic in Haughville, a historic working class African American neighborhood north of Freedman Town.\u201d<\/p>\n

Winters deliberately portrays a healthcare system in which a doctor providing medical care to those who need it most is rare enough to be used as an identifier. It is, in this way, a critique of a world so broken that even doctors lose sight of the basic tenets of their profession. Yet it is a critique of our world as well. After all, isn\u2019t a less dramatized version of this issue also common in our medical system?<\/p>\n

While today\u2019s physicians are not faced with the dilemma of treating runaway slaves, increasingly heated conversations about immigration and legal status are throwing doctors into a political crossfire. Who, in today\u2019s United States, is entitled to healthcare and whom are doctors supposed to treat? In a country without universal healthcare, does Dr Venezia-Karbach\u2019s belief that healthcare is a basic human right appear quixotic?<\/p>\n

Our group struggled with these questions just as we struggled with the multitude of tensions created by the structure of medical training. How can the pressure to achieve financial success and prestige be balanced with the desire to treat the most vulnerable patients? And are we as physicians truly impartial in how we view those we treat?<\/p>\n

Underground Airlines<\/em> is a work of fiction, but art, as Hamlet reminds us, can hold a mirror up to nature. Segregation and bias come in many different forms. Levels of student debt have been linked<\/a> to medical specialty choices and increased callousness of medical professionals toward their patients. At the same time, research has shown racial disparities<\/a> in basic healthcare markers such as blood pressure, blood glucose, cholesterol, and glycosylated hemoglobin control. Multiple studies have revealed that these disparities are due to underlying implicit bias<\/a>. But if these tendencies and biases are unconscious, what can we do to change?<\/p>\n

There are, of course, no easy answers. But if change begins anywhere, it begins with awareness and conversation. Now, more than ever, we must pause and look at our own reflections.<\/p>\n

Next Month:<\/strong><\/p>\n

We will discuss Jesse Ball\u2019s A Cure for Suicide<\/em>.<\/p>\n

Questions to consider:<\/u><\/p>\n

-Is the \u201ccure\u201d in the novel truly a cure?<\/p>\n

-If so, what is it meant to be a cure from?<\/p>\n

-What does Ball seem to suggest about the nature of mental healthcare?<\/p>\n

-Are medical treatments sometimes worse than the diseases they seek to cure?<\/p>\n

More articles in this series<\/a><\/p>\n

\"claire_McDaniel\"<\/a>Claire McDaniel<\/strong> is a third year medical student at Georgetown University School of Medicine in Washington, DC, participating in the school\u2019s Literature and Medicine Track. Additionally, she is an MBA candidate at Georgetown University McDonough School of Business.<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

\"daniel_marchalik3\"Daniel Marchalik<\/strong> is a urologist at MedStar Washington Hospital Center in Washington, DC. He directs the Literature and Medicine Track<\/a> at the Georgetown University School of Medicine and writes a monthly column for the\u00a0<\/em>Lancet<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The Doctor\u2019s Book Club Ben Winters Underground Airlines My country tis of thee, Late land of slavery, Of thee I sing. Land where my father\u2019s pride Slept where my mother […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":39165,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[765],"tags":[],"class_list":["post-39160","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literature-and-medicine"],"yoast_head":"\nClaire McDaniel and Daniel Marchalik: Medicine, from fiction to today - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/05\/11\/claire-mcdaniel-and-daniel-marchalik-medicine-from-fiction-to-today\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Claire McDaniel and Daniel Marchalik: Medicine, from fiction to today - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The Doctor\u2019s Book Club Ben Winters Underground Airlines My country tis of thee, Late land of slavery, Of thee I sing. 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