Nick Hornby’s recent bestseller How to Be Good is narrated by Katie Carr, a middle-aged physician in the throes of a marital crisis, a midlife crisis, and a professional crisis. As she works her way through the conflicts in her life, dealing with issues of loyalty, obligation, guilt, love, and lust, one of her mantras is: I can’t be that bad, I’m a doctor. Her assumption is that because she is a physician, she already has the benefit of the doubt. Indeed, the first time she frames herself in a moral light is the first time she notes her job: “Listen: I’m not a bad person. I’m a doctor.” This begs the question, is there something intrinsically good about being a doctor?
Though the motives that underlie many a medical career are altruistic and the process of becoming a physician demands the masochistic air of a penitent, the desire to “do good” does not necessarily translate into good actions. If it is true that health care workers collectively kill many thousand patients a year, or that medical errors are a leading cause of death in the United States, it would behoove the medical community to examine its interventions on behalf of humanity by querying what, exactly, is the point of medicine. Are we actually even doing any good?
Those who have benefited from penicillin, appendectomies, and countless other therapies (as sophisticated as ophthalmologic microsurgery or as basic as a daily teaspoon of prune juice) might line up in defense of the health care profession. Those who have been subject to, but not the beneficiary of, countless experiments; those who have died at the hands of unnecessary or imprecise medical interventions; and those who have endured the probing and prodding of medical hands but who would have gotten better without those prying fingers, might be more willing to speak on behalf of the prosecution. Yet, even bearing in mind this latter population, even with the recent data about medical mistakes, and even with a well-acknowledged history of medical mischief from the infamous examples set by Tuskegee and the Nazi doctors to the less well-known human rights abuses and institutional review board violations that have been perpetrated, it is probably true that most people, like Katie Carr, consider health care workers to be people who do good work. This assumption can easily slip into the assumption that health care professionals are therefore “good people.”
Nick Hornby recognizes that our jobs shape and are shaped by who we are, that work is often one of the ways by which we define ourselves. As children, we imagine our futures by projecting what we want to be as grown-ups; as adults, however much we may relish the hours out of the office or factory or hospital, our jobs consume much of our time and energy. We probably only spend more time sleeping than working (of course, during various parts of a medical education, that may not be true either).
In the selected passage, Katie has been making a “mental list of the things I feel guilty about, and whether there is anything I can do about making any of it better.” She describes how the mundane aspects of the physician’s job, such as paperwork and interactions with difficult patients, try one’s ability to remain good and corrupt her best intentions. The passage marks a turning point, where she realizes that intention itself is not sufficient. As Katie tries to discover what it means to live a “good” life, she half-heartedly, almost against her will, attempts to restructure her relationship with one of her patients in a more compassionate vein. She finally tries to live up to the moral demands of a “good” profession rather than simply incorporating into her identity the assumption of beneficence.
Katie Carr learns that her assumption about being good by virtue of her job simply cannot be true. As this novel effectively portrays, it is all too easy to rest on one’s laurels; the effort to lead a “good” life, like the effort to be a “good” physician, demands that we reflect on our values and assess our assumptions. Being a good physician is, as Katie Carr finds out, not something that comes with a label or a degree but is a never-ending process.
Schuyler W. Henderson, MD