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Shea, Sandra L., PhD

doi: 10.1097/01.ACM.0000232420.96546.1f
Medicine and the Arts

Dr. Shea is associate professor, Department of Family and Community Medicine, and Year One Curriculum Director, Office of Education and Curriculum, Southern Illinois University School of Medicine, Carbondale, Illinois.

Anne Farmakidis, senior editor of Academic Medicine, is editor of “Medicine and the Arts.” (Unsolicited submissions are welcome.)

James Herriot was the pseudonym for James Alfred Wight, a veterinarian who began practicing in Yorkshire, England during the Depression. In his 50s, he began writing about his career. The first four books were published in the United States as All Creatures Great and Small, All Things Wise and Wonderful, All Things Bright and Beautiful, and The Lord God Made Them All, phrases taken from the 1848 hymn “All Things Bright & Beautiful” by Cecil Alexander. Herriot wrote of the struggles and glories of being a vet as the calling changed from old traditions to new resources, from “draughts” to antibiotics, from carthorses to indoor pets. He writes of large landowners with hundreds of cattle and innkeepers with a few pigs. He writes of straightforward diagnoses and stubborn puzzles.

I use some of his examples to teach medical students to consider improbable possibilities. The species may differ, but the problem solving skills do not. One of these was his blinding realization that he was not seeing hoof-and-mouth disease in a herd of cows, but rather a cross-contamination of cowpox from a recently inoculated farmer’s son. The former diagnosis would have brought about the destruction of a family business while the latter was cured with ointment.

This selection is notable for two reasons—the vivid description of depression and the impact a pet’s life and death can have on its owners. Depression as a medical condition, as opposed to “the blues,” has been recognized for years, but misconceptions remain. While Herriot concedes that he was no psychiatrist, he adds that working hard and having a goal will bring a person out of a depression in time. It is true that some types of depression are transitional or identified with particular stressors, for example, adjustment disorder with depressed mood. Other types of depression, like major depression, do not respond simply to hard work and time. Patients might be damaged by unreasonable expectations for recovery, but helped by assurance that there are cures for depression, which can include following a daily schedule, such as care of a pet.

Herriot’s descriptions of a “dark valley” and the statements he gives Andrew to speak ring true: “Well, this is one of my good days. I’m just tense and dreadfully unhappy. On my bad days I’m terror-stricken, despairing, utterly desolate.” In fact, they ring so true one wonders about Herriot’s insight.

When Wight died in 1995, his son, Jim, authored the biography The Real James Herriot: A Memoir of My Father in which he discusses Wight’s own depression, with early descriptions of his father as “a worrier” and later of his treatment in the 1960s that included medications and electroshock treatments. His son writes movingly of his father’s resolve to keep working and, indeed, his belief that he could find a cure through hard work. Like Andrew, the combination of medical treatment and the structured refuge of his career proved successful for Wight.

This excerpt also speaks to the powerful bond between human and pet. “Please let me become the person my dog thinks I am” is a popular bumper sticker about the simplicity and wonder of these relationships. Patients and health professionals have experienced the unconditional love for and by their pets and the stress relief that originates from their species of choice. Pets have been described as healers in their own right and can be found as therapeutic workers in hospices, hospitals, senior centers, and nursing homes. When I had cancer and was enduring 12 months of chemotherapy, my cats rousted me out of bed every morning no matter how sick I was. They were relentless in their needs while tireless in their comfort. Ten months into my chemo I was too sick and too sad to cry for myself, but felt free to weep for days when one of them suddenly died. His death somehow allowed me the release for him that I could not allow for myself. My oncologist and family practitioner wisely understood that my blood values did not suddenly plummet just from insomnia. His surviving brother usually slept at the foot of my bed but abruptly moved to my pillow and for weeks slept with one paw on my shoulder. He ceased when chemo finally ended and, heartbreakingly, only resumed five years later when he contracted the tongue cancer that eventually forced me to put him to sleep. In each case my grief and symptoms were no less real because my friend had four legs instead of two. Wight had dogs all his life—he would have understood.

Wight’s recovery from his depression allowed him to continue as a veterinarian and to begin his career as a writer. Like other sufferers of depression, his ability to see the illness from the inside and then put pen to paper eloquently enlightens the “dark valley” for everyone.

© 2006 Association of American Medical Colleges