It is one of the novels my father read when he was young and advised me to read “Shahika” (A.J. Cronin, 1937). The book appears to be the memoirs of a doctor, but its real subject matter is deeper: How long can an idealistic physician who starts out with good intentions withstand the pressure of the system?
The protagonist of the novel Andrew Manson is a young physician. He trusts science, seeks the truth, wants to be useful. Because medicine is not just a profession, it is a stance.
His first post is in a mining town in South Wales. Sick miners come in. It is there that the physician realizes: Coughing is not just a symptom. It is the sound of the cogs of the wheel. There is dust in it, there is dampness, there is poverty and neglect. The physician does not only listen to the lungs; he also sees how a system consumes people.
In the novel Dr. Page an old, washed-up physician. Dr. Denny a hardened physician who has lost hope. They are not bad. But they are worn out. Because most of the time it is not evil that corrupts people, but disappointment. After a while “it won't change anyway” and one gradually gives up.
Then Manson moves to Aberalaw. “Medical aid” medicine changes within the system. There is no longer just treatment. There is administration, there is money, there is pressure. The invisible hand of the institution whispers to the physician:
“Be quick.”
“Be in tune.”
“Do not disturb.”
“Don't ask too many questions.”
And this is where Cronin's most painful observation begins: Medicine ceases to be an idealistic endeavor and becomes an administrative job. There is less time for the patient. Less listening. Less care. In the end, the physician is left with two options: Either to defend the truth and pay the price... or to conform to the balance established by the system.
The price is always high. Because truth requires time, and the system requires speed, silence and harmony.
Title of the novel “Shahika.” It means the summit. But in this novel, the summit is not money, not fame, not promotion. The summit is this: Not losing the essence of the profession even as the conditions become more difficult.
Yes, Manson tries to push himself to his own greatness despite the order. Even within that order, Manson tries to get to the root of the miners' lung diseases; he manages not only to resist but also to get results. But the novel also says this: One good person is not enough. If the system is wrong, it exhausts, isolates and changes even the best person.
In other words, the issue is not only to train good physicians, but also to establish a system that protects good physicians.
Oh daddy...
While you're reading this book. “Will my son be such a doctor one day?” you thought, Dad.
You have a daughter like that, Dad.
Can I say I've never lost my shahiku...
Sometimes I lost.
Sometimes I get tired.
Sometimes I was silent.
But I know this:
I never gave up completely.