A Doctor's Searing Fiction

In "Bloodletting and Miraculous Cures," his debut collection of short stories, 33-year-old Canadian author Vincent Lam dissects the lives and loves of four medical students in Toronto with all the objectivity and humanity befitting his training as an emergency-room physician. We start with the doomed affair between test-score-obsessed Ming and the inefficient, emotional Fitz, who is dumped because he's not Chinese. Next we meet Ming, Sri and Chen under the fluorescent glare of the dissecting table: "They all wore clean, new laboratory coats that still had creases down the arms and over the breast pockets from being folded and stacked in a box." The new students are flummoxed by the ethical dilemmas of medicine from day one. Should they slice through a crucifix tattooed on a corpses arm? Sri wants to respectfully cut around it; Ming wants to dissect by the book.

Little do they realize how their lives as doctors will hinge on this awkward dance between cold, hard science and a bending of the rules, an underlying theme in Lam's gracefully paced stories. Chen smashes the glass of a bird-flu isolation ward where one of our doctors wishes to be left alone to die without infecting others. Blatant lies are told to wives of dead men, even as their corpses lie in the helicopter a few feet from them. "Lies are about belief, about a reality suspended because we want to believe the lie. Both the teller and the recipient must trust each other for everything to hang together," writes Lam. The reader is relieved when the wife is told her husband got the best care he could have, even though we know it's not true.

We see them in emergency rooms, on precarious evacuation flights and struggling with deadly viruses. We watch them grow jaded, more comfortable with breaking the rules. Patient volume rises in the few hours before midnight, thinks Fitz: "We speak of volume as numbers of patients, the way they fill our fixed space. It is also the volume of noise that we actually hear. The crying of the child, the belligerence of drunkenness, the thin whine of a failed suicide." The cumulative effect over the years is different for each. For one it's exhaustion to the point of near insanity, for another it's alcoholism. For Ming—ever able to study to the test, a robotic perfectionist—it's a total lack of understanding of how Chen is falling apart even as he makes his patients better.

Perspective shifts with each story, allowing us to watch the young doctors' progress and demise through each other's eyes. What is tragedy for one character becomes information revealed in a casual aside in another story. Fitz is such a master at rationalizing his drinking on emergency flights that we fall for it. That's until the reader is in Chen's mind: he casually mentions how Fitz arrived for his shift with slurred speech and "didn't know how much people had talked in that indelible way. Fitz had resigned from the hospital the next day, signed on with the flight company."

Lam takes us through the moral dilemmas of today's medical profession with dark humor but also with tenderness for the weak spots of each of the doctors. "Each day, more human anatomy was exposed, more of the organs lifted from their shy hiding places into their first glimpse of light," writes Lam of the dissecting table. But he could just as easily be referring to his characters, whose vulnerable layers are methodically revealed through Lam's unique ability to make the reader meet his scientific pace. It's fiction, but when Lam writes about procedures, his training comes through. He even provides us a glossary of medical terms and doctor tricks, like sitting down in front of a patient to create the perception of time or trying to calm another who has every reason to fear: "Sri feels his own heart pounding, remembers they are taught to speak in the mood they wish the patient to absorb." The balancing act never stops.

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