A Fortunate Man: The Story of a Country Doctor

"Did it make them decide to become doctors? Probably slightly trepidatious as well. It’s recently been republished with a foreword by a writer called Gavin Francis, for the same sort of reasons. Francis tells a story about when he was training to be a doctor, or had just qualified, trying to give the book to everyone as a present and it becoming very expensive because it was out of print. It was published in ’67 and was kept in print by the Royal College of GPs at one point because it had this influence on doctors. I have another friend who decided to retrain as a doctor because of it. The story behind it is that Berger’s friend Victor Anant, who was a writer he met in Paddington Station, introduced him to Dr John Eskell. He became Berger’s doctor, and Berger was fascinated by his practice and his isolation. He was a country GP, living in this community in the New Forest, and he had this extremely intimate relationship with the people around him because he was their doctor, but also because of that he had to be extremely distant. Like many of Berger’s books it’s uncategorizable. It’s a photojournalistic collaboration with a photographer called Jean Mohr. Jean’s photographs and John’s writing add up to these case-studies. The photographs are documentary, showing what is happening to someone in a consultation, and the prose narratives also describe true events. But Eskell’s name is changed to Sassall, these case studies are blended and edited together in such a way that from fact comes this fiction, which is itself an attempt to get closer to the ‘fact’ of the doctor’s experience. So the book uses fictional devices for documentary ends. It all adds up to a portrait of a country GP working in what seems now a very different version of the NHS, but also in a very different, far more patriarchal, society. In the process of trying to write about someone’s life, it has to reflect on the impossibility of doing that. There’s always this distance which it’s the work of literature to negotiate, to examine, but to realise ultimately is never bridgeable. Support Five Books Five Books interviews are expensive to produce. If you're enjoying this interview, please support us by donating a small amount . That’s one of the reasons the subject of a doctor is so interesting, because of this very strange pattern of intimacy and distance. The position of the doctor in society is analogous to the position of the writer in society. Maybe you could say it’s Berger drafting a warning to himself. There are passages in the book that talk about Sassall’s mental health issues. He did later take his own life. He was a fortunate man because he was so committed to and absorbed in his work. But it’s also an ironic title, because it wasn’t enough for him. When Berger found out about his suicide it deeply affected him. There’s an interview in the early 90s where he talks about this and the very strange position of knowing that, in writing this book, he drew a line around Sassall’s life. Berger’s interpretation was that from that point Sassall felt as though he had to move on from that life. I wonder if it played a role in Berger wanting to see himself as a storyteller, and far more immersed in the community around him."

"It captures a moment in time at the Forest of Dean, at a changing point in history. I think it’s just pre-Thatcher. But that doesn’t really help with the Forest of Dean, because it’s probably still slightly pre-Thatcher there. You know, they shot the recent Star Wars there, not far from where this book is set; they needed a kind of primordial, moss-filled forest-swamp, and they chose the Forest of Dean. So the landscape is almost virgin and primordial, but at the same time, you get this very forward-thinking, almost revolutionary, doctor John Sassall. He’s kind of as much an alchemist as he is a doctor. He reads a lot. He’s almost as much a sociologist as he is your standard GP. He has to be a real Renaissance man to do his job. Some of his cures, if you can call them that, are quite clever and psychological. There’s an amazing scene where he rushes to the aid of somebody who’s been crushed under a fallen tree, and Berger describes the animal noises coming from the man who the accident has literally befallen, and the doctor, in his quiet manner, being something akin to a vet with a frightened animal. And you have this amazing duality in the book, the words and the pictures. The photographs give you the sense of the doctor’s isolation, and—because they’re black and white—they have this amazing timeless quality. The idea of a country doctor, I think, is quite a stark turn-of-the-20th-century image. Sassall was a thoroughly modern man in a very backward—in both the pejorative and the sincerely correct sense. He’s in the sticks, you know? The Forest of Dean is quite isolated, a kind of interzone. It is between things; it isn’t in most people’s minds a destination in-and-of-itself. One of the reasons that I love the book is you get this sense that John Berger has gone to see this man in his habitat. It’s almost a nature documentary, this little microcosm of the country doctor as viewed through the lens of John Berger. It’s quite episodic, this book. It is really beautiful, and has a very humane but quite wild heart to it. On the surface you have this almost prosaic life of a country doctor, but nothing is really normal. The life of this man is absolutely extraordinary: the things that he does and the decisions he makes, and the—I don’t think it’s a spoiler to say—tragic epilogue, which is terribly unexpected. But then, you begin to see the ghosting of it throughout the book, perhaps. I don’t know. A friend of a friend, I think. I remember the doctor was a great reader, and had a large social group. He wasn’t himself of that place. I can’t remember exactly where he was from, but somewhere with a cultural life, you know? So he would go off and do other things. That’s another key thing in the book: this idea of belonging and strangeness, which is I think key to landscape writing. Who is an incomer and what belongs in a landscape? How do we judge the suitability of nature and architecture and people within a place? What is the interplay between all of these things? The doctor, the way that John Berger wrote about him, was really central to this whole community. Then his influence and his skills really began to fan out and have a great impact on a wide circle of people. That is, the influence of one person within a landscape. I think that’s what drew me to this book. I think that’s dangerous. I think you have to focus and zero in on aspects of a scene, a situation, a society of course—as Joan Didion and Denis Johnson did—but I think it’s a slippery slope to just ignore a bigger picture because this thing, the people , don’t fit with your imported worldview, otherwise you’ll get a very dull two-dimensional view of a place, and you begin to write a narrative that’s not actually real. A wished-for narrative. Without wanting to go too far, that’s a sort of National Socialist route of storytelling, isn’t it? Who belongs here, who does not belong here, who do we want, and who do we want to get rid of, and who will we close our eyes to, or who will we deport? We need to have a generosity of spirit, but at the same time, we need to be honest about what’s going on in places."

"John Berger was an astonishingly skilled and observant witness of anything he turned his gaze onto. He started out writing on art for the New Statesman in the 1950s and his essays there are extraordinary. They were so original, so new, they made people look at old paintings in a completely novel way. When he turns that genius onto the doctor-patient consultation he picks out some of the many levels of non-verbal interaction that go on in an everyday medical consultation. They’re revealed in all their subtlety. And it’s a portrait of a man he loved, the doctor John Sassall. A Fortunate Man opens with six observations of Sassall working among his patients in the Forest of Dean in 1966. Berger describes beautifully how the doctor himself has to constantly change what kind of person he is depending on what patient he’s dealing with, and what that patient expects. Sassall allows himself to be a chameleon, to become the doctor that he thinks that patient most needs. And I think that is one of the hallmarks of a really effective practitioner. Does the patient need a warm, friendly, arm on a shoulder, or something more informal and jokey, or more of a patriarch, or do they need a scientist to lay out the statistics? People at different phases of illness need different kinds of doctors. I think Berger captures that. The book becomes an extended meditation on the practice of medicine, which is an attempt to engage a deep sense of fraternity. Berger keeps coming back to this word: the doctor is like an elder brother — not a father figure — and we want the doctor to witness our suffering. There’s a beautiful meditation on the idea that in times of extremes, of dying, the value of the doctor is not just the morphine they prescribe, but that they have seen many others die before. He explicitly says that this is a benefit the clergy once provided by the death bed – not absolution, but witness and having witnessed others die. This is, in a way, so obvious: when you practice medicine you realise that this is what a lot of people need from you. But it’s rare to have it articulated so well, so concisely. Mohr and Berger lived with Sassall for six weeks, and were with him for every patient visit during that time, even on night calls. And Berger said of Jean Mohr he’s the perfect photographer for that, because he’s completely invisible — like a lamp stand! Patients wouldn’t even notice him taking pictures of them. The two men went back to Geneva and worked independently for a month on the project, and John was dissatisfied with the results. He thought they’d both tried to tell the story on their own, and realised they had to go back to the drawing board and make the words and the pictures into a conversation. And they succeed brilliantly. As you read the book, your appetite is whetted by a bit of text and then it’s satisfied by a photograph, which raises other questions, which the text goes on to explore. It’s very beautifully done. I never met Sassall – he shot himself in 1982. I was contacted by his son Simon, and we met. He was very open about the fact that his father was a troubled man who suffered extreme swings of mood. Sassall’s wife had always helped him through those periods and she died in the late 1970s. The reason Berger calls him a ‘fortunate’ man is because he gets to do exactly what he wants, which is to pursue his dream of the universal — of what is it to attempt to become a kind of renaissance man or woman in the twentieth century. This is, of course, not possible in the way it was in the fifteenth century: there are simply too many areas of knowledge to cover. But it’s still possible to pursue a passion for trying to understand as many different human perspectives as you can. Sassal wanted to be with and to help as many different kinds of people as he could in a particular restricted community. I don’t want to comment or theorise about Sassall’s suicide. But I don’t think the fact of it detracts from Berger’s position — that Sassall was pursuing exactly what he wanted to pursue. And that’s the point that Berger makes in his epilogue – he respects Sassall’s decision, and admires that he held on ‘for as long as he could.’ A lot of people who have lost a loved one to suicide will take exception to Berger’s conclusion: he transforms the act from one in which those of us left behind agonise over what we could have done differently, to one in which we feel gratitude that he or she stayed with us as long as they could. Support Five Books Five Books interviews are expensive to produce. If you're enjoying this interview, please support us by donating a small amount . Berger writes “John Sassall, the man I loved, has killed himself and yes his death has transformed the story of his life. It has made it more mysterious, not darker. I see as much light there as before.” How do you take something positive out of a suicide ? But Berger manages it, by asking: what if we look at it like this? What if we’re just grateful for the years that we had? And yes maybe it means I didn’t understand him as well as I thought I did. I loved that man, but I didn’t know him as I thought I did. “The book becomes an extended meditation on the practice of medicine” It reminds me a little bit of a wonderful paper, published in The Lancet in 1917/18 by W. H. R. Rivers, the psychiatrist who treated Siegfried Sassoon and Wilfred Owen. He talks about how he developed a technique at Craiglockhart, which at the time was very new, of trying to find a redeeming feature of the horror that the men had experienced in the trenches. He gives the example of a man wracked with panic attacks and flashbacks of a going out onto the battlefield and finding his friend blown apart by a shell and trying to gather the bits of his friend together and his personal effects for his widow. And he’s tortured by this memory. Rivers says, well we can’t suppress the memory but we can perhaps find some aspect of that awful experience that’s positive. Many people in the trenches died slowly, and in great pain, but this man obviously didn’t, he was killed instantly. Rivers reports that when he put it like this the man’s expression changed straight away, and from that night onwards his nightmares stopped. When dreams of the event came back, they didn’t have that same horror. The man found he was even able to talk with his friend in dreams. Rivers insists that it’s possible to take something very dark, and find in it some aspect which is tolerable, or redemptive, and switch your perspective on it."