The pen is mightier than the sword, by Amanda Sheppeard (Australian Doctor, 15th September 2014)

 5 Australian doctors turned authors
By his own admission, Dr Abraham Nevski is a dedicated and highly skilled professor of general medicine at the Royal Prince John Hospital.

He loves practising medicine, and gets a big kick out of teaching the young doctors who come under his supervision.

Colleagues and friends can be counted on to agree with his sentiments, but they might add that he is a tad eccentric and maybe prone to being a little conceited regarding his own abilities.

They might also say he would make a pretty decent detective if he ever wanted to change professions, after he was integral in helping to uncover the truth about a spate of suspicious deaths on the hospital’s general medical ward 3B.

Dr Nevski became aware of the deaths when he returned to the hospital after a holiday.

But we don’t want to give too much away …

The background story
After all, our good doctor-turned-super-sleuth is a fictitious character dreamt up by Professor Paul Komesaroff AM, a practising endocrinologist in Melbourne, professor of medicine at Monash University, Melbourne, and internationally renowned expert on healthcare and clinical ethics.

And he stresses his new book Riding a Crocodile is definitely a work of fiction.

But that doesn’t stop the inevitable question that Professor Komesaroff has fielded plenty of times: ‘Who is Dr Nevski based on; what about his gorgeous young registrar Rebecca, or Dr Nevski’s nemesis and ward head nurse Desmond Ray?’

“It’s a question I have been asked a lot, who I have based the characters on,” says Professor Komesaroff. “The truth is they are their own characters and they are not based on anyone.”

Characters and plot aside, Riding a Crocodile does provide an intimate insiders’ view into life inside a major teaching hospital.

For the non-medical reader, it is almost voyeuristic, as we see the human side to the clinicians who spend their days treating, healing, explaining, consoling, teaching, arguing with hospital bureaucrats, managing difficult patients and their families, and struggling with a complex web of ethical and moral dilemmas.

“Through the medium of this novel, I have set out to present the full depth and complexity, including the emotional complexity, of life in a hospital,” explains Professor Komesaroff.

“The novel’s not really about the hospital, it’s about the human condition. I’ve really tried to make it authentic. I was committed to the idea that this had to be an honest account.

“This is like nothing I’ve ever written before.”

This is an excerpt from Professor Komesaroff’s new novel Riding a Crocodile:

“Abraham’s system of observation and deduction had never let him down. Now, back in his office, with troubled but determined resoluteness he disciplined himself to apply the method with precision and rigor. When immersed in the role of super sleuth he often felt intoxicated with his own power. Today, despite the wild, underlying turmoil, his mind felt like a steel knife.

Putting aside his unruly emotions, his familiar glass of whiskey in hand, he took himself through the facts one by one in a cool, machine-like way. There had been six deaths in the ward in the last four weeks. This was in itself not completely unprecedented. Deaths certainly occurred: that was a somber feature of this kind of work. The patients in the ward were usually very elderly and, after all, had been admitted to the hospital because they were so unwell that they could not be managed elsewhere.

In addition, it was always impossible to predict precisely the exact course of an illness. In fact, when asked by relatives — or occasionally, patients — how long someone would like, he always refused to give an exact answer, explaining that predictions invariably turned out to be wrong.

Of the six patients who had died four were clearly terminally ill, and a decision had already been made to limit their care. In two of these cases — those of Mrs Gurewitz and Mr Alvarez — an explicit judgement had been made that death was imminent, even if the expected time frame was longer than that which eventuated. It was acknowledged that the process of “keeping someone comfortable” — which often involved administration of opiates or other medications — could on occasion shorten the process, even if that was not the primary intention. Mr McLeod also had an incurable cancer that would inevitably have killed him.

However, his life expectancy was possibly longer; indeed with careful treatment he might have lived on for weeks, or maybe months. In all these cases though, the rapidity of the process was inexplicable. The patients did not seem sick enough to die when they did. They had not displayed the usual signs of approaching death, such as changed patterns of breathing and deepening levels of unconsciousness, and there were no other conditions of which Abraham was aware that might have explained a sudden deterioration.”

Reprinted with permission from the author and publisher, UWA Publishing.

Riding a Crocodile
2014 UWA Pubilishing
RRP $26.99

Want to read more?
Australian Doctor has five copies of Riding a Crocodile to give away to readers.
Email your name and postal address to: 19 October. Five winners will be selected at random.

A massive challenge
Professor Komesaroff is no stranger to writing. He has dedicated decades to penning hundreds of clinical journal papers, articles and speeches. But this is his first work of fiction and a project he freely admits was a massive challenge.

It was originally conceived as an “easy-to-read textbook” centred on the bioethical principles and moral issues associated with hospital life. Instead, it turned into an easy-to-read series of think-pieces on ethics, peppered with mystery, scandal, a bit of sex, and a plot with plenty of twists and turns.

Professor Komesaroff hopes it will appeal to a wide cross-section of readers, from people who want to know more about life behind the scenes in a big hospital, to fellow medical professionals and students who will relate on a different level. And to those who just love a good mystery read.

“I wanted to make the book accessible, I didn’t want it to be seen as a staid, philosophical text,” he says.

In September 2010, he took a couple of weeks off work, and went to a hotel, where he set up his computer and just wrote without distraction.

“It got me going,” he says. “I must have been ready.”

As he wrote, his characters began to take on a life of their own. Professor Komesaroff found himself drawn into the intimacy of their lives.

“Getting to know the characters was one of the most bizarre experiences I have ever had,” he admits. “You create these characters and they assume lives of their own, and these are now people I know very well.”

He confesses that writing the sex scenes left him “nauseated”, but he was determined not to give up. As he sees it, “If you want to take people to the edge, you’ve got to go to the edge yourself.”

The whole writing process took years, and he admits he went through 17 drafts of the novel before he was happy with the finished product.

Ethics are a major focus of this story and Professor Komesaroff’s work has not shied away from exploring some of the trickiest ethical dilemmas, in particular end-of-life care.

In the book, Dr Nevski also gets to see medicine from the other side, when his father becomes ill and needs to be hospitalised.

“That’s the thing with doctors — they don’t realise what it’s like to be a patient and how vulnerable you are until it happens,” Professor Komesaroff says.

In the public eye
This year, he was Victoria’s finalist in the Australian of the Year Awards, and in June he was named on the Queen’s Birthday Honours List. Professor Komesaroff received a Member of the Order of Australia medal for “significant service to ethics in medicine as a physician, researcher and philosopher”.

He is also deeply committed to fostering social harmony between people in Australia and overseas. He established the Global Reconciliation Network in 2002, and the non-profit organisation now has projects underway in more than 40 countries.

Professor Komesaroff doesn’t shy away from taking a stand on issues in his professional  life either, with his determination to speak his mind landing him at the centre of a dispute with the Royal Australasian College of Physicians last year over the organisation’s moves to change its structure.

Around the same time, the college’s ethics committee, which he had headed since its inception, was dumped just days after it released controversial guidelines urging doctors it ditch free drug samples — a decision he still describes as a mystery.

Professor Komesaroff believes it is vital for health professionals to see ethics as more than the “soft and fuzzy part of medicine”. He hopes his novel will make a difference.

“The ethics is actually the hard part,” he says.

“With the science, you get there in the end, but you never know the right decision with ethics. It’s not science but ethics that keep you awake at night, wondering if there is something you should have done differently.”

Leave a Reply