This is an unusual book: a high-camp satire spliced with a textbook of biomedical ethics. It follows Abraham, a hospital physician, over two months of inpatient ward service. We watch him diagnose patients, teach students, mentor junior doctors. He holds his clinical and interpersonal skills in very high regard. His perspicacity is such that he can tell, for example, that the sad young woman sitting at the other end of the train carriage is about to attempt suicide. He is tortured by the question of whether to intervene. Abraham’s arrogant conviction of his extrasensory humanity slowly erodes as he crashes into various ethical challenges.
Komesaroff is a well-regarded medical ethicist and doctor whose textbooks are meditative and beautifully written. His novel reads in parts like an introduction to biomedical ethics: characters deliver philosophical speeches; Abraham ponders his dilemmas as if Socrates is right there in his head; a full-length ethics essay the protagonist writes takes up most of one chapter.
The book interrogates issues such as end-of-life care, student-teacher relationships and the role of corporate-style hospital management. The cost-cutting chief executive of Abraham’s hospital targets the sick elderly: limiting their admission, engaging a consulting company full of cheerful maniacs to extract not-for-treatment orders, attempting to hasten their death.
This saves the hospital and the state millions.That there is a fine line between respecting a patient’s autonomy regarding end-of-life decisions and expediting their death for our own fiscal and emotional convenience is a preoccupation within this book. The novel asks us: who should decide what value we place on a person’s life?
Though the prose is often overwrought and mawkish, what I took away from Riding a Crocodile was an affirmation that it is a doctor’s duty to advocate for their patients, to push back against politicians’ and managers’ attempts to ration care and, importantly, to retain a sense of personal humility.