Riding a Crocodile is… a suspenseful detective account of pathos, humour, suffering, indignity, conflict and love that inscribed illness, ageing and death. I loved the description of the story as Hospital Noir. I can see the film version of Crocodile arriving some time in the near future with Clive Owen as the troubled star.

…This novel is very relevant to me, just now. My mother, frail and elderly, is transfused each week with blood products at her local hospital,  as an outpatient. Is she at risk of cost-reducing decisions in the hospital’s office of finance? Might scarce blood resources be better allocated to young people?
Helen W:  http://melbourneblogger.blogspot.com.au/2014/12/medicine-and-literature-riding-crocodile.html?m=1

Thanks for your book!  Thanks for your insights into the human condition and the love and compassion you teach to us. Thank you for portraying the frailty and grandness of human beings in such an engaging book… I just couldn’t stop reading it!

Thanks also for expressing so clearly the dangers of decision making processes that don’t include collective debate and reasoning. Time for debate should not be spared when deciding on matters that affect not only individuals but our society as a whole; you argued for this so clearly in the book.

I hope that many people read your book as the messages you convey are priceless to today’s society.

There is a long tradition of physicians turned writers, including Chekhov, Keats, Conan Doyle, and Somerset Maugham. More recent doctor–novelists include Alexander McCall Smith, Michael Crichton, and Khaled Hosseini. In Australia, Peter Goldsworthy is probably our most prominent writer–physician, with John Murray and now Paul Komesaroff joining the tradition.

Medicine provides plenty of material for the novelist. As Peter Goldsworthy said in an interview in the Medical Journal of Australia: ‘You can’t write a novel unless you have constant human contact – talking to people, listening to what they say, and studying their character – medicine’s perfect for that.’ A medical practitioner sees diverse people, often in crisis. They watch relationships change, and fail to change. They witness messy storylines being played out in front of them. They confront birth and death, disease and desire.

American doctor and writer Ethan Canin noted in the New York Times that ‘for a writer, medicine has the merit of constantly bringing you close to the dark side of life’. Like Canin, Komesaroff has worked in hospitals, and he draws on this darkness for both plot and theme. The novel’s protagonist is Professor Abraham Nevski, a caring, likeable doctor, though not without flaws. A series of unexpected deaths occur in the hospital, and Nevski starts to investigate. At the same time, he is mourning the death of his wife and fighting the growth of corporate managerialism at the hospital. While the book is more hospital story than detective story, there are some interesting twists in the mystery and aspects of the dénouement were surprising.

It is not plot, however, that gives this book its energy, but rather the themes it explores. I imagine that Komesaroff is fascinating to talk to, in particular about the issues his novel raises. At what point should we move from medical intervention to palliative care for patients over seventy? Who can make decisions about an individual’s quality of life? What role should family wishes play in decisions about medical care for very ill or disabled people? How should financial, medical, and ethical issues influence hospital decision-making? These and many other ethical questions are raised in this novel, both through the action and through Nevski’s inner monologue and discussions with colleagues. To explore these issues, Komesaroff goes further: he has Nevski write an article about ethics in medicine, extracts from which are included in several chapters of the novel. These sections, reproduced with modifications from Komesaroff’s Experiments in Love and Death (2008), are interesting meditations on the complexity of medical ethics in practice, but they do interrupt the flow of the novel…

Of all the patients, I was particularly intrigued by Ursula Timoshenko, who sees Nevski regularly and pours out a litany of medical jargon about her ailments as if ‘words were, and remained, her life’. Although her conversation and seeming hypochondria are extreme, she is neither a caricature nor comedic figure but rather a figure of tragedy, caught in the mesh of her own grief and traumatic past. For me, she was one of the few characters beyond Nevski and the young registrar, Rebecca, who came to life. She illustrates nicely Nevski’s (and one suspects the author’s) belief that, ‘You don’t have to climb Mt Everest or swim the Amazon or go bungee jumping to experience the limits of experience … You don’t need to ride a crocodile. You just need to listen to the stories of people.’

…[H]ere we have an Australian novel of ideas, starting with a quote about the death of the other from philosopher Emmanuel Levinas. This is a novel that lays out the complexity of clinical practice in a way that makes it interesting and comprehensible to lay people. Komesaroff also mounts a convincing critique of how economic rationalism is imported into the health-care system and of simplistic approaches to rationing care and to euthanasia. Like a hospital, this novel is an odd mix of the intriguingly complex and the mundane.

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.

I have just finished reading your book.

I cried much through it and loved it too. I was able to recognize much of what you say because of my years of volunteering at the Hadassah Hospital’s hospice where many of the things you report resonate ceaselessly. If only because these are the issues you write about (in disregard of what you think – never available to me – or what you do), I want you as my personal physician… though this might mean the impossible: moving to Australia!

It is such a pity that you do not work in education because such a book should be written for that discipline too. I liked it so much that I’m even ready to disregard your psychologizing inclinations (…although fortunately only a few examples were found). It is all you promised:  mystery, sex, and ethics.

Thanks for the book. I am looking forward to the next one.

AN ARMADALE doctor believes he has written the world’s very first bioethical thriller. Professor and physician Paul Komesaroff ’s latest book, Riding a Crocodile: A Physician’s Tale, explores the issues and ethics of life and death.

Prof Komesaroff said the book goes behind the scenes at a hospital and follows a physician
who becomes aware of disturbing changes taking place in the hospital.

“It explores the daily life of a practising doctor as he encounters a range of different problems that come up with his patients, his personal life and the hospital.

“It’s written as a detective story and a thriller. It’s the first bioethical thriller.”

Prof Komesaroff works at Monash University and is also director of the Centre for Ethics in
Medicine and Society.

Riding a Crocodile is his 14th book, but his first work of fiction. It is available from bookshops
and online.