“Thanks for your insights into the human condition” – Tere Dawson, community activist

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.

“…an Australian novel of ideas,” Rachel Roberston, Australian Book Review, October 2014

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.

“An unusual book: a high-camp satire spliced with a textbook of biomedical ethics”, Karen Hitchcock, The Australian, 24th September 2014

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.

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
www.uwa.edu.au

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:
amanda.sheppeard@cirrusmedia.com.auby 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.”

An unsettling detective story: Review of “Riding a Crocodile” by Rama Gaind (PSNews Online)

 

Riding a Crocodile: A Physician’s Tale
By Paul Komesaroff, UWA Press, $26.99

This fictionalised account – and an insider’s tale – sheds some light on the machinery of a major teaching hospital and interweaves it with an unsettling detective story that explores the morals of life and death issues that have significant current crucial current climate.

Melbourne-based Professor Komesaroff, a physician and philosopher at Monash University, is a published author of 14 books, but this is his first novel.

While it’s an inventive work that laces together events, characters, predicaments, places and dilemmas, it does not mean that the book is “completely disconnected from real experiences”.

It exudes authenticity. In fact, it has intricately been threaded together following “contact over many years with patients, nurses, doctors and others who have shared their stories with me”.

Needless to say, the lessons provided have been unexpected and often astonishing.

Regarded as a ‘hospital noir’, it articulately examines the workings of biomedicine and discloses the suffering, love, misery, wittiness, confrontations and how self-respect etches some lasting effects on ageing, illness and death.

Riding a Crocodile follows a professor as he becomes aware of some alarming vicissitudes that become apparent at the hospital. After a succession of suspicious deaths, a bewildering world consumes him as he confronts the dangers that surround him.

It is contemporary, has some stirring moments and provides some stimulating food for thought.

With an international reputation in health care ethics, Professor Komesaroff is a Member (AM) in the General Division of the Order of Australia – an honour accorded to him in the 2014 Queen’s Birthday Honours List.

The award was in recognition of his significant service to ethics in medicine as a physician, researcher and philosopher.

“I cried much through it…”: Letter from Professor Zvi Bekerman, Ph.D., School of Education, Hebrew University, Jerusalem

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.

 

Doctor tells thrilling tale, by Holly McKay (19 Aug 2014 Stonnington Leader)

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.

“An exciting read”: Riding a crocodile by Paul Komesaroff. Published by Greenleaf March 1, 2014 by cayocosta72

Abraham Nevski is a respected medical professor who takes his work at Royal Prince John Hospital, a busy teaching hospital very seriously. Returning to work after a break, he discovers that things are different. Unexplained deaths are occurring at an alarming rate and Abraham puts everything, including his life on the line to uncover the truth to save his beloved hospital and his patients.

An exciting read reminiscent of early Robin Cook. A highly recommended read.

Riding a crocodile by Paul Komesaroff. Published by Greenleaf

“It is very difficult to put this book down as it is so topical and blends mystery and drama with everyday hospital life.”: Blue Wolf Reviews ( 21st August 2014)

This is an intense and tightly woven story that has layers of complexity.  The health system, hospital life, personnel and ethics are closely woven together with mystery and death.  It is very difficult to put this book down as it is so topical, blending mystery and drama with everyday hospital life.  The dilemma of aged-care, new developments of Technology to extend life and budget constraints, are all topical issues which the  author has used in a rattling good murder mystery.

Issues such as prolonging life, death with dignity and hospital budgets feature as daily concerns along with unexplained deaths.

Abraham Nevski is a Professor of Medicine at the Royal Prince John Hospital and is trying to answer the difficult questions of Ethics, relating to aspects of Medicine and Life.  He is confident and assured when dealing with students, patients and the process of diagnosis.  In fact, his very confidence and his exalted view of himself, disallows him from confiding his insecurities and personal tragedies to his colleagues.  He supports and encourages other Doctors, while the recent death of his wife, and deterioration of his Parents’ health, are a constant diversion, clouding his judgements.

The story weaves in and out of Wards, I.C.U., and a Clinic.  Many fascinating new cases are presented, with a medical history given.  In all cases, the people are regarded as individuals who are unique and mostly well-loved by their families. A major concern of the Hospital centres on Finance and the enormity of costs when treating the Aged, for prolonged periods of time.

The C.E.O. Of the hospital introduces a programme called “Freedom to Choose.” When elderly and terminally-ill patients are admitted, they and their relatives are approached and asked to sign a Consent form for Staff to switch off Life-Support machines, if needed.  The ugly side of this is a bonus paid to the ward staff, for the highest “turn over” of beds in a month.

Professor Nevski is writing a Paper on Ethics in Medicine and brings to light many pertinent and thoughtful arguments and ponderings, which give the reader insight into his thinking.

Because his mind is so insightful, he determines to solve the mysterious deaths in the Hospital, using logic, reasoning and data.  The Professor allows his judgement to be swayed by personal relationships, becoming deeply compromised in the process.

It is very difficult to put this book down as it is so topical and it blends mystery and drama with everyday hospital life.  The dilemma of Aged-Care, new developments of Technology to extend life and Budget constraints, are topical issues.  The author uses these in a rattling good murder mystery and it is easy to become engrossed in this book.

http://www.bluewolf-reviews.com/index.php/books/fiction/item/655-riding-a-crocodile-a-physician-tale

“A very thought provoking book…”: Some comments from a reader of Crocodile

Well I have to say I was squirming in my seat for a lot of the novel.  Not in a bad way!  A very thought provoking book.

I like how you left the ending hanging.  Not knowing the ongoing fate of the characters had me pondering the impact of the events, particularly with regards to Rebecca.  I keep thinking about the impact of all these events on her life and I wonder what fate she has been destined to?…

I like how you stirred the pot in regards to advance care directives.  The commentary on directives from the characters tended to be one sided; however the voice of dissent in regards to ACDs is not particularly strong at this present time, so to have the characters present limitations around this process I think will be thought provoking to many.  Directives are increasingly touted as the answer to all our woes and unfortunately I am starting to see examples of services and individuals absolving themselves from having ongoing therapeutic and sometimes difficult dialogue in regards to treatment choices and life values.  Fatalistic assumptions that because the piece of paper is signed, we don’t have to talk about that anymore.  Very sad really.

I keep thinking of Abraham too, how many of his foundations became unravelled so quickly.  Someone who to others must have come across as so confident and strong and grounded.  A reminder that grounding ourselves is a fairly tenuous concept and constantly needs to be re-examined as we move as individuals through time and place.

The most poignant part of the book for me by far was the relationship between Abraham and his father.  My own father has a history of bipolar and is now in the advancing stages of dementia, often swinging between phases of delirium, anxiety, mania and depression.  Much of my own ‘baggage’ through life came from the relationship with my father and the impact that his illness had through my childhood and then through my whole life.  Hearing Abraham’s thoughts really struck a chord for me.  It is a relationship that I am eternally bound to and has had an inextricable impact in defining who I am, so I agree with your professor Nevski.  Watching my father in delirium now stirs up all the old detritus once again and it is hard to see the years of fermentation that had turned that s__t into fertiliser.

Thank you for some really challenging writing and for provoking reflection within my own life.