“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.

“I could almost feel that you had written it for me personally…”: From A. Page, retired English teacher

This afternoon I have completed my reading of your novel.  Wow!  It is wonderful!

I wish I was still teaching Year 12 English and your novel was on the syllabus; what a goldmine of ethical and philosophical reflection to form the basis of student discussion and writing!  The novel I enjoyed teaching most was Chaim Potok’s, “The Chosen”,  which I taught on at least four occasions. I enjoyed every re-read and the class work which followed.  I could not put your book aside; I felt the necessity to read it as often as possible.  For some reason, I sense a strong connection between Potok’s and your novel.  Their ‘hearts’  are very similar.

There is so much in your book which relates to the experiences of my life that  in imagination I could almost feel that you had written it for me personally.  When I started this email, I envisaged identifying touchstones, ideas and experiences with which I can identify but soon realised that  the process might become a long novel of its own.  Sufficient to say that my work,  my church work with the elderly, my interest in medicine, my younger son’s career in medicine, my wife’s cancer and subsequent death,  responsibility for the the later stages of the lives of elderly relatives,  interest in ethics and the big questions of life, et alia have all endeared the book and its ideas to me.

Heartiest congratulations on a grand literary achievement.

“Ethical positions will always be fragile…”: Reflections on reading “Crocodile” from Colin Nettelbeck, Emeritus Professor of French, University of Melbourne

Some reflections on my reading of Crocodile,  which I very much enjoyed. During the process, I always looked forward to going back to the book. It’s now been about a week since I finished it, so my thoughts and feelings have had time to settle a bit.

Probably because of my French bias, I found myself reading it in the spirit of the philosophical novels of the 18th century—Voltaire, and Montesquieu especially—and also of the work of Camus. Of course the issues raised are contemporary and urgent, and your protagonist’s dilemma of finding himself having to work within a paradigm that is repugnant to him is one that is widely shared today; his mix of candour, innocence, careful reasoning, commitment, intelligent resistance and self-doubt are very recognisable as charactertistics of many of those I would classify as “goodies” in my own world, and I find him very engaging. Voltaire’s ultimate solution, in Candide, is withdrawal from the world, and Abraham doesn’t do that, except for the frequent slogs of whisky. But his path condemns him not just to the periodic anguish of difficult cases, but to the knowledge that his ethical positions will always be fragile. This is the Camus of La Chute, and it puts me in mind of the Montesquieu who opined that if God didn’t exist we would have to invent Him, humanity by itself being so inexorably recalcitrant.

Your evocation of what it’s like to work in a big hospital is very vivid; for me, having been a patient in intensive care at the Alfred, it is very revealing to see what might have been going on around me as I remained absorbed in the effects of my own illness! Your various case studies are all colourful, and the ethical questions you derive from them are all thought-provoking.

My big disappointment lies in the underlying picture of the powerlessness of doctors to fight successfully against the economic model. I’m glad you get rid of your CEO, but in real life most of them don’t commit murder or attempt it, and when they blunder, they get bonuses that would keep a small town’s economy (including its hospital) alive for a year. I have been saying (to myself and to anyone else that might listen) in recent years, that my one hope for overturning the rule of the monster that is sucking the humanity out of us was that doctors would rebel, refusing to treat those corporation managers and politicians who so zealously oil the machine every day, until they come to their senses. I guess I’ll have to give up on that idea.

Thank you for an engrossing and pleasure-filled read.

“Riding a Crocodile” launch speech by Professor John Wiltshire, La Trobe University

I must have read Riding a Crocodile four times, because I was one of the people whom Paul asked to comment on his book from its first draft onwards.

Reading Crocodile once more, I’m again impressed by the ambition and complexity of the novel. As a non-medical person, I have always found it an eye-opening account of life in a big public teaching hospital. I have also found it a demanding, sometimes emotionally exhausting, experience. The novel is packed through with Abraham Nevski’s taxing encounters – with other staff, like the on-going tension with the nurse Desmond Ray – but still more of them with patients. Each of these patients, Paul shows, has a different backstory, a different medical history, and all of them, inevitably, present the staff with their own unique medical challenges. At the same time, threading through these dramas – and inseparable from them – Crocodile raises a wide range, even a plethora, of difficult, possibly intractable, ethical issues.


‘The vast sea of suffering and sorrow through which medicine ploughs its way’, Paul shows Abraham thinking, ‘could not be described by a set of rational scientific principles or laws. Indeed, it was the intractability of the project, the irreducibility of suffering to reason, that for him constituted the immutable, tantalizing core of clinical practice.’ It’s this ‘core’, this messy, unpredictable and endlessly testing complex of human meanings that Paul has set out to capture in this novel. As you know, Paul is a distinguished medical ethicist, and it was a natural development out of his work as a writer on ethics, that he embark on a novel – a novel that should somehow render and capture those ‘minute particulars’ of behaviour and circumstance in which ethical or moral meaning resides. Paul has managed to do this: Riding a Crocodile doesn’t have any of the stick figures so common in bioethical writing. And crucially, while we become irresistibly engaged with, and admiring of, Abraham, at the same time, he’s also taken down a peg or two, and there’s comedy in his posturing and conceit. At the same time, again, there’s a strain of tragedy in his story, and if at the close he finds a modicum of victory, he also suffers a catastrophic collapse.


To pull off a novel of this complexity is really something, and like everyone here, I congratulate Paul and rejoice in his achievement.

Speech presented at launch of “Riding a Crocodile”, Melbourne, July 29th 2014 by Professor Ann McCulloch, Deakin University, Melbourne

That wonderful image of riding a crocodile reminds me that if this is our inevitable mode of travel in an age of global economic rationalism we must be always vigilant, that we, at any point in the journey, can be taken with the crocodile at feeding time when it is securing its prey. Crocodiles take their victims into the watery depths and kill them before they satisfy their hunger. We as experts in our fields have become victims or perpetrators at the hands of managerialism. Paul’s novel reminds us that if we decide to go along with the ride there is an art to not being responsible for the killing- in other words we must struggle within the new frame of reference to sustain our integrity, endemic to our calling, whether that be in medicine or in developing models of knowledge that lead to problem-solving; they must remain humanitarian whilst cost-effective. Time will tell whether there exists at the heart of this equation an unresolvable contradiction.


Riding a crocodile: A Physician’s Tale has a particular significance for ‘Baby Boomers’ and, of course the impact of baby-boomer mentality on a younger generation who, after all, are confronting problems of a different ilk. Baby boomers reaching the autumn of their days in their professional roles are concerned with mortality in a way that is not merely a philosophical awareness of death. If they have been lucky enough to reach this age with parents still alive they also must deal with the double assault of death and what it means to be an ‘adult child’ as well as a parent. This book explores not only what it is like for all people engaged in the medical profession where death is a constant event to be dealt with but with how death impinges in the psyche at different ages and whether there is ever a possibility that people become expendable. There are two major ironies of course: people over seventy plus and baby boomers considering their movement toward their next decade or so of life contributed financially to medical expertise that has been able to create the technology that extends life and yet under the new regime of economic imperatives might be deemed the first dispensable ones. These issues inform the plot of this remarkable and poignant novel.


Trans-disciplinarity is a major force in the humanities- this novel has played out in dramatic form the extent to which it resides in the practice of medicine. Paul constructs scenarios throughout the novel demonstrating how all disciplines inform the life of a physician. No one after all wants to be a bean counter; not all things can be judged by dollars and cents. His protagonist is a philosopher as well as a practising physician and it takes a particular kind of wise writing to tell a story whilst engaging with philosophical axioms and succeed, simultaneously in sustaining an interest in the narrative. Paul achieves a balance between action and ideas.


Quite apart from the philosophically sound explorations into ethics and the querying of the classical relationship between knowledge and virtue –this is an exciting novel. One is genuinely interested in the characters: the plot is structured with a magician’s hand suspending expectation, disrupting vain predictions and creating a metaphoric model whereby the behaviour of the protagonist, who is both detached and yet immersed, becomes a motif for our engagement in ethical questions – yet he is also each of us, no matter what our occupation, attempting to know the recipient of our training and knowledge and whether we see that recipient as a client, a trainee, a member of a family, or primarily a human being who like us lives a life entailing love, accomplishment, fear, joy , despair and a relentless longing to make sense of this world.


Fiction offers something that cannot be represented by other disciplines (whether history, Journalism, sociology etc.) in that its rendering is experiential and via the characters it can offer a perspectival view of living, enacting exchanges that are emotional as well as Socratic and when it is good it constructs intersecting realms of empathy. I feel the plight of the characters as much as I accept and reject their intellectual understandings.


I believe that all speeches at a launch of a provocative novel must engage in gender issues – it’s surely ideologically polite to do so. My particularly aggressive feminist friends have queried me (and this following comment does not discount me from a feminist sensibility- after all aren’t all intelligent people feminist?)-They have queried: why is it that I have written primarily (though not only) about male writers. I was surprised at the query initially and had not been aware that this is what I had done – I assumed that it was the content of the work rather than the gender of the writer or artist that attracted me-but thinking it through I learnt to reply that perhaps I feel that I understand women but men remain a puzzle for me to unravel. This book we are launching today is definitely written by a man and this is not a criticism – it is an observation that seeks to access how men and woman represent each other. Great novels are less interested in ideological correctness and more interested in investigating ‘truths’ however impossible it might be to capture them. My otherwise genteel and civilized brother, who I should add sustains an unbreakable loyalty to his wife, once said to me “ Ann, don’t you realize that men when meeting a woman always regard her firstly as a potential sexual partner”. I remember replying, despite being somewhat disconcerted by his view, that does he assume that women don’t do the same?. And of course this is why we become healthily repressed (and neurotic according to the Freudian model) and, although one recognizes that need for repression in relation to our sexuality (discontented but civilized) we should be careful not to repress instincts that tell us that economic management does not serve to make us more civilized. I think that this novel represents these dilemmas beautifully. Given my interest in unravelling the problem of what it might be to be a man as opposed to a woman, I have always been intrigued with the relationship between fathers and sons which in my experience seem always to be a troublesome one of a particular kind. Paul, via his protagonist, answers this question for me in a way I had not encountered before. You must read the novel to discover his philosophical view of this: his rendition of the why the father refuses to give approval to the son whilst the son relentlessly and obsessively seeks it is indeed insightful (see pages 168-170).


Thank you Paul for this unique work of art.

New book provides insider’s account of life in a major teaching hospital, explores issues and ethics of life and death


Scott Eathorne: http://www.quikmarkmedia.com.au
What really happens behind the scenes at a hospital? In Riding a Crocodile (UWA Press, $26.99) Melbourne-based professor & and physician Paul Komesaroff that provides a fictionalised account into life in a major teaching hospital.

Told through a chilling detective story that explores issues and ethics of life and death with contemporary relevance, Riding a Crocodile follows a professor who becomes aware of disturbing changes taking place in the hospital. A series of suspicious deaths then throws his world into confusion and he has to confront the dangers that close in around him.

Riding a Crocodile is a topical, thrilling and deeply thought-provoking novel.

“…it kept me on the edge of my seat.”

I found the story very absorbing and it was difficult to put down. Though those not in the medical or paramedical field may find it quite technical it would appeal to the vast majority of readers. It has empathy, its characters are human and may well have been sought from your personal experiences, it has a plot, it kept me on the edge of my seat and it had a climax. I am busy recommending “Riding The Crocodile” to my family and friends.

Tania Tobias

“…a deep dive into the world of the hospital”

Riding a Crocodile provides an insightful, unique, and very human deep dive into the world of hospital based health care from a physicians perspective whilst contrasting the overlapping roles and responsibilities of those of us responsible for health system reform. It flags the essence of the question how much does it cost to care? It is important for all health professionals to pause, lift their gaze from the patient and consider what health reforms can mean for the communities that we serve. Crocodile provides a brave template for this discussion. I have colleagues queuing up to read this book (I may need to buy another copy).


Bernie Westley

General Practice, Clinical Advisor and Linguist

“…a very fine book, both engaging as a narrative and spreading puzzlement and reflection on so many ultimate issues”: Letter from Alphonso Lingis on reading “Crocodile”

I found myself reading Riding a Crocodile slowly, each of the encounters and events opening beneath a network of perplexing issues.  I remembered what I found so troubling and captivating in Experiments in Love and Death.  The encounters and events progress in so concrete a way that I almost was there, and then the issues–of life, of decision, of worth–open up without being resolved.  So I found myself moved to puzzle and ponder.  Riding a Crocodile is not only a mystery narrative (“hospital noir”) but an involvement in the whole of Abraham’s life and an immensely thoughtful and through-provoking experience.

I was increasingly aware of the tact and sensibility of the author, in encountering and dealing with so many different kinds of patients–suffering  people.  And the growing sense that Abraham, Rebecca, and Duncan are also patients, suffering with their patients.

I read the book slowly, but also continuously; drawn by the narrative to know again and again: what happens next?  Passages where Abraham withdraws, to the office that is his retreat, and also to his writing, are essentially connected with the pressure of events to which he is exposed.

I much appreciated the composition, the language that is clear, the dialogue that is natural, a language that does not call attention to itself, and that conveys so directly both the events of the narrative, and the issues of life, decision, meaning that are reflectively worked.

Much of the reason the narrative is so engaging is that each of the personages, patients or staff, are quickly revealed to be more complex than they appear on the surface.  And Abraham in each of the events and encounters is complex and conflicted.

This is a very fine book, both engaging as a narrative and spreading puzzlement and reflection on so many ultimate issues.  I could not help but thinking of so much of what you have learned and thought and felt that went into it.  Such that it was for me also a long visit with you.

I am grateful to have read it and grateful to you for all the travail and endurance you have devoted to this writing.



“Crocodile” and “The magic mountain”

A few people have asked me about the relationship of “Riding a Crocodile” to “The Magic Mountain” by Thomas Mann, having noticed some references, including a couple of common character names and other features. It is true that I have been deeply influenced by Mann, whose work I love very much. In fact, “Mountain” has preoccupied me for years, with its dreamlike setting that epitomises the decaying world around it. The Royal Prince John Hospital does have some similarities to the Berghof Sanitorium, even if the cultures they reflect are worlds apart. Like so many authors, however, I can only dream about the possibility of approaching Mann’s exquisite, poetic lyricism or his incisive, ruthless insight into individual subjectivity.