Doctors Tell all—And It’s Far Worse Than You Think
In November, Meghan O’Rourke, whose chronic disease went undiagnosed for years, wrote about the morale crisis among doctors.
Meghan O’Rourke describes a medical-treatment system that is entirely foreign to my personal experience, and I’m a 60-year-old U.S. citizen who has had half a dozen major surgeries and various other treatments, undergone at facilities throughout the country. My routine checkups, consults, hospitalizations, etc., have unfailingly been in environments of genuine interest and concern, and involved thorough examinations and diagnoses, and universally positive results.
But there is a caveat. I am the beneficiary of what I would guess is the largest “socialized medicine” system in the United States: the U.S. military. I am the son of a career Air Force officer, and I myself am a retired Army officer. So I have been cared for by military docs all my life. They are salaried. They have nothing to gain by cramming in more patients, or ordering more diagnostics, or enduring the host of other ills that O’Rourke describes.
So I wonder: Do doctors in our military medical facilities, or, as another example, in Europe’s socialized-medicine states, suffer the same woes? Or, conversely, might our civilian docs find the socialized-medicine environment more conducive to their, and their patients’, health?
After reading this article, three simple yet very satisfying words came to mind: it’s about time. Why do I say this? Because I am a physician who has experienced everything that those described in the article have experienced.
I have had the experience of doing everything I could do for a patient, including making the diagnosis that ultimately led to his demise and then getting sued for doing so. I have had the experience of treating a patient who demanded a test, even though I was sure it wasn’t necessary. I have had the experience of consulting with a family that insisted I insert a feeding tube into their 90-plus-year-old mother, who had such severe dementia that she didn’t speak.
I have also seen a transformation of medicine. In the past, you took whatever time you needed to care for your patient. Now medicine has become mired in a shift-work mentality, whereby it doesn’t matter how much time you take, because in the end, you are still going to order that CT scan, “just to be safe.”
Something has to change, or the plight of doctors will get even worse. I hope that everyone who reads Ms. O’Rourke’s article can put themselves in the shoes of their doctor, and for one second understand what he or she is going through. If they do, I think they will see that medicine is not glorious, and is less rewarding and lucrative than it once was. As for me, I figured that out long ago. I no longer practice, and now work for an insurance company.
Frank L. Urbano, M.D., M.B.A.
As a health-care provider, I’d like to note that all providers want the best care for every patient. We are faced with the hard reality that providing this type of care is not supported by the health-care industry, or, unfortunately, by patients who believe what they are told by insurers and large health-care organizations. We are trained very well to help our patients and to make sure that high-quality care is delivered every time. But that training goes unused. We are paid to see as many patients as possible in as little time as possible. We are forced to treat every insured patient, because they have insurance—but all too frequently, nothing is wrong with them. We are heartbroken when uninsured patients cannot access the care they need. We are increasingly under pressure to work for less and less pay. What begins as true dedication ends up being unrecognizable as such to everyone involved. If people understood this, maybe they would see that health-care providers are also suffering.
The Art of Translation
In “The Mystery of Murakami”
(September), Nathaniel Rich observed that the celebrated Japanese author’s prose is riddled with bad sentences.
I was shocked to read Nathaniel Rich’s review of Colorless Tsukuru Tazaki and His Years of Pilgrimage. Rich decries Haruki Murakami’s “crime” of “awkward construction” and cliché-ridden language without once acknowledging that the English-language examples he uses to support his claim were written not by the author but by the translator, Philip Gabriel. Reviews such as this perpetuate the illusion that literary translation is a transparent process. Rich would have done well to compare various translations by Murakami’s many English-language translators, to see whether some of the weaknesses he ascribes to the author were the fault of a mediocre translation.
Programs in Creative Writing and Translation, University of Arkansas at Fayetteville, Fayetteville, Ark.
Nathaniel Rich replies:
I’m grateful for Kathleen Heil’s note, and regret that, in my discussion of Murakami’s prose, I might have assumed too much knowledge about his English-translation process, which has been well documented over the years. As a translator myself, I’m sensitive to the sensitivities of translators. Perhaps even more sensitive than Heil, since the implication of her letter is that the person responsible for the clunky stretches of prose in Murakami’s new novel is not Murakami but the translator, Philip Gabriel.
I don’t believe that Heil’s theory holds up under scrutiny. For one, Murakami closely supervises his English translations, as he and his translators have often attested. Murakami is an excellent English speaker who has taught writing at Princeton and Tufts. In fact, Murakami is himself a prolific translator from English to Japanese. He knows what a cliché is, and he can recognize one in English. The same goes for repetition and clunky dialogue. It would be patronizing to insist otherwise. “The English version of my books is very important,” Murakami said in a Paris Review interview (conducted in English). “So it must be very precise.”
Consider, also, that he has been translated into English by three translators: Gabriel, Alfred Birnbaum, and Jay Rubin. Yet there is a remarkable uniformity of style and prose across Murakami’s translated fiction. So much uniformity, in fact, that the translation of Murakami’s previous novel, 1Q84, was split cleanly in two by Rubin and Gabriel. In my essay I quoted from seven of Murakami’s previous novels and discussed the full scope of his work with the intention of indicating that his prose (and his plots, characters, and style) has remained strikingly consistent throughout his career.
I think the most honest position is to accept that the intermittent clunkiness of Murakami’s prose is due not to incompetent translators but, rather, to translators who are doing their best to convey the original as accurately as possible.
Unfortunately Heil missed the main argument I was trying to make in this part of my essay, which is that the many stretches of dead prose serve an important function in his fiction. The prose is often flat on purpose; it is strategically flat. In my essay I explain why this might be.
The Big Question: Readers Respond to the November Issue
Who is the most underrated politician in history?
James K. Polk: He oversaw the transition to a bicoastal nation.
Cicero: He influenced law, politics, and literature, and increased the influence of Christianity.
— Karl Tarbox
Jimmy Carter: the only modern president who genuinely valued peace over war
— Jenny Sue Kakasuleff
Shirley Chisholm: After being elected to Congress in 1968, she ran for president in 1972—the first black woman to do so. Her service as a legislator through the early ’80s impacted racial equality, veterans’ affairs, education, and women’s issues.
— Kathleen Nicoll
Henry Clay: He’s mainly remembered for losing three presidential elections, but he essentially held off the disintegration of the Union through sheer force of will.
— John McFerrin
Lee Kuan Yew: He ushered in Singapore’s independence, routed corruption, and turned a tiny island with no natural resources into an economic powerhouse.
— Peter Joel
Eugene V. Debs: Over several decades his policy ideas were adopted despite his losing every presidential bid.
Gouverneur Morris: the author of much of the Constitution
Pontius Pilate: He managed a no-win situation as well as could be done at the time.
— Jack Saviola
Themistocles: Had he not influenced the Athenians to spend their silver windfall on a navy, they would have been conquered by the Persians.
— Patrick Lee Miller
Wayne Morse: He cast one of only two votes against the Gulf of Tonkin resolution.
— Nick Jacobs
Andrew Johnson: He inherited the conclusion of the American Civil War and had to begin the process of Reconstruction with a Cabinet that was just as divided as it was when Lincoln presided over it. In exchange for his efforts, he was impeached because he had the stones to fire Secretary of War Edwin M. Stanton.
— Charles Allport
Jeanette Rankin: the only legislator to vote against both world wars
— Ray Katz
George H. W. Bush: for cleaning up Reagan’s mess and setting up Clinton