We live in an era of prodigious medical writing. Memoirs seem especially popular, in addition to books presenting overviews of the various kinds of controversies that continually rage in medicine and medical practice. It is difficult to know precisely why this outpouring of writing by doctors has intensified of late but it is a broadly welcome development. Medicine is a key element of all human societies and thus merits close examination and consideration. It is good to see this happening.
2019 saw a particular rush of books by Irish doctors including this one, ‘Just One More Question: Stories from a life in Neurology’ by Professor Niall Tubridy. Tubridy graduated from the Royal College of Surgeons in Ireland in 1991 and went on to work in hospitals in Dublin, London, Paris and Melbourne. Since 2004, he has been a consultant neurologist at St Vincent’s University Hospital in Dublin and is also a professor of clinical medicine at University College Dublin.
‘Just One More Question’ is an exceptionally readable account of neurology cases from over the course of Tubridy’s career, interspersed with reflections on his own life, medical training and career as a neurologist. Happily, Tubridy does not limit his focus to rare or eye-catching neurological cases, but includes plenty of common conditions and illnesses that are likely to be seen at various points by GPs, psychiatrists and various others. Tubridy also does a good job conveying what it is like to work as a consultant in the Irish health service: the day-to-day routines, the stresses and the rewards.
One of the most interesting features of this book is the sheer number of case histories that Tubridy presents. These are mostly quite concise stories arranged in short chapters of four to six pages each, thus creating a series of bite-sized instalments, often featuring one or two cases in each along with some more general thoughts about the particular diagnosis under discussion. Tubridy’s reflections on his personal and professional life are also interesting and provide good context for the clinical encounters outlined. His memories of his own father, psychiatrist Dr Pat Tubridy, are especially warm and engaging.
Tubridy’s points about medical training and clinical practice will undoubtedly resonate with many psychiatrists, especially those who trained at roughly the same time as Tubridy:
As medical students and junior doctors we had a deep sense of camaraderie – that we were all in it together. We would go in on Saturday morning and not leave the hospital until Monday evening. After twenty-four hours we were paid half time and after forty-eight hours we were not paid at all. This is inconceivable to the junior doctors of today and, with the introduction of the European Working Time directive that limits the hours doctors are legally allowed to work, the team structure we were weaned on has become fractured. Less ridiculous hours is, of course, a good and humane thing, but I wonder if the loss of a sense of belonging has led to a sense of isolation for some of our young trainees. (pp. 208–209)
As often happens over the course of medical careers, Turbidy appears increasingly aware of the limits of medicine, a realisation which applies equally, of course, in psychiatry: ‘People expect doctors to make a diagnosis and then be able to explain the mechanics involved before starting to treat them. Yet medicine is still something of an art…’ (p. 257).
Tubridy also writes well about the psychological stresses of medical practice and suggests that ‘trying to maintain the precarious balance between efficiency and empathy is one of the main reasons for doctors burning out. Everyone has a finite reserve of empathy and no one can possibly get on with everyone they meet’ (p. 261).
As the Sunday Business Post rightly points out, Tubridy’s book ‘teems with interesting characters’ and it is certainly, in the words of the Sunday Independent, ‘compelling … colourful, thoughtful’. Perhaps the most obvious comparator in the existing literature is the work of neurologist Oliver Sacks who explored the cases of his patients in enormous depth and at great length in his various books. But, as the Sunday Times points out, while ‘Sacks hoped that his neurological tales … could bring us closer to where the psychic and the physical meet … Tubridy’s concerns are less rarefied. He wants us to understand the human toll that illness takes’.
Tubridy is certainly very attuned to human suffering and human confusion, but he uses these accounts of illness and treatment to shed light not only on the many neurological disorders he describes, but also on the challenges and rewards of diagnosing and treating them. In the end he advises, towards the conclusion of his book, that ‘one day the sky will fall in on each of us. I urge you to celebrate the fact when today is not that day’ (p. 289). Carpe diem indeed.
Conflicts of Interest
None.
