While clearing out her mother’s books in 2020, Polly Morland finds a battered copy of John Berger’s A Fortunate Man stuck at the back of a bookshelf, untouched for some decades. The book offers a poetic description of six weeks in the life of Dr John Eskell, a single-handed country doctor serving the population of a rural valley. As she flicks through the pages, realizing that her mother must have bought the book when pregnant with her, Polly Morland recognizes a black and white photograph of the valley. She is struck by the coincidence that this book is about the very valley where she has made her home for the past decade. John Berger’s account of his time observing the life of a country doctor is regularly described as lyrical due to the poetic attention paid to the landscape of the valley, which is never named in the book. Since the valley remains anonymous in Berger’s book, Polly Morland only recognizes it from Jean Mohr’s illustrative photographs.
Polly Morland goes on to realize that she is acquainted with the country doctor who was Dr John Eskell’s successor, a woman of about her own age who has spent 20 years serving the population of the valley in which they live. The idea of revisiting John Berger’s examination of the doctor-patient relationship in the rural and remote valley emerges, and Polly Morland goes on to spend nine months walking and talking with the eponymous Fortunate Woman. The resulting 200 pages of text and photographs (by Richard Baker) are an intimate portrait of a general practitioner’s relationship with her patients, painstakingly contextualized in a seasonally changing landscape. Patient case studies are spread through the book, focusing on how the doctor understands and responds to the community she serves. The cases cover a range of pathologies: cancer, broken hip, heart attack, depression and anxiety, with the caseload predictably skewed towards elderly people. Remarkably, for 21st-century general practice, the current doctor, like her predecessor, has had ongoing relationships with some of the families in the valley for years, allowing her to assess signs and symptoms against everyday long-term patterns of behaviour and temperament. This means that highly stoic characters who consult with non-specific symptoms are given careful attention and, in one story, a man reluctant to have treatment is actively persuaded into hospital care by the doctor. The forbearing farming type who rarely seeks healthcare despite debilitating symptoms is one continuity with Berger’s book 55 years earlier.
Another continuity is a dreamy, timeless impression of valley life that Berger summoned, somewhat outside of the ordinary march of time, helped by never naming the valley (although the internet suggests the Forest of Dean). Morland does not name the valley either and where Berger gave Dr John Eskell a pseudonym, the doctor in A Fortunate Woman, like her patients, is neither named nor given a pseudonym. This timeless effect is disrupted when the COVID-19 pandemic and its attendant restrictions interrupt the routines of rural general practice. The lyrical descriptions of rural landscapes contrast with anxieties of infection, hospitalization and premature death.
This book’s best bits are the touching stories of human suffering and support, both quotidian and all-engulfing. One of the doctor’s few seriously ill child patients knows she is dying of leukaemia. The child is nursed at home by her mother, with whom she has a close relationship. The child shields her mother from acknowledging imminent death and trusts the doctor with a letter to be posthumously presented to the soon-to-be bereaved mother. The reluctance of some older patients to seek professional help is remarkable: a man removes his teeth with pliers sooner than visit a dentist, and a farmer gets through a fortnight of lambing with a broken hip.
Alongside the lyrical landscapes and patient portraits, Polly Morland includes musings on themes such as the changing nature of general practice in the UK from the 1960s to the 2020s; the shift from predominantly male to female doctors; the role of a General Practitioner’s spouse; how continuity of care has disappeared; and the nature of loneliness in old age. These reflections are interspersed with the doctor’s personal and professional story, including how she arrived in the valley and her collaboration with the late Dr John Eskell’s former colleagues. Eskell’s own story is re-told in the traces of others’ recollections. Interweaving fragments of the life story of Dr John (as he’s known in the valley) works well to counter some of the partiality of John Berger’s earlier account.
A Fortunate Man was criticized for painting a picture of the country doctor as a lone hero, offering his healing services solely through his strength and virtue. Mrs Eskell’s integral role in providing general practice is written into existence in Polly Morland’s story; it was widely known that without his wife, ‘Dr John’ could not have functioned. Betty Eskell supported the medical work as an unpaid member of the team, an intermediate with the doctor. She also protected Dr John from the excesses of his bipolar condition and saved him from several suicide attempts by removing his gun to a neighbour’s house. It was only after his wife’s death that John Eskell took his own life. Dr John was a hero, but not necessarily in the way that Berger portrayed him. The risk that Eskell’s successor – the fortunate woman – is also made to play the role of lone hero are hedged by attention to her supporters: her husband, her teenage offspring and the wider primary care team.
Polly Morland has produced a thoughtful and readable contribution to understanding how healing works in a community setting, and to seeing its failures in context. With the device of one doctor’s story, Polly Morland introduces a range of urgent themes around how primary care is organized, staffed and experienced that both echo and expand upon those raised by John Berger half a century earlier. Polly Morland’s book is ostensibly documentary, with writing styles more common in fiction, demonstrating why we need to think about the culture as well as the science of medicine to grasp the particularities of how medical practice plays out in particular settings.
A Fortunate Woman
By Polly Morland, Illustrated by Richard Baker
Picador Jun 2022