A Fortunate Man. John Berger

      Philip Toynbee, writing in the Observer a few days later, called it ‘a series of brilliant descriptive sketches … a genuine tour de force, and the admirable photographs of the local countryside and its inhabitants match and illuminate the text with an unusual degree of sympathetic understanding’. Toynbee felt particularly well-qualified to comment on the accuracy of Berger’s portrayal of the physician: the book’s subject happened to be his own doctor. ‘The Sassall who emerges from these pages – both from the text and from the photographs – is indeed the man that I myself have known, liked, and admired for several years. But he is more than the man I know, not because Berger has romanticised him or enlarged him, but because Berger knows him better than I do and has thought about him harder.’

      A Fortunate Man is a memorial not just to this exceptional individual but to a way of practising medicine that has almost disappeared. Sassall’s approach to his practice is all-consuming – in today’s culture of working-time-directives and the commercialisation of disease it would be almost impossible to sustain. Sassall has made a Faustian pact: he is rewarded with endless opportunities for experiencing the possibilities inherent in human lives, but at the cost of being subject to immense, and at times unbearable pressures. These pressures manifest themselves as episodes of profound depression, periods during which he is overwhelmed by ‘the suffering of his own patients and his own sense of inadequacy’.

      The book opens with a series of ‘case studies’, though the term is too clinical and doesn’t reflect either the emotional subtlety of Berger’s word-sketches or the versatility of Sassall’s responsiveness to his patients. They are glimpses of the situations Sassall responds to every day, recognisable to any doctor, but they convey the extraordinary depth of Sassall’s commitment to his patients. They tell of the struggles of those patients, and also show how powerful an influence the landscape exerts on the community and its stories. As Berger writes in the opening pages: ‘Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.’ Within that landscape the community looks to Sassall as a ‘clerk of records’; the figure to whom they tell their stories: ‘He keeps the records so that, from time to time, they can consult them themselves.’

      Berger and Mohr follow Sassall through these parallel landscapes – the physical landscape of rural England and the metaphorical one of his patients’ lives. The moral possibilities of medical practice are drawn out, without shying away from the risks that doctors like Sassall run in identifying so closely with those suffering mental and physical pain. The myth of Faust, the life of Paracelsus, the works of Conrad, and the dream of the universal are each examined for the ways they illuminate aspects of Sassall’s motivation. He is compared to one of Conrad’s Master Mariners who sets out to compass not the globe, but the totality of human experience.

      Towards the end Berger tries to make an assessment of Sassall’s contribution to society and his community, but finds that he cannot. A society that doesn’t know how to value the lives of its people can’t adequately account for the value of easing their pain. ‘What is the social value of a pain eased?’ Berger asks, ‘What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but extremely difficult diagnosis compare with painting a great canvas?’ The absurdity of the questions reveals just how far we have to go in appreciating the value not just of art, but of life.

      In the years after publication Berger moved to Haute Savoie, a remote Alpine district in the south-east of France close to the Swiss and Italian borders, in order to live closely with people who worked the land. ‘I didn’t go to university,’ he told me, ‘the peasants were my university professors.’ Like Sassall in rural Gloucestershire, Berger became a ‘clerk of records’ for the people he came to live amongst. He poured his reflections on their lives into his trilogy Into Their Labours, as well as works such as The Seventh Man: his exposition, again with Mohr, of Europe’s exploitation of peasant migrant labour. As a story-teller, Berger wishes to lose his identity in that of his subject and his readers, just as Sassall sought to lose his identity in those of his patients. His assessment of Sassall could stand for an assessment of his own life and work: ‘Like an artist or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.’

      In the late 1970s Sassall left the Gloucestershire practice and travelled for a while in China, learning the ways of the barefoot doctors who were then the main providers of medical care in rural China. In April 1981 his wife Betty died, at the age of 61. At the end of his Observer review, Toynbee confessed to a ‘quarrel’ with Berger for leaving Betty out of the narrative, though the book is dedicated in part to her: ‘this racked and pain-haunted man would have collapsed long ago, and perhaps irretrievably, if it hadn’t been for his wife’, Toynbee wrote. ‘Her role is as archetypal as his.’ Sassal’s suicide a little over a year later in August 1982, only a couple of months after retiring from medical practice, deepens the enigma of his life. A careful reading of A Fortunate Man reveals its title to be a paradox; fitting for a study of a man whose very openness to experience – his gift to the world – was also his undoing.

      A Fortunate Man is almost fifty years old, but remains fresh, urgent and relevant; a reminder for physicians and patients alike of the essence of medical practice – of the differences between healing and medicating. It is a text with resonance for anyone who admires Sassall’s pursuit of the universal. Like all great works it is many things: a celebration of a way of medicine that we have all but lost, a ground-breaking exercise in photo-documentary, a literary-photographic creation of lasting beauty and a personal study of a man who aspired to an impossible ideal. Sassall’s goal was an intimate appreciation of what it means to be human; medicine was just the vehicle he chose to reach it. In my own work as a general practitioner his kindness and imaginative empathy are an inspiration, but at the same time he stands as a warning of what can happen when boundaries between a physician and his or her patients breaks down.

      In trying to assess Sassall’s qualities as a physician Berger wrote ‘he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity’. This quest for recognition, and for a sense of fraternity, has rarely been articulated so beautifully. Back in 1967, Tom Maschler concluded his Guardian review of A Fortunate Man saying simply: ‘I am grateful for it.’ I too am grateful: to Victor Anant for suggesting the book in the first place, to John Berger and Jean Mohr for crafting such a masterpiece, and of course to Sassall, and his family, for permitting the intimate details of his life and attitudes to be set down. Through this new edition I hope many more readers come to know that gratitude.

      Gavin Francis

      * Interview in Marxism Today, December 1984, with Geoff Dyer.

      A Fortunate Man

      Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.

      For those who, with the inhabitants, are behind the curtain, landmarks are no longer only geographic but also biographical and personal.

      One of them shouted a warning, but it was too late. The leaves brushed him down almost delicately. The small branches encaged him. And then the tree and the whole hill crushed him together.

      A man breathlessly said that a woodman was trapped beneath a tree. The doctor asked the dispenser to find out exactly where: then suddenly picked up his own phone, interrupted her and spoke himself. He must know exactly where. Which was the nearest gate in the nearest field? Whose field? He would need a stretcher. His own stretcher had been left