Amy Givler, MD

I’ve been thinking about what I said in my last post — that I wish the fictional protagonist of The White Tiger were my patient.  Aravind Adiga’s writing is so vivid, Balram seems like a real person to me. The book is a glimpse into his yearning for a better life, and, as I wrote before, his choosing to “break out of the cage” of his old life by hurting other people. Maybe that was the only choice available to him — he certainly seemed to think so. But I wonder. And that’s why I wish he was my patient.

But all day I’ve been thinking about that wish. If he were my patient, what on earth would I say to him?

I would certainly do a lot of listening. He is a person with few social ties — isolated and rootless. The path he chose out of poverty meant severing himself from his past. Social ties are important for health. Having emotional connections with others is associated with healthier lives. And he had no connection with God. I would certainly point him to God.

His goal in life was money and the power that comes with it. But there’s a spiritual side to people that can’t be ignored — at least not forever. Jesus Christ came to fill the deepest parts of people’s spirits. I would love Balram to meet Him.

I read a lot. The characters in most books generally fade into the background of my memory. The protagonist of The White Tiger, by Aravind Adiga, however, won’t be fading anytime soon. He is an self-made man in India, an entrepreneur who rises from poverty. But this is no Horatio Alger story, with a hard-working, morally upright protagonist. No, this protagonist, Balram, chooses the only path he sees available to him to leave his grinding poverty behind — and it’s a path that involves hurting others.

Now the logical thing would be for me to say that I disliked the book. But I didn’t. And I say this even though it’s an earthy book — not quite graphic, but earthy. Early on, I knew this character Balram, and I experienced what he was experiencing. He is absorbed with life, and with his quest for freedom from the chains of servanthood, and I became absorbed with his quest. I wanted to talk with him, to reason with him to choose a path that didn’t involve hurting other humans. I liked him and figured there must be another path available to him. I wish he was one of my patients.

Of course, my perspective is that of a woman of privilege who has always had a variety of choices before me. That is what poverty strips a person of — choices.

When I was a much younger doctor I became frustrated with my patients who hadn’t bought the prescriptions I had prescribed. Or, those who had bought it but hadn’t taken it regularly. Or maybe they were still smoking, or not yet exercising, or still eating too many fatty foods. Now I ask many questions, and try to avoid frustration completely. I don’t know what living this person’s life is like. Maybe they have done all they can do to get to the appointment that day. Maybe their life is so chaotic that it’s going to take several visits for them to understand the danger of their medical condition. Maybe they didn’t understand what I was telling them last visit and I need to slow down and explain it again, and this time more carefully.

Maybe they haven’t had the opportunity to make many choices in their life.  To move toward health is a choice. It’s a choice that even the poor, whether they realize it or not, do have available before them.

A friend recently asked me how she could better connect to her children’s doctor. She has three young children and sees their doctor regularly but doesn’t think his temperament fits their family. She’s thinking of changing doctors, but wonders whether she should just try harder to relate to her current one.

I told her I group doctors into two categories — those who want to make all the medical decisions, and those who don’t. Of course there’s a range, and all doctors fall somewhere on the spectrum between seeing themselves as the dispenser of medical wisdom and wanting patients to make their own decisions for their care. I fall squarely in the middle. I see myself and my patients as members of a team. I know some things (knowledge about diseases and medicines, etc.), they know some things (what’s worked for them in the past, what side effects are tolerable, etc.), and together we figure out how to move forward and maximize their health.

My friend’s doctor is far over on the “I’ll make the decisions” scale. He doesn’t explain things well and she gets frustrated. I suspect she’ll be happier with someone who listens more, and seeks out her input into her children’s health.