When a novelist of the rank of Henry James or George Eliot chooses to place a doctor at the center of a novel, we gather around to hear, to see, to witness our work in the hands of a creative genius. It is "vouchsafed to a few to salvage without effort from the whirlpool of their own feelings the deepest truths, towards which the rest of us have to find our way through tormenting uncertainty and with restless groping," wrote Freud [2] about the creative writer. No wonder we turn to James and Eliot: Perhaps they can help us to fathom what happens before our gaze.

A country doctor commits a diagnostic error that costs a peasant his leg. A doctor afire with the passion of reform loses his own quest for goodness. When a healthy patient chooses death, her doctor has no cure. And a generation finds refuge from evil and death not in wellness but in disease. The plots of the four novels annotated below revolve around illness and death. As macabre and unjust as many deaths, those depicted in these tales stand concretely and irrefutably for death itself and yet resonate with metaphorical connotations of knowledge and meaning. That which literary scholar Walter Benjamin finds true in fiction is true in medicine: "What draws the reader to the novel is the hope of warming his shivering life with a death he reads about" [3]. Our own privileged position at the bedside endows us with knowledge and gives us a key to meaning. No end, though, to our tormenting uncertainty.

I have read these novels many times, and each reading is new. I wonder how these novelists knew so much about my work. Their narratives give me heart, if only because they give names to the untellable. The dying writer Dencombe in Henry James's story "The Middle Years" utters what could be a doctor's credo: "We work in the dark—we do what we can—we give what we have. Our doubt is our passion and our passion is our task. The rest is the madness of art" [4]. Let us be on with our art.

Madame Bovary

Gustave Flaubert

Published in 1856

Flaubert's Dr. Charles Bovary is a simple man with modest expectations. He sets broken bones, attends at childbirth, and joins his country patients in their country lives. When he attempts to repair the clubfoot of a villager, his ambition leads to disaster. Bovary's wife Emma expects much more of life, seeking to replace Charles's ordinary love with the romanticized and imagined love of others. After dying by her own hand, Emma is laid out in a classic deathbed scene that will stay with medical readers forever. Flaubert presents a literary corporealization of his characters in this novel [5], reducing (or elevating) them to their flesh and bones and realizing the doctor's gaze with the writer's reach.

Middlemarch

George Eliot

Published in 1871-72

Eliot's novel examines medicine as a secular vocation. Dr. Lydgate practices the best medicine he can, trying to bring to England the advances in pathology and physiology that he learned on the continent. Based on contemporary ideas of pathology and influenced by late-19th century discoveries of organic processes [6], Lydgate's medicine conflicts with the beliefs and practices of his more traditional colleagues. Eliot adopts organic metaphors of physiologic webs of relationships to portray her characters' social landscape and personal entanglements. This dense fictional study of the doctor's place in the community and his ultimate downfall encompasses the social and political realities of the day, offering a case study of the inextricability of a medicine from its people.

The Wings of the Dove

Henry James

Published in 1902

This complex novel turns on a sickness. American orphan and heiress Milly Theale falls ill with an unexplained disease. She visits Sir Luke Strett, a leading London doctor, whose prescription for the patient is that she live. Characterized by psychoanalytic parallels, this doctor-patient relationship features a doctor who "reads" his patient and a patient who, in being recognized, feels cared for. No one knows what Milly Theale dies of, but die she does when betrayed by her loved ones. Doctor readers of The Wings of the Dove will experience the depth and truth of Sir Luke's diagnosis and will comprehend "the great empty cup of attention" [7] that the physician places at the command of his healthy and dying patient.

The Magic Mountain

Thomas Mann

Published in 1924

Hans Castorp is a young German engineer who perhaps suffers from tuberculosis and is treated at a sanatorium in the Alps at Davos. Thomas Mann adopts metaphors of illness, decay, and treatment to examine love, social philosophy, personal fate, courage, and death. Freed by disease from the ordinary constraints of their lives, Castorp and his fellow patients are also liberated from the inhibitions of the body and soul. Only the opening battles of World War I have the gravity necessary to bring these patients with tuberculosis back to the real world. The novel is a breathtaking confrontation with the deep meanings of the doctor's work and the patient's plight [8].