Reviewed by Rebecca Foster
When I first heard about journalist Polly Morland’s A Fortunate Woman: A Country Doctor’s Story, which was later shortlisted for the 2022 Baillie Gifford Prize, I knew I wanted to read it for its insider’s look into general practice in England. But the more I learned about it, the more I was intrigued by how it might be responding to and recasting a book from 55 years prior, A Fortunate Man: The Story of a Country Doctor by John Berger. The similarities go much further than the title and subject matter, though: these two biographical works, both illustrated with black-and-white photographs, are set in the same English valley and the female subject of Morland’s is the next-but-one successor of the doctor who stars in Berger’s.
There’s more, too: Morland was inspired to write this after discovering a copy of A Fortunate Man that had fallen behind her parents’ bookshelves, as she was moving her mother into care and clearing the family home in the summer of 2020. From its photographs, she recognized the area where she herself had been living for a decade. She also knew the current doctor, a woman who had been the GP there for 20 years. When Morland contacted her, she learned that the doctor was not only aware of Berger’s book but had read it at age 17 when she was considering medical school. It had helped to cement her decision, and it was only a year or so after she’d begun working in that very valley that she happened to pick the book up again and realised she’d unwittingly followed in its subject’s footsteps. The coincidences are uncanny.
In the summer of 2022, I asked Twitter whether I should read Berger’s or Morland’s book first. The photographer Morland worked with, Richard Baker, replied that I should start with the Berger, for reasons that would become clear. I dutifully borrowed a copy of the original 1967 edition from my local university library and gave it a go, but before long became bogged down in a book that feels very much of its time in the way of a pretentious art film.
Berger (1926–2017), an art critic and Booker Prize-winning novelist, spent six weeks shadowing the doctor, to whom he gives the pseudonym John Sassall, with Swiss documentary photographer Jean Mohr, his frequent collaborator. Sassall’s dedication was legendary: he attended every birth in this community, and nearly every death. The book opens with him racing to the side of a forester trapped under a fallen tree. He attends emergencies, routine appointments, and home visits alike in full suit and tie, only removing his jacket during strenuous procedures. Sassall’s middle-class origins set him apart from his patients. There’s something condescending about how Berger depicts the locals as simple peasants. “The area as a whole is economically depressed” and “one of extreme cultural deprivation, even by English standards,” he writes. Mohr’s photos include soft-focus close-ups on faces exhibiting a sequence of emotions, a technique that feels outdated in the age of video.
Along with recording the day-to-day details of medical complaints and interventions, Berger waxes philosophical on topics such as infirmity and vocation. He anticipates Susan Sontag (famous for Illness as Metaphor) with his thinking:
Illness separates and encourages a distorted, fragmentated form of self-consciousness. The doctor, through his relationship with the invalid and by means of the special intimacy he is allowed, has to compensate for these broken connections and reaffirm the social content of the invalid’s aggravated self-consciousness.
Berger also probes Sassall’s character, questioning what makes a good doctor and acknowledging that Sassall was unable, despite his diligence, to give everyone the consistent, holistic care he wished to. He portrays Sassall as restless and prone to depression. “I sometimes wonder,” Sassall told Berger, “how much of me is the last of the old traditional country doctor and how much of me is a doctor of the future. Can you be both?”
A Fortunate Man is a curious book, part intellectual enquiry and part hagiography. I finally began to make more progress through it when I also picked up Morland’s book and read the two in tandem. With its layers of local history and its braided biographical strands, A Fortunate Woman takes up many of the same heavy questions but feels more subtle and timely. It also soon delivers a jolting surprise: the doctor Berger called John Sassall was likely bipolar and, soon after the death of his beloved wife Betty, committed suicide in 1982. His story still haunts this community, where many of the older patients remember going to him for treatment. His male successor was still in post when Morland’s subject (likewise kept anonymous) started working – a bridge of continuity between past and present.
Like Berger, Morland keenly follows a range of cases: a woman who’s never been the same since being hit by a car as a child, a man who’s been lambing for two weeks with a broken hip, a lady in a nursing home with a chest infection. There are moments of high drama – after four miscarriages, a woman in her fifth pregnancy begins bleeding and it’s touch and go whether her baby will survive – and of daily care for ongoing conditions, as well as situations Sassall couldn’t have imagined in his time, such as supporting a transitioning teen. “The doctor,” as Morland invariably refers to her, makes her home visits by e-bike and is known for having a penchant for sweets and listening to audiobooks while walking her three dogs. She is also a horsewoman and relaxes by taking exercise and listening to loud music. As the book progresses, we see this beautiful valley cycle through the seasons, with certain of Baker’s landscape shots deliberately recreating Mohr’s scene setting.
The timing of Morland’s book means that it morphs from a portrait of the quotidian for a doctor and a community to, two-thirds through, an incidental record of the challenges of medical practice during COVID-19. While it does not have such a narrow pandemic focus as Gavin Francis’s Intensive Care, they are both excellent books that I would mention in the same breath for the absorbing and compassionate look at everyday practice superseded by unprecedented circumstances. Morland’s doctor runs vaccination clinics and frets over her Covid-infected patients; the drawer of sympathy cards she sends to bereaved families empties far too often.
In a blog for Waterstones, which chose A Fortunate Woman as its nonfiction book of the month in March 2023, Morland describes the work as “a portrait-in-miniature” of the doctor and area and, like A Fortunate Man, a defence of the primacy of the doctor–patient relationship. A major change from Berger’s day is that women now constitute over half of GPs. The doctor was a rarity in that she lived and worked in the same town, so was invested in her community and committed to continuity of care. This is an endangered model, though, and in the blog post Morland decries the “shift towards a transactional model of healthcare.” This is in contrast to the patient-centred support she describes in the book: “what she offers those in her care is time. … It is iterative, a virtuous activity in the true Aristotelian sense: a pursuit meaningful in and of itself, both ethically and interpersonally … its lifeblood is trust. Looked at in this way, each primary care consultation becomes a waypoint on a journey”.
It was only through outside research that I identified the location of the GP practice in question as the Forest of Dean in Gloucestershire. While A Fortunate Woman takes pains not to identify its subject, she came forward at around the time of the book’s paperback release to express her gratitude at being part of this project. Perhaps because she is no longer working in the area – she is now based in Monmouthshire – Dr Rowena Christmas felt able to disclose her involvement. As she expressed to a Guardian reporter:
if I’m honest, I’m very worried about where we’re going to be in five years’ time. I’m seeing really good, strong practices folding and handing their contracts back. It is so relentless now. I start at seven and it’s very rare that I’m home before eight o’clock at night. My days still have amazing moments with long-term patients. If you haven’t got those magic moments, then the job is brutally hard.
Sassall and Christmas were fortunate indeed to be engaged in work that is not just a job but a meaningful vocation – but Sassall’s suicide and the relentless chipping away at NHS funding are evidence that the UK’s GP services are a threatened treasure, one that we would do well to protect at all costs.
Rebecca Foster is a freelance proofreader and book reviewer who writes for the TLS and Wasafiri and blogs at Bookish Beck.
John Berger, A Fortunate Man: The Story of a Country Doctor (Allen Lane/Penguin, 1967). [Reissue available: (Canongate, 2016). 978-1782115038, 176pp., paperback.]
Polly Morland, A Fortunate Woman: A Country Doctor’s Story (Picador, 2023). 978-1529071177, 256 pp., paperback.
BUY at Blackwell’s via our affiliate links – BERGER. MORLAND. (Free UK P&P)
