The unforgiving tides. The true story of a young doctor’s encounters with mud, medicine and magic on a remote South Pacific island

OVERALL RATING Very good

STRENGTHS Gripping stories, real people, and interesting conditions; first-person narrative; coming-of-age of a doctor

WEAKNESSES For this type of book, none

AUDIENCE Anyone and everyone, but especially physicians who are going through or remember the first terrifying trials of their new medical knowledge and skills

Footprints in the sand. The unforgiving tides come in and wash them away. Not a trace remains. At 25, Dr Ross Pennie, with his newly honed clinical skills and his head full of medical facts and procedures, took a voluntary CUSO (formerly Canadian University Service Overseas) posting at the Vunapope Mission in remote Papua New Guinea. Aiming for CUSO’s seemingly impossible goal of fostering lasting change, he wonders whether, like the footprints, he will leave only a soon-forgotten impression.

In medicine, as in all endeavours, despite everyone’s best intentions, things sometimes go wrong. These stories of medical successes and failures arise from Pennie’s first posting in Papua New Guinea. His tales of performing his first unassisted appendectomy during an earthquake, dealing with myriad hair-raising complications of pregnancy and childbirth, and fighting persistent infections with drugs, good advice, and even magic range from heartbreaking to hilarious. Confronted with a bitter dose of reality in this primitive place, he makes do without modern medicine and equipment, gets called out at all hours for all kinds of reasons, and deals with “an endless queue” of patients.

The first time I read this book, I read it right through. I could not put it down. It was like a National Geographic extravaganza featuring someone I had met. Pennie’s descriptions are vivid, his characters alive. You feel as though you are by his side as he negotiates with the Catholic nursing sisters, comforts mothers camped out with their entire families beneath their children’s hospital beds, and wrestles with self-doubt and feelings of hopelessness.

The second time I read the book, I saw more clearly how Papua New Guinea left its footprints permanently on Dr Pennie. His illusions get shattered; his eagerness is tempered; and his high-mindedness to some extent becomes replaced with practicality and humility.

He is horrified to discover that some doctors had let patients die just because it was the weekend or because the dispensing technician was drunk and it was against “hospital policy” for anyone else to unlock the pharmacy. The first time he has to give up the struggle and let a child die, he says, “I had been forced to change my role from eager physician-scientist to modest doctor-healer who knows no higher calling than the relief of suffering.” He invents a special milk formula that has amazing curative effects on children who become malnourished after weaning. He works out a dosing schedule and educates hospital staff and parents in how to administer it. When he goes on holiday, however, the milk formula is discontinued at the hospital, and once children go home, parents do not follow through, and malnutrition sets in again. When he realizes an old woman’s bush medicine is the source of typhoid, he resorts to giving her a “magic” stone to hide under her fire and convinces her to boil away the evil spirits.

A warmer, humbler, more compassionate physician emerges from these experiences. Pennie learns to take joy in small things and to accept the fact that “[n]o one appreciated the great legacy I thought I’d be leaving behind.” The mission priest tells him that for every patient for whom he cared, he was “a lantern in a dark land,” and he realizes “there was magic in every moment, even if those moments didn’t last.”

I recommend this book to doctors old and young as a source of colourful stories, humour, wisdom, and nostalgia. They will see themselves at every turn whether their coming-of-age as a doctor took place on an exotic South Sea island or in a gritty downtown clinic. Some footprints go deep.

• Copyright© the College of Family Physicians of Canada