The Unexpected Patient

Dr Himali McInnes

Harper Collins

Otago Daily Times, October 2nd 2021

“The practice of medicine is both an art and a science… [The art ] exists in that liminal space between health practitioner and patient, a space that is a lodestone of desire and belief, fraught with potential conflict”.

In The Unexpected Patient,  Dr McInnes explores how interactions at this interface can profoundly alter a practitioner’s understanding of themselves, their patient, or medicine itself.

Based on interviews with clinicians from across the spectrum, from rural GPs to surgeons, nurses to therapists, medics and (where possible) patients, the book describes 14 instances where a patient’s story has come to define the practice of the clinician treating them. Each chapter begins with a description of the case, a biography of those involved and the significance of the encounter for the physician. These portraits are then expanded into a broader exploration of the socio-cultural context of health and disease, and how New Zealand’s medical system functions as a whole.

These are – with the odd exception – not stories of heroic interventions or strange and unusual illnesses, but there is something in each encounter that is memorable and, in some cases, life-changing. In some instances, a patient is remarkable for their very unremarkability. There is the young Māori woman imprisoned for manslaughter and struggling with addiction and PTSD. The alcoholic Māori man unable to stop smoking despite his chronic lung condition. The asthmatic Cambodian child whose mother cannot be with her in the ER because she is packing chickens on the night shift. That such stories, which arise from poverty, social and cultural dislocation, inter-generational trauma and disadvantage, are so familiar– and accepted – puts the lie to the idea of New Zealand as an egalitarian society.

In other cases, it is the similarity between doctor and patient that resonates: A 30-something rural GP supporting another young father through terminal cancer, a Samoan nurse for whom an unexpected revelation echoes her own experience of abuse.

Then there are those individuals whose journeys speak to the power of hope, faith and the resilience of the human spirit. To the ways in which listening and being open to other ways of understanding and responding to physical and psychological pain can be as powerful as any physical intervention.

Although blunt in her critique of an underfunded social and medical system lacking in cultural awareness and systemically biased, Dr McInness also highlights aspects of our healthcare that excel, and the book itself is a recognition of the potential for transformational change. Those interviewed for this book, practitioner and patient alike, have been generous and brave in what they have reveal about themselves, and speak with clarity and honesty about difficult and contentious issues. There will be readers who will consider the idea that Western-based psychiatric practice can operate in parallel with traditional Māori concepts of mental well-being, for example, or that a ketogenic diet could improve outcomes for diseases as diverse as cancer and Alzheimers, an anathema. Anecdotes may not be data but these stories, which reveal as much about doctor as patient, illuminating the reciprocity of the therapeutic relationship and the way in which the intangible contributes to healing, challenge the reader to approach them with an open mind.