Benjamin Abelson
Commentary on The Doctor and After the Shift
Commentary on The Doctor and After the Shift

About 130 years separate Luke Fildes’s The Doctor, a depiction of a young boy—perhaps his own son—dying from typhoid fever, and Owen Smith’s After the Shift, a raw illustration of a health care worker’s despair and isolation during the COVID-19 pandemic. So much time between them, and yet these 2 healers are transiently connected across centuries and continents. I originally saw Fildes’s The Doctor during a lecture in my first year of medical school, alongside other students in my class. Our untrained eyes peered deep into the work of art, beyond the screen that was waving ever so slightly in the breeze of the air-conditioning, the color contrasts of the boy’s faded yellow blanket muted by the deficiencies of our whirring projector. We turned off the room lights for a better view, finally discerning the faint outlines of the boy’s mother, weeping on the table behind him—a detail that was previously invisible and suddenly devastatingly obvious. I now find myself again drawn to Fildes’ work, as millions of people around the world experience the death of their family members from a distance—relegated to the shadows, like the boy’s mother—and the doctors’ intimacy with patients is blurred by layers of rubber gloves, disposable gowns, masks, and face shields. I once viewed The Doctor as representative of the intimacy of doctoring—the physician deeply interwoven within the life of his patient and family—but the lack of touch always bothered me. Despite the warmly personal setting depicted inside the family’s home, the father’s hand resting on his wife’s shoulder is the only evidence of physical contact as we watch the boy sleep—and die. Why isn’t the boy’s head nestled into the crook of his father’s elbow? Why aren’t his legs curled in his mom’s lap? Why isn’t the doctor touching his patient? Why must this poor child die alone? So many have died alone, without friends or family, the burden of the final breath resting on the shoulders of the health care providers who are shielded by masks and gloves but have no protection against their own isolation. The intimacy of doctoring—the mutual vulnerability of patient and physician that forges deeply personal relationships between the sick and their healers—can be devastating. I suspect that Fildes intentionally made the patient the physical centerpiece of the work, but he placed the doctor within the same spotlight, the 2 figures beautifully connected but painfully separated. The patient’s pale skin and slightly opened mouth blend into the white shirt and pillow as life fades from his body. His left arm is outstretched, falling to the side after desperately reaching for his physician, his limp fingers curled in his empty hand. The half-empty medicine bottle on the table proves useless, and the doctor feigns confidence as he strokes his beard, knowing that death awaits. Owen Smith’s doctor—both his physical position, and his emotional state—perfectly mirrors Fildes’s doctor from 130 years prior. In After the Shift, Smith’s healer is seated alone on a subway platform, his worn mask briefly pulled around his neck, his wrinkled scrubs and hunched posture evidence of his coffee-resistant fatigue. He sits alone, pondering the ventilator settings of the patient he left in the ICU, knowing that death awaits. Doctoring is inherently about connection with another life, whether that relationship is defined by a psychiatrist’s intimate verbal engagement or the careful slice of a surgeon’s scalpel. Yet the struggles then become our own as we internalize the suffering of others. Medical training, although aimed at developing physicians with masterful bedside manner and skillful clinical acumen, is not conducive to the type of work–life balance that could serve as a salve to our own wounds. Instead, we learn how to effectively remain imbalanced, and with that imbalance, comes isolation. Doctors make inattentive partners, unpredictable friends, and distracted parents, but we soldier on, working hard to make emotional connections with patients and coworkers, family and friends, with whatever emotional reserve remains. What would Fildes and Smith talk about if they grabbed coffee together? Despite Fildes’s and Smith’s doctors being separated by the invention of vaccines, 2 World Wars, the birth of flight, and the automobile, their conversation would be casual and resigned, distant yet familiar. One of them wielded useless therapies against a typhoid outbreak in the 1870s, forced to watch a boy dying in front of his parents; the other was overwhelmed by the hopeless death taking place in his hospital while mobile morgues filled up outside of cutting-edge 21st-century hospitals. Together, they would share similar stories about triumph and despair, miracles and failures. They would lift each other up and find companionship in their lonely healing.