Prescription: Ice Cream - A Doctor's Journey to Discover What Matters ****
Alastair McAlpine
Pan Macmillan
“I think mental health among medical professionals is something that's like a dirty secret. We all know about it. We all know it’s a huge problem, but no-one is ever willing to talk about it. And if I was going to be honest, I had to talk about it.”
Joburg-born and Canada-based paediatric infectious diseases physician and author of Prescription: Ice Cream: A Doctor's Journey to Discover What Matters, McAlpine (who believes “everyone has a book in them, but not everyone has a story to tell”) spoke of the necessity of penning his memoir.
“When we put those elements together — the history of addiction, the craziness of internship, and then leading up to those tweets — it was like, ‘OK, I think there’s a story here’,” he says of the genesis of Prescription: Ice Cream.
The achronological account of McAlpine’s internship at Chris Hani Baragwanath Hospital, his struggle with alcoholism and shift to palliative paediatrics was borne from a slew of tweets he posted in February 2018 in which he asked his terminal paediatric palliative patients what they enjoyed in life. The responses went viral and publishers Pan Macmillan approached him for a book deal.
McAlpine was initially wary of sharing his personal history, but realised the book would be incomplete without including his challenge with alcoholism, the amicable physician, who replaced his alcohol cravings with enjoying an ice cream, tells me.
I drank to get f**ked-up, McAlpine writes of his relationship with alcohol as an adolescent, with the abuse continuing well into his years as a medical student at the University of Cape Town. His inability to stop drinking resulted in his suspension from med school; he was only allowed to return on the condition he enter, and successfully complete, a rehabilitation programme.
“It was the lowest ebb I've ever been because addiction is so misunderstood. It carries the stigma of being a weak person who is unable to say no to drugs or alcohol,” says McAlpine.
“Addiction strips you of everything, and then it decides whether it wants to kill you or put you into some kind of institution. It's a lonely, brutal illness.”
The stigma that people who suffer from addictions “have really rough histories that would justify ... not justify ... but explain it” contributed to a sense of fraudulence he experienced while in rehab.
“You have to get vulnerable. You have to say, 'I can't do this, I have a problem and I need help'. It was a big moment for me to say I am worthy and I don't need to feel like I'm a fraud in rehab because I didn't have a brutal childhood,” he admits.
“And the truth is that addiction cuts across socioeconomic lines,” he candidly states.
“I didn't have that. I had your standard, middle-class, privileged, white South African upbringing.”
McAlpine attributes his “shift in thinking and that help” to the rehabilitation centres he was admitted to, his counsellors, his fellow recovering addicts and alcoholics, and “a higher power — as I conceived it,” he adds without further elaborating on the nature of (t)his personal deity.
“And heavy metal. Which I will wax lyrical about at any opportunity,” he grins.
“I think we all need to find the things that make us happy. And they come from unusual places sometimes.”
McAlpine was introduced to metal by his Welsh roommate at Tabankula rehabilitation centre in Kommetjie, writing That night, sleep did not come. There was an uncomfortable pressure in my chest.
'Can't sleep, yeah? ... Like your body is exhausted but your head is swimmin' a million miles per hour? Try this.'
'What is it?'
'Never mind. It might help. Or it might make you mental.'
I put my headphones in and closed my eyes. An unearthly shriek pierced through the cacophony, sounding only peripherally human, like a creature drowning in boiling water ... I wasn't sure it could be called music.
'Mate, this is just not my thing. Sorry.'
'Fair enough. But I got one question for ya. What were you worried about while it was going on?'
'Nothing,' I finally admitted. He broke into the biggest grin I'd seen from him since I arrived.
'Exactly.'
“I had a clear, thoughtless mind. No anxiety,” McAlpine recalls.
“It's so crazy and wild that you simply have no other room for anything else. And that's really calming. It's like a protective blanket.”
It was thanks to his niche taste in music that he managed to get through to a teenage boy he tended to in palliative care who was a fellow fan of Norwegian black metal band Emperor. A rapport developed between the paediatrician and a patient who, before their bonding over the extreme rockers' thrashing tunes, was unco-operative, barely allowing doctors to examine him.
“It [metal] was a component of my recovery and I was able to use that love to connect with a patient who wouldn't connect with anybody else.”
Forming connections is a fundamental in McAlpine's life, relaying how he found he connected with his paediatric patients in a way which didn't translate to mature patients: “Adult medicine was providing me with that intellectual connection. Paediatrics provided the emotional connection for me.
“I think it's the only specialty that will make you to laugh at three in the morning when you've been called to the ward and a child blows a raspberry at you or someone comes jumping on your back,” he smiles.
As per the nonlinear narrative of his book, our conversation heads to the direction of his internship years at Bara (which the book opens with), where, after losing a patient, he writes I began to realise that grief was not an emotion Baragwanath gave you time to dwell in.
“It's so crazy and so busy,” McAlpine says of the continent's largest hospital.
“You're going 150km/h all the time. And it felt normal at the time, but it's really not normal,” he concedes.
“I hope it comes across in the book that I don't hate or despise Baragwanath Hospital. It's a beautiful, crazy, flawed place, much like our healthcare system,” he nods.
“It leaves a mark on people. For better or for worse and when you're there for three years, you certainly have your fair share of experiences.”
He describes his feelings towards Baragwanath as “incredibly ambivalent”: as much as it offered him professionally, as much it eroded him personally.
“It numbed me. It took away my ability to sit with grief.”
McAlpine likens the inopportunity to process grief to callusing: “Physicians' souls start to callus, and then you start heading into a very dangerous place where you lose your humanity as a physician, which is sad because most of us went into medicine because we're humanitarians.”
The sense of humanity loss is exacerbated by the “feeling that we spend more time on administration and typing up notes and less time with our patients”, which resulted in him having to protect himself by “building a wall. I can't care too much. I can't give too much of myself. I can't actually listen to them because I just don't have the time,” he says dejectedly.
“And that ultimately left me unhappy. It left the patients unhappy and there has to be a better way.”
McAlpine is cognisant of the amount of emotional energy one is willing to expend, writing about a doctor who introduced him to the “cookie jar” analogy: you reach a point where you can no longer replace an empty, or even near-full, jar with another cookie.
“I almost didn't put it in the book because it felt too like childish,” he says of this culinary sagacity.
“I think there's something there. The notion that wherever, whoever we are, we have a certain amount of emotional energy for the day. And if you keep giving from a cookie jar, you end up giving a piece of yourself.
“But if you don't give it, the patients feel unhappy because they feel like you're not giving them the time and emotion they deserve. It's a tricky one, but I do know many South African doctors have no more cookies in their cookie jar,” he somberly states.
On the topic of the South African healthcare system, McAlpine writes how his registrar, Dr Chloe Shepard* (*he employs pseudonyms throughout), gently explained to him that you can't attempt to solve every socioeconomic issue in Soweto.
“It's morally distressing,” says McAlpine of having to send impoverished patients home.
“You know what needs to be done to really help someone. You know the reason they're here is because they live in an overcrowded condition and the real solution is that we need better housing and more space. But we're simply physicians in a hospital, we're not politicians with the ability to build new houses,” he says heavily.
Alcoholism, addiction, penurious patients, children in palliative care: McAlpine's life is near-synonymous with depression, trauma and grief, yet he manages to maintain a sense of empathetic levity in writing. To what extent does he believe one should incorporate humour, or lightness, when surrounded by illness and death?
McAlpine refers to a quote à la John “JD” Dorian, a physician in the TV series Scrubs (“one of my favourite shows”) which he includes in the opening pages of the book: 'The truth is, you should consider yourself lucky if you even occasionally get to make someone — anyone — feel a little better'.
“The way we get through the day is through jokes and laughter,” McAlpine explains.
“That's what we have to do, because if we were to just sit in the seriousness of it all, if, potentially, one or two of your patients dies every day, if you were to stop and really think about it, you would quit after a week. I think what some people don't understand is that in order to simply get by, there has to be a sense of making life, of making humour. Even if it's very dark humour, making light of it, because otherwise it would be so unbearably heavy that no one would get through,” McAlpine continues.
“I think it has to come into the book because otherwise readers would feel that was unbearably heavy.”
The weightiness of the material led to the decision to construct a nonlinear narrative, he adds.
“Starting with rehab and addiction was too heavy for a book about hope and joy and meaning among all the heaviness,” he explains.
“I wrote the epilogue to say 'this is what happened after my five minutes of fame',” he says of the attention he received after his tweets received a deluge of retweets.
McAlpine attributes the attention his tweets garnered to children's “innocence and ability of cutting through the BS”.
“When you're faced with your own mortality and time is limited, you really do see through it all,” he says of his young patients, whose responses to what they loved in life included their parents, families, pets, going outside, stories, being read stories and reading stories, humour, farts, jokes and the beach. The value children attach to kindness is unmatched, McAlpine adds.
“And ice cream and how much they loved ice cream,” he smiles.
McAlpine-The-MD decries the daily consumption of ice cream (“it's full of sugar and fat”), yet describes sharing an ice cream with someone or enjoying one on your one as “very human. That resonated with the kids. Ice cream becomes a metaphor for what they want, which is connection”.
As for how much ice cream McAlpine ingested while writing his book?
“Too much,” he laughs.
“I think I've single-handedly kept Häagen Dazs or Magnum afloat!”
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