Fringe Medicine

First published in the NASGP Newsletter in October 2018
Medics have a long-standing relationship with the annual August circus that is the Edinburgh Fringe.

Medical students reprise their pantomimes as reviews. Specialty registrars mine their store of horror stories to test whether a career in theatrical stand-up would be more rewarding than a career standing up in an operating theatre – former obstetrician Adam Kay is one who made the move. Peri-retirement consultants play the Fringe one last time, creaking their way happily through the old routines.

There is never a shortage of shows of professional interest to doctors. I don’t usually turn to the BMJ for cultural hints, but they highlighted The Mould that Changed the World. It’s a musical about the history, blessings and problems of misuse of penicillin. Well, you know the story. In truth, it isn’t a great show for grown-ups. More fun to be a child performing it in a school production. And hopefully taking in the message.

I hold up my hand: I have never understood why for so many doctors John Berger and Jean Mohr’s book A Fortunate Man, about GP John Sassall, encapsulates the ideal to which all doctors should strive. I hoped a show examining how the book was made and claiming to compare medical practice then and now might change my prejudice. Sadly, no. Sassall apparently acknowledged every patient utterance with “I know”. Really? Did no-one find that irritating? And the final statement, about how Sassall was so devoted to patients he wouldn’t have put up with the current box-ticking, I found patronising. Do the show’s authors think modern GPs prefer paperwork to patients?

At the Fringe you may well be baffled but you are unlikely to be bored. With any luck you will have some laughs. But whatever you see, the buzz of Edinburgh in August is a tonic in itself.

Many performers take to the stage to share their anxieties: menstruation, impotence, infertility, sexuality, body dysmorphia (in one show, once inside the venue, audiences were required to remove all their clothes). Autobiographical shows may be cathartic for the performers but do you want to spend 55 minutes living someone else’s existential angst?

However, if you have a point beyond the personal to make, humour may be a powerful way to get your message across. In her show Pricks, Jane Byrne, who has endured 70,000 pricks since she was diagnosed diabetic at the age of four, uses laughter rather than lecturing to educate people about diabetes.

This year several comedians with a cause plumbed their personal experiences to tackle dementia. Pip Utton’s solo show And Before I Forget that I Love You, I Love You wasn’t comedy – the title captures the tragedy and pain of losing someone to dementia. In past shows Utton has turned himself into Hitler, Churchill, even Maggie Thatcher. This year, he was a grieving husband giving the eulogy at his wife’s funeral, telling us that when the diagnosis of dementia brought her career to an end, she insisted they draw up a revised bucket list to accomplish while she was still able. Five years later she is dead, and then we witness his identity and capabilities degraded by the same disease, until Utton morphs into their son, giving his father’s eulogy. It was totally absorbing, painfully real – no surprise to learn that Utton’s mother died of Alzheimer’s. I hope it got a good audience and helped people understand brain failure.

Dementia, along with obesity and its attendant chronic problems is one of the threats to the viability of the NHS. Of any health service. Several performers looked forward to a post-NHS healthcare, and didn’t like what they saw. Be your own surgeon, anyone?

Mark Thomas is an active political campaigner, born at his namesake hospital 54 years ago. He has been howling with rage at the politicians across the river ever since. In Check up Our NHS @ 70 he took a serious look at the NHS.

He spoke with patients and GPs, he spent a month shadowing staff at St Mary’s Paddington and he interviewed Dame Sally Davies, Chris Ham, Michael Marmot, and two former Health Secretaries. His findings: the good – the dedication of staff in the face of appalling pressure. The disappointing – cancer outcomes. The tragic – increasing gap in life expectancy between the rich and the poor. The ruinously expensive – the internal market, and PFI which Frank Dobson admits is the decision he most regrets.

It wouldn’t be Mark Thomas without humour – see his sleeve gastrectomy and you could do one yourself tomorrow – and it wouldn’t be Mark Thomas without anger. He rails at the ideological decisions that are bleeding clinical care of funds and making the likes of Richard Branson even richer. He laments the return of the fear which Aneurin Bevan’s NHS had eliminated. Looking to his own future, he doesn’t see hope in more technology. It’s people like the dementia nurses he met, who find creative ways to ease their patients’ distress. Will kindly care be there for him, and for us, when that’s what we need?

Mark Thomas’s show is on tour and you can catch him at the Arcola in London in October. And why not plan to do the Fringe next year? How would you choose from 3000 shows? You can start the day with the irreverent Shakespeare for Breakfast (e.g. Macbeth covets Duncan’s allotment and kills him with a croissant) and squeeze in maybe six shows before a late-night review (Shitty Deal Puppet Theatre for instance), but you need a strategy. Friends’ shows. Friends’ children’s shows. Word of mouth. Tips from people in queues – very useful. Reviews, even. Checking the Fringe app to find out what is on now, nearby, to fill that 90-minute gap can lead to the crazy boundary-testing shows that make the Fringe so stimulating. A Korean group dressed in tissue paper grunting through a show billed as Chekhov’s Cherry Orchard? A woman blowing a feather around while her companions unload a bucketful of rocks? Why?

At the Fringe you may well be baffled but you are unlikely to be bored. With any luck you will have some laughs. But whatever you see, the buzz of Edinburgh in August is a tonic in itself. No rest-cure but a great pick-me-up. The 2019 programme will be published next June so look out for it.