Novel Medicine: Love in the Time of Cholera
Authors: Gabriel García Márquez, A Mark Clarfield
Journal: Journal of the Royal Society of Medicine (2007)

There is no doubt that Gabriel Garcia Marquez deserved the Nobel Prize for literature when he won it in 1982. That may well be the case, but why should a doctor read this book? First of all, one of the main characters, Juvenal Urbino, is a physician. Following his antics, it is fun to read about medical practice in the late 19th and early 20th centuries on the Caribbean coast of Colombia, where the book's action takes place. Real medicine, it seems—the technological advances of the past century notwithstanding—offers some universal and unchanging truths. For example, in his old age the doctor ‘did not attend patients in the clinic, but whenever he passed by and had time to spare, he would go in to remind his more advanced students that there is no medicine better than a good diagnosis.’

Secondly, the book's title offers something ‘medical’. But nothing is that simple for Garcia Marquez. We learn that in this story cholera can be many things: a killer, an excuse to take a long love-filled boat journey, or a metaphor for war. Regarding the latter, throughout the story bloated corpses turn up intermittently and disturbingly. The author never quite makes clear whether the bodies are (as Thomas Pynchon pointed out in The New York Times) the result of ‘el cholera’ the disease or ‘la cholera’—anger, which if not controlled can end in violence and ultimately war.

The reader can't help but smile at the double entendre involved in the name of the physician protagonist Dr Juvenal Urbino. Our medical hero is a sophisticated and extremely eligible bachelor, winning the hand and perhaps the heart—Garcia Marquez tantalizes us with ambiguities throughout—of the lovely Fermina Daza. Up until this match, she had promised herself to the young but prematurely old Florentino Ariza. Our hapless alter-hero is not put off by this setback and—in a time span not unlike that which I hope remains for me to read in—he takes precisely 51 years, nine months and four days to recapture the heart of the lover who spurned him so long ago.

Another reason this captivating book should interest all physicians (except perhaps the paediatricians) is that it is absolutely full to bursting with insights about ageing and old age. For example, Florentino begins to suffer from various ill-defined symptoms at age 40, which today would hardly be considered old. After his doctor reassures him that it is ‘only’ his age, ‘[Florentino] was shaken by a visceral shudder that left his mind blank, and he had to... lean against the wall so that the first blow of old age would not knock him down.’

Later on in the novel, the reader learns something of which every geriatrician is aware: the fear that old people have of falling. For example, ‘Florentino Ariza was very sensitive to the faltering steps of age. Even as a young man he would observe elderly couples who helped each other across the street, and they were lessons in life that had aided him in detecting the laws of his own aging.’

Finally, and no surprise to anyone familiar with Garcia Marquez's work, not only love but sex even into old age comprises a central theme. The author treats this aspect with delicacy but frankly. For example, suspecting her elderly mother of planning to have sexual relations with the even more wrinkled Florentino, Fermina Diaz's middleaged daughter protests loudly, ‘Love is ridiculous at our age, but at theirs it is revolting.’ In protest, the old lady confides in her daughter-in-law, ‘A century ago, life screwed that poor man and me because we were too young, and now they want to do the same thing because we are too old.’

In this vein, the author offers a poignant touch relating to touch. As the two old people begin, ever so slowly, over several days, to make physical contact, Florentina reaches out to take Fermina's hand. ‘Both were lucid enough to realize, at the same fleeting instant, that the hands made of old bones were not the hands they had imagined before touching.’ Lest we lose all hope as to what awaits us all, Garcia Marquez goes on to reassure us of the power of true love, since ‘In the next moment, however, they were.’

This book is worth the read, both for the sake of its literary qualities as well as for the doctor, its approach to life, love and, above all, ageing.