The Citadel, by AJ Cronin

Before I begin discussion about this novel, The Citadel, I would like to introduce how I even thought to do this. I was meandering through Snapchat when I stumbled upon The Met Gala. I was fascinated by the outfits people were wearing, and strictly for comedic purposes, I began looking through. Well, the videos showed a picture of a Donatella Versace, and then it dawned on me that these designer brands were family businesses (a little late to realize this obvious concept, but hey, better late than never). I googled Versace, and naturally the rivalry with Giorgio Armani came up. I then read about Armani, and found out that he almost became a doctor because of this book. Indeed, this book is seen as the impetus for the National Health Service in Britain. Already, there are two monumental impacts as a result of this one novel. Armani may never have been a fashion mogul, and Britain’s healthcare would be in total shambles (The NHS is already struggling a bit, but at least it exists). So, I decided to read this book.

The novel follows the tale of Andrew Manson, a fresh-faced doctor from Scotland, who arrives in a Welsh mining town in order to pay off his loans. He initially begins work as an assistant, and earns a meager salary. However, this is good enough for him, and he works diligently and dutifully for the townspeople.


Manson is a fairly hot-blooded individual, and throughout his time in the Welsh town, he begins to question everything he ever learned in medical school, and its applicability. He even uses dynamite to blow up an unhealthy sewer because he’s realized that it is the source of the typhoid epidemic in his town (which is completely illegal, but ends up working).

I was hooked at this point, because I can relate to Manson. Getting good grades in high school and college did not immediately transfer to job skills. I struggled in the research lab at the beginning, and to be honest, am still finding it difficult to be a good researcher. It’s part of a learning curve, but the feeling of ineptitude is something we share. Manson, however, always make the moral decision, and is a strong advocate for honest medical practices and fairness. This is in stark contrast with other people in the profession, who are either corrupt or outdated, and therefore dangerous. Adhering to his ideals is difficult for Manson as the book continues. Being a good person often means that he makes less money than other people who lie in order to get more medical visits. While that isn’t a concern for me, what did shock me was that Manson’s attempt to expose the system brought him many enemies who tried to dispose him from the profession.

While part of my decision to choose the medical profession stems from financial stability, it is only in the sense that I want a job that is respected, and therefore, constantly in demand. I’ve seen what unemployment has done, even to my immediate family, and the shifting jobs and constant change can cause extraordinary stress that I wish to avoid. I only wish for stability of job, and something that is not easily replaced. The fact that honest practices earn less money isn’t the concern for me, because that’s fine so long as the job is stable. What concerns me is the threat to his employment. Another concern is the fact that unorthodox and illegal treatments (illegal because they are not approved yet, as opposed to having detrimental effect or no merit) results in the doctor being ostracized, even if it works.

The issue of doing something that is legal but won’t work, as opposed to illegality that works is something I still have to tussle with. Without a doubt, this is a case-by-case situation, but this is the eternal question applied to the medical profession: do the ends justify the means? I have yet to come up with an answer, and in the novel (no doubt for literary purposes), Andrew comes out of his court hearing for illegal but effective actions as innocent. However, in today’s society, no such guarantee exists, and therefore I will have to ask practitioners about how they do such things.

This was a highly enjoyable book to kick of the 2018 summer, and I hope to add many more concepts to help shape my view of medicine.


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