Early during my first year of medical school, I completed a questionnaire that a graduate student was circulating for her thesis. Her survey included the question “Would you rather be intelligent or kind?” The answer was obvious to me and took not a second’s thought: I checked “intelligent.” I was, after all, beginning medical school, and intelligence was what I needed, what mattered. Looking back, the entirety of my career has been a slow understanding that I checked the wrong box.

Accidental Kindness is a collection of previously published essays arranged so as to give a sense of how the author’s thoughts on the human side of medicine have evolved. At the centre of the book and perhaps the author’s life is the loss, when he was 13, of his father. It was a sudden death from heart failure that occurred in an ER, and Stein held his dad’s GP responsible. It seems that for years a complex mix of feelings smouldered within: a sense of injustice, anger, and grief. Stein believes that his father’s death fuelled his decision to become a physician.

After many years practising medicine, he himself made a serious error—not a medical error, but an interpersonal one. In exasperation, he said something—something that broke his unspoken pact with an HIV+ patient who persistently failed to adhere to her treatment plan and whose condition was deteriorating. (I think he’s far harder on himself than any reader would be.) Stein subsequently made two more mistakes with patients and he ended up taking a leave from his practice. This provided him with time for reflection.

The first essay considers medical students and the anatomy lab. Beyond acquainting them with the human body, the intimate experience of dissecting a once living, breathing human changes people emotionally. Stein’s response was more extreme than that of his classmates. Other essays address:
*doctor-patient interactions;
*his own experience selecting a neurosurgeon and internist when he was diagnosed with a tumour of the skull;
*how we subconsciously take in a huge amount of accurate information about people by watching them and how problems start when we second-guess ourselves using the tools of our intellect.

A large part of the book focuses on a case in which a surgeon irreparably damaged a patient’s facial nerve when removing a tumour of the parotid gland. Stein interviewed both the physician and the patient. Having done a lot of work with addicts, he also includes an interesting account of an appointment with one here.

As the title suggests, this is a work about kindness. It’s also about errors and forgiveness. It is not simplistic or sentimental. It’s nuanced and feels true.

I’d never heard of this book and my picking it up at all was, ironically, accidental. I’m glad I did. In its humanity and reflectiveness, it reminded me of Jay Baruch’s The Tornado of Life, another fine book by a physician-writer.

There is drama to being a doctor. At its best, doctoring is a specific form of impersonation, or in-personation. It is when I take a patient’s passion (her pain, her complaint) within myself for a few seconds. When the disorder of a meandering conversation pulls me into the patient’s story, making their story my story, and seeing it through their eyes begins to create order in me. It is a kind of self-transformation. It can’t be acted. It lies in some deeper script indelibly written in the nervous system, connecting astonishment and gratification. ( )