The Hospital as Jungle : Tiger Country by Nina Raine at the Hampstead Theatre

Jane Macnaughton reviews Tiger Country: At the opening of Nina Raine’s new play about life in an acute hospital, Emily, the new junior doctor in A&E appears with a copy of the Oxford Handbook of Medicine stuffed in the pocket of her scrubs.  My heart gave a jump at the sight as it brought it all back – those days of frenzy and fear during six months as an SHO in A&E.  Raine portrays the hectic choreography of acute hospital medicine and surgery beautifully in this play having spent some time researching and hanging out in various London and Oxford hospitals.  One excellent scene compares responses to two admissions to A&E: one a 24 year-old girl that Emily – lacking a sufficient team – was trying inexpertly to resuscitate – and the other, a balletically co-ordinated response to a workman who had fallen 30 feet from scaffolding.  The play portrays the steady decline of Emily’s idealism in the context of the realities of an NHS system that is understaffed and under-resourced.  Emily’s cynical boyfriend (who is also a junior in the same hospital) tells her: ‘It’s what you have to do.  Unspoken overtime.  That’s how the NHS is run.  On “goodwill”’.  The theme of teamwork – and the lack of it – comes through strongly.  The title suggests a context where it is really every man for himself.  And I mean ‘man’, as the medical world portrayed in this play is still strongly discriminatory.  The hard-nosed Indian registrar, Vashti, swallows her ambition at the end to criticise a senior colleague for mistreating her beloved aunt.  She makes what I think was the most interesting speech in the play complaining about how the system under which she is forced to work forces her to deny the person she is:

What is it about this place that makes you the opposite of what you are?  Pretend you are a man if you are a woman, pretend you’re English if you’re Indian, I mean listen to the voice I’ve invented for myself.  It’s like something out of Jennings.  “Jolly bad show!”  I’m like Prof Bhatacharia, a ponsy Indian man in pin-striped suit with a watch on a chain who shuns everything Indian.’

Despite the excellent acting and direction, however, I felt the play ultimately disappointed.   Especially in the first half I felt I was watching a live version of ‘Casualty’ or ‘ER’.  Here were lots of people being cynical about their jobs but essentially what came through was the glamour and excitement of it all, and a sense of ‘Gosh, wouldn’t it be great to be able to know those things or do all that’.   The play was all about the egos and sensibilities of the doctors, which were large and self-absorbed. I came away feeling that they should all just get over their complexes and focus on what an extraordinary privilege it is to the job they do.  In our field of medical humanities, the role of the arts, certainly in an educational context, is to allow students and doctors the chance to get out of their own heads and inside the perspectives of others.  I have written about this elsewhere in a short essay in the Lancet, entitled ‘The dangerous practice of empathy’.  I was first alerted to the play by the fact that the director initially wanted to use this piece as an editorial in the programme.  Sadly, because the request came too late (the week before the programme went to press), it wasn’t included, but it might have provided an interesting backdrop to the play’s themes.   The drama focuses on the interior preoccupations of doctors – patients are bit-part players, which for most of us in clinical practice is not how we think of our work.   But If you are in London at any time before 5^th February 2011, I would definitely recommend this play as a great night out at a super venue, and for its ability to portray something of the inner workings of the acute end of the NHS.

For another view on the play see Michael Billington’s review in the Guardian.