Pulp Fiction

And the Hidden Link between Photography and Medicine

My first job after college was as a photo researcher at Magnum Photos. 

I was a young liberal arts grad, in love with photography and especially with the work of the French street photographer, Henri Cartier-Bresson. Cartier-Bresson co-founded Magnum in 1947 with three of his friends, including the glamorous war photographer Robert Capa. 

Back in the late 1980s, Magnum was the premier photo agency in the world - a small, storied, exclusive fraternity of elite photojournalists, run as an autonomous collective with all the organizational chaos that term evokes. The CEO gave the orders but the photographer-members called the shots - by consensus or lack thereof.

To be invited to join Magnum was the greatest honor a photojournalist could receive. It meant that in the opinion of the best you belonged with them. There was no jury of experts, only of peers - new members were elected at the raucous, week-long, annual meeting, which alternated between New York and Paris. 

Because of Magnum’s prestige, the job was highly competitive; every young photographer wanted to work there. My resume should never even have gotten a second look. But I had connections.

My mentor at Princeton was a writer named Gloria Emerson, who made her name in Vietnam as the first female war correspondent at The New York Times. Her friend was the Magnum photographer Susan Meiselas, who documented the Sandinistas in Nicaragua. Gloria told me I should work at Magnum to develop my eye, and she told Susan to tell Magnum to hire me. 

When it came to Gloria, people did as they were told.

My main role at Magnum was to find pictures for clients. For example, Time Magazine (remember them?) would call, and say they needed a shot for a story on Afghanistan. I would sift through dozens, sometimes hundreds, of slides and contact sheets and send over a selection.

The job was low-paying and often tedious, but Gloria was right: it trained my eye. Since then I have never wondered if a photograph is good; I just know right away.

And there were perks. During my first week at Magnum, I met Cartier-Bresson. In my second week, I met Josef Koudelka.

If Magnum were a body, then Cartier-Bresson would be the brain, with perfectly composed images and his philosophy of “The Perfect Moment”. Capa would be the heart, with bold action shots and his famous quote, “if your pictures aren’t good enough, you aren’t close enough”. And Koudelka would be the soul.

Josef Koudelka is most famous for his work with the Roma, or Gypsies as he called them, and as he was known himself. For most of the year, he traveled with the Roma in caravans around Europe, documenting them with his Leica camera, eating and drinking with them, and sharing their lives.

Once a year he would show up at Magnum for the annual meeting. Luckily for me, that year was New York.

While in the city, Koudelka camped out at the Magnum office, dumping his rucksack against the wall and unrolling his sleeping bag in the corner. During the day he would drink and hang out with the staff; at night he took over the darkroom. He worked alone, developing and printing dozens of rolls of black and white film taken over the previous months. 

Koudelka was like a patron saint to the other Magnum photographers. He represented the real thing, the man they all wanted to be and measured themselves against - an itinerant artist; an outsider and iconoclast; a wanderer and journeyman - a faithful servant to his art but free in every other way.

How can I forget the day I met Josef Koudelka? 

He had unruly gray hair, a patchy gray beard, blue eyes magnified by round glasses, and a wrinkled, weathered face. He spoke hardly a word of English and carried around two glasses and a bottle of vodka.

I was standing at my workspace behind a long table, peering at slides through a loupe on a lightbox. Koudelka threw an arm around my shoulders, and patted himself on the chest by way of introduction, “Josef!” 

He poured two shots. We clinked glasses and downed them. He poured another two, gave a toast in his native Czech, and we tossed those back too. He gave me a big smile and wandered off to the next employee.

Years later, as a Family Medicine resident at Beth Israel Medical Center in downtown New York, I admitted a patient who bore an uncanny resemblance to Josef Koudelka. Same thinning, disheveled hair; same creased face; same open smile. 

I still remember his name, Francisco, and that he was a carpenter - not a photographer but not that far off. Like Koudelka, his English was limited to a few keywords. Like Koudelka, he had no permanent home. And like Koudelka, he drank - a lot.

Someone had called the cops on Francisco for acting unruly in the street and they took him to the ER. By the time I met him he was in acute alcohol withdrawal, with a fluctuating mental status and elevated vital signs.

Honestly, if I could have had a few drinks with him the way I did with Koudelka and sent him on his way, that would have been ideal. Nothing works better for alcohol withdrawal than a little more alcohol. 

But that’s not how we do things in medicine. 

Instead, we started him on Ativan, a benzodiazepine that acts like alcohol, and pumped him full of fluids and vitamins. Then we admitted him to detox, a dangerous process that can kill a patient if you’re not careful.

Over the next few days, Francisco resembled Koudelka less and less. He became floridly disoriented and hemodynamically unstable. He required escalating doses of Ativan - enough to knock out a (nonalcoholic) horse - until we had to transfer him to the ICU for continuous IV drips and monitoring. 

By the time he returned to our team he was a lot better. More clear, sometimes even lucid. On rounds, he mentioned his family back in El Salvador, which he had fled because of political violence. 

What would he do when he got discharged, the chief resident asked? He gave us a wink and a grin: “Fiesta!” I couldn’t tell if he was teasing or being serious. Probably both.

Around the same time, in 1994, Quentin Tarantino released his classic movie, Pulp Fiction. In one of my favorite scenes, two hit men, Jules and Vincent, sit in a booth at a diner after witnessing a “miraculous” event. 

Jules tells Vincent that he is thinking of quitting the murder business and relinquishing his worldly possessions to “walk the earth”:

Vincent:

Wat’cha mean, “Walk the Earth”?

Jules:

You know, like Caine in Kung Fu; walk from place to place, meet people, get into adventures….

Vincent:

…So you decided to be a bum?

Jules:

I’ll just be Jules, Vincent; no more, no less.

Vincent:

No, Jules. You’ve decided to be a bum… without a job, a residence or legal tender, that’s exactly what you’re going to be: a f***ing bum.

Jules:

Look, my friend, this is just where you and I differ.

Is Koudelka like Caine from Kung Fu, and my patient a bum? Is there more than meets the eye and it’s the other way around? Or is it simply a case where you and I will differ?

People sometimes ask about my path from photography to medicine. Is there a connection, something common to both? 

The answer is yes. Both medicine and photography require intimate contact with a wide range of folks.

Both provide the tools to treat patients and subjects as unique individuals with a shared humanity.

And both will teach you that people can be so alike on the surface, so different underneath, and so similar again when you dig deeper still.