The Genocidal Healer

Sector General #8

by James White

Physician, heal thyself

Surgeon-Captain Lioren of the Monitor Corps was a hard-driving perfectionist who expected the same high standards to be met by all who worked with him. But while on a First Contact mission on the planet Cromsag, where plague had reduced a peaceful civilization to barbarism and war, Lioren's perfection was his undoing. In his zeal to find a cure for the plague, he inadvertently caused the death of the entire planetary population.

Lioren's guild lead him to seek a commensurate penalty--death. But the Monitor Corps was loath to waste talent. Instead, Lioren was stripped of his rank and assigned to Sector Twelve General Hospita as a lowly trainee in the Psychology department.

Then Lioren met the huge alien Groalterri, the first of its kind to allow contact with the Galactic Federation. It was vital that Sector General succeed in curing the giant being, but it would not even speak to anyone--except Lioren. The medical problem was a simple one, but what the alien needed most was the one thing that Lioren could nog give. For before he could offer help, Lioren would have to do the impossible--forgive himself. . .

Genres: Science Fiction, Science Fiction Fantasy, Fiction, Space Opera, Medical, Speculative Fiction, Hard Science Fiction

219 pages, Mass Market Paperback

First published January 1, 1991

About the author

Librarian Note:
There is more than one author in the Goodreads database with this name.

James White was a Northern Irish author of science fiction novellas, short stories and novels. He was born in Belfast and returned there after spending some early years in Canada. He became a fan of science fiction in 1941 and co-wrote two fan magazines, from 1948 to 1953 and 1952 to 1965. Encouraged by other fans, White began publishing short stories in 1953, and his first novel was published in 1957. His best-known novels were the twelve of the Sector General series, the first published in 1962 and the last after his death. White also published nine other novels, two of which were nominated for major awards, unsuccessfully.

White abhorred violence, and medical and other emergencies were the sources of dramatic tension in his stories. The "Sector General" series is regarded as defining the genre of medical science fiction, and as introducing a memorable crew of aliens. Although missing winning the most prestigious honours four times, White gained other awards for specific works and for contributions to science fiction. He was also Guest-of-Honour of several conventions.

Reviews

[Alexander Winzfield · Rating 5 out of 5]

I confess to being less than objective when it comes to this book: it was perhaps the first SF book I fell in love with (I read it when I was about 9), and it influences me to this day.
Imagine Star Trek...but in a hospital. And with actual ALIENS, not human actors with a bit of putty on their faces, but really different ALIENS, beings utterly unlike us. Sounds fun, but how do you run a complex institution when many of the races breathe completely different air? Or when some are as tiny as a pencil where others are larger than the hospital itself? Or (and this is one that comes up in the book) when the doctor resembles a vicious predator that preys on the patient's species?
It's much more than just dry questions of management...this has a pretty epic story. Lioren, who is furry and has a bunch of eyes, is a brilliant doctor who just wants to do the right thing. He makes a mistake in a moment of desperation...and the consequences are catastrophic. Not quite able to bring an end to himself, Lioren is demoted, and struggles to find purpose, and to atone for his sins. Yes, that's right, it's also a pretty empowering tale of overcoming depression and finding friendship in the oddest of places (some of the chums Lioren meets in the cafeteria include an empathic insect and a beaver-like creature who is incapable of lying). It may not be the most celebrated of SF nor have the most astounding of ideas (and I see most rate it pretty low even in the Sector General series to which it belongs) but I love it, and recommend it heartily.

[Leslie · Rating 3 out of 5]

March 2021 reread in Kindle omnibus "General Practice": Adjusting my rating from 3 to 3.5*
------------------------
This 8th book of the Sector General series is the first one to not feature Dr. Conway since the very first book. While I found it interesting to have a non-human main character for the first time, Lorien (a Tarlan) was a more frustrating protagonist than Conway ever was. Plus the many discussions about religion, though appropriate, were of less interest to me than other types of ethical debates. However, I would be interested in reading more about Lorien in a future book to see how his "punishment" ends up! White made a small but significant change in his writing which enhanced the 'alien-ness' of the narrator - all masculine & feminine pronouns were replaced by neuter ones (it instead of he or she).

Oh, and just in case anyone is horrified by the title - Lorien isn't a mad killer or even a mercy killer, just an arrogant doctor who made a mistake due to insufficient information and impatience. This is not a spoiler as these facts come out in the very beginning of the book.

[Valerie]

I'll get into more detail later. The story of how 'Surgeon-Captain' Lioren became 'Padre' Lioren is an interesting story of a philosophical quest, started as a response to a crisis, and continued when it becomes a matter of life and death.

My copy is very shopworn, because it's been read frequently, and was used when I bought it.

Fair warning: this is not an easy book to read. Lioren has been through such an ordeal that one of the ways he's able to connect with people is to tell them his own story, and make them realize they aren't the only people in the cosmos with problems.

The story begins with a recap, told in the course of a court-martial, of what happened on Cromsag. Though Lioren has already been cleared of criminal negligence in a civil hearing, he (note that, since the story is told from Lioren's point of view, his gender is indicated, whereas the genders of members of other species are designated by the canonical 'it') believes that the exoneration is not just, and insists on prosecuting himself in his own court-martial, demanding not only a guilty verdict but also a death sentence.

O'Mara, for the defense, (assisted by Cha Thrat) argues that this would be a criminal waste, and that the penalty for Lioren's malfeasance should be commensurate not with the dreadful consequences, but with the relatively minor misbehavior, which, (o'Mara argues) would have been the response of any similarly obsessive and inflexible medic in the same situation. O'Mara also argues that Lioren's fault is excessive dedication and overconfidence, which is, in o'Mara's opinion, remediable.

These preliminary arguments comprise the first chapter. The next section is a recounting of the Cromsaggar Incident in all its disturbing detail.


The recounting of the Cromsag Incident for the court-martial is told in the third person, but it's always from the point of view of Lioren. In the course of the description of the treatment of the universally infected Cromsaggar, Lioren doesn't come across as a very sympathetic character. By this I mean not only that he has difficulty empathizing with others (who, after all, are not very forthcoming in explaining their behavior), but also that he's not very lovable himself. He's represented as impatient, obsessed with status, and more than a little arrogant. The stated doubts about whether the surviving Cromsaggar are even WORTH saving (however much they're discounted by Prilicla as not representing Lioren's true feelings) are a good indication that he shouldn't have passed the psychological tests required to become a doctor, despite his technical skill. Maybe he should never have even considered or been considered for a career that involves social interactions with patients. Lioren should know that it's not the doctor's right to make ANY decisions about the 'worthiness' of patients, even the most difficult.

And this impatience should raise concerns even in people who don't already know it ended disastrously. There are several warning signs: the fact that the patients' already weakened state deteriorates quickly when they're forced to stop fighting. The fact that interest in nonviolent excitements improves the clinical picture nearly as much as violence. The fact that despite a generally low level of sexual activity, there are still infants (some of these might be older than their apparent age due to plague affects on the maturation rate, but there are still infants). The fact that the only case of sexual activity Lioren personally witnesses is in the neighborhood of a recent battle. The fact that Thornnastor is not satisfied with the cure it develops, and urges caution specifically involving the endocrine effects of the disease and the cure. The limited information acquired from the Cromsaggar themselves...

At one point a dismissive mention is made of the abandoned settlements as 'of interest only to an industrial archaeologist'. But this is a very foolish dismissal. Without knowing how the Cromsaggar lived BEFORE the plague, it's not possible to collect relevant information from reluctant informants who no longer believe that there WAS a time before the plague. And surely there must be archives somewhere detailing the beginnings and progress of the plague, and how the Cromsaggar dealt with it? The Cromsaggar have not themselves destroyed the evidences of their former civilization, and it's quite likely that, at least at first, their medics and other citizens hoped that the old ways could be restored once the plague ended.

Although the medical archives would likely be largely fruitless (except in detailing what was tried and failed), even something as simple as knowing how long the plague had lasted until the point where the Tenelphi 'discovered' Cromsag would be helpful, since the adaptations would take generations to become ingrained.

Given the limitations of the knowledge of Cromsaggar history, physiology, etc, it's probably inevitable that disaster occurs. O'Mara argues that part of Lioren's problem is that he takes too much responsibility for things he had no control over, and indeed, except for his prudishness in refusing to listen in to a Cromsaggar coming-of-age ritual, it's hard to see how any other doctor would have behaved differently. It's all very well for Thornnastor, safe at Sector General, to urge caution: but the fact is that most of the people who ended up gruesomely dead on Cromsag probably would have died anyway of the plague if not for Lioren's overreach. And, as several people point out, the quickness of Lioren's response saved the lives of the few adult survivors. So Lioren's self-accusation of genocide wouldn't survive in any fair court.

Lioren knows before the court-martial that if he fails in his self-prosecution, he will be remanded into o'Mara's custody. O'Mara argues that Lioren's crime was at least partly o'Mara's fault, in that Lioren didn't properly complete his training. So the training is resumed in a probationary manner. And where does o'Mara put Lioren? Where does o'Mara put all the self-starting misfits at Sector General?

In the course of Lioren's orientation, a lot more is revealed about Braithwaite's history. Cha Thrat's history we already know, but Braithwaite has been somewhat obscure, and it becomes obvious that this is deliberate. Braithwaite only comes out of the shell for therapeutic purposes. We'll see more of Braithwaite later.

All this is essentially prequel. Lioren's true education begins when he's assigned to learn more about the Nallajim Senior Physician Seldal. His complaint that the briefing he gets is inadequate is valid. O'Mara argues, essentially, that Lioren should be unprejudiced, and that a more thorough briefing would be counterproductive. Maybe, o'Mara suggests, there's nothing to find.

The rest of the book involves Lioren's attempt to carry out his charge. From the beginning, it leads in unexpected directions, including requiring Lioren to befriend a couple of lowly interns, a Kelgian and a Hudlar. Lioren, who insists that no abasement or abuse is too great, nevertheless begins to think that maybe the punishment isn't as bad as he first thought. Which, of course, exacerbates his guilt...

Having decided to approach his investigation of Seldal by talking to the entity's patients, Lioren starts with one that's bound to startle anybody who's been working through the series in order. Doctor Mannen was an important figure in the early history of Sector General, and most readers will probably retain an impression of him as in early middle age--and early Senior Physician, and one of the first Diagnosticians. The discovery that at this point he is decrepit, bedridden, and terminal in advanced old age will likely make most readers feel old themselves, even if they didn't read the earlier books hot off the presses.

Seldal learns that Lioren has been able to render Mannen a more cooperative patient, though Lioren won't explain how. So though this is only one of Seldal's patients, Seldal asks Lioren to interview Seldal's least cooperative patient, in hopes of a second breakthrough.

The description of Groalterri society is necessarily largely speculative, because the Groalterri generally refuse contact with the Federation. And in a lot of ways it's indicative of how people interpret information how they DO speculate, based on the admittedly limited facts they do have.

The Groalterri are BIG. Tralthans are frail an sylphlike by comparison. Even the Groalterri 'Smalls' (as with many macrospecies, immature Groalterri are much smaller than adults) require very special accommodation. The Groalterri adolescent Hellishomar has been sent to the Galactics because the adults are at a loss as to how to treat it, either for its immediate injuries, or for its long-term problem. And it's HUGE: but by comparison with adults, it's still small.

Lioren is assigned to try to elicit Hellishomar's cooperation. Up until now, Hellishomar has been sullenly accepting treatment, and trying to get people to leave it to die. Lioren's mission is to try to find out why Hellishomar is so depressed and uncooperative.

Up to this point, Lioren has been largely ignoring the spiritual elements of his own ordeal. But hearing the story of Small Hellishomar the Cutter, he is forced to face a question. Hellishomar believes that it remains telepathically deaf well into adolescence because it has sinned. And it believes that it has exacerbated this sin by despairing. So Lioren is forced to investigate the question 'What is the difference between a crime and a sin?'.


One thing I should note in this book is that White represents Lioren's understanding of religion as remarkably westernized for a supposedly galactic student of theology. I'm reminded of Betty Williams' account of her attempt to broaden the horizons of Northern Irish schoolchildren. Once, she explained, she told a group of children that she was going to bring a Buddhist priest to talk to the class. "Is he a Protestant Buddhist, or a Catholic Buddhist?", one of the students asked. When he heard this story, the Dalai Lama laughed heartily. But one wonders how White would have responded.

I very strongly reject o'Mara's theory about why adult Groalterri don't communicate with Smalls, by the way. I think it more likely that the Smalls are telepathically deaf, and normally develop their talents during adolescence. As for why the adults can't tolerate children around them, if the children are projecting telepathically, essentially at a yell, at all times, it's not surprising if the Parents, being unable to muffle the outbursts, rely on distance to mute the yells. Perhaps what adolescents learn, when they begin to be able to hear their own voices, is how loud they are, and how to modulate their telepathic voices.

The silly 'ontogeny recapitulates philogeny' argument o'Mara floats has not only been disproved for many decades, it never did make much sense. Infants and children are NOT 'stupid'. Most of them are highly intelligent--they're just ignorant. The notion that nonhumans are 'savage': rude, crude, and violent, has always been absurd. And where did White ever get the idea that early modern humans violently wiped out Neanderthals? There's no evidence for this, and substantial evidence against it. Modern humans, Neanderthals, Homo erectus, and even, probably, some australopithecines, shared the Earth for quite some time, and there's no evidence for conflict. A comparable argument might be that modern elephants violently wiped out mammoths and mastadons. In fact, humans are heavily implicated in the extinction of mammoths and mastadons (though probably not solely responsible)--but modern elephants are not.

Lioren's interviews with Hellishomar are not for attribution (mostly). But they lead Lioren not only to research the Federation religious beliefs (with the abovenoted lacunae), but also to try to find out how telepathy might miscarry. Hellishomar's story indicates that Hellishomar believes that the failure of telepathic sensitization is because of personal moral failings. But Lioren doesn't believe this--and, as a doctor, he's probably right--but he's stymied by a lack of understanding in the Federation about the mechanics of telepathy.

This is what leads him to seek permission to interview the other telepathic patients in the hospital, which in turn leads him on into his researches in regards to religion. Lioren refuses to state his own beliefs (or, rather, doubts), ostensibly out of fear of influencing the beliefs of others. But he describes the beliefs of others to help the patients he's turning to for help deal with their own doubts.

It's not clear what Lioren learns from the Protector of The Unborn he consults. Nor is it clear why he doesn't interview the Telfi patients, who might have given him some useful information about how telepathy works among them. But it's fairly obvious why he and Khone have an in-depth discussion about religion. This discussion is not particularly helpful in the attempted cure of Hellishomar, but it is helpful both in the therapies of Khone and Lioren. In a sense, this conversation is the core of the book. The resolution of the original (almost forgotten) problem, and of Hellishomar's problem are not yet settled: but many other problems are at least started on. One thing that surprised me was the Tarlan attitude to apologizing. I hadn't considered that some peoples might consider apologies dishonorable. Perhaps I shouldn't have been surprised: but I had considered Lioren's arrogance personal rather than cultural.

I have to say I disagree with a lot of the arguments made between Lioren and Khone--but I probably wouldn't have argued with them, if I were there. This is more a reflection of my detestation for argument than a reflection of the level of disagreement, most likely. One of the arguments I've always disagreed with, for example, is the idea that a complex present predicates a creator. But this is a minor argument, anyway. The final suggestion is a little unorthodox, and I'm not sure if I agree with it: but, as Khone says, "There is always doubt".

The preparations for the surgery, the surgery itself, and the resolution can be summed up by Hellishomar's reaction when asked how it feels: 'Fascinated'. The description of the surgery from the point of view of an observer would likely be similar to that of a person watching nanobots do microsurgery on a screen, and it would probably take a difficult act of perspective shift to realize that the surgeons are nearly the same size as Lioren.

The problem of what would have happened if the surgeons couldn't achieve a cure is an important philosophical problem. And in a sense, it's not resolved, only put off. Especially since the disabled adolescent, Hellishomar, is quite strict in its religious beliefs. What it might have chosen to do if it couldn't be cured and/or returned home is a disturbing thought.

In an earlier book, Conway is informed that one of the preparations for becoming a Diagnostician is having to learn to deal with the near-certainty of some cases being incurable. He really doesn't get much practice in that. Which is good for his patients, but it leaves him not well prepared for the inevitable failures. Lioren doesn't have to worry about that, but he's unlikely to feel grateful for the lesson.

[Sherrez · Rating 3 out of 5]

Coming of code blue emergency to this was really a god send . MC was clearly more likeable than tra chat ever was . The character lioren is a surgeon than did accidental genocide on the people of cromsag , while being impatient for a "cure" from thornmaster , who instead of running it on a select batch , ran it on everyone and killed them.

this is the setup for the story and lioren altho cleared by the tralan court insisted to be court martialed and punished for his sins with omara defending him. He wanted to be killed instead. fleet commander dermod ( loved that he made an appearance again) , ruled that he was to be confined to the hospital instead and was assigned to work as a trainee psychologist under omara's care because his skills were too valuable.

lioren went around three different species , mannen , khone ( love that he was here too ) and lastly i forgot the species and name but a small cutter interacting with them and exploring various themes

this book was heavily themed based , about forgiveness of one self , humility , religion etc etc . There is too much to get too and went way over my head . is not that i don't like scifi with such a heavy emphasis on themes but out of the past 7 sector general books it was always a backdrop to the story .

although this book was good , my 3.5 star rating leans towards 3 because it's not expected when the book the series has always been a light reading , so go so deep into it's themes and meandering explanations especially with khone.

also i think the parent's were fucked up in a sense their motivation for telepathically asking for the monitor corp to pick it up was due to wanting it to die , or experience life outside of the planet.

omannen's not liking himself is actually something that was quite unexpected as he confided that he only liked himself because of the multiple personalities that hid himself away from the bitterness of himself , compared to seldal who made friends with his tralthan personality to improve his flaws.
the big surgery in the end was really cool too fun read.

[Daggry · Rating 5 out of 5]

The most moving of the three Sector General novel(la)s I’ve read thus far. Some readers will chafe at the extensive religious conversations, but I was sufficiently invested in Lioren’s growth arc, including how that intersected with the religious beliefs and concerns of other struggling alien beings.

At the outset, Lioren isn’t terribly likable. But as in other stories in this series, it’s satisfying to untangle what is his personality and what is an artifact of his species’ expected social behaviors. That's one terrifically interesting aspect of these books: well-developed alien biologies and cultures that clash in unexpected and often ultimately fruitful ways.

Lioren’s story is fundamentally about emerging from depression and embracing friendship. But I love that along the way we get to explore different ways of honoring one’s culture, taking responsibility, and delivering justice.

[Pat · Rating 2 out of 5]

(Read as part of General Practice omnibus.) Took me a looooong time to read. (In fact, I stopped and reread some stuff not recorded here. Then made myself finish it.) Do love the earnest care for individuals; didn't love the bizarre and unpleasant alien culture Lioren encounters. And then we got into looooong discussions of religon; and ... Yeah. Not my cuppa. Still, we get an outlandish operation at the book's climax; and a nice little revelation of how successful the operation was; and a satisfactory conclusion. Not a favorite, though.

[Jim Standridge · Rating 5 out of 5]

Excellent story. This is kind of a "physician heal thyself" story. Here he gives a new meaning to diving into your work, as the patient is the size of a medium scout ship. Keeps the interest up well throughout. White does a great job in making strange, weird and totally alien characters into regular people leading interesting lives in an inter-galactic hospital. With correspondingly inter-galactic patents. If you haven't read any of this series, you are missing out.

[Tanya · Rating 3 out of 5]

this is a fairly short book, just over 200 pages. took awhile to get into the story, and there seemed to be several deviations from the main story but in the end it all makes sense.

this is the weakest of the sector general series (at least of the ones i have read) so far. almost could have been even shorter. the writing style also seems a bit off from the other books in the series.

[Caitlin · Rating 4 out of 5]

Lioren, like Cha Thrat, has cultural and personal mores that clash with those of Sector General--and some flaws that lead to disaster. Wishing to punish himself, for a while he sinks into despair, but can't really help but try to help people, with some spectacular results. More new, fantastically weird alien species.

[Erika Worley · Rating 5 out of 5]

Amazing book for anyone who enjoys medical dramas, aliens, and philosophical questions, this is absolutely the book for you!

[Wayne's · Rating 5 out of 5]

Loving the series

[Karen-Leigh · Rating 4 out of 5]

Last time I rated this I gave it 5 stars, I am a lot fussier these days. It is still a really good book and all the characters come alive and are interesting. I immediately wanted to reread the first books because I could not remember a Carmody and wanted to know more about him. A tiny bit of all the regulars and the new people all worked for me. Feeling a bit anxious..only four books left. That is always one sign of a really good series when I really really do not want it to end.

Physician, heal thyself

Surgeon-Captain Lioren of the Monitor Corps was a hard-driving perfectionist who expected the same high standards to be met by all who worked with him. But while on a First Contact mission on the planet Cromsag, where plague had reduced a peaceful civilization to barbarism and war, Lioren's perfection was his undoing. In his zeal to find a cure for the plague, he inadvertently caused the death of the entire planetary population.

Lioren's guild lead him to seek a commensurate penalty--death. But the Monitor Corps was loath to waste talent. Instead, Lioren was stripped of his rank and assigned to Sector Twelve General Hospita as a lowly trainee in the Psychology department.

Then Lioren met the huge alien Groalterri, the first of its kind to allow contact with the Galactic Federation. It was vital that Sector General succeed in curing the giant being, but it would not even speak to anyone--except Lioren. The medical problem was a simple one, but what the alien needed most was the one thing that Lioren could nog give. For before he could offer help, Lioren would have to do the impossible--forgive himself. . .

[Joy · Rating 5 out of 5]

Surgeon-Captain Lioren knows it was his own impatience to bring an untested cure to a plague planet that brought about the population's death. His colleagues know the extenuating circumstances and forgave him. But Lioren will carry his guilt to his grave, and that can't be too soon for him.

Lioren considers his new assignment at Sector General to be a well-deserved punishment. To everyone's astonishment, he is soon achieving results where orthodox physicians have failed, and infuriatingly, he won't tell them how. Success or failure with his new patient will determine the Federation's effect upon an entire species. Lioren must face parts of himself he never wants to look at again, or fail his patient completely.

White addresses religious beliefs, simply but helpfully, for the only time I'm aware of in this series. The effect becomes slightly long-winded at times, but with a high and rewarding overall impact. I assigned my 5 stars with enthusiasm.

[Rob · Rating 4 out of 5]

This 8th book in the sector general series was just as good as the last one if not better. It seems like james white really lived in this world and each book opens more of his vision as the stories unfold. I find myself both eager to read the last few books of his series and somewhat sad that these are all that remains of this world.

[Thom Dunn]

V. S. RECO, 11-30-2011}

12-01-2011. This is #8 in a 12 book series and is considered one of the best. The Wikipedia article on these "Sector General" novels is especially thorough and links to articles on each of the 12 titles.

[Erik Graff · Rating 3 out of 5]

The author grew up wanting to become a doctor but family considerations made that impossible. Instead, he went on to virtually create a sub-genre of science fiction focused on medicine.

[Howard]

15

[Howard Brazee · Rating 2 out of 5]

The first part had very dry style. It's an old style SF universe. The best thing is that it has healing instead of war.