country doctor photo essay

‘Country Doctor’: W. Eugene Smith’s Landmark Photo Essay

Dr. Ernest Ceriani made a house call on foot, Kremmling, Colo., 1948. The generalist was the lone physician serving a Rocky Mountain enclave that covered 400 square miles.

W. Eugene Smith/Life Pictures/Shutterstock

Written By: Ben Cosgrove

For his groundbreaking 1948 LIFE magazine photo essay, “Country Doctor” — seen here, in its entirety, followed by several unpublished photographs from the shoot — photographer W. Eugene Smith spent 23 days in Kremmling, Colo., chronicling the day-to-day challenges faced by an indefatigable general practitioner named Dr. Ernest Ceriani.

Born on a sheep ranch in Wyoming, Dr. Ceriani attended Chicago’s Loyola School of Medicine but opted not to pursue a medical career in the big city. In 1946, after a stint in the Navy, he was recruited by the hospital in Kremmling, and he and wife Bernetha, who was born in Colorado, settled into the rural town. Dr. Ceriani was the sole physician for an area of about 400 square miles, inhabited by some 2,000 people.

Eugene Smith’s at-times almost unsettlingly intimate pictures illustrate in poignant detail the challenges faced by a modest, tireless rural physician—and gradually reveal the inner workings and the outer trappings of what is clearly a uniquely rewarding life.

“Country Doctor” was an instant classic when published, establishing Smith as a master of the commanding young art form of the photo essay, and solidifying his stature as one of the most passionate and influential photojournalists of the 20th century. In 1979, the W. Eugene Smith Memorial Fund was founded to support those working in the profoundly humanistic style of photography to which Smith dedicated his life and his art.

Dr. Ernest Ceriani made a house call on foot, Kremmling, Colo., 1948. The generalist was the lone physician serving a Rocky Mountain enclave that covered 400 square miles. W. Eugene Smith/Life Pictures/Shutterstock

Ralph Pickering held his 5-week-old baby while waiting to be Dr. Ceriani’s first patient of the day. Pickering, a horseback guide to tourists coming to see the majestic Rocky Mountains, traveled from an outlying ranch to reach the doctor’s office. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani sat at the bedside of a patient as he assessed flu symptoms during a house call. When Smith began “Country Doctor,” he shot for a period of time with no film in his camera, to help Ceriani get used to his presence without wasting precious film. W. Eugene Smith/Life Pictures/Shutterstock

In the backseat of a car, Dr. Ceriani administered a shot of morphine to a 60-year-old tourist from Chicago, seen here with her grandson, who was suffering from a mild heart disturbance. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani examined a feverish 4-year-old girl suffering from tonsillitis. Although most of his patients were children, Ceriani was initially inexperienced in pediatrics when he started his practice, and studied up on it whenever he had the chance. W. Eugene Smith/Life Pictures/Shutterstock

Though he had no vacations and few days off, Dr. Ceriani did have use of a small hospital, which was equipped with an X-ray machine, an autoclave and an oxygen tent, among other medical necessities. Here, he explained an X-ray — he developed the film himself — to one of his rancher patients. W. Eugene Smith/Life Pictures/Shutterstock

The doctor taped a patient who broke some ribs after a horse rolled over him. “His income for covering a dozen fields is less than a city doctor makes by specializing in just one,” LIFE’s editors noted, “but Ceriani is compensated by the affection of his patients and neighbors, by the high place he has earned in his community and by the fact that he is his own boss. For him, this is enough.” W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani used a syringe to irrigate wax from an elderly man’s ear to improve his hearing. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani examined the stitches in the lacerated hand of a young patient. W. Eugene Smith/Life Pictures/Shutterstock

Two friends transported Dr. Ceriani to Gore Canyon so he could enjoy a few hours of recreational fishing, a rare treat for the hard-working physician. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani fly-fished on the Colorado River. W. Eugene Smith/Life Pictures/Shutterstock

Thirty minutes into his fishing excursion, Dr. Ceriani was called to an emergency: A young girl hasd been kicked in the head by a horse and was badly injured. W. Eugene Smith/Life Pictures/Shutterstock

The child’s worried parents looked on as Dr. Ceriani, surrounded by nurses, examined their two-year-old daughter. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani had stitched the girl’s wound to minimize scarring, but he then had to find a way to tell the parents that her eye could not be saved and they needed to take her a specialist in Denver to have it removed. W. Eugene Smith/Life Pictures/Shutterstock

The doctor helped a rancher carry his son into the hospital. The inebriated young man dislocated his elbow when he was thrown from a bronco at a rodeo. W. Eugene Smith/Life Pictures/Shutterstock

The injured elbow required a painful reset. W. Eugene Smith/Life Pictures/Shutterstock

“Don’t tell my mother,” said the young man. Still under the effects of ether, he didn’t realize she’d been holding his hand during the procedure. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani checked the blood pressure of 85-year-old Thomas Mitchell, who came to the hospital with a gangrenous leg. Knowing that Mitchell might not be strong enough to endure the necessary amputation, Ceriani had been postponing surgery. W. Eugene Smith/Life Pictures/Shutterstock

When Mitchell finally rallied, the doctor gently carried him from the basement ward up to the operating room of the hospital, which had no elevator. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani gave the 85-year-old man spinal anesthesia before amputating his gangrenous left leg. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani responded to a late-night call when an 82-year-old man suffered a heart attack at a boarding house. Town marshal Chancy Van Pelt and one of the man’s fellow tenants stood by. W. Eugene Smith/Life Pictures/Shutterstock

Knowing the man who suffered the heart attack at the boarding house will not make it through the night, Dr. Ceriani called for a priest from the kitchen. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani helped the town marshal carry the heart attack victim to the ambulance. There, the country doctor would see that his patient was as comfortable as possible, knowing there was nothing he can do to save him. W. Eugene Smith/Life Pictures/Shutterstock

The treeless ranching community of Kremmling, Colo., stood on a 7,000-ft. plateau beneath the towering Rocky Mountains. W. Eugene Smith/Life Pictures/Shutterstock

Dr. Ceriani held 11-month-old son Gary as his wife, Bernetha, steadied 3-year-old Phillip on a fence while watching a parade. Though they’d been married for four years at the time Smith was profiling the doctor, Mrs. Ceriani still struggled with the unpredictability of her husband’s schedule. W. Eugene Smith/Life Pictures/Shutterstock

A fund-raising committee in Kremmling was able to raise $35,000 in 1947 to purchase the home of the town’s retiring physician and turn it into a 14-bed hospital. The funds were used to stock the tiny hospital with as much equipment — some of it war surplus — as could be afforded. Middle Park Hospital had only three wards that could accommodate 14 patients. With a new hospital in place, the town then put out a call for a new general practitioner — a call answered by Dr. Ceriani. W. Eugene Smith/Life Pictures/Shutterstock

After finishing a surgery that lasted until 2 AM, Dr. Ceriani stood exhausted in the hospital kitchen with a cup of coffee and a cigarette. “The nurses,” LIFE noted, “constantly admonish him to relax and rest, but because they are well aware that he cannot, they keep a potful of fresh coffee simmering for him at all hours.” W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Dr. Ernest Ceriani in the small Kremmling, Colo., hospital. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Doctor Ceriani checked 4-year-old Jimmy Free’s foot, cut when the boy stepped on broken glass. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Dr. Ceriani examined his handiwork after the partial amputation of a patient’s leg, Kremmling, Colo., August 1948. The patient, Thomas Mitchell, was suffering from a gangrenous infection. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. An operating room in Kremmling, Colo. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Dr. Ceriani with a patient. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Dr. Ernest Ceriani delivered a baby. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Maternity ward, Kremmling, Colo., 1948. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. An incubator in Kremmling, Colo., 1948. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. The contents of a country doctor’s bag, Kremmling, Colo., 1948. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Doctor Ceriani and town marshal Chancey Van Pelt carried a patient from a cabin in the hills near Kremmling, Colo., 1948. W. Eugene Smith/Life Pictures/Shutterstock

Not published in LIFE. Dr. Ernest Ceriani on his way to a house call in foul weather, Kremmling, Colo., 1948. W. Eugene Smith/Life Pictures/Shutterstock

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• LIFE Photo Essay

W. Eugene Smith’s Landmark Portrait: ‘Country Doctor’

F or his groundbreaking 1948 LIFE magazine photo essay, “Country Doctor” — seen here, in its entirety, followed by several unpublished photographs from the shoot — photographer W. Eugene Smith spent 23 days in Kremmling, Colo., chronicling the day-to-day challenges faced by an indefatigable general practitioner named Dr. Ernest Ceriani.

Six decades later, Smith’s images from those three weeks remain as fresh as they were the moment he took them, and as revelatory as they surely felt to millions of LIFE’s readers as they encountered Dr. Ceriani, his patients and his fellow tough, uncompromising Coloradans.

Born on a sheep ranch in Wyoming, Dr. Ceriani attended Chicago’s Loyola School of Medicine but opted not to pursue a medical career in the big city. In 1946, after a stint in the Navy, he was recruited by the hospital in Kremmling, and he and wife Bernetha, who was born in Colorado, settled into the rural town. Dr. Ceriani was the sole physician for an area of about 400 square miles, inhabited by some 2,000 people.

Eugene Smith’s at-times almost unsettlingly intimate pictures illustrate in poignant detail the challenges faced by a modest, tireless rural physician — and gradually reveal the inner workings and the outer trappings of what is clearly a uniquely rewarding life.

“Country Doctor” was an instant classic when first published, establishing Smith as a master of the uniquely commanding young art form of the photo essay, and solidifying his stature as one of the most passionate and influential photojournalists of the 20th century. In 1979, the W. Eugene Smith Memorial Fund was founded to support those working in the profoundly humanistic style of photography to which Smith dedicated his life and his art.

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The Picture Show

From the library of 'life', revisiting 'country doctor,' a 1948 photo essay.

Claire O'Neill

Dr. Ernest Ceriani, the subject of a 1948 Life magazine story titled "Country Doctor," pauses after a long surgery. W. Eugene Smith/Life hide caption

Dr. Ernest Ceriani, the subject of a 1948 Life magazine story titled "Country Doctor," pauses after a long surgery.

"Although 20 percent of Americans live in rural areas only 9 percent of the nation's physicians practice there." That's according to a 2004 study by the U.S. Department of Health and Human Services. In short, the study reads, "despite greater need for health care, rural residents have fewer visits to health care providers and are less likely to receive recommended preventive services."

Of course, that's just one study. Although, personally, I know I'd be a lot less inclined to see the doctor if walk-ins weren't available a few blocks away.

It makes sense that health care would be difficult to access in remote locations. You either have to move to the medicine, or it has to come to you. What kind of person does it take to be a country doctor? Here's one example, now almost 65 years old.

Photographer W. Eugene Smith became a war photographer for Life magazine in 1942. Though seriously wounded while photographing World War II, he returned to photojournalism and made a big splash with this 1948 photo essay about the life of Dr. Ernest Ceriani, a practitioner in the small town of Kremmling, Colo.

The result of 23 days with Ceriani, Country Doctor "was an instant classic," according to Life.com, where the original essay has just been republished in its entirety , "setting Smith firmly on a path as a master of the unique art form of the photo essay, and solidifying his status as one of the most passionate and influential photojournalists of the 20th century."

As it is today and likely always will be, health care was an important issue in 1948, and Life wanted to explore that issue by focusing on, as it were, a life. I'd be interested in seeing the life of a contemporary country doctor. Do you know any?

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W. Eugene Smith’s ‘Country Doctor’: Revisiting a Landmark Photo Essay

‘Country Doctor’ was an instant classic when first published in LIFE in 1948, establishing W. Eugene Smith as a master of the photo essay.

Source: W. Eugene Smith’s ‘Country Doctor’: Revisiting a Landmark Photo Essay

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W. Eugene Smith: Master of the Photo Essay

100 years since the birth of W. Eugene Smith, we take a look at the work of a remarkable talent who described his approach to photography as working “like a playwright”

W. Eugene Smith

W. Eugene Smith’s membership with Magnum may have been brief, spanning the years 1955-58, but his work left left a deep impression on many of Magnum’s photographers, as it has upon the practice of photojournalism generally. Smith is regarded by many as a genius of twentieth-century photojournalism, who perfected the art of the photo essay. The following extract from Magnum Stories ( Phaidon ), serves as a pit-stop tour through his most enduring and affecting works.

With “Spanish Village” (1951), “Nurse Midwife” (1951), and his essay on Albert Schweitzer (1954), “Country Doctor” is first of a series of postwar photo essays, produced by Smith as an employee of Life magazine, that are widely regarded as archetypes of the genre. The idea to examine the life of a typical country doctor, at the time of a national shortage of GPs, was the magazine’s, not Smith’s. Though it was preconceived and pre-scripted, with a suitable doctor cast for the role before Smith got involved, he was immediately attracted to the idea of its heroic central character. He left to shoot the story the day he first heard about it – and before it was formally assigned, lest his editors decide to allocate the job to a different photographer.

Country Doctor

He described elements of his approach in an interview for Editor and Publisher later the same year:

“I made very few pictures at first. I mainly tried to learn what made the doctor tick, what his personality was, how he worked and what the surroundings were… On any long story, you have to be compatible with your subject, as I was with him.

I bear in mind that I have to have an opener and closer. Then I make a mental picture of how to fill in between these two. Sometimes, at the end of the day, I’ll lie in bed and do a sketch of the pictures I already have. Then I’ll decide what pictures I need. In this way, I can see how the job is shaping up in the layout form.

When a good picture comes along, I shoot it. Later I may find a better variation of the same shot, so I shoot all over again.”

"When a good picture comes along, I shoot it. Later I may find a better variation of the same shot, so I shoot all over again."

- w. eugene smith.

Central to his method was his seeking to fade “into the wallpaper”. De Ceriani, the subject of the story and the one constant witness to his working approach, recalled in an interview with Jim Hughes, Smith’s biographer, that after a week Smith “became this community figure. He may not have known everybody, but everybody knew who he was. And you fell into this pattern: he was going to be around, and you just didn’t let it bother you. He would always be present. He would always be in the shadows. I would make the introduction and then go about my business as if he were just a doorknob.”

Smith set about what might have been a straightforward assignment with a demanding intensity. “I never made a move where Gene wasn’t sitting there,” Ceriani explained; “I’d go to the john and he’d be waiting outside the door, so it would seem. He insisted that I call when anything happened, regardless of whether it was day or night… I would look around and Gene would be lying on the floor; shooting up, or draped over a chair. You never knew where he was going to be. And you never knew quite how or when he got there. He would produce a ladder in the most unusual places.”

For a four-week shoot, Smith selected 200 photographs for consideration by Life , and while he clearly had some influence over the layout, he did not control it. It did not live up to his expectations; in the interview with Editor and Publisher, Smith stated that he was “depressed” thinking about just how far short it fell. It’s not clear how different it might have been had he done the layout himself. We know that the prints he made were rejected by Life ’s art director, on the grounds that they were too dark and would not reproduce well on the magazine’s pages. Smith’s vision was darker in other regards too. Photographs not featured in Life’ s layout, but reproduced or exhibited later, include a powerful series of 82-year-old Joe Jesmer being treated following a heart attack – an old man whose face terrifyingly reveals the apparent consciousness of his imminent death. Smith also chose, for his own exhibitions, troubling photographs of Thomas Mitchell prior to his leg amputation, as well as other images more baroque than those selected by Life . But the two brilliant images between which the layout hangs – his opener of the stoical doctor on his way to the surgery under a brooding sky and his closer, showing Ceriani slumped in weary reflection with coffee and cigarette – clearly reflect Smith’s won intentions for how the story should appear.

It is in the sophistication of its narrative structure that Smith’s innovation lies. In recorded conversations between Smith and photographer Bob Combs in the late 1960s, he elaborated on the ingredients of his approach (referring here to another story, “Nurse Midwife”):

“In the building of a story, I being with my own prejudices, mark them as prejudices, and start finding new thinking, the contradictions to my prejudices, What I am saying is that you cannot be objective until you try to be fair. You try to be honest and you try to be fair and maybe truth will come out.

Each night, I would mark the pictures that I took, or record my thoughts, on thousands of white cards I had. I would start roughing in a layout of what pictures I had, and note how they build and what was missing in relationships.

"In the building of a story, I being with my own prejudices, mark them as prejudices, and start finding new thinking, the contradictions to my prejudices, What I am saying is that you cannot be objective until you try to be fair."

I would list the picture to take, and other things to do. It began with a beginning, but it was a much tighter and more difficult problem at the end. I’d say, ‘Well, she has this relationship to that person. I haven’t shown it. How can I take a photograph that will show that? What is this situation to other situations?’

Here it becomes really like a playwright who must know what went on before the curtain went up, and have some idea of what will happen when the curtain goes down. And along the way, as he blocks in his characters, he must find and examine those missing relationships that five the validity of interpretation to the play.

I have personally always fought very hard against ever packaging a story so that all things seem to come to an end at the end of a story. I always want to leave it so that there is a tomorrow. I suggest what might happen tomorrow – at least to say all things are not resolved, that this is life, and it is continuing.”

Smith refers to working “like a playwright”. Elsewhere he compared his work to composing music, but perhaps it is the literary reference that is most relevant to “Country Doctor”. His doctor is the emblematic hero of a drama that unfolds through several episodes – literally, acts. His opening and closing tableaux have all the content of soliloquies: single moments loaded with psychological detail and environmental description that frame the play. Unlike the experience of a play in the theatre where we watch it once, from beginning to end – we read the magazine essay back and first, at the very least reviewing the images again once we have read through it. The details of the doctor’s actions lend weight to the opening and closing portraits, and vice versa, so that the depth of its characterization reveals itself across the images as a group. It would not work if it were not wholly believable as a record of a real man, and real events. As such, its strength and its place in the history of the genre lies in the manner in which it combines a record of reality within an effective dramatic structure; in short, as a human drama.

Smith’s essay-making technique was not something he developed independently of the media that published his pictures. It began with essays produced in the early 1940s for Parade , where photographers were encouraged to experiment with story structure (without the tight scripting Smith later encountered at Life magazine) and where stories often focused on an attractive central character achieving worthwhile goals against formidable odds. Although Smith is on record as being in constant struggle with Life over its scripts – as well as its layouts, the selection of photographs, and the darkness of his prints – it seems appropriate to view his achievement as the product of a dialogue with the needs and practices of the magazine. The battles were over the details of particular decisions rather than over the mission or purpose. In fact, Smith wholly identified with the Life formula, taking and refining it to a new level of sophistication.

After Smith left life in 1954 – after several prior resignations, his final departure was over the editorial slant given to his essay on Albert Schweitzer – he embarked on his ambitious Pittsburgh essay. Working for the first time outside the framework of a magazine, with only a small advance from a book publisher, and encouraged by Magnum’s reassurance that he would find a worthwhile return from serial sales of independently executed essays, he believed that he was positioned to produce his best work yet. He wrote to his brother that he Pittsburgh essay would “influence journalism from now on”, and described in an application for a Guggenheim Fellowship that he “would recreate as does the playwright, as does the good historian – I would evoke in the beholder an experience that is Pittsburgh.”

It did not really work. Becoming a landmark in the ambition of the photo essay, and including some of his strongest photographs, the Pittsburgh essay nevertheless failed to be the symphony in photographs for which Smith strove, After four years of work, it was finally published in the small-format Popular Photography Annual of 1959 , run as a sequence of “spread tapestries” – as he described his intended layout to the editor of Life . He titled the essay Labyrinthian Walk, indicating the story was less about the city than a portrait of himself locked in a life-or-death struggle with a mythical demon. Although he himself was responsible for the layout, he judged it a failure. The dream – or necessity – of Magnum failed also. He did only two minor assignments in the time he was a member, and he left completely broke, his family in poverty, with Magnum itself smarting from the investment it too had ploughed into the Pittsburgh project.

After the “Country Doctor” story was published, Smith declared that he was “still searching for the truth, for the answer to how to do a picture story”. Later, in 1951, he stated in a letter to Life editor Ed Thompson, “Journalism, idealism and photography are three elements that must be integrated into a whole before my work can be of complete satisfaction to me.” In 1974, 20 years after embarking on the Pittsburgh essay, Smith was vindicated with the triumphant artistic and journalistic success of “Minamata”, his story about the deformed victims of the pollution by the Chisso chemical plant in Japan. The story became a new paradigm for the possibilities of photojournalism, in part because of its unambiguous moral purpose.

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Exploring the ‘Country Doctor’ Photo Essay by W. Eugene Smith

by ASMP | Aug 7, 2019 | ASMP Legends

Cross-posted from PDNPulse [by Greg Scoblete ]

In 1948, W. Eugene Smith was commissioned by Life Magazine  to profile Dr. Ernest Guy Ceriani, a traveling doctor who provided 24-hour care to residents of the small town of Kremmling, in the Rocky Mountains.

As Magnum notes, the series “is widely regarded as representing a definitive moment in the history of photojournalism.” Part of its power lies in Smith’s “wallpaper” approach to photography–he faded into the background so he could capture intimate moments.

Martin from All About Street Photography has produced this interesting exploration of the  Country Doctor  series for those who want to take a deeper dive into this iconic work.

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What Photos From 1948 Can Teach Us About Doctors, Patients And Screens

• Audrey M. Provenzano

In 1948, LIFE magazine published a photo essay by Eugene Smith titled " Country Doctor ." Each grainy photograph is magnetic. The images capture more than Dr. Ceriani and his patients in a rural Colorado community; they capture the human connection that is at the heart of any healing relationship. I ache for more of that connection in my daily practice.

Whether Dr. Ceriani is checking blood pressure, beaming at a squalling newborn or peering at an eardrum, the connection between him and his patient is at the center of every image. His attention never wavers. Nor is it drawn away to a screen — in fact, none of the images show Dr. Ceriani consulting a medical record of any kind.

What the photos do show is Dr. Ceriani in pinstripes, on a home visit to a bedbound patient with a fever. Later at the office, he reviews an X-ray, takes sutures out of a boy’s hand, and sits at his desk, deep in conversation with a patient. Other moments are not so idyllic: One photograph captures Dr. Ceriani’s face, sweaty and ashen, preparing himself to tell the parents of his young patient that they must take her to Denver to have her eye removed.

Recently, I’ve wondered what a photographer might capture if he followed me. The images would show comparable moments. I, too, remove sutures, evaluate fevers, and counsel patients at my desk. I often pull up X-rays to review with patients, although unlike Dr. Ceriani I do not do so with a cigarette dangling from my lips.

But in truth, most of the photographs would capture me gazing at a computer screen and pushing around a mouse. That is what I spend most of my time doing.

A few months ago, a patient came to see me for a cough: dry, lingering, worse at night. I started to place an order for a chest X-ray while we went on to talk about his arthritis, but after a few mouse clicks and taps on the keyboard, I realized that he’d stopped talking.

“Hey doc,” he said. He waved his hand between my face and the screen and snapped his fingers. “Are you listening?”

I was humiliated. I sat not three feet from him, yet I was so far away that he had to snap at me to bring me back.

This is the central dysfunction of my primary care practice: I am so distracted by the electronic medical record, or EMR, that I can’t pay attention to my patients.

EMRs are an essential tool in medicine. Practicing medicine has grown exponentially more complex since 1948 — even healthy patients have volumes of data that we must follow: allergies, screenings, vaccinations and so on. Pen, paper and the foggy human memory are entirely inadequate.

In addition, our fund of medical knowledge has exploded. While Dr. Ceriani could have expected medical knowledge to double over the 50 years of his career, it now doubles, by one estimate,  every 73 days . Physicians must rely on references and guidelines to provide care to patients, and the easiest way to access that vast quantity of information is through a computer screen.

But using an EMR is a complex and time-consuming task. When I next ordered a chest X-ray, I kept count, and it required 22 clicks of the mouse and 54 key strokes.

And entering orders is only a small portion of what I do with the EMR. A recent time-motion capture study showed that for every hour physicians spend seeing patients, we spend two hours using an EMR to review labs and imaging, write letters, and document visits. It is no wonder that our profession is beset with a burnout epidemic . Being present with our patients seems almost an afterthought.

Of course, returning to Dr. Ceriani’s practice environment is not realistic or desirable. He could offer few treatments to his patients, most not very effective. And I do not wish to romanticize a time when racism, sexism and classism so ardently plagued medical practice.

But I cannot look at " Country Doctor " without a searing sense of loss for our profession. In each image I see that ineffable moment of connection in which a caregiver is wholly focused on a patient’s concern. I long to establish that connection with each of my patients, whether we are discussing a new tumor or a fleeting rash. But so often, I am running late, the patient needs orders placed, and the screen pulls me away.

Yes, EMRs are indispensable. But the way we currently use them erodes our relationships with patients. There are efforts to address the problem: scribes to take down notes and orders, sophisticated dictation software, and care teams to help with aspects of a visit such as verifying medications. All of these interventions do help — but they are insufficient.

I know that in order for me to establish that connection with a patient, I need time . Time to listen to my patient and to pay attention to her . Then, I need more time to attend to notes and orders in the EMR, without being rushed into my next visit.

The poet J.D. McClatchy once wrote that “love is the quality of attention that we pay to things.” Indeed, Dr. Ceriani’s love for his patients radiates from every image in " Country Doctor ." By that measure, it is easy to understand the despair of so many who have concluded that our health care system is irretrievably broken. We pay more attention to our EMRs than to our patients because we do not have enough time to give the attention that each require.

I am hopeful that we can bring more time for connection back to our clinic rooms. If we are successful, the next time-motion study of physicians will show us completely still, our attention wholly focused on our patient, with our computer in the corner, screen dark, only an afterthought.

Audrey M. Provenzano is a primary care physician at MGH Chelsea Health Center. She frequently writes about health care and is host of " Review of Systems ," a podcast on health systems with the Harvard Center for Primary Care. You can follow her on Twitter @audreymdmph .

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• Five Favorite Photos

Five Favorite Photos – W. Eugene Smith, Master of the Photo Essay

Josh solomon.

• July 23, 2018

To pick only five photos from any distinguished photographer’s catalog is difficult most days. Today, in particular, it’s outright impossible. That’s because today’s subject is none other than the master of the photo essay, W. Eugene Smith.

Smith’s career is the stuff of legend. His work includes classic photo essays such as Country Doctor, Minamata, and his magnum opus, Pittsburgh, a photo essay so large in scope that it still hasn’t been seen in its entirety. With every successive collection of photos, Smith pushed the form of the photo essay (and photography itself) to its very limits.

When I look back on all the photographers I’ve studied, W. Eugene Smith is the one who’s influenced me the most. I find I can always come back to one of his photos and see and learn something new every time, whether it be about composition, photo technique, or photo ethics. So instead of trying to reduce his impossibly large catalog of images down to his five absolute best, I’m going to pick the five images from which I’ve learned the most, and what they’ve taught me. Let’s get started.

Waiting For Survivors

This first photo is my personal favorite of W. Eugene Smith’s, and a great introduction to his work. Not only does it showcase Smith’s signature style of classically informed composition, it also reveals his sensitivity towards the often tragic events he was assigned to cover.  

“Waiting for Survivors” came about in the immediate aftermath of the sinking of the SS Andrea Doria, an Italian ocean liner bound for New York City. The tragedy was, and still is, the worst disaster to occur in United States waters and one that newspapers clamored to cover.

One would expect such coverage to involve shocking photos of the sinking ship, or of survivors being helped ashore (and there were plenty of those images made by other photogs). Eugene Smith thought differently. Instead of inducing shock, he wanted empathize with his audience by portraying the nervous anticipation of a nation as the lives of Andrea Doria’s passengers hung in the balance.

Smith accomplished this with the image of a nun waiting for news about the survivors of the wreck. A scene like this is already ripe for a photojournalist’s picking, but it is Smith’s timing and compositional nous that makes it special. Smith caught the nun leaning slightly to the left, with her hand covering her mouth and eyes looking upward in anticipation. Smith also makes the nun’s white habit do double-duty in this image; it frames her face and also provides emphasis by way of stark contrast from the grey background. It’s a simple composition, but one timed and crafted with Smith’s signature standard of perfection.

The Walk to Paradise Garden

“The Walk to Paradise Garden” is a tonal shift from Smith’s often intense and tragic subject matter. But it’s precisely because of this shift that it was one of Smith’s personal favorite photos. Devoid of context, the image of two children walking out of a dark forest toward the light is already beautiful as it is. But when we understand the backstory of this shot it becomes even more poignant.

Two years before this picture was taken, Eugene Smith worked as a photojournalist in the Pacific theater of World War II, photographing the horrors of war from Iwo Jima to Guam. During this time, he was wounded by shell fragmentation and was sent home. His recovery, both physically and psychologically, was brutal to such an extent that he couldn’t even use his camera.

After two years, Smith became fed up and impatient with the recovery process and decided one day to load a roll of film. Seeing as his previous photographs were of pain and tragedy, he wanted his first photograph in two years to be one of hope and new life, and so he chose as his subjects his own children, Pat and Juanita.

As for the rest of this story, it’s best for the man himself to tell it:

“Pat saw something in the clearing, he grasped Juanita by the hand and they hurried forward. While I followed my children into the undergrowth and the group of taller trees—how they were delighted at every little discovery!—and observed them, I suddenly realized that at this moment, in spite of everything, in spite of all the wars and all I had gone through that day, I wanted to sing a sonnet to life and to the courage to go on living it….”

Spanish Wake  

Spanish Wake is a fascinating piece of Eugene Smith’s body of work in that it contains a great many lessons for the photographer, as well as insight into Smith’s own philosophy towards making images.

On one level, this is an example of Smith’s classically informed style of composition. He heightens the drama of the scene by way of heavy contrast, which is so heavy that it creates a dramatic chiaroscuro effect (favored by painters such as Caravaggio and Rembrandt) which naturally emphasizes everything the light hits. Smith also paid particular attention to the eye-lines of each subject, which eventually lead the viewer straight to the corpse laying upon the bed, as well as expressing the inner grief of each of the mourning subjects. It’s also worth noting that this photo bears an eerie resemblance to one of Rembrandt’s masterpieces, The Anatomy Lesson of Dr. Nicolaes Tulp . Whether or not this was intentional is anybody’s guess, but considering Smith’s penchant for classicism I wouldn’t be surprised if it was.

On another level, the creation of this photo can teach us a little bit about photo ethics. If the lighting in this photo seems too perfect to be natural, that’s because it’s staged. The photo’s lighting, subject placement, and even the eye-lines are all either staged or retouched. Candid photography purists may be put off by this, but to this end Smith himself offers up his own arguments.

For Smith, authenticity of the emotion of a scene outweighed the authenticity of the scene itself. In a publicized interview between him and another great photographer, Philippe Halsmann, Smith says, “I don’t object to staging only if I feel that it is an intensification of something that is absolutely authentic to the place.” Smith’s code of ethics dictated that he only ask the family for permission to photograph (which was given enthusiastically by the son of the deceased) and then felt it was his duty to authentically portray the grief of the family. For him, that was justification enough to retouch.

His last words on the subject in the interview illuminates his attitude towards editing more than any others:

“I didn’t write the rules — why should I follow them? Since I put a great deal of time and research to know what I am about? I ask and arrange if I feel it is legitimate. The honesty lies in my — the photographer’s — ability to understand.”

Country Doctor

Perhaps Eugene Smith’s most famous series of photos is the Country Doctor photo essay. It’s the essay that established him as the master of that form, and set the standard for every photo essay to follow.

In 1948, the US was experiencing an alarming shortage of doctors practicing in remote areas, and LIFE decided to show how damaging the shortage really was. W. Eugene Smith was then assigned by the magazine to cover Dr. Ernest Guy Ceriani, a country doctor practicing in the small town of Kremmling, Colorado. The ensuing essay would see Smith following Dr. Ceriani throughout the town and countryside, detailing the often gruesome cases Ceriani would be called upon to fix at any hour.

What makes this particular essay such a masterwork was Smith’s ability to capture the raw emotion of Ceriani and his patients. By what Smith called “fading into the wallpaper”, he was able to get up close to Ceriani and his patients at a truly personal level. Through his lens we can really see and feel the exasperation and desperation of a single doctor called upon to care for a small town and four hundred miles of countryside, as well as the terror and pain of that area’s afflicted citizens.

Of the many incredible photos in the essay, my favorite is Smith’s portrait of Ceriani at rest after performing an operation. Ceriani’s tired slump as well as his blank downward gaze perfectly epitomizes his reaction to the near-Sisyphusian task of caring for an entire countryside by himself. Smith finishes the image by casting Ceriani in a harsh light and using high contrast, elevating the stress and tension of his situation.

Iwazo Funaba’s Crippled Hand

Our last photo is one from W. Eugene Smith’s final photo essay, Minamata. Hardcore Smith fans may be expecting the flagship photo of this essay, which happens to also one of the finest photos ever made , but out of respect for the family and memory of those depicted we will choose a different but equally powerful image; Iwazo Funaba’s Crippled Hand.

Iwazo Funaba was one of the many victims of Minamata disease, a disease caused by the illegal dumping of industrial waste by the Chisso Corporation in the small fishing town of Minamata, Japan. The waste bioaccumulated in the fish and the seas surrounding Minamata, and when the fish were eaten by the town’s residents, the result was severe mercury poisoning. Over a span of thirty-six years, tens of thousands of people were affected by the disease, with little to no intervention by the local government or the Chisso Corporation.

W. Eugene Smith and his wife Aileen Smith took it upon themselves to chronicle the sufferings of Minamata’s citizens from 1971 to 1973 in the hope that they could raise awareness about Minamata disease. What resulted was a masterclass of a photo essay. The entire collection of photos illustrates perfectly the horrors of Minamata disease, with Smith using wide-angle distortion, high contrast, and extreme close-ups to heighten the horror of these already horrific scenes.

Of the many incredible images in this essay (including the aforementioned), the photo of Iwazo Funaba’s crippled hand always stands out to me. Smith’s use of shallow depth-of-field is masterful here, as Funaba’s out-of-focus head serves as the perfect background to her contorted hand. We can also make out that Funaba’s head is tilted upwards and her mouth is agape, which suggests that she’s screaming in pain. Gruesome as it is, it’s a powerful image that perfectly communicates the pain of the diseased victims.

W. Eugene Smith’s repertoire is much more vast than this list can suggest, and I would highly recommend that any aspiring photographer or photo enthusiast delve deeper into his catalog. Below are some useful links:

The Jazz Loft (movie)

Nurse Midwife

Albert Schweitzer in Africa

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Josh Solomon is a freelance writer and touring bassist living in Los Angeles. He has an affinity for all things analog. When not onstage, you can find him roaming around Southern California shooting film and humming a tune.

Wow … thank you for providing this short excerpt 😉

Josh, you’re helping to make this the best site out there.

Great stuff.

amazing content, thank you vey much keep up

A great article about one of my favorite photographers. I always thought it was interesting that he used such a variety of different cameras. It seems like a lot of the great phographers preferred one type or another, but Gene seemed to switch it up a lot. What a lot he witnessed in his too short life….

Thank you. Gene Smith is probably the photographer I most admire and try to emulate; I saved the 1959 Popular Photography Annual containing his Pittsburgh essay for more than 40 years until I gave it to a young newspaper photographer when he married my niece. Smith wasn’t fond, to say the least, of the layout and reproduction quality of the Pop Photo publication. After his Minamata essay came out, Smith was severely beaten by Chisso company thugs — suffering injuries that lasted the rest of his life, I think. I have his Minamata book.

Thank you for this site. I have the picture The Walk to Paradise Garden. I finally got a chance to look up W. Eugene Smith’s other photography. Poignant and beautiful. This knowing of the background of this picture is bringing me hope in this Pandemic we are going through in NY at this time.

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Five favorite photos – imogen cunningham’s after ninety, five favorite photos – mathew brady & co. shoot the civil war, five favorite photos – elliot erwitt.

Country Doctor, 1948

When Life Magazine published a series of pictures on the life of a country doctor in 1948, it caused a seismic shift in perceptions about photo journalism.

W. Eugene Smith had spent over three weeks shadowing a Colorado general practitioner to produce his picture essay. It drew widespread attention, and was seized upon aesthetically as a radical new artistic direction.

The life of a hard-working, rural physician was seen in this intimate study of a humble man who quietly dedicated his life to helping others – often requiring long hours into the night as seen here. The poignant, uncompromising narrative created by these images touched many Americans, and soon altered the ambitions  of professional photographers who followed Smith’s pioneering example.

Smith was later to produce more ground-breaking photographic reports, one of which, ‘Man of Mercy’, 1954 opened the eyes of the world to the work of Dr Albert Schweizer as he tended the leper colonies in Africa.

Even in the 1970s Smith was still emphatically tackling the most demanding of subjects, documenting the terrible effects of mercury pollution on the inhabitants of a Japanese fishing village of Minamata. The photographic evidence was unwelcome by the chemical company responsible for the poisonous waste disposal, and he was badly beaten by thugs employed by the firm. Smith almost lost his eyesight as a result of the attack.

The camera was undoubtedly his enduring, life-long passion. He began taking photographs for his local newspapers ­straight after graduating from high school, moving to New York to work on the staff of Newsweek. He also secured freelance commissions from other leading publications including Collier’s, Harper’s Bazaar and The New York Times.

Smith became highly-regarded for his work and his incessant perfectionism, but his thorny personality made him difficult to work with. He was fired from Newsweek for refusing to abandon his 35mm Contax camera for a larger format.

This led him to the doors of Life magazine, where he was assigned to cover the front lines of the Pacific combat zones during the US war offensive against Japan. Sadly, landing the prized position at Life was not as fortunate as it may have seemed – he was severely wounded by a grenade in Okinawa in 1945, and it required two years for him to recuperate.

He underwent 32 operations, and it wasn’t until 1947 after a painful convalescence that he was able to pick up his camera again.  He explained that, ‘The day I again tried for the first time to make a photograph, I could barely load the roll of film into the camera. Yet I was determined that the first image would be a contrast to the war photographs, and that it would speak to an affirmation of life.’

This photo was titled ‘The Walk to Paradise Garden’, picturing his own two children entering a forest clearing. It was to become one of his most celebrated pictures, and was a centerpiece of the seminal photographic exhibition ‘The Family of Man,’ at the Museum of Modern Art in New York in 1955.

Clearly his experience of being at the heart of a ferocious conflict left an indelible mark. He pointed out that that alongside his battle pictures covering grim news events, they set him on his path to produce the most socially-conscious body of work of any of his contemporaries.

Following the brilliant ‘Country Doctor’ series, he decided to examine life in an impoverished part of Spain. Moving to live in a struggling village over a period of months, he saw at first hand the desperation of locals attempting to rely for sustenance on their exhausted soil. ‘Spanish Village’ from 1951, resulted in some of his most moving, heartfelt prints. Immersing himself to such a degree with his subjects was unheard of in photography.

However, his relationship with Life magazine was always a turbulent one, and despite the accolades that both he and the magazine received for his photo essays, he never seemed at ease.

Smith’s high sense of humanitarian purpose was at odds with a mass-appeal magazine like Life, who were trying to embrace the optimism of the mid 1950s in the US. He resigned, and had to pursue freelance work, joining the Magnum agency that represented many leading photographers.

They were able to support him and enabled him to secure grants. In 1956 he began an ambitious photo-essay on the city of  Pittsburgh , an industrial city beleaguered in social upheaval. He moved there and obsessively took over 11,000 photographs detailing its decline and the effect this was having on residents.

Sadly, Smith never recovered from the sense of trauma he felt recording their plight; the pictures were never published, and he was mentally and financially broken. He could only turn to a teaching post in Arizona, while trying to pull together his archives. He suffered a fatal stroke in 1978, aged 60.

He was inducted into the International Photography Hall of Fame in 1984, and he was described as ‘being famous at twenty and a legend at forty’. More revealingly in Smith’s own words, ‘I am always torn between the attitude of the journalist, who is a recorder of facts, and the artist, who is often necessarily at odds with the facts. My principle concern is for honesty, and above all honesty with myself.’

Country Doctor

W. Eugene Smith

W. Eugene Smith's 1948 photo essay 'Country Doctor' in LIFE magazine established the artist as a master of the photo essay, and solidified his stature as one of the most passionate and influential photojournalists of the 20th century.

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W. Eugene Smith (1918-1978) was a pioneer of photojournalism and master of the photographic essay. He is credited with creating the concept of the photo essay, telling a story in pictures with matching captions.

After World War II, LIFE magazine assigned staff photographer W. Eugene Smith a human interest story about a doctor in rural America. They sent him to Kremmling, a small and remote town in northern Colorado. His subject: Dr. Ernest Ceriani.

At first, Smith observed Dr. Ceriani and earned the trust of the townspeople. He wrote: 'I spent four weeks living with him. I made very few pictures at first. ... I simply faded into the wallpaper and waited.' The resulting story spanned 11 pages in LIFE's September 20, 1948 edition.

Smith's intimate series depicts Dr. Ceriani as a heroic yet weary figure who made house calls, delivered babies, and tended to the young and old alike. Through Smith's lens, Ceriani carries the weight of the world on his shoulders as the only doctor within 400 miles.

A LIFE compendium later summarized 'Country Doctor' as "an instant classic when published, establishing Smith as a master of the commanding young art form of the photo essay, and solidifying his stature as one of the most passionate and influential photojournalists of the 20th century." As TIME magazine explained in its 2016 compendium '100 Photographs: The Most Influential Images of All Time': "By digging so deeply into his assignment, Smith created a singular, starkly intimate glimpse into the life of a remarkable man. It became not only the most influential photo essay in history but the aspirational template for the form.'"

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Middle East Crisis Blinken Says Challenges Remain as U.S. Pushes for Gaza Cease-Fire Deal

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• A destroyed house in Rafah in southern Gaza. Mohammed Abed/Agence France-Presse — Getty Images
• A mass prayer for the release of hostages held in Gaza at the Western Wall in Jerusalem. Ronen Zvulun/Reuters
• Israeli military bulldozers maneuvering near the border with Gaza. Ammar Awad/Reuters
• Carrying the body of a person killed after an Israeli raid near the West Bank city of Tulkarem. Alaa Badarneh/EPA, via Shutterstock
• Palestinians in central Gaza after leaving the compound around Al-Shifa Hospital in Gaza City. Agence France-Presse — Getty Images
• Smoke near the site of an Israeli airstrike on the Lebanese village of Adaysseh. Rabih Daher/Agence France-Presse — Getty Images
• Aid packages airdropped on the Gaza Strip. Agence France-Presse — Getty Images

‘We’ve closed the gaps, but there are still gaps,’ Blinken says of cease-fire talks.

Secretary of State Antony J. Blinken said on Thursday that “challenges” and “gaps” remain in talks for a possible deal between Israel and Hamas that would pause the war in Gaza and allow for the release of Israeli hostages.

“There’s still real challenges. We’ve closed the gaps, but there are still gaps,” Mr. Blinken said, speaking alongside his Egyptian counterpart at a news conference in Cairo.

“It’s still difficult work to get there,” he later added.

While Mr. Blinken also repeated an assessment he made in a Wednesday television interview that the “gaps are narrowing” between Israel and Hamas, and that an agreement is possible, his words indicated caution. A U.S. official confirmed that William Burns, the director of the Central Intelligence Agency, would travel to Qatar on Friday for negotiations. Mr. Blinken declined to confirm Mr. Burns’s travel.

People briefed on the talks said an agreement between Israel and Hamas was unlikely to be reached imminently.

Mr. Blinken spoke on Thursday after meetings with President Abdel Fattah el-Sisi and Egypt’s foreign minister, Sameh Shoukry, continuing his sixth swing through the Middle East since the war began. Mr. Blinken plans to travel on to Israel .

Among his goals is brokering a temporary Gaza cease-fire, which the United States is also seeking through a United Nations resolution . It will bring the resolution to a vote Friday morning, Nate Evans, a spokesman for the U.S. mission, said in a statement.

Mr. Blinken also joined several Arab foreign ministers to discuss how Gaza could be governed and kept secure once Israel finishes its military campaign there. Among them were ministers from Saudi Arabia, Qatar, the United Arab Emirates, Jordan and the Palestinian Authority. The group also discussed providing Gaza’s desperate population with more humanitarian aid.

Before his trip to Egypt, Mr. Blinken visited Jeddah, Saudi Arabia, where he held a late-night meeting with Crown Prince Mohammed bin Salman. Mr. Blinken emphasized the Biden administration’s long-term goal of “the establishment of a future Palestinian state with security guarantees for Israel,” the State Department spokesman, Matthew Miller, said in a statement on Thursday.

Mr. Blinken and the crown prince also “continued discussions on achieving lasting regional peace and security, including through greater integration among countries in the region and enhanced bilateral cooperation between the United States and Saudi Arabia,” Mr. Miller said.

That was a reference to discussions between the Biden administration and Saudi Arabia about a possible deal in which the country would establish normal diplomatic relations with Israel for the first time. In return the Saudis have asked the U.S. for security guarantees, arms sales and backing for a civil nuclear program. Such a deal would also likely require Israeli support for a path to Palestinian statehood.

“We are getting close to a point where we will have agreements,” Mr. Blinken said when asked about the negotiations.

A senior U.S. official said that most of the progress had been made on bilateral issues between the United States and Saudi Arabia.

Such a U.S.-Saudi agreement would require approval from the U.S. Senate, which is not assured. And Israel’s prime minister, Benjamin Netanyahu, has said that he would not support a Palestinian state.

Mr. Blinken acknowledged the obstacles, but called the effort critical.

Mr. Netanyahu’s office said Thursday that a delegation of mediators from Israel, Egypt, Qatar and the United States would meet in Doha, Qatar’s capital, on Friday to “advance the release of hostages” still being held in Gaza.

Along with Mr. Burns, of the C.I.A., that will include David Barnea, the director of Mossad; Prime Minister Mohammed bin Abdulrahman Al Thani of Qatar; and Abbas Kamel, the Egyptian intelligence minister, according to Mr. Netanyahu’s office.

In Israel, Mr. Blinken will discuss the potential Saudi normalization agreement as well as Israel’s war plans and ways to protect and deliver more aid to civilians there.

Julian E. Barnes contributed reporting.

— Michael Crowley traveling with Secretary of State Antony J. Blinken

U.S. resolution at the U.N. calls for a sustained cease-fire in Gaza.

The United States is circulating a resolution at the United Nations calling for “an immediate and sustained cease-fire” in the Gaza Strip, as experts warn of imminent famine in the enclave and pressure grows for stronger international action.

The Security Council resolution drafted by the United States contains the strongest language that Washington has supported so far, and was an apparent reversal for Israel’s closest ally. In February, the United States vetoed a Council resolution demanding an immediate humanitarian cease-fire.

The new resolution also condemns the Hamas-led attacks on Israel of Oct. 7 that set off the war and the hostage-taking that day, and expresses support for the negotiations to free those still being held in Gaza.

The Security Council will bring the resolution to a vote on Friday, Nate Evans, a spokesman for the U.S. mission to the United Nations, said in a statement.

When the United States vetoed the earlier resolution, which had been put forward by Algeria, American officials said they had done so because they were concerned that it could disrupt hostage negotiations. But Biden administration officials have grown more forceful in recent weeks in their push for a cease-fire, as conditions have further deteriorated in Gaza and the death toll has exceeded 30,000 .

The resolution being circulated by U.S. diplomats and obtained by The New York Times on Thursday says that the Council “ determines the imperative of an immediate and sustained cease-fire to protect civilians on all sides, allow for the delivery of essential humanitarian assistance, and alleviate humanitarian suffering, and towards that end unequivocally supports ongoing international diplomatic efforts to secure such a cease-fire in connection with the release of all remaining hostages.”

The resolution also notes the “deep concern about the threat of conflict-induced famine and epidemics.”

The call for an “immediate” cease-fire was markedly stronger language than a draft Security Council resolution that the United States circulated in February, which called for a temporary cease-fire “as soon as practicable.”

The Biden administration also used the resolution to reiterate its opposition to Israel’s planned invasion of Rafah, a city in southern Gaza, which is packed with war refugees. It expresses “concern that a ground offensive into Rafah would result in further harm to civilians and their further displacement including potentially into neighboring countries.”

— Michael Crowley and Thomas Fuller Michael Crowley reported from Cairo and the Middle East and Thomas Fuller from San Francisco.

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Doctors bring harrowing stories from Gaza hospitals to Washington.

Volunteer doctor details dire conditions at a gaza hospital, nick maynard, part of a delegation of doctors who volunteered in gaza, described “appalling atrocities” and the need for an immediate cease-fire at a news conference at the united nations on tuesday..

I spent two weeks at Al Aqsa Hospital, and I think it’s fair to say I wasn’t remotely prepared for what I was going – what I saw. I saw the most appalling atrocities. One child that I’ll never forget had burned so bad you could see her facial bones. We knew there was no chance of her surviving that, but there was no morphine to give her. So, not only was she inevitably going to die, but she would die in agony. Some days we didn’t have any surgical gloves, so we had to wash previous ones. Sometimes we had no surgical drapes. Many days we had no morphine. Knowing that actually a lot of those resources were probably in depots somewhere or maybe in lorries queuing up outside at Rafah but could not be distributed. And this is what is so urgent about the need for a cease-fire is, the only way that aid that’s being delivered to Gaza - and we welcome every bit of aid - the only way that aid is going to get to where it’s needed is if there is a cease-fire.

The memories are indelible. Screaming families carrying bloodied loved ones through the doors of an overcrowded hospital. A boy trying to resuscitate a child who looked not much older than himself. A 12-year-old with shrapnel wounds to his head and abdomen being intubated on the ground.

What he saw that January day at the Nasser Hospital in Khan Younis in southern Gaza — after a missile strike on an aid distribution site — has haunted Dr. Zaher Sahloul, an American critical care specialist with years of experience treating patients in war zones, including in Syria and Ukraine.

He and other volunteer doctors who have returned from besieged hospitals in Gaza took their firsthand accounts to Washington this week, hoping to convey the suffering to the Biden administration and senior government officials and to press for an immediate cease-fire.

Dr. Sahloul showed American officials — including members of Congress and officials from the White House, State Department, Defense Department and the United States Agency for International Development — a photo of the 12-year-old boy and his death certificate. The child never woke up from surgery after being intubated, the doctor said, and the hospital could not reach his family amid a near-total communications blackout.

Two other doctors in the delegation — Amber Alayyan, a Paris-based deputy program manager for Doctors Without Borders, and Nick Maynard, a British surgeon — said that medical system in Gaza had been wiped out by the war between Israel and Hamas.

“This is the deliberate destruction of the whole health care system,” Dr. Maynard said in an interview.

He described operating on chest injuries from explosions with few anesthetics or antibiotics at the Al-Aqsa Hospital in Deir al Balah in central Gaza in December and January. “The lack of pain relief was particularly disturbing because we saw lots of children with awful burns,” he said.

There was a limited supply of sterile gloves and surgical drapes, and the hospital’s record-keeping abilities had collapsed, rendering follow-up care nearly impossible, he said. Dr. Maynard said he walked through hallways packed with displaced people to check on patients he had operated on and sometimes failed to find them.

Also in the delegation was Thaer Ahmad, a Palestinian American emergency medicine physician. He was with Dr. Sahloul in January as Israeli forces encircled Khan Younis and began closing in on Nasser Hospital, the largest still functioning in the enclave at the time.

“I had to go,” Dr. Ahmad said in an interview. “They’re my people.”

He said that he had a toddler and a 2-month-old baby at home in Chicago when he traveled to Gaza. He contrasted his wife’s experience of delivery — in a safe, well-resourced hospital with an obstetrician she knows well — with the plight of pregnant women in Gaza , who have been starving and giving birth in shelters.

Not long after the doctors left Gaza, Nasser Hospital was raided by Israeli forces in what the military said was a search for Hamas members, weapons and the bodies of Israeli hostages. Before that, fighting had raged around the sprawling hospital for weeks, devastating the surrounding area.

The Israeli military said at the time that its operation was “conducted to ensure minimal disruption to the hospital’s ongoing activities.” Videos from the raid depicted chaos inside the damaged, smoke-filled hospital , punctuated by automatic gunfire and explosions, and health ministry described rapidly deteriorating conditions , and said patients had died from a lack of power and oxygen, and video footage from the scene.

“I will regret, for the rest of my life, leaving when I did,” Dr. Ahmad said.

— Anushka Patil

Israel’s raid on Al-Shifa Hospital grows into one of the longest of the war.

One of Israel’s longest hospital raids of the Gaza war stretched into a fourth day on Thursday, as the military said that it had killed dozens of people it described as terrorists in the previous 24 hours in its operation at Al-Shifa Hospital.

Israel has staged a series of raids on Al-Shifa in northern Gaza, the largest medical facility in the territory, arguing that Hamas used it as a command center and concealed weapons and fighters in underground tunnels there. Since the latest attack began on Monday, the Israeli military has reported killing more than 140 people it said were terrorists in and around the hospital, far more than in past raids.

On Thursday, the military said it had also detained 600 people at the hospital. The Israeli accounts could not be independently verified.

The Al Jazeera news network and Wafa, the Palestinian Authority’s news agency, reported on Thursday that Israeli forces had blown up a building used for surgery that is one of the largest at the complex. The Israeli military said it had no comment on the reports.

Iyad Elejel, who lives about 500 yards from Al-Shifa, said the situation was “very terrifying,” adding in a phone call on Thursday: “We are hearing the constant sounds of clashes, gunshots, shelling, bombing, quadcopters and planes all day and all night.” Smoke had infiltrated the apartment where he is staying with 30 relatives, making it hard to breathe, he said.

Mr. Elejel said the children in the apartment were becoming used to the cacophony. “We try to convince them that the sounds they are hearing are from fireworks, but they don’t believe it,” he said.

Nobody has been able to leave the apartment since the raid began, Mr. Elejel said, and the family feared that they could run out of food soon. He said that when he looked out of his window Thursday morning, he saw “many dead bodies lying on the main street” out front. Israeli soldiers have been forcing people in the area to leave their apartments and head south, so the neighborhood was emptying out, Mr. Elejel said.

The military said in an earlier statement that it was continuing to “conduct precise operational activity in the Shifa hospital, eliminating dozens of terrorists over the past day during exchanges of fire.” It also said it was preventing harm to civilians and had located storage sites for weapons.

Mohammed Abu Kmail, a 35-year-old marketing consultant, said in an interview that he was with his wife and two daughters in their apartment, near the hospital, when they woke up before dawn Tuesday to the sound of gunfire close to their building.

He said that around 8 a.m., Israeli soldiers entered nearby buildings, and stripped and handcuffed about 25 men, including himself. He said that, after being scanned by a camera, he and some of the others were released. The account resembled those of other men detained in Gaza since the war began.

The Israeli military said in a statement that detained people “are treated in accordance with international law” and that “it is often necessary” to have detainees remove clothing so it “can be searched and to ensure that they are not concealing explosive vests or other weaponry.”

Israeli forces have carried out a series of raids on medical facilities in Gaza, arguing that Hamas has used them for military purposes. The armed group has denied doing so.

Israel made northern Gaza the initial target of its ground invasion of the enclave, which started on Oct. 27, and it first raided the hospital in November. It later provided evidence that Hamas had constructed a lengthy tunnel under the hospital. A later analysis by The New York Times found that Hamas had used the complex for military purposes. The Israeli military, however, has struggled to prove that Hamas maintained a command-and-control center under it.

Even before the current raid began, international aid workers said that the hospital barely functioned and was incapable of serving the acute health care needs of northern Gaza as it had before the conflict.

The World Health Organization had hoped to conduct a mission to the hospital on Thursday to provide fuel and food for staff and patients, as well as to assess the situation there, but permission had been denied because of security issues, according to Dr. Rik Peeperkorn, who represents the organization in Gaza and the West Bank.

The W.H.O. is “terribly worried” about the situation, he said, adding that it had not been possible to contact staff members there.

Israeli officials said earlier this week that Hamas personnel had returned to the hospital, prompting its operation. Military analysts said Israel’s decision to withdraw most of its forces from the north, in part to concentrate on defeating Hamas in other parts of Gaza, had in effect left a security vacuum .

The initial raid on Al-Shifa became a lightning rod for criticism of Israel over military action around hospitals and the danger it poses to patients and medical staff. The raid also became a symbol of a broader debate about the human cost of Israel’s military campaign to destroy Hamas in Gaza, in which tens of thousands of civilians have been killed or wounded.

Lauren Leatherby contributed reporting.

— Matthew Mpoke Bigg and Hiba Yazbek

The House speaker says he will invite Netanyahu to address Congress.

House Speaker Mike Johnson said Thursday that he planned to invite Prime Minister Benjamin Netanyahu of Israel to address a joint session of Congress, moving to welcome a leader who has become a flashpoint for partisan disagreement in American politics over the war in Gaza.

Mr. Johnson, Republican of Louisiana, brought up the invitation one day after Mr. Netanyahu assailed Senator Chuck Schumer, the majority leader, in a private meeting with Senate Republicans for a speech in which the New York Democrat singled him out as an impediment to peace and called for eventual elections to replace him.

“I would love to have him come and address a joint session of Congress; we’ll certainly extend that invitation,” Mr. Johnson said of Mr. Netanyahu in an interview on CNBC. Mr. Johnson said he had also been invited to speak in front of the Israeli Knesset.

Mr. Schumer on Wednesday declined a request from Mr. Netanyahu to speak virtually to Senate Democrats at their own closed-door party lunch, saying it was not helpful to Israel for discussions with the prime minister to happen in a partisan forum.

But on Thursday, he said he would support an address by the Israeli prime minister in front of the entire Congress if Mr. Johnson moved forward with the invitation.

“Israel has no stronger ally than the United States and our relationship transcends any one president or any one prime minister,” Mr. Schumer said in a statement. “I will always welcome the opportunity for the prime minister of Israel to speak to Congress in a bipartisan way.”

The statement came a week after Mr. Schumer delivered an explosive speech on the Senate floor in which he harshly criticized Mr. Netanyahu, naming him and his right-wing coalition alongside Hamas and Mahmoud Abbas, the Palestinian Authority leader, as the main obstacles to peace.

The remarks and the Republican backlash that has followed have underscored a growing partisan divide in the United States over Mr. Netanyahu’s leadership as Israel’s war against Hamas rages on, and a struggle between members of both parties to define themselves as the true allies of the Jewish state.

A spokesman said that Mr. Johnson had not yet discussed any plans with Mr. Schumer, who would have to sign off on any invitation for an address before a joint session of Congress.

Mr. Netanyahu enraged Democrats in 2015 by accepting an invitation from Republicans who then controlled the House and Senate to deliver an address to Congress condemning the Iran nuclear deal as the Obama administration was negotiating it.

— Annie Karni Reporting from the Capitol

Israel’s Supreme Court asks authorities to hold off on the deportation of Gazan cancer patients.

Gazans who had been receiving medical treatment in Israel were to be deported back to the Palestinian territory on Thursday but have received a temporary reprieve from Israel’s Supreme Court.

The Supreme Court decision came in response to a last-minute petition filed by rights organizations and 13 cancer patients on Wednesday evening asking for the deportation to be blocked. The court asked the Israeli government to hold off on any action until it had time to review the petition.

Tamir Blank, the lead attorney for the patients, said on Thursday that seven names had been added to the petition since the decision.

“We’re making the argument that Israel created such conditions in Gaza that it cannot sustain people who have cancer and nobody with cancer can survive there for a reasonable amount of time,” he said.

The Israeli government said in a court filing on Thursday that it agreed to the court’s request not to deport any of the patients while the petition was under review. It also asked for 30 days to prepare its own response to the petition.

COGAT, the Israeli agency that oversees policy for the Palestinian territories and that was named along with the government in the petition, did not respond to questions about the petition or the patients involved. It said in a statement that “at present, Gazan residents and their escorts, who have received medical treatment in Israeli hospitals and who are not in need of further medical care, are returned to the Gaza Strip.”

“We emphasize that as of this moment, the coordination of the return of the Gazan patients has stopped and the issue is being discussed in court,” the statement added.

Months of bombardment and dire shortages of supplies since the war began in October have brought Gaza’s already struggling health care system to what aid organizations have said is the brink of collapse. Israel has raided several of Gaza’s main medical complexes , saying it is rooting out Hamas activity, a charge health officials deny.

The health care system was ill equipped to provide advanced cancer treatment even before the war. To get treatment in Israel, Gazans had to navigate several obstacles, including getting the Palestinian Authority’s Health Ministry to agree to absorb the cost of treatment and the Israeli authorities to issue a permit to cross the border.

Since the war began, Israel has sent some Palestinian workers back to Gaza, and rights groups say some Gazans receiving medical treatment have chosen to go back.

The 20 people named on the petition, most of whom are cancer patients and the majority of whom are adults, according to Mr. Black, do not want to return to Gaza. All of them were in Israel before the war began, mostly at hospitals in occupied East Jerusalem.

They were scheduled for deportation because they were no longer receiving “active treatment,” according to the attorney, rights groups and a hospital.

Dr. Fadi Atrash, the head of the Augusta Victoria Hospital in East Jerusalem, said that the Israeli authorities had contacted his hospital last week for an updated list with the names and statuses of Gazan patients. The hospital was told that 11 cancer patients who were no longer receiving active treatment would be sent back to Gaza this week, he said.

Completing chemotherapy or radiation is not the end of treatment for cancer patients, the doctor and rights groups argued. Patients might need hormone therapies, and require follow-ups and regular checkups, none of which are feasible in Gaza.

“Sending them back to Gaza — it’s like putting them in a higher risk to be killed because it’s a war zone,” Dr. Atrash said.

Aseel Aburass, the director of the department for occupied Palestinian territories at Physicians for Human Rights-Israel, which took the lead on the petition, said that it was “crazy” to send the patients back to a war zone when they need follow-up care.

“They’re still weak and their immune system is weak,” she said, adding: “This is a death sentence.”

Myra Noveck and Johnatan Reiss contributed reporting.

— Cassandra Vinograd

2018 Primetime Emmy & James Beard Award Winner

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