The River Story, attributed to Irving Zola, by New Zealand sociologist John B. McKinlay

“A Case for Refocusing Upstream: The Political Economy of Illness” McKinlay, J.B. (first published 1975)

My friend, Irving Zola, relates the story of a physician trying to explain the dilemmas of the modern practice of medicine:

“I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I jump into the cold waters. I fight against the strong current and force my way to the struggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank and revive him with artificial respiration.

Just when he begins to breathe, I hear another cry for help.

I jump into the cold waters. I fight against the strong current, and swim forcefully to the struggling woman. I grab hold and gradually pull her to shore. I lift her out on the bank beside the man and work to revive her with artificial respiration.

Just when she begins to breathe, I hear another cry for help.

I jump into the cold waters. Fighting again against the strong current, I force my way to the struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay him out on the bank and try to revive him with artificial respiration.

Just when he begins to breathe, I hear another cry for help.

Near exhaustion, it occurs to me that I’m so busy jumping in, pulling them to shore and applying artificial
respiration that I have no time to see who is upstream pushing them all in…”

Reference

Mckinlay, J. (1994). A case of refocusing upstream: The political economy of illness. In P. Conrad (Ed.), The sociology of health and illness: A critical approach (pp. 551–561).
New York, NY: Palgrave Macmillan