Small by Small is a triumph of personal and artistic vision which at once narrates a victorious journey with all its struggles to becoming a doctor, and what such a journey entailed for a student studying in Nigeria in the 1990s.
By Michael Chiedoziem Chukwudera
In the early 90s, when Ike Anya was studying Medicine at the University of Nigeria Enugu Campus (UNEC), he came to be known as the medical student who walked around campus with a big novel. In medical schools all over the world, there are such students; the ones who in the rigour and tasking routines of medical school, seek solace in the pages of novels. From a young age, Anya fell deeply in love with literature, and in his medical school days, he continued with it. He had always wanted to write a book, a goal which did not come very easy to him. Small by Small, which narrates his ordeal in medical school, arrives nearly 30 years after medical school.
Small by Small begins with Anya and his friends passing their second qualifying exams, widely regarded as the ultimate test to pass through medical school. He then goes back to his childhood and traces his journey through his primary and secondary school days, where as a brilliant boy with multiple interests, he faces a tough choice deciding on what to study in school before settling on medicine.
Anya’s coming-of-age years span from the late 80s to the early 90s, in which Nigeria was embroiled in military dictatorships. This ranged from Ibrahim Babangida’s extremely long and tiresome dictatorship to Sani Abacha’s tyranny which came shortly after MKO Abiola’s election was nipped in the bud. It was in this hostile political environment that Anya grew up while training to become a doctor. Although the scope of the book is quite straightforward in its vision of telling the story of how the author became a doctor, the story assumes the political environment of the times and has enough minor diversions related to the life of the characters in the book to enrich the story.
Reading Anya’s Small by Small affected me in unprecedented ways. Before becoming a writer, I wanted to be a physician, too, and even while I studied Botany at the university, as a teenager I’d hoped to go to medical school after undergraduate studies. Through Small by Small, seven years after I was a university student in Awka, it felt like on the pages of the book I was attending the medical school I never went to. Its attention to detail, tender narrative, and how the book tended to hit directly at the details I wondered about the medical school experience moved me. I saw myself in the pages, moving with the author and his friends, built from a recollection which stretched decades through memory.
The story in the beginning goes back and forth but has a clear plot. And from time to time certain scenarios are brought to the fore, not exactly fitting into the narrative, but like an extra shade of colour to it.
Anya’s writing is remarkable, but it is the content of his story and how it unfolds that enriches the book. His experiences are complete with their high and low moments. The way which Anya responds to these situations gives us a better grasp of his character. All through his challenging years in medical school, there are the happy times and the sad times, and the story contains its fair share of episodes of success and failure, in which the author participates fully.
In the beginning, we meet him rolling in the grass with a classmate after they have passed their second MB. It is such a joyous moment that you can feel the joy leaping out of the pages. Later on, when in his fifth year Anya gets a re-sit and afterwards, fails paediatrics, he is shattered and begins to be nonchalant. In his final year, this affects his attitude to surgery. In this difficult time, Anya’s friends and classmates help console him. One of them particularly advises him to brave the storm and not allow his despair to impinge on his self-confidence irredeemably. One of the most interesting parts of the book is when his friend calls his house after his final year to inform him that he passed medicine but not surgery. The reaction of his parents to the story, choosing to celebrate their son’s success in spite of his setbacks, comes across as an invigorating moment in the book. Anya goes back to school afterwards, invigorated and ready to take on the challenges and rewrite the courses he failed. Throughout the book, in the places where the author is with his family and friends, the picture is almost always of warmth in good times and encouragement in times of struggle.
Another point that stands out in Small by Small is when we briefly meet his maternal grandmother. We experience an affectionate relationship with her, which evokes introspection. She loves him and calls him by the name of her late husband, of whom she believes he is a reincarnation. Anya describes the evolution of his relationship with her; her habit of pouring encomiums on him made him shy in his younger years, but as he came of age, it made him proud. After he’s admitted to study medicine in Enugu, he has a long conversation with her, in which he breaks down the long journey to finally becoming a doctor to her, and she encourages him in the Abiriba Igbo dialect, saying, “Ọkwa m da ezi unu, ife dum bu nkenta nke nta” which translates to mean “everything worthy is achieved little by little” or small by small in the Nigerian Pidgin parlance. It is from this experience that the book gets its title.
Anya’s storytelling is powerful; he is candid about his struggles and uncertainties and never speaks solely as an intelligent person who figures his way out of his challenges. He writes about his unimpressive performance as he begins his job after an emergency trip to Lagos, after successfully completing medical school. He pens down his struggle with figuring out how to locate veins in his patients’ arms, about running to see a patient after the nurses alert him and only to realise he had no idea what to do when his classmate who had been working six months before him asks him if he knew what to do. And then eventually becoming something of an expert after many months of consecutive practice.
Anya’s book could have been even more if he were not discreet about certain matters. Early in the book, Anya admits that when deciding where to study between Lagos and Enugu, Enugu was the better choice because his father was a professor of medicine there. The story could have been enriched by a narrative of the author’s personal relationship with his father, who from what has surfaced in public from time to time, was quite an interesting man. Also in medical school, there is no mention of a love life or interest, and if there was none, why there wasn’t. To the book’s credit, it showed an enviable discipline towards the focus of its narrative, but the best books know how to divert readers’ attention and bring it back to the focus, which Anya’s book does a few times. As much as this is a critical view, it passes too, for a commendation of the book’s craftsmanship, in leaving its reader wondering about more.
In the end, Small by Small is a coming-of-age story of the life of a young man taking shape. It is reflective and heralds crucial moments where life-shaping decisions are made. It successfully blends the dichotomy of highs and lows, and success and failure on the pathway to progress. In Anya’s narrative, one comes across the challenges of becoming a doctor, and in how he relays the practice of the profession, the fine line between medicine as a science and craft (part of which is artistic for its beauty and use for creativity) becomes apparent. Doctors have from time been capable of great artistic skill because the profession requires the same skill set with which artists sharpen their craft; study, adept observation, and tireless practice. Perhaps this is why doctors often make such great writers. Anya’s life as a child with multiple interests, and arts especially literature who ends up becoming a doctor goes full circle in this aspect. In his acknowledgement, he relays his long-standing goal of writing a book which as time went by, seemed to be elusive. Hence this book is a triumph of personal and artistic vision which at once narrates a victorious journey with all its struggles to becoming a doctor, and what such a journey entailed for a student studying in Nigeria in the 1990s.
Michael Chiedoziem Chukwudera is a freelance writer who writes on literature and culture for Afrocritik. His debut novel, “Loss is an Aftertaste of Memories” is forthcoming from Mmuta Books.