We are already one. But we imagine that we are not. And what we have to recover is our original unity.
-Thomas Merton
I recently sat with a group of residents and students to discuss two fictional short stories that are classics in the Medical Humanities: “The Use of Force,” by William Carlos Williams (1938) and “Brute,” by Richard Selzer (1982). Both stories are difficult and violent.
In “The Use of Force,” Williams tells the story of a home visit to see a sick child. The doctor must examine the child’s throat because he fears the child has diphtheria. Things do not go well. He tries to cajole the child and to enlist the help of the parents. The child resists and the parents are reluctant to force the child to cooperate. The doctor’s thoughts are transparent to the reader: he despises the parents for their weakness, admires the child for her strength and tenacity, and eventually loses his temper. “In a final unreasoning assault, I overpowered the child’s neck and jaws.” The doctor sees the tell-tale membranous discharge in the throat, thus sealing the diagnosis.
In “Brute,” Selzer tells the story of a man brought to the emergency room in the middle of the night, roaring drunk and handcuffed. He has a deep gash across his forehead. The man is powerful and fights the doctor’s attempts to repair the cut. The doctor and patient are alone in the room, and the reader is privy to the doctor’s anger and exhaustion. In frustration, he finally grabs two large sutures and sews the man’s earlobes to the mattress. “I have sewn your ears to the stretcher,” I tell him. “Move, and you’ll rip ‘em off.” Along the way, the doctor-narrator tells us of his rage.
My discussion group reflected on the stories in ways I did not expect. They took the narrative conflicts personally. These residents and students have experienced long and difficult on-call nights and times of great frustration in patient-care settings. They have certainly had moments when interacting with patients was difficult and exhausting.
Yet, some were very critical and unforgiving of the way the doctors in the stories reacted. “That’s just wrong!” they declared. “No one should ever treat patients that way!”
The stories ARE difficult. The doctors get their tasks accomplished, but they are angry and sometimes profane in the process.
It was an opening for me to talk about the difference between “Professionalism” and “Humanism.” We work to train professionals – people who have certain sets of attributes, skills and demeanors with which they will practice high-quality medicine with integrity and empathy. This is a good goal. “Humanism,” on the other hand, is broader than professionalism. These are qualities we hope every physician brings to the table from childhood. Humanism refers to a deep respect of humans individually and collectively, and concern for their general welfare and flourishing.
In the examples we looked at, both doctors were, strictly speaking, professional. The child’s throat was examined and the man’s laceration was repaired. The spoken dialogue is, by and large, “professional” and focused on the medical issue at hand.
But, “humanism,” that is another story. Williams speaks of the doctor’s “fury” while Selzer speaks of his doctor’s “rage.” Both doctors overpower their patients. The inner dialogue is the focus.
Both essays close with the doctor-narrator expressing shame and regret. A physician can be perfectly professional but lack humanism, depending on how he or she see patients and co-workers. Being attentive to our "inner dialogue" can tip us off to when we are in danger of losing our humanism.
The discussion helped me see the difference. Great writing and great colleagues can do that.
___
References:
Williams WW, The Doctor Stories, New Directions, New York, 1984. MCW Library WZ 350 W728d
Selzer R, The Doctor Stories, Picador, New York, 1998. MCW Library WZ 350 S469d
A wonderful discussion of the topic can be found at: Goldberg JL,Humanism or Professionalism? The White Coat Ceremony and Medical Education, Academic Medicine 2008; 83:715-722.
