In my lectures, I often quote Wendell Berry. I offer the following 12 page lecture to introduce you to one of the people who has had a profound influence on me and many of the folks I admire. I don't agree with everything, but his association with the earth and civilization is profound...
Delivered as
a speech at a conference, “Spirituallity and Healing,” at
Louisville, Kentucky, on October 17, 1994.
I
From
our constant and increasing concerns about healthy, you can tell how
seriously diseased we are. Health, as we may remember from at least
some of the days of our youth, is at once wholeness and a kind of
unconsciousness. Disease (dis-ease), on the contrary, makes us
conscious not only of the state of our health but of the division of
our bodies and our world into parts.
The
word “health,” in fact, comes from the same Indo-European root as
“heal,” and “holy.” To be healthy is literally to be whole;
to heal is to make whole. I don’t think mortal healers should be
credited with the power to make holy. But I have no doubt that such
healers are properly obliged to acknowledge and respect the holiness
embodied in all creatures, or that our healing involves the
preservation in us of the spirit and the breath of God.
If
we were lucky enough as children to be surrounded by grown-ups who
loved us, then our sense of wholeness is not just the sense of
completeness in ourselves but also in the sense of belonging to
others and to our place; it is an unconscious awareness of community,
of having in common. It may be that this double sense of singular
integrity and of communal belonging is our personal standard of
health for as long as we live.
Anyhow,
we seem to know instinctively that health is not divided.
Of
course, growing up and growing older as fallen creatures in a fallen
world can only instruct us painfully in division an disintegration.
This is the stuff of consciousness and experience. But if our
culture works in us as it should, then we do not age merely into
disintegration an division, but that very experience begins our
education, leading us into knowledge of wholeness and holiness. I am
describing here the story of Job, of Lazarus, of the lame man at the
pool of Bethesda, of Milton’s Samson, of King Lear. If our culture
works in us as it should, our experience is balanced by education; we
are led out of our lonely suffering and are made whole.
In
the present age of the world, disintegration and division, isolation
and suffering seem to have overwhelmed us. The balance between
experience and education has been overthrown; we are lost in
experience and so-called education is leading us nowhere.
We
have diseases aplenty. As if that were not enough, we are suffering
an almost universal hypochondria. Half the energy of the medical
industry, on suspects, may now be devoted to “examinations” or
“tests” – to see if, though apparently well, we may not be
latently or insidiously diseased.
If
you are going to deal with the issue of health in the modern world,
you are going to have to deal with much absurdity. It is not clear,
for example, why death should increasingly be looked upon as a
curable disease, an abnormality, by a society that increasingly looks
upon life as insupportably painful and/or meaningless. Even more
startling, is the realization that the modern medical industry
faithfully imitates disease in the way that it isolates us and
parcels us out. If, for example, intense and persistent pain causes
you to pay attention only to your stomach, then you must leave home,
community, and family and go to a sometimes distant clinic or
hospital, where you will be cared for by a specialist who will pay
attention only to your stomach.
Or
consider the announcement by the Associated Press on February 9,
1994, that “the incidence of cancer is up among all ages, and
researchers speculated that environmental exposure to cancer-causing
substances other than cigarettes may be partly to blame.”
This
bit of news is offered as a surprise, never mind that the environment
(so called) has been known to be polluted and toxic for many years.
The blame obviously falls on that idiotic term “the environment,”
which refers to a world that surrounds us. Our laboratories have
proved long ago that cigarette smoke gets inside us, but if “the
environment” surrounds us, how does it
wind up in side us? So much for division as a working principle of
health.
This,
plainly, is a view of health that is severely reductive. It is, to
begin with, almost fanatically individualistic. The body is seen as
a defective or potentially defective machine, singular, solitary, and
displaced, without love, solace, or pleasure. Its health excludes
unhealthy cigarettes, but does not exclude unhealthy food, water, and
air. One may presumably be healthy in a disintegrated family or
community or in a destroyed or poisoned ecosystem.
So
far, I have been implying my beliefs at every turn. Now I had better
state them openly.
I
take literally the statement in the Gospel of John that God loves the
world. I believe that the world was created and approved by love,
that it subsists, coheres, and endures by love, and that, insofar as
it is redeemable, it can redeemed only by love. I believe that
divine love, incarnate and indwelling in the world, summons the world
always toward wholeness, which ultimately is reconciliation and
atonement with God.
I
believe that health is wholeness. For many years, I have returned
again and again to the work of the English agriculturist Sir Albert
Howard, who said in The Soil and Health,
that “the whole problem of health in soil, plant, animal, and man
[is] one great subject.”
I
am moreover a Luddite, in what I take to be the true and appropriate
sense. I am not “against technology” so much as I am for
community. When the choice is between the health of a community and
technological innovation, I choose the health of the community. I
would unhesitatingly destroy a machine before I would allow the
machine to destroy my community.
I
believe that the community – in the fullest sense; a place and all
its creatures – is the smallest unit of health and that to speak of
the health of an isolated individual is a contradiction in terms.
We
speak now of “spirituality and healing” as if the only way to
render a proper religious respect to the body is somehow to treat it
“spiritually.” It could be argued just as appropriately (and
perhaps less dangerously) that the way to respect the body fully is
to honor fully its materiality. In saying this, I intend no
reduction. I do not doubt the reality of the experience and
knowledge we cal “spiritual” any more than I doubt the reality of
so-called physical experience and knowledge; I recognize the rough
utility of these terms. But I strongly doubt the advantage, and even
the possibility of separating these two realities.
What
I’m arguing against here is not complexity or mystery but dualism.
I would like to purge my own mind and language of such terms as
“spiritual,” “physical,” “metaphysical,” and
‘transcendental” – all of which imply that the Creation is
divided into “levels” that can readily be peeled apart and judged
by human beings. I believe that the Creation is one continuous
fabric comprehending simultaneously what we mean by “spirit” and
what we mean by “matter.”
Our
bodies are involved in the world. Their needs and desires and
pleasures are physical. Our bodies hunger and thirst, year toward
other bodies, grow tired and seek rest, rise up rested eager to exert
themselves. All these desires may be satisfied with honor to the
body and its maker, but only if much else besides the individual body
I s brought into consideration. We have long known that individual
desires must not be made the standard of their own satisfaction. We
must consider the body’s manifold connections to other bodies and
to the world. The body, “fearfully and wonderfully made,” is
ultimately mysterious both in itself and in its dependencies. Our
bodies live, the Bible says, by the spirit and the breath of God, but
it does not say how this is so. We are not going to know
about this.
The
distinction between the physical and spiritual is, I believe, false.
A much more valid distinction, and one that we need urgently to learn
to make, is that between the organic and the mechanical. To argue
this – as I am going to do – puts me in the minority, I know, but
it does not make me unique. In The Idea of a Christian
Society, T. S. Eliot wrote “We may
say that religion, as distinguished from modern paganism implies a
life in conformity with nature. It may be observed that the natural
life and the supernatural life have a conformity to each other which
neither has with the mechanistic life.”
Still
I wonder if our persistent wish to deal spiritually with physical
things does not come either from the feeling that physical things are
“low” and unworthy or from the fear, especially when speaking of
affection, that “physical” will be taken to mean sexual.
The
New York Review of Books of
February 3, 1994, for example, carried a review of the correspondence
of William and Henry James along with a photograph of the two
brothers standing together with Williams’ arm around Henry’s
shoulders. Apropos of this picture, the reviewer, John Bayley, wrote
that “their closeness of affection was undoubted and even took on
occasion a quasi-physical form.” It is Mr. Bayley’s qualifier,
“quasi-physical, “ that sticks in one’s mind. What can he have
meant by it? Is this prurience masquerading as squeamishness, or
vice versa? Does Mr. Bayley feel a need to assure his
psychologically sophisticated readers that even though these brothers
touched one another familiarly, they were not homosexual lovers?
The
phrase involves at least some version of the old dualism of spirit
and body or mind and body that has caused us so much suffering and
trouble and that raises such troubling questions for anybody who is
interested in health. If you love your brother and if you and your
brother are living creatures, how could your love for him not be
physical? Not spiritual or mental only, not “quasi-physical,”
but physical. How could you not take a simple pleasure in putting
your arm around him?
Out
of the same dualism comes our confusion about the body’s proper
involvement in the world. People seriously interested in health will
finally have to question our society’s long-standing goals of
convenience and effortlessness. What is the point of “labor
saving” if by making work effortless we make it poor, and if by
doing poor work we weaken our bodies and lose conviviality and
health?
We
are now pretty clearly involved in a crises of health, one of the
wonders of which is its immense profitability both to those who cause
it and to those who propose to cure it. That the illness may prove
incurable, except by catastrophe, is suggested by our economic
dependence on it. Think, for example, of how readily our solutions
become problems and our cures pollutants. To cure one disease, we
need another. The causes, I think, can be traced back to the old
idea that our bodies are not very important except when they give us
pleasure (usually, now, to somebody’s profit) or when they hurt
(now, almost invariably, to somebody’s profit).
This
dualism inevitably reduces physical reality, and it does so by
removing its mystery from it by dividing it absolutely from what
dualistic thinkers have understood as spiritual or mental reality.
A
reduction that is merely theoretical might be harmless enough, I
suppose, but theories find ways of getting into action. The theory
of the relative unimportance of physical reality has put itself into
action by means of a metaphor by which the body (along with the world
itself) is understood as a machine. According to this metaphor –
which is now in constant general use – the human heart, for example
is no longer understood as the center of our emotional life or even
as an organ that pumps; it is understood as “a pump,’ having
somewhat the same function as a fuel pump in an automobile.
If
the body is a machine for living and working, then it must follow
that the mind is a machine for thinking. The “progress” here is
the reduction of mind to brain and then of brain to computer. This
reduction implies and requires the reduction of knowledge to
“information.” It requires, in fact, the reduction of everything
to numbers and mathematical operations.
This
metaphor of the machine bears heavily upon the question of what we
mean by health and by healing. The problem is that like any
metaphor, it is accurate only in some respects. A girl is only in
some respects like a red rose; a heart is only in some respects like
a pump. This means that a metaphor must be controlled by a sort of
humorous intelligence, always mindful of the exact limits within
which the comparison is meaningful. When a metaphor begins to
control intelligence, as this one of the machine has done for a long
time, then we must look for costly and distortions and absurdities.
Of
course, the body in most ways is not at all like a machine. Like all
living creatures and unlike a machine, the body is not formally
self-contained; it’s boundaries and outlines are not so exactly
fixed. The body is not, properly speaking, a body. Divided from its
sources of air, food, drink, clothing, shelter and companionship, a
body is, properly speaking, a cadaver, whereas a machine by itself,
shut down or out of fuel is still a machine. Merely as an organism
(leaving aside issues of mind and spirit) the body lives and moves
and has its being , minute by minute, by an interinvolvement with
other bodies and other creatures, living and unliving, that is too
complex to diagram or describe. It is, moreover, under the influence
of thought and feeling. It does not live by “fuel” alone.
A
mind, probably, is even less like a computer than a body is like a
machine. As far as I am able to understand it, a mind is not even
much like a brain. Insofar as it is usable for association of
thoughts and feelings with words, for the connections between words
and things, words and acts, thought and memory, a mind seems to be in
constant need of reminding. A mind unreminded would be no mind at
all. This phenomenon of reminding shows the extensiveness of mind –
how intricately it is involved with sensation, emotion, memory,
tradition, communal life, known landscapes, and so on. How you could
locate a mind within its full extent, among all its subjects and
necessities I don’t know, but obviously it cannot be located within
a brain or a computer.
To
see better what a mind is (or is not), we might consider the
difference between what we mean as knowledge and what the computer
now requires us to mean by “information.” Knowledge refers to
the ability to do or say the right thing at the right time; we would
not speak of somebody who does the wrong thing at the wrong time as
“knowledgeable.” People who perform well as musicians, athletes,
teachers, or farmers are people of knowledge. And such examples tell
us much about the nature of knowledge. Knowledge is formal, and
informs speech and action. It is instantaneous; it is present and
available when and were it is needed.
“Information,”
which once meant that which forms or fashions from within, now means
merely “data.” However organized this data may be, it is not
shapely or formal or in the true sense in-forming. It is not present
where it is needed; if you have to “access” it, you don’t have
it. Whereas knowledge moves and forms acts, information is inert.
You cannot imagine a debater or a quarterback or a musician
performing by “accessing information.” A computer chock full of
such information is no admirable than a head of a book chock full of
it.
The
difference, then, between information and knowledge is something like
the difference between a dictionary and somebody’s language.
Where
the art and science of healing are concerned, the machine metaphor
works to enforce a division that falsifies the process of healing
because it falsifies the nature of the creature needing to be healed.
If the body is a machine, then its diseases can be healed by a sort
of mechanical tinkering, without reference to anything outside the
body itself. This applies with obvious differences, to the mind;
people are assumed to be individually sane or insane. And so we
return to the utter anomaly of a creature that is healthy within
itself.
The
modern hospital, where most of us receive our strictest lessons in
the nature of industrial medicine, undoubtedly does well at surgery
and other procedures that permit the body and its parts to be treated
as separate things. But when you try to think of it as a place of
healing – of reconnecting and making whole – then the hospital
reveals the disarray of the medical industry’s thinking about
health.
In
healing, the body is restored to itself. It begins to life again by
its own powers an instincts, to the extent that it can do so. To the
extent that it can do so, it goes free of drugs and mechanical helps.
Its appetites return. It relishes food and rest. The patient is
restored to family and friends, home and community and work.
This
process has a certain naturalness and inevitability, like that by
which a child grows up, but industrial medicine seems to grasp it
only tentatively and awkwardly. For example, nay ordinary person
would assume that a place of healing would put a premium on rest, but
hospitals are notoriously difficult to sleep in. They are noisy all
night, and the routine interventions go on relentlessly. The body is
treated as a machine that does not need to rest.
You
would think also that a place dedicated to healing and health would
make much of food. But here is where the disconnection of the
industrial system and the displacement of industrial humanity are
most radical. Sir Albert Howard saw accurately that the issue of
human health is inseparable from the health of the soil, and he saw
too that we humans must responsibly occupy our place in the cycle of
birth, growth, maturity, death, and decay, which is the health of the
world. Aside form our own mortal involvement, food is our
fundamental connection to that cycle. But probably most of the
complaints you hear about hospitals have to do with the food, which
according to the testimony I have heard, tends to range from
unappetizing to sickening. Food is treated as another unpleasant
substance to inject. And this is a shame. For in addition to the
obvious nutritional link between food and health, food can be a
pleasure. People who are sick are often troubled or depressed, and
mealtimes offer three opportunities a day when patients could easily
be offered something to look forward to. Nothing is more pleasing or
heartening than a plate of nourishing, tasty, beautiful food artfully
and lovingly prepared. Anything less is unhealthy, as well as a
desecration.
Why
should rest and food and ecological health not be the basic
principles of our art and science of healing? Is it because the
basic principles already are technology and drugs? Are we
confronting some fundamental incompatibility between mechanical
efficiency and organic health? I don’t know. I only know that
sleeping in a hospital is like sleeping in a factory and that the
medical industry makes only the most tenuous connection between
health and food and no connection between health and the soil
Industrial medicine is as little interested in ecological health as
is industrial agriculture.
A
further problem, and an equally serous one, is that illness, in
addition to being a bodily disaster, is now also an economic
disaster. This is so whether or not the patient is insured. It is a
disaster for us all, all the time, because we all know that
personally or collectively, we cannot continue to pay for cures that
continue to get more expensive. The economic disturbance that now
inundates the problem of illness may turn out to be the profoundest
illness of all. How can we get well if we are worried sick about
money?
I
wish it were not the fate of this essay to be filled with questions,
but questions now seem to be the inescapable end of any line of
thought about health and healing. Here are several more:
Can
our present medical industry produce an adequate definition of
health/ My own guess is that it cannot do so. Like industrial
agriculture, industrial medicine had depended increasingly on
specialist methodology, mechanical technology, and chemicals; thus,
its point of reference has become more and more its own technical
prowess and less and less the health of creatures and habitats. I
don’t expect this problem to be solved in the universities, which
have never addressed, much less solved the problem of health in
agriculture. And I don’t expect it to be solved by the government.
How
can cheapness be included in the criteria of medical experimentation
and performance? And why has it not been included before now? I
believe that the problem here is again that of the medical
industry’s fixation on specialization, technology, and chemistry.
As a result, the modern “health care system” has become a way of
marketing industrial products, exactly like modern agriculture,
impoverishing those who pay and enriching those are paid. It is, in
other words, an industry such as industries have always been.
Why
is it that medical strictures and recommendations so often work in
favor of food processors and against food producers? Why, for
example, do we so strongly favor the pasteurization of milk to
health and cleanliness in milk production? (Gene Logsdon correctly
says that the motive here “is monopoly, not consumer health.”)
Why
do we so strongly prefer a fat-free or germ-free diet to a
chemical-free diet? Why does the medical industry strenuously
oppose the use of tobacco, yet complacently accept the massive use
of antibiotics and other drugs in meat animals and poisons on food
crops? How much longer can it cling to the superstition of bodily
health in a polluted world?
How
can adequate medical and health care, including disease prevention
be included in the structure and economy of a community? How, for
example, can a community and its doctors be included in the same
culture, the same knowledge, and the same fate, so that they will
live as fellow citizens, sharers in a common wealth, members of one
another?
II
It
is clear by now that this essay cannot hope to be complete; the
problems are too large and my knowledge too small. What I have to
offer is an association of thoughts and questions wandering somewhat
at random and somewhat lost within the experience of modern diseases
and the often bewildering industry that undertakes to cure them. In
my ignorance and bewilderment, I am fairly representative of those
who go, or go with loved ones, to doctor’s offices and hospitals.
What I have written so far comes from my various efforts to make as
much sense as I can of that experience. But now I had better turn to
that experience itself.
On
January 3. 1994, my brother John had a severe heart attack while he
was out by himself on his farm, moving a feed trough. He managed to
get to the house and telephone a friend who sent the emergency rescue
squad.
The
rescue squad and the emergency room staff at a local hospital
certainly saved my brother’s life. He was later moved to a hospital
in Louisville, where a surgeon performed a double-bypass operation on
his heart. After three weeks, John was returned home. He still has a
life to live and work to do. He has been restored to himself and to
the world.
He
and those who love him have a considerable debt to the medical
industry, as represented by two hospitals, several doctors and
nurses, many drugs and many machines. This is a debt that I
cheerfully acknowledge. But I am obliged to say also that my
experience of the hospital during John’s stay was troubled by much
conflict of feeling and a good many unresolved questions, and I know
I am not alone in this.
In
the hospital what I will call the world of love meets the world of
efficiency- the world, that is, of specialization, machinery, and
abstract procedure. Or, rather, I should say that these two worlds
come together in the hospital but do not meet. During those weeks
when John was in the hospital, it seemed to me that he had come from
the world of love and that the family members, neighbors, and friends
who at various times were there with him came there to represent that
world and to preserve his connection with it. It seemed to me that
the hospital was another kind of world altogether.
When
I said early in this essay that we live in a world that was created
and exists and is redeemable by love, I did not mean to
sentimentalize it. For this is also a fallen world. It involves
error and disease, ignorance and partiality, sin and death. If this
world is a place where we may learn of our involvement in immortal
love, as I believe it is, still such learning is only possible here
because that love involves us so inescapably in the limits,
sufferings, and sorrows of mortality.
Like
divine love, earthly love seeks plenitude; it longs for the full
membership to be present and to be joined. Unlike divine love,
earthly love does not have the power, the knowledge, or the will to
achieve what it longs for. The story of human love on this earth is
a story by which this love reveals and even validates itself by its
failures to be complete and comprehensive and effective enough. When
this love enters a hospital, it brings with it a terrifying history
of defeat, but it comes nevertheless confident of itself for its
existence and the power of its longing have been proved over and over
again even by its defeat. In the face of illness, the threat of
death, and death itself, it insists unabashedly on its own presence,
understanding by its persistence through defeat that it is superior
to whatever happens.
The
world of efficiency ignores both loves, earthly and divine, because
by definition it must reduce experience to computation, particularly
to abstraction, and mystery to a small comprehensibility.
Efficiency, in our present sense of the word allies itself inevitably
with machinery, as Neil Postman demonstrates in his useful book,
Technoply. “Machines,”
he says, “eliminate complexity, doubt, and ambiguity. Tha creature
is itsey work swiftly, they are standardized, and they provide us
with numbers that you can see and calculate with.” To reason, the
advantages are obvious, and probably no reasonable person would wish
to reject them out of hand.
And
yet love obstinately answers that no loved one is standardized. A
body, love insists, is neither a spirit nor a machine; it is not a
picture, a diagram, a chart, a graph, an anatomy; it is not an
explanation; it is not a law. It is precisely and uniquely what it
is. It belongs to the world of love, which is a world of living
creatures, natural orders and cycles, many small, fragile lights in
the dark.
In
dealing with the problems of agriculture, I had thought much about
the difference between creatures and machines. But I had no so
clearly understood and felt that difference when John was in recovery
after his heart surgery, when he was attached to many machines and
was dependent for breath on a respirator. It was impossible then not
to see that the breathing of a machine, like all machine work, is
unvarying, an oblivious regularity, whereas the breathing of a
creature is ever changing, exquisitely responsive to events both
inside and outside the body, to thoughts and emotions. A machine
makes breaths as a machine makes buttons, all the same, but every
breath of a creature is itself a creature, like no other, inestimably
precious.
Logically,
in plenitude some things ought to be expendable. Industrial
economics has always believed this: abundance justifies waste. This
is one of the dominant superstitions of American history – and of
the history of colonialism everywhere. Expendability is also an
assumption of the world of efficiency, which is why that world deals
so compulsively in percentages of efficiency and safety.
But
this sort of logic is absolutely alien to the world of love. To the
claim that a certain drug or procedure would save 99 percent of all
cancer patients or that a certain pollutant would be safe for 99
percent of a population, love, unembarrassed, would respond, “What
about the one percent?”
There
is nothing rational or perhaps even defensible about this but it is
nonetheless one of the strongest strands of our religious tradition –
it is probably the most essential strand – according to which a
shepherd, owning a hundred sheep and having lost one, dos not say, “I
have saved 99 percent of my sheep,” but rather, “I have lost
one,” and goes and searches for the one. And if the sheep in that
parable seem to be only a metaphor, then go on to the Gospel of Luke,
where the principle is flatly set forth again and where the sparrows
stand not for human beings, but for all creatures: “Are not five
sparrows sold for two farthings and not one of them is forgotten
before God?” And John Donne had in mind a sort of equation and not
a mere metaphor when he wrote, “If a clod be washed away by the
sea, Europe is the less, as well as if a promontory were, as well as
if a manor of thy friend’s or of thine own were. Any man’s death
diminishes me.”
It
is reassuring to ecology moving toward similar idea of the order of
things. If an ecosystem loses one of its native species, we now know
that we cannot speak of it as itself minus one species. An ecosystem
minus one species is a different ecosystem. Just so, each of us is
made by – or one might better say, made as – a set of unique
associations with unique persons, places, and things. The world of
love does not admit the principle of the interchangeability of parts.
When
John was in intensive care after his surgery, his wife, Carol was
standing by his bed, grieving and afraid. Wanting to reassure her,
the nurse, said, “Nothing is happening to him that doesn’t happen
to everybody.”
And
Carol replied, “I’m not everybody’s wife.”
And
in the world of love, things separated by efficiency and
specialization strive to come back together, And yet love must
confront death, and accept it, and learn from it. Only in
confronting death can earthly love learn its true extent, its
immortality. Any definition of health that is not silly must include
death. The world of love includes death, suffers it, and triumphs
over it. The world of efficiency is defeated by death; at death, all
its instruments and procedures stop. The world of love continues,
and of this grief is the proof.
In
the hospital, love cannot forget death. But like love, death is in
the hospital but not of it. Like love, fear and grief feel out place
in the hospital. How could they be included in its efficient
procedures and mechanisms? Where a clear, small order is fervently
maintained, fear and grief bring the threat of large disorder.
And
so these two incompatible worlds might also be designated by the
terms “amateur” and “professional” - amateur, in the literal
sense of lover, one who participates for love; and professional in
modern sense of one who performs highly specialized or technical
procedures for pay. The amateur is excluded from the professional
“field.”
For
the amateur, in the hospital, or in almost any other encounter with
the medical industry, the overriding experience is that of being
excluded form knowledge – of being unable, in other words, to make
or participate in anything resembling an “informed decision.” Of
course, whether doctors make informed decisions in the hospital is a
matter of debate. For in the hospital even the professionals are
involved in experience; experimentation has been left far behind.
Experience, as all amateurs know, is not predictable, and in
experience there are no replications or “controls;” there is
nothing with which to compare the result. Once one decision has been
made, we have destroyed the opportunity to know what would have
happened if another decision had been made. That is to day that
medicine is an exact science until applied; application involves
intuition, a sense of probability, “gut feeling,” guess-work, and
error.
In
medicine, as in many modern disciplines, the amateur is divided from
the professional by perhaps unbridgeable difference of knowledge and
of language. An “informed decision” is really not eve imaginable
for most medial patients and their families, who have no competent
understanding of either the patient’s illness or the recommended
medical or surgical procedure. Moreover, patients and their families
are not likely to know the doctor, the surgeon, or any of the other
people on howm the patient’s life will depend. In the hospital,
amateurs are more than likely to be proceeding entirely upon faith –
and this is a peculiar and scary faith, for it must be placed not in
a god but in mere people, mere procedures, mere chemicals, and mere
machines.
It
was only after my brother had been taken into surgery, I think, that
the family understood the extremity of this deed of faith. We had
decided – or John had decided and we had concurred – on the basis
of the best advice available. But once he was separated from us, we
felt the burden of our ignorance. We had not known what we were
doing, an done of our difficulties now was the feeling that we had
utterly given him up to what we did not know. John himself spoke out
of this sense of abandonment and helplessness in the intensive care
unit, when he said, “I don’t know what they’re going to do to
me or for me or with me.”
As
we waited and reports came at long intervals from the operating room,
other realizations followed. We realized that under the
circumstances, we could not be told the truth. We wold not know,
ever, the worries and surprises that came to the surgeon during his
work. We would not know the critical moments or the fears. If the
surgeon did any part of work ineptly or made a mistake, we would not
know it. We realized, moreover, that if we were told the truth, we
would have no way of knowing the truth we would have no way of
knowing that the truth was what it was.
We
realized that when the emissaries from the operating room assured us
that everything was “normal” or “routine,” they were
referring to the procedure and not the patient. Even as amateurs –
perhaps because we were amateurs – we knew htat what was happening
was not normal or routine for John or us.
That
these two worlds are so radically divided does not mean that people
cannot cross between them. I do not know how an amateur can cross
over into the professional world; that does not seem very probable.
But that professional people can cross back into the amateur world, I
know from much evidence. During John’s stay in the hospital there
were many moments in which doctors and nurses – especially nurses!
– allowed or caused a the professional relationship to become a
meeting between two human beings, and these were invariably moving.
The
most moving, to me, happened in the waiting room during John’s
surgery. From time to time a nurse from the operating room would
come in to tell Carol what was happening. Carol, from politeness or
bravery or both, always stood to receive the news, which always left
us somewhat encouraged and somewhat doubtful. Carol’s difficulty
was that she had to suffer the ordeal not only as a wife but as one
who had been a trained nurse. She knew, from her own education and
experience, in how limited a sense open-heart surgery could be said
to be normal or routine.
Finally,
toward the end of our wait, two nurses came in. The operation, they
said, had been a success. They explained again what had been done.
And then they said that after the completion of the bypasses, the
surgeon had found it necessary to insert a “balloon pump” into
the aorta to assist the heart. This possibility had never been
mentioned, nobody was prepared for it, and Carol was sorely
disappointed and upset. The two young women attempted to reassure
her, mainly by repeating things they had already said. And then
there was a long look as parents sometimes give to a sick or
suffering child, when they themselves have begun to need the comfort
they are trying to give.
And
then one of the nurses said, “Do you need a hug?’
“Yes,
“ Carol said.
And
the nurse gave her a hug.
Which
brings us to a starting place.
