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FORUMOn Dissection and Healing
Fact is, just about all of us, no matter our intelligence or skill or profession, are pretty clumsy at the business of dying. And to separate patients from doctors, as if they had different needs for healing, is a mistake of the first order. We're in the same boat. Understanding this, feeling in your bones that your patients' journey is your journey, carrying this awareness with you into every examining room you enter, can make the difference between being a competent doctor and a great one. —The Healing Path, Philip Simmons As medical students, we are taught to seek perfection. Nothing is inherently wrong with this ambition. On the contrary, perfection is the engine for both art and science. It inspires creativity and enforces discipline. As my friends more colloquially state, "If we weren't so anal, we wouldn't be here." However, in science, the drive for perfection often brings with it the dangers of dissection. Wholeness is messy and complicated, so we dissect in order to master each of the component parts. Already in my second year, I have learned to dissect my patient, Mr. Jones, into an HPI, a PMH, an ROS, and a PE. I have also learned to split myself: if I am to be a doctor, I am not to be a patient. If I am to be a healer, I am not to be wounded. This is the starting point for the extraordinary March 20 symposium moderated by Dean Daniel Lowenstein titled, "What is Healing?" Welcoming ImperfectionThe three featured speakers, Dr. Balfour Mount, Rabbi Lawrence Kushner, and Professor Philip Simmons, each in his own way, encouraged us to welcome imperfection, including the ultimate imperfection of death itself. The more we develop our capacity to do so, the more we can heal. It's a hard lesson for us students. Pride gets in the way, and the daily grind leaves us exhausted. But teachers like the speakers at the symposium can be our guides.
First to speak was Dr. Balfour Mount, a surgical oncologist and professor of palliative medicine at McGill. He happens to have esophageal cancer, but he did not mention this once during the course of his talk. Rather, he blended patient stories and scientific data with religious teachings from various faiths. His beautiful description of healing and woundedness set the tone for the evening: "Healing," he said, "is a movement toward wholeness and integrity." In contrast, "woundedness involves being isolated from our healing depths, dominated by the ego's fear of depths and the need to control. Woundedness involves being defended, denying, closed, and fearful, stuck in the physical and perhaps denying the sacred...." These definitions underscore Prof. Simmons's insight that both physicians and patients are in the same boat—both can be wounded and can be healers. Both must attend to their wholeness. The Gain of Giving UpNext to speak was Rabbi Lawrence Kushner, the rabbi-in-residence at Hebrew Union College–Jewish Institute of Religion in New York, whose storytelling reflected wit and insight matched by a deep humility. How many people can get away with a sentence like, "Both medicine and religion are preoccupied with strategies for eternal life"? Rabbi Kushner can. His talk was centered on the paradox that one can reach eternal life only when one gives up on living forever. Accordingly, "being a healer, whether physical or spiritual, means that you, yourself have given up on living forever and that you have made friends with your own death." Quoting a Hasidic story, he cautioned against the easy temptation of medicine to dissect—to divide a tree into the leaf, the twig, the bark, and the trunk, and in so doing lose the whole that is the tree. "All our names are superimposed on a seamless reality," he said. And so too, I humbly submit, is that of my patient Mr. Jones. Perhaps I can start to put him back together again, to see him as a seamless reality.Finally, Prof. Simmons, the driving force behind the symposium (along with Dean Lowenstein), wheeled up to the front of the lecture hall. I have not mentioned that Prof. Simmons has ALS because I respect his wish "to spend as little time being a patient as possible." But allow me now to set the scene. Given the rather macabre descriptions in textbooks, I was struck by how well Prof. Simmons looked. He was poised and smartly dressed, displaying a smile with a healthy dose of attitude, Salman Rushdie-esque. I'd have pegged him for an English professor from a hundred yards away. Only when I saw his difficulty in the simple act of drinking from a cup placed on the table did I realize how extraordinary this illness was, and how much more extraordinary the man. To Savor MysteryI recommend reading Prof. Simmons's book, Learning to Fall, but for now I'll quote this excerpt from his speech: "I was coming to understand that at its deepest levels, life is not a problem, but a mystery.... At one time or another, each of us confronts an experience so powerful, bewildering, joyous, or terrifying that all efforts to see it as a problem are futile. Each of us reaches the end of reason's rope. And when we do, we can either grip harder and get nowhere, or we can let go, and fall. For what does mystery ask of us? Only that we be in its presence, that we fully, consciously, hand ourselves over. That is all, and that is everything."As medical students, we have learned to divide life and death, the former being a noble calling within us and the latter being a force external to us, evidence of our failure and imperfection as healers. The healing symposium challenged this fundamental division, urging us to see the duality of life and death, to let go of our drive for perfection and allow ourselves to be present, in the moment. Ultimately, we are patients too. Death is within us as surely as life, but it is our choice to embrace mystery, to look past divisions and boundaries, to move towards wholeness, and to heal. —Harsha Reddy, a second-year student at HMS
Student Research Gets Limelight Photo by Graham Ramsay Sam Brown, HMS '01 (above right), and keynote speaker Eric Lander compare notes during the 61st Soma Weiss medical and dental student research day, April 12. The annual event honors the memory of Weiss, an inspiring teacher and physician at HMS and a faculty supporter of the first student research day in 1940. Brown, one of four student speakers, presented a talk on surgical infections in St. Petersburg, Russia. He and Edward O' Rourke, HMS assistant clinical professor of pediatrics at Children's Hospital and Harvard Medical International, found high rates of infection during surgery, apparently due to poor compliance with antibiotic prophylaxis and practice standards. Lander, founder and director of the Whitehead Center for Genome Research at MIT, sketched the progress of genome research from the days of "chromosome schlepping," circa 1985, to this year's publication of the human genome sequence—and beyond. "The genome project is just the beginning," he said, predicting that research now under way in comparative genomics and human variation will lead to a fuller understanding of our origins as a species and our medical vulnerabilities as individuals. |
