Intoxicated By My Illness - Medical Literature

[blike]

Kind of an interesting read, especially for those of us who are considering a career in medicine.

 

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Intoxicated By My Illness

And Other Writings on Life and Death

Anatole Broyard

 

The Patient Examines The Doctor

Now that I know I have cancer of the prostate, the lymph nodes, and part of my skeleton, what do I want in a doctor? I would say that I want one who is a close reader of illness and a good critic of medicine. I cling to my belief in criticism, which is the chief discipline of my own life. I secretly believe that criticism can wither cancer. Also, I would like a doctor who is not only a talented physician, but a bit of a metaphysician, too. Someone who can treat body and soul. There's a physical self who's ill, and there's a metaphysical self who's ill. When you die, your philosophy dies along with you. So I want a metaphysical man to keep me company. To get to my body, my doctor has to get to my character. He has to go through my soul. He doesn't only have to go through my anus. That's the back door to my personality.

I would hope that my doctor's authority and his charisma might help to protect me against what the anthropologist Richard Shweder calls "soul loss," a sense of terrible emptiness, a feeling that your soul has abandoned your ailing body like rats deserting a sinking ship. When your soul leaves, the illness rushes in. I used to get restless when people talked about soul, but now I know better. Soul is the part of you that you summon up in emergencies. As Mr. Shweder points out, you don't need to be religious to believe in souls or to have one.

I would like my doctor to understand that beneath my surface cheerfulness, I feel what Ernest Becker called "the panic inherent in creation" and "the suction of infinity." When he says, "You have prostate cancer. It has gone beyond the prostate into the rind. I think it's probably in the lymph nodes. It may be in the tailbone." Then the panic inherent in creation immediately rises up before you. I would like him to know what I mean if I told him that, like Baudelaire, "I cultivate my hysteria with joy and terror." Or if I said, like Hamlet to Horatio, "I may think meet to put an antic disposition on." My friends flatter me by calling my performance courageous or gallant, but my doctor should know better. He should be able to imagine the aloneness of the critically ill, a solitude as haunting as a Chirico painting. I want him to be my Virgil, leading me through my purgatory or inferno, pointing out the sights as we go.

My ideal doctor would resemble Oliver Sacks. I can imagine Dr. Sacks entering my condition, looking around at it from the inside like a kind landlord with a tenant, trying to see how he could make the premises more livable. He would look around, holding me by the hand, and he would figure out what it feels like to be me. Then he would try to find certain advantages in the situation. He can turn disadvantages into advantages. Dr. Sacks would see the genius of my illness. He would mingle his daemon with mine. We would wrestle with my fate together.

To the typical physician, my illness is a routine incident in his rounds, while for me it's the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity. I don't ask him to love me - in fact, I think the role of love is greatly exaggerated by many writers on illness. Sick people can get sick of a love that has to be purchased for the occasion like flowers or candy brought to the hospital

I see no reason or need for my doctor to love me - nor would I expect him to suffer with me. I wouldn't demand a lot of my doctor's time: I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.

I think that the doctor can keep his technical posture and still move into the human arena. The doctor can use his science as a kind of poetic vocabulary instead of using it as a piece of machinery, so that his jargon can become the jargon of a kind of poetry. I see no reason why he has to stop being a doctor and become an amateur human being. Yet many doctors systematically avoid contact. I don't expect my doctor to sound like Oliver Sacks, but I do expect some willingness to make contact, some suggestion of availability.

I would also like a doctor who enjoyed me. I want to be a good story for him, to give him some of my art in exchange for his. If a patient expects a doctor to be interested in him, he ought to try to be interesting. When he shows nothing but a greediness for care, nothing but the coarser forms of anxiety, it's only natural for the doctor to feel an aversion. There is an etiquette to being sick. I never act sick with my doctor. As I've said, I have been accelerated by my illness, and when my doctor comes in, I juggle him. I toss him about. I throw him from hand to hand, and he hardly knows what to do with me. I never act sick. A puling person is not appealing.

I have a wistful desire for our relationship to be beautiful in some way that I can't quite identify. A famous Surrealist dictum says that "Beauty is the chance meeting, on an operating table, of a sewing machine and an umbrella." Perhaps we could be beautiful like that. Just as he orders blood tests and bone scans of my body, I'd like my doctor to scan me, to grope for my spirit as well as my prostate. Without some such recognition, I am nothing but my illness.

When we are seriously ill we bring our records, our medical histories, from our personal physicians to the specialist to whom we have been referred. This may tell him more about us - which vulnerabilities we have shown in the past and which capacities for resistance. The specialist learns what kind of body or system he is dealing with. He gets information that his own examination and all the machines in the hospital may not be able to give him. Since so many patients have been psychoanalyzed, or have undergone psychotherapy of some kind, I wonder whether they shouldn't bring to the specialist a brief summation of these findings, too, so that this new doctor knows whose body he's treating and what its spiritual composition is. How can a doctor presume to cure a patient if he knows nothing about his soul, his personality, his character disorders? It's all part of it.

 

Physicians have been taught in medical school that they must keep the patient at a distance because there isn't time to accommodate his personality, or because if the doctor becomes involved in the patient's predicament, the emotional burden will be too great. As I've suggested, it doesn't take much time to make good contact, but beyond that, the emotional burden of avoiding the patient may be much harder on the doctor than he imagines. It may be this that sometimes makes him complain of feeling harassed. A doctor's job would be so much more interesting and satisfying if he simply let himself plunge into the patient, if he could lose his own fear of falling.

The connotation of going beyond the science into the person is all I'm asking - that there be a sign of willingness, more than a kind of Pascal-like dialogue, which is too much to ask. It could be done almost in pantomime. There is the way a doctor looks at you. One doctor I saw had a trick way of almost crossing his eyes, so he seemed to be peering warmly, humanistically, into my eyes, but he wasn't seeing me at all. He was looking without looking. I never felt that I contacted him. When I went to Schachtel for psychotherapy, instead of having me lie on a couch so that I was looking at the ceiling with him behind me, he sat across a table and we talked. He did not wish to make any eye contact because he felt if we did that while I was talking, his eyes would show, or I would imagine they were showing, approval or disapproval. So for fifty minutes while I talked he avoided my eyes. And if our eyes did meet he would start back as though I had touched him in the genitals. I think doctors have something like this, a systematic avoidance of that click of contact.

Other doctors give you a generic, unfocused gaze. They look at you panoramically. They don't see you in focus. They look all around you, and you are a figure in the ground. You are like one of those lonely figures in early landscape painting, a figure in the distance only to give scale. If he could gaze directly at the patient, the doctor's work would be more gratifying. Why bother with sick people, why try to save them, if they're not worth acknowledging? When a doctor refuses to acknowledge a patient, he is, in effect, abandoning him to his illness.

There's a paradox here at the heart of medicine, because a doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction, and the music of his humanity that compensates us for all the speechless machines. When a doctor makes a difficult diagnosis, it is not only his medical knowledge that determines it but a voice in his head. Such a diagnosis depends as much on inspiration as art does. Whether he wants to be or not, the doctor is a storyteller, and he can turn our lives into good or bad stories, regardless of the diagnosis. If my doctor would allow me, I would be glad to help him here, to take him on as my patient.

Although I don't expect to die for some time, my urologist is young and I see us as joined till death do us part. We will go through this together. Sometime in the future, in the neighborhood of years, when my doctor's hair has turned gray and he has had intimations of mortality, I'll die with him. Since I think of him as a star, I will not "fall as apples fall, without astronomy," as Wallace Stevens put it. We are what the French call un couple malade, a marriage of doctor and patient. Perhaps later, when he is older, he'll have learned how to converse. Astute as he is, he doesn't yet understand that all cures are partly "talking cures," in Freud's phrase. Every patient needs mouth-to-mouth resuscitation, for talk is the kiss of life. Besides talking himself, the doctor ought to bleed the patient of talk, of the consciousness of his illness, as earlier physicians used to bleed their patients to let out heat or dangerous humors.

Yet it's too easy to accuse the doctor, to blame the absence of natural talk on him. It's also true that much of what the patient asks is ineffable. Even Chekhov would be hard put to answer him. For example, I would like to discuss my prostate with my urologist not as a diseased organ but as a philosopher's stone. Since science tells us that energy cannot be lost in the universe, I want to ask him where, if the treatment blocks my prostate, my sexual energy goes. Could I turn it around on the disease, like a cornered rat? Would he agree that my life now is a balancing between yes and no? Is there an Ur-desire, an archaeology of passion that antedates or supercedes the prostate? Why do I sometimes feel that I'd like to excrete this unfaithful organ?

In asking such unanswerable questions, I'm no exception. Every patient invites the doctor to combine the role of the priest, the philosopher, the poet, the lover. He expects the doctor to evaluate his entire life, like a biographer. The sick man asks far too much, he is impatient in everything, and his doctor may be afraid of making a fool of himself in trying to reply. Each of us is a specialist in one field only.

Of course a physician may reasonably ask: "But what am I supposed to say? All I can tell the patient is the facts, if there are any facts." But this is not quite true. The doctor's answer to his patient is yet to be born. It will come naturally, or at first unnaturally, from the intersecting of the patient's needs with the doctor's experience and his as-yet-untried imagination. He doesn't have to lie to the sick man or give him false assurances: He himself, his presence, and his will to reach the patient are the assurance the sick man needs. Just as a mother ushers her child into the world, so the doctor must usher the patient out of the world of the healthy and into whatever physical and mental purgatory awaits him. The doctor is the patient's only familiar in a foreign country.

Not every patient can be saved,but his illness may be eased by the way the doctor responds to him - and in responding to him the doctor may save himself. But first he must become a student again; he has to dissect the cadaver of his professional persona; he must see that his silence and neutrality are unnatural. It may be necessary to give up some of his authority in exchange for his humanity, but as the old family doctors knew, this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and everything to gain by letting the sick man into his heart. If he does, they can share, as few others can, the wonder, terror, and exaltation of being on the edge of being, between the natural and the supernatural.

 

 

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I think the take-home paragraph in that essay is

 

" I see no reason or need for my doctor to love me - nor would I expect him to suffer with me. I wouldn't demand a lot of my doctor's time: I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way."

 

 

[fafalone]

Dr. Cox from Scrubs is my hero for a doctor

[aman]

It's a good creed to see when you start getting old or something nasty creeps up on you. Hell, we live forever. but then we die.

Just aman

[Zarkov]

" I would like a doctor who is not only a talented physician, but a bit of a

metaphysician, too."

 

Yes the artist, and the scientist, willing to leap to heights few dare to go, true creativity!

 

When you are dealing with the unknown, tool and information are finr but it is only through creative leaps that unknown solutions can be found.

[fafalone]

Please don't confuse artists and scientists with crackpots.

[Zarkov]

New catagory, crackpots, well let me introduce a ludite!

 

And please do not continue stalking me, Thank you Fafalone

[fafalone]

As a forum user and administrator, I have every right to read every post you make on this site. Every user on this site has the right to read your forum posts, it is not stalking. Everyone also has the right to reply with any message they desire (provided it is not vulgar).

[aman]

You guys put me in your wills and wind up with tubes sticken out of ya, I'll pull the plug for ya anytime. Just let me know cus I'm reliable. I'd never let a friend down.

Yer buddy

Just aman

[aman]

Back to the thread, the most valuable advice I've seen from a doctor was that the cancer did not mean you were in danger. The patient was in danger before the cancer was discovered and now had options available to stay alive.

Just aman

[Guest Syntax]

Is it possible to get a wart on your penis?

[Radical Edward]

yes, they're called men.

[aman]

Not a man wearing duct tape underwear.

Just aman

[Ami]

i'm inceridbble upset at this thread.... well, that's my two cents....

[aman]

Sorry Ami, Syntax does have a useable 2 cents out of each quarter he puts in but sometimes he's a little off the wall. Still you have to accept a little sparring between minds and as you get older, experience will help you understand operating room humor from veterans.

Just aman

[Ami]

i appreciate that... /me smiles at quirks that always makes things interesting

[aman]

Nobody likes boring old uninformative unending posts like on some sites. So Ami, in the future would you want a grumpy old MD like DR Faf treating you or a compassionate happy DO like DR Blike treating you? Pretend you just broke a finger and needed to chose real quick.

What kind of advice could you give to DR. Faf so he could make it through med school without coming out a grumpy nerd?

Dr Fafs football team is in first place so I think he should go party, maybe get an obese girlfriend.

Just aman:banme:

[Ami]

well, an obese girlfriend always helps. if he's going to a football game party, i advise against airhead types, then he'll be sure to turn out grumpy, trying to keep his dolt of a wife happy, he needs someone to cook for him My advice, stay away from kids till you are old enough to apprciate the exuberance, and let them keep you happy, old grumpy Dr. Faf

[Ami]

and maybe get laid

[Katie]

Lol

[aman]

I forgot Faf, an obese blind woman is a good start to teach a MD bedside manners. This is a thread about doctors being better than human and it takes practice.

Just aman

[Ami]

i have to ask, what inspired the addition of blind?

[aman]

Originally posted by Ami

and maybe get laid

Just aman

[Ami]

was there supposed to be writing with that?

[Guest beloveddad]

I was greatly impressed by the essay " Intoxicated by my illness" when the first time I read it. I have great interest in reading Anatole Broyard 's other writings on life. Would you please send me a copy ? I willl be appreciated! My email address is zhangjianling200@eyou.com

[coquina]

My friend's wife was diagnosed with breast cancer 13 years ago. She managed to stay alive for 11 years. About 8 years longer than was initially expected.

 

She had started nursing school earlier in life, and quit to raise her kids. When she got sick, she went back and finished, because she wanted to be able to understand what her doctors were telling her. If she felt her doctor wasn't treating her like a member of his team, she fired him and found somebody else. When a doctor told her she was terminal, she fired him and found somebody else. She wasn't afraid to die, she was determined to stay alive until her children finished school. Her youngest child was six when she was diagnosed, she was a senior in high school when she died.

 

The difference between Shirley and the man who wrote the article is the author said, "I want my doctor to..." Shirley said, "My doctor will..." She was only about 5', but she refused to be intimidated. She would tell them, you do your part, I'll do mine. She "did hers" even to the extent of administering her own chemo through a PIC line.