Literature in Medicine

[Sancho]

I realize, of course, that it isn’t very Sancho Panza-ish of me to start a thread. I generally prefer to tag along with other people’s ideas but I’ve been thinking about this for a while and it has just jumped to the head of the line. I’m interested in the thoughts of my fellow forum members on this subject:

What do you think of the treatment of medicine in literature? (No pun intended) Or for that matter the treatment of literature in medicine. (Have you ever tried to read a JAMA article?) How does literature attack the problem of disease, cancer, epidemic, trauma, diagnosis, patient/doctor communication, science vs. art in medicine etc. A couple of texts immediately come to mind: Faulkner’s As I Lay Dying, Hemingway’s A Farwell to Arms.

It seems to me that the more scientifically advanced medicine becomes the less language is required. And yet, regardless of the sophistication of the medical tests administered to a patient, the diagnosis of an illness still requires a dialog between the patient and the doctor. How many times have you been to the doctor’s office and after about a minute into your description of your symptoms the doctor cuts you off and tells you what your symptoms/disease/diagnosis are?

Last night my wife returned from work a total basket case. Her closest friend at had just been diagnosed with cancer. They are both Health Care workers so they both know, in excruciating detail, what lies ahead. Whether with a friend, a relative, or through ones own personal experience, I suppose just about everyone has had to or will have to deal with cancer or disease in their lifetime.

[den]

There are different requirements of general practitioners and mental health care doctors in their bedside manner. Sometimes a g.p. does have to interrupt to get to practical information to gather the facts. A psychiatrist should not interrupt, a good counsellor always listens.

Yes I've read JAMA and CMA journals, I dated a radiologist for while. I've also read Camus' The Plague and Marquez' Life in a time of Cholera among many other books of similar vein, and while these are great attempts to humanise medicine and the practice of, it depends on what one is reading them for.

THe historical and socio-political impact of disease on various cultures and eras in history fascinates me. So reading of it through the life of an illustrious fictional doctor like Dr. Juvenal Urbino, or Hana, the harried nurse in The English Patient, can help relay more factual information that may be too dry and boring as many medical texts can be. But I'm reading those for entertainment value as well as the added benefits of some factual information.

But if one is wanting to study and gather information for the possible impact of cancer, I would turn to a medical text, scholarly journal or required reading for students in medicine for precise factual information.

[den]

This is a portion of something I posted elsewhere ...


The Plague ...

The fixation and examination of death and it's affects are a curiosity for Dr. Rieux, as he detachedly goes about his duties in administering to the dying and also dealing with the ones left behind, those in `exile' as it were, looking in from the ramparts of the walled city, hoping to keep the plague at bay.

Cottard and Tarrous' visit to the opera house to see Orpheus contains absurd and ironic views of how people were thinking their status and cultural association would stop the advance of the plague so they couldn't possibly die from it.

People's behaviours of escapism, reckless extravagance, ongoing drinking in cafes, nursing the sick, idling away time, hoping, watching, waiting to read of the end of the plague in the newspaper, all this activity becomes man's fate, they have no control over this disease, it's taken their choices from them.

Everyone is on the same base level, the plague knows no social economic selection. Camus said `the habit of despair is worse than despair itself'. Man too must accept death, for as Dr. Rieux states `Death means nothing to men like me, it's the event that proves them right.'

Camus gets gruesomely fixated on the impact the plague has on the town of Oran's inhabitants. Even when facts are staring them in the face, the presense of flea-ridden rats, people still hold on to the belief that they will be the one to outsmart death.

[Sancho]

Den, thanks for those two thoughtful posts. I suppose there are really two separate subjects here: medicine in literature and literature in medicine. I´m particularly interested in the humanistic side of the subject as opposed to the scientific side. I confess I haven´t read Camus´ The Plague but you´ve piqued my interest and I share your interest in how societies deal with disease and epidemic. As you mentioned, the plague did not recognize class boundaries; someone could not buy their way out of it. Cancer (etc.) still seems to be ignorant of class distinction. I´m trying to remember a text I read a long time ago for a school project. It involved an old man (possibly a king) who had lived a long and full life and had accomplished a great deal in his lifetime. As his body began to fail, he became more and more dependent on a servant girl to do for him those things that he could no longer do for himself. At some point he is all most totally dependent on her and he realizes that he never even knew of her existance prior to his health failure. I can´t for the life of me remember where that story came from.

I think that truth in disease may lie somewhere between the hard cold scientific facts and the human psyche, or emotion, or pain. Physicians, for the most part I think, maintain an emotional distance from their patients. Probably for professional reasons, or perhaps to maintain their own sanity. I think that this may some what miss the point. I realize, of course, that most good GP´s are stretched way too thin and they´ve got very little time to spend with each patient. Particularly when someone starts rambling on and on, like Sancho does. But I also think that there is a lot of arrogance in that profession. I´m willing to bet that most people will not question a doctor´s diagnosis that was made during a five minute office visit, even though that person may have been living with their particular malady for quite some time. Of course it goes both ways. Many patients, I´m sure, have unreasonable expectations. A doctor cannot cure someone´s decades-long five pack-a-day habit with a five minute office call.

[amuse]

dr. dean ornish is, in my opinion, a genius.
he's a cardiologist, wrote/published Dr. Dean Ornish's Program For Reversing Heart Disease, the only scientifically proven non-surgical method of reversing of coronary artery disease.
the connection between the heart and the heart is glaringly obvious, no more so (in my opinion) than when he mentions silent ischemia, and the connection between that and basically hiding the emotions. like he links stuff not only to medical roots, but emotion/historical/etc. as well...and that's what he works on with patients - diet, lifestyle, environment, meditation, healing the past/present.
this is the only book i read three times when researching the heart.
would write more but am on slight time crunch here.

later:
he did long-term studies and long-term follow-ups. his focus is not just in changing disease, it's changing the factors around the person that lead to it. the good news is, he's influenced many people in his profession (have read a few books by doctors who changed the way they think about medicine because of him), and been highlighted on tv, etc. like any change it takes discipline, and it's multifaceted, but oh my goodness!
as far as prof. credibility goes, there are three pages minimum acknowledging professionals in his field at the beginning of his book. he's also given speeches on this to standing room only crowds of doctors, and is the Clinical Professor of Medicine at UCSF.
ok i'm finished! :D

but i can't recommend that book enough. haven't read his others, but oh, my. that one is worth countries, lifetimes even.

[Sancho]

“One fine morning in May, a slim young horsewoman might have been seen riding a glossy sorrel mare along the avenues of the Bois, among the flowers…”
--Grand …
(Hats off)

Den, your recommendation of Camus’ The Plague was perfect for this thread. I read it last night and although I probably need to mull it over for a while, let me give you a couple of my early impressions of the book. Perhaps you can tell me if I’m on track.

My French stinks so I read an English translation. As with most translations, the language was a bit “pinched.” I enjoyed almost hearing the French in the background.

I thought the book was worth reading if only for Tarrou’s monolog in Part IV. This is where he describes to Rieux how he’d been a victim of the “plague” previously. It was a truly humanistic view of execution, murder and social activism. It also gave rise to the most optimistic theme of the book: there is good and evil in everyone but all things being equal, folks are mostly good.

The Plague; the novel and even the word itself, is a metaphor for any epidemic/quarantine/siege on a community. Many critics, it seems, have made much ado over the Plague in Oran as a metaphor for German occupation of French towns during WWII. I’d like to go one further and say that what makes this text timeless is that we can use it as a metaphor for any siege, - real or imagined. It could go from the siege of Troy right down to the strangle hold that Aids has on certain communities today. I may even be able to make the argument that it covers the plague of soccer-moms in SUVs who’ve laid siege to my suburban Atlanta town.

I don’t want to put a spoiler in here, but I loved the last sentence. (The town was celebrating after the plague was beaten and the quarantine had been lifted) “He [Dr. Rieux] knew what those jubilant crowds did not know but could have learned from books: that the plague bacillus never dies or disappears for good; that it can lie dormant for years and years in furniture and linen-chests; that it bides its time in bedrooms, cellars, trunks, and bookshelves; and that perhaps the day would come when, for the bane and the enlightening of men, it would rouse up its rats again and send them forth to die in a happy city.”

[Sancho]

Amuse, I also purchased your recommended book. I haven’t yet read it cover to cover but I have browsed it. I am taken by Dr. Ornish’s dual humanistic/scientific approach to medicine. I think that he has hit the nail on the head. We need more like him. Oh yes, and I love the recipes in the back. I don’t think that I have heart disease yet, but you never know; after all I am a victim of an American diet. (I’ve got a big ‘ole weakness for fried chicken) – (and that “burrito as big as your head” that the senora’s sell me.) Incidentally, my wife’s friend who is now a cancer patient is a fantastic cardiologist.

[den]

I've always wondered, who the hell has time to smoke more than a pack of cigs a day? :as-sleep: blech, if you have the cig dangling from your mouth smoke gets in your eyes and burns your lip and stuff. I smoke about half a pack a day ... `cause I'm so busy I guess. :lol:


I too believe that ill-ness and dis-ease stem from physical as well as the emotional spiritual realm of the senses, that there is an (sometimes) imperceptible link that is not easily identified.

If you read the Classical Hippocratic Oath, you will see the strong ties to mythology, art, accountability and honour. There are elements to treating all as equals, `be they free or slaves'. And there is also a principal addressed to treat the sick on a personal, individual basis and with discretion and dignity.

http://www.pbs.org/wgbh/nova/doctors/oath_classical.html


If you read the Modern version,

http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

you will see more emphasis on science, but in regards advancements in treating people that they're still individuals who deserve to be treated with dignity and respect.

I find it interesting, the use of the term `art' in both versions. Doctors have medical practices. What could be more human than practicing your craft? Be it medicine, writing, or tool and die making. Practice suggesting there's always room for improvement, that repetition and experience are not means to an end, not a way of achieving god-like status, but to fullfil one's duty of a life worthwhile, not spent in vain, to themselves and others when choosing such a profession.

I think more people who exalt doctors as all-knowing all-seeing beings should read both versions of the oath. It does bring doctors back down to earth, whether they're accountable to greek gods or the governing body of their college or university.






Den, thanks for those two thoughtful posts. I suppose there are really two separate subjects here: medicine in literature and literature in medicine. I´m particularly interested in the humanistic side of the subject as opposed to the scientific side.

[den]

Wow, you read the book in one night? Glad you liked it! I too have a translated version. I also noticed especially with some of the dialogue a few awkward phrases.

Grand, laboriously working on his writing, but Tarrou more successful, also shows the humanist side to how people deal with, as you say, a state of emotional and physical siege. Trying to suspend time, set thoughts and ideas into words on paper, almost as a distraction or denial of reality or as if this will be the cure.

While Grand is explaining the difficulties he's having with (obsessively) composing his first line, Rieux is overcome with the sounds of the background `buzzing', `that unseen flail threshing incessantly the languid air' , the ever-present reality of the plague looming in the background.

Camus and his absurdist vision of man again. ;) Have you read his `autobiographical' The First Man? I highly recommend it as it will give you his background into growing up in French colonial Algiers.







Den, your recommendation of Camus’ The Plague was perfect for this thread. I read it last night and although I probably need to mull it over for a while, let me give you a couple of my early impressions of the book.

{snip}

“He [Dr. Rieux] knew what those jubilant crowds did not know but could have learned from books:

[Sancho]

I’m a hopeless insomniac. I’ve been using The Adventures of Augie March to get to sleep but I’m afraid The Plague had the opposite affect on me. Thanks for explaining the background “buzzing” I missed that part.

Do you suppose Camus intended us to have any sympathy towards Cottard? A lot of the critics seem to think that the plague is a metaphor for German occupation, which would of course make Cottard a metaphor for the Vichy French. What are the odds that Camus may have thought of French Colonialism in Algiers as a bit of a plague?

I’ll have to pick up a copy of The First Man. It sounds interesting. When I purchased The Plague, I also bought his short novel The Fall. I’m probably going to read that next.