The Human Side of Medicine
GEWEN, BARRY
Writers & Writing THE HUMAN SIDE OF MEDICINE BY BARRY GEWEN Arthur's Kleinman's The Illness Narratives: Suffering, Healing and the Human Condition (Basic, 284 pp., $19.95) has all the...
...If he had a fault, it was a rather brittle personality...
...He urges more emphasis on the social sciences and humanities, courses in communication skills, and psychiatric training for every prospective MD...
...It is the kind of book that one can take along on a vacation without feeling guilty...
...Just out of medical school, he discovered leukemia and the causes of thrombosis and embolism, before moving on to identify the cell as the site ofdisease—a finding called by one authority "the greatest advance which scientific medicine had made since its beginning...
...Still, the pages turn quickly, and a reader picks up a good amount of information about such medical byways as the Thalidomide scandal and the early history of cocaine...
...then, in terms direct and simple, she told me...
...He also reminds us that the dark side is not very distant: A majority of people over 60 suffer from some sort of chronic illness...
...He has seen the worst...
...As Nuland describes them, Rudolf Virchow and Joseph Lister were near-perfect men...
...Nuland is a skillful limner, attentive to personality and capable of summing up an individual's contribution in a few lines, while showing how it fits into the evolutionary arc...
...Feeling helpless to alleviate her agony and angry with himself at his impotence, he happened to ask her what the dreadful experience was like...
...The tone is all wrong, and perhaps the best way to explain this is to say that in the face of intolerable suffering, the book lacks a quality of reverence, of awe...
...Once an insurance clerk with a wife and two children, he sustained a brain injury from an automobile accident that left him child-like and simple-minded...
...Although stating that his aim is to "explain to patients, their families and their practitioners what I have learned," to "popularize a technical literature, " he is the most peculiar of popularizers, composing sentences like the following: "The ethnography of the physician's care lags far behind the phenomenological description of the experience of illness.' This gap between aim and execution is symptomatic of a larger shortcoming...
...Who among us would choose to return to the "simple life" if it meant sacrificing the wonders of painless dentistry...
...As a member of the Reichstag from 1880 to 1893 and a Berlin city councillor for 42 years, he sponsored major reforms in sanitation and public health, so angering Bismarck that the conservative chancellor challenged him to a duel...
...The author could scarcely be better equipped to grapple with these issues...
...Kleinman offers enough horror stories of doctors who hide behind their titles, neither listening nor responding to those in their care, to persuade his readers that the nation's medical schools should be conscientiously rethinking their curriculums...
...As the liaison to a rehabilitation unit at a teaching hospital, he worked with adolescent paraplegics and quadriplegics...
...The real challenge is for the physician to engage in negotiation with the patient as colleagues involved in care as collaboration...
...Simply rearranging the sequence of the questions overtaxed his concentration and recall...
...He is up-to-date not only in medicine and psychoanalytic theory but in literature and ethnography as well, and can cite Philip Larkin or Clif f ord Geertz as easily as he discusses dysthymic and somatization disorders...
...In mid-life, Virchow changed careers, becoming his country's leading anthropologist...
...After his wife divorced him and a court denied him visitation rights with his family, he moved into a seedy hotel where he lives alone on a welfare check, passing the time with naps and long walks, and avoiding human contact as much as possible...
...From describing medicine's triumphs, it shifts into a tract about Brotherhood, with blacks, Jews and women all getting careful mention...
...Each day from then on, her trust established, she tried to give me a feeling of what she was experiencing...
...Virchow, the father of cellular pathology, is one of those prodigies who make everyone else appear to be living in slow motion...
...This suited his great accomplishment, theintroduction of antiseptic surgery...
...Most radical of all, he suggests failing anyone who does not display the proper attitude...
...In under 300 pages, Kleinman tries to cover everything from the reform of American medical education to the treatment of mental disease in the People's Republic of China...
...Both a psychiatrist at Harvard's medical school and a professor of anthropology at the university, he brings with him a wealth of knowledge and erudition...
...Kleinman explains that he first became interested in his specialty when he was a medical student...
...He was thro wn of f balance by no velty of any kind...
...The world of The Illness Narratives is a chillingly hopeless place, peopled by individuals who might have stepped out of the pages of Kafka or Dostoyevsky...
...Lister, on the other hand, possessed a character that won unanimous praise from his contemporaries, what Nulandlabels "a kind of earthbound saintliness...
...Success, if such exists, is not measured by a cure...
...Among the most memorable is Paul Sensabaugh (the name is fictitious), a true-life underground man...
...Following these two giants, the narrative enters the 20th century—and loses its way...
...Sherwin B. Nuland's chatty, entertaining Doctors: The Biography of Medicine (Knopf, 489 pp., $24.95) travels across 2,500 years of medical history to arrive at the same prescriptions as The Illness Narratives...
...Kleinman ends up seeming superficial, even though one senses that with his patients he exhibits the compassion and understanding he calls for...
...At such a pace, it is little wonder that the analyses and recommendations come off sounding like platitudes...
...Writers & Writing THE HUMAN SIDE OF MEDICINE BY BARRY GEWEN Arthur's Kleinman's The Illness Narratives: Suffering, Healing and the Human Condition (Basic, 284 pp., $19.95) has all the elements of a remarkable work...
...Instead of a beginning and an end, it has a flow and context...
...This is not a volume for those seeking to block out life's unredeemable dark side...
...Kleinman argues that a chronic illness cannot be handled like a ruptured appendix...
...It is no exaggeration to say that as a result of Lister's work, literally millions of lives have been saved...
...Overall, Doctors is ideal summer reading, light but instructive...
...From this incident, Kleinman learned that it was important to try to make contact in even the most desperate cases...
...His day was a good one if he could get through it believing that no one had stared or laughed at him or treated him 'like a child.'" The high point of his existence is his weekly visit to the hospital clinic, where Kleinman saw him for over a year...
...His book is about the development of medical science from Hippocrates to the present, traced through the lives of the men (and occasional women) whose achievements deserve to be remembered...
...The cogency of Kleinman's criticisms is still one more virtue of his book...
...The last chapter, on transplants, forsakes the biographical method altogether...
...The standard names are included—Galen, Vesalius, William Harvey—together with some that may not be so familiar to laymen: Ambroise Paré, who reformed the practice of surgery in the 16th century, René Laënnec, the inventor of the stethoscope...
...One difficulty is Kleinman's writing style...
...Paul didn' t have much to say, but he liked the repetition each week of the same questions and had become good at answering them, as long as they were asked slowly and in the same order...
...Almost as affecting are the police lieutenant whose severe back pains cause him to scream into his pillow at night, and the masochistic historian whose destructive upbringing with a brutal, drug-addicted father and crippled, paranoid mother appears to have doomed him to psychotic depression and possible suicide...
...Every case is different, personal psychology and family background play a major role, and patients must be made part of their own treatment...
...The examples fly by—a few pages for the diabetic amputee and on to the self-hating homosexual enduring 15 years of abdominal pain, with a pause now and then for "interpretations...
...Not surprisingly, the two figures that stand out most vividly in the book were products of the 19th century, the golden age of the belief in progress...
...He spent years with a chronic pain center, treating or studying over 2,000 patients...
...What is more, his clinical experience is of a kind that would compel any person to serious reflection...
...Kleinman is intent on bringing us the bad news...
...She stopped, quite surprised, and looked at me from a face so disfigured it was difficult to read the expression...
...He told me that actually he just liked to sit and hear the doctor talk...
...While she spoke, she grasped my hand harder and neither screamed nor fought off the surgeon or the nurse...
...He is old-fashioned enough to believe in progress, and the history of medicine is certainly the strongest argument in favor of that dog-eared doctrine...
...The author, a surgeon and faculty member at Yale's medical school, believes health care is on the verge of a humanistic tum after centuries of considering the body merely as an object...
...Yet for all its strengths, The Illness Narratives does not live up to its promise...
...Nothing would so concentrate the minds of medical students and residents as the recognition that if they perform poorly in learning how to provide psychosocial care for the chronically ill, they will not graduate as doctors...
...This argument is not so much made as stated, but that is hardly a significant failing because Nuland's interest lies elsewhere...
...Its subject is the treatment of chronic illness, those long-term incurable maladies that require a doctor to be no less a philosopher than a technician, and to be able to deal with the profoundest possible questions—about the meaning of pain and death...
...He had the job of comforting a seven-year-old girl with burns over most of her body who, day after day, was having the charred flesh tweezed away from her wounds...
...The book is a plea for better care: less mechanistic and reductionist, more humane and nurturing...
Vol. 71 • July 1988 • No. 13
