Month: January 2018
“Where there is love for the man, there is also love for the art.” Hippocrates; On Precepts
I am late for my first meeting as writer in residence for the Cumming Medical School. As I spiral through the TRW parkade on the Foothills campus, my windshield blanketed in condensation, I crank the heat, peering through the tiny crescent of clarity at the bottom of the windshield. The parkade must be full. Have I missed the red neon warning (FULL) at the entrance?
Inching past the cars whose owners were more organized than I (had they risen earlier? Drunk coffee rather than tea? Driven directly to the lowest level, wasting no time dreaming of Level 1?), I consider the possibility that the stereotypes are true. That English majors – and perhaps their Humanities colleagues in general – are, indeed, less capable of coping with life’s concrete challenges than their STEM counterparts.
Surely the cars in this parkade (resting comfortably between yellow lines as my sedan judders along, sweating, darting, recoiling like an eight-year-old in Musical Chairs) belong to people who have spent years in laboratories, emergency rooms and surgical theaters. People focused on real-world issues of anxiety and health, rather than the worry-lines of a sedan and its imaginary relationship to imaginary eight-year-olds. What was I thinking, accepting this role of writer-in-residence at the Cumming School of Medicine? What value could a creative writer bring to the owners of comfortably parked cars?
But before I can flesh out the pros and cons of my Humanities-based education, a black F150 backs out of a spot.
I am saved.
Salvation is a relative term, however. I learned that in my Paradise Lost course.
Have I mentioned that I have the visual-spatial skills of … well, an English major? The health sciences center is wonderfully bright and airy but its glass-doored spaces have few distinguishing features.
If you stood in the center of the atrium, closed your eyes and turned around rapidly, it would be impossible to tell, upon opening your eyes, which direction you faced. At least for someone with my visual-spatial sensibilities.
Thankfully, on this, the first day of my residency, I am meeting my Cumming contact in the only location I am capable of finding in the Health Sciences Center – the coffee shop.
Having apologized for my tardiness, I ask if there is a shuttle between the two campuses. I describe my experience in the parkade, leaving out the personification of my sweaty sedan. Surely there is some way to avoid the downward spiral of the spot-less parkade.
No, I am told. There is no formal thread connecting the Health Sciences Center to the Other Campus.
As I consider the pros and cons of traveling between campuses on foot, I realize that I had thought of the University of Calgary as a sort of museum, unfolding to visitors through a labyrinth of wings – Arts, Sciences, Medicine, Kinesiology, Business and so on.
Rooms that are separate but connected, where you can study in peace but then float back to the main atrium, finding signs that point toward the other wings. A naïve vision of the university, obviously. Obviously each faculty rises abruptly from its foundations, in the manner of a tower filled with grain, too busy, too absorbed in its own work to acknowledge the other towers, however fascinating the work of the other towers might be.
Still, I had hoped that the faculties of my institution would be more solidly linked. And here, perhaps, lies my attraction to the writer-in-residence position. The bleeding of the arts into the practice of medicine. The potential for interdisciplinary collegiality to build an intricate system of Plus-15s between the world’s towers.
I remain hopeful that the medical school is less a new world than a new wing.
But I can’t shake the new-world sensation as I move through the first-week challenges of the novice. My knowledge of the university, of the English department and its enigmatic processes, has no relevance on the Foothills campus. I am no longer a fifth-year PhD candidate but a novice.
Let me give you an example.
The email invitations I receive from the wonderfully welcoming Cumming faculty often conclude with: “Meet me at Hippocrates!”
To the Cumming neophyte this imperative invites a pleasant list of speculations.
Hippocrates the restaurant? The lecture hall? The pita place? The parkade, god forbid?
But my Humanities-based education leaps to my rescue, whispering in my ear that Hippocrates is likely a tallish, concrete representation of the man who helped define modern medicine. Who drafted an oath that has maintained at least part of its relevance through the centuries, preserved like a message in a bottle, washed up on the shore of the Cumming School of Medicine.
Meeting our own Hippocrates for the first time, I make a mental note to read about the man whose name has been familiar to me since I was a child. Where did I first hear his name? I am just old enough to remember Marcus Welby, M.D., and later in life I gobbled up E.R. and Chicago Hope. Cumming readers should feel free here to roll their eyes or flex their gag reflex as they reflect on the failures of the Doogie Howsers, the Gregory Houses and the Cristina Yangs to accurately capture the life of a physician. I’m sure creative license was taken. Feel free to stop by and chat about your most hated (or your best loved?) medical show. Most days you’ll find me in the Global Medicine workspace.
But to return to Hippocrates – it was likely on the small screen that I first encountered this Greek man and his enduring oath.
And now I am determined to get to know this influential figure. In fact, what better way to begin my first blog post than with a pithy quote from Hippocrates, if I can find one that fits my meandering message.
So I climb up to the Health Sciences Library, where I am not only welcomed with enthusiasm but am ushered without ado into the office of Library Director Diane Lorenzetti. Unfazed by this interruption, she is fascinated by my new role. Make yourself at home in a quiet carrel or a meeting room, she tells me. And I do.
But first I wend my way through the stacks, seeking a tome that fulfills an impossibly perfect, Platonic-ideal sort of vision of a book on medical history. This text could never exist in real life; who even reads books any more?
But then I see it.
The thick spine, steel-blue with imposing gold letters – it reminds me of my art history textbook back at U of A.
Medicine: Perspectives in History and Art, by Robert E. Greenspan, M.D.
I haul it down from the shelf, run my fingers over the cloth cover. The glossy sheen of full-page color plates: The Anatomy Lesson of Dr. Nicholales Tulp by Rembrandt; a sketch of the skeletal system by da Vinci; and …
The Visit of the Physician (The Love Sick) by van Mieris the Elder. Each image suggesting a story in the life of a patient, a physician, a human body.
I flip through the pages and notice a section near the beginning on Hippocrates, but I can’t help thumbing past it. Focus, I tell myself. You’re looking for a quote from Hippocrates – an opening hook for the blog.
On page 35 I spot an illustration of a man who is half-human, half cadaver. His head is turned from the gaze of the viewer, as if he is embarrassed by the intimate depth of his exposure. Or perhaps someone has simply called his name.
His head, for the most part, is that of a living being – one eye, barely visible, but open; pink flesh; hair curly and slightly sweaty, as if he has just awakened from a midday nap.
But the pink flesh has been peeled away by the illustrator, revealing – according to the plate description – the venous system of the shoulder and neck. Revealing networks of veins (blue) and arteries (red), as well as a series of muscles (plaid).
Can you see the plaid muscles? (perhaps someone at Cumming will explain to this medical neophyte why the muscles are plaid in this illustration.) Here is a detail from the neck area:
So what made me stop at this particular image? The Medicine text is full of arresting images; I had casually flipped past an arrow remover, the first operation performed with ether, the circular amputation technique and a 1930s ad for cigarettes:
All these I simply scan. But I can’t flip past the half-stripped man.
Perhaps it’s because I recently had an extremely comprehensive tour of the anatomy lab, where I glimpsed what must have been the foot of a formerly alive human being, under cover of a plasticky bag, as well as a smorgasbord of porcine organs neatly folded into a fridge. Perhaps it’s because I recently asked a Cumming student about his first experience in the lab (he remembers mostly the silence). I also recently read a Vincent Lam story about dissection (“Take All of Murphy”) and I can still smell the acidic sweetness of formalin.
But, anatomy labs aside, this image of the half-stripped man gives me pause. It seems unfair, somehow, to treat the man in the illustration – I have come to think of him as Earl – as both living and dead. So invasive, this stripping away of Earl’s protective layer, the thin sediment of flesh that guards his vulnerable, pillowy coils and silken pouches from the violence of the outside world. This dualistic image muddies Earl’s identity. Is he human or cadaver? Of course the cadaver is still human, is it not? Or was, at one point.
Perhaps Earl is wholly dead but has died recently; that would explain the healthy glow of his flesh. But under what circumstances does a physician dissect a recently deceased man? It seems unfair to the viewer, too, to juxtapose the view of dissection, which must be performed on a man whose last breath has left his body, with the view of pink, living flesh. How are we meant to characterize this man?
Even from the small square footage of pink flesh visible in the image, that area not altered by dissection or obscured by hair, you can see that Earl is (was?) muscular, fit. Attractive. The sleek bands of muscles on his torso suggest hours on the rowing machine, or shooting free throws. His ribs undulate beneath his skin but not in a gaunt, bony way; they are interconnected by unseen plaid ropes which enable this man to heave, leap, tuck and twist. These ribs lure the fingertips of a lover, lend themselves to a leisurely touch, transforming the abstract idea of beauty into a concrete, breathless rise and fall.
This juxtaposition of elegant undulation with the inner workings of red, blue and plaid ask too much of the viewer, do they not? They confuse the beauty of the surface with the workmanlike interior. An interior that is at once taut and fragile. The stripped-back interior of Earl’s body reminds us that the surface is just that. A surface. The workings beneath the skin – the coursing of blood and oxygen, the digesting of food, the four chambers hammering beneath a rib cage, morning noon and night – that’s what really matters. Isn’t it?
And here, surely, we have stumbled across one of the divides between the Humanities and medicine. The English major drones on in great detail, exercising the part of her brain that specializes in metaphor, imaginary landscapes and plaid musculature. Whinging about the injustice of a cadaverous drawing, while expecting the very best from her own medical practitioners. The practitioner, on the other hand, studies the actual landscape of the body, is unafraid of running a thin blade along its surface (after a certain amount of practice on someone like Earl, presumably) and spilling open the contents, in the name of investigation, containment, and healing. Are these two approaches to Earl mutually exclusive?
I turn away from the illustration, reminding myself that I am looking for information on Hippocrates (I can hardly begin the blog post without finding my quote from the great Hippocrates), and I flip back to Greenspan’s introduction.
But allow me to digress for a moment, gentle reader, and share an unrelated anecdote from the introduction.
But actually, before I share that anecdote, allow me to digress (gentle reader, if you are offered a chance to bet on whether I reach the end of the Greenspan tome during my tenure at Cumming, I suggest you wager ten dollars against me). Bear with me while I share the quotation Greenspan selected for the beginning of his introduction. It is a lengthy one, so brace yourself.
“There is nothing men will not do, there is nothing they have not done, to recover their health, and save their lives. They have submitted to be half drowned in water, and half choked with gases, to be buried up to their chins in earth, to be seared with hot irons like galley slaves, to be crimped with knives like cod-fish, to have needles thrust into their flesh, and bonfires kindled on their skin, to swallow all sorts of abominations, and to pay for all of this as if to be singed and scalded were a costly privilege, as if blisters were a blessing and leeches a luxury. What more can be asked to prove their honesty and sincerity?”
The quote comes from Harvard professor Oliver Wendell Holmes, MD. Greenspan borrows from Holmes to illustrate the value mortals place on medical care, presumably since the days of Hippocrates and before.
I will digress one more time (torn by the knowledge that Hippocrates, the original goal of my research, is only five pages away!), if, gentle reader, you’ll bear with me while I tell you that the name, “Oliver Wendell Holmes” sounded familiar to this English major and, when I googled him, I found that he was also an essayist and poet.
In fact, one of the poems on the Poetry Foundation website showcasing Oliver Wendell Holmes’s oeuvre is titled, “Cacoethes Scribendi,” a Latin phrase referring to the uncontrollable urge to write. Surely Wendell Holmes points me toward the connection between the Humanities and medicine. Surely it’s an omen. A sign that my time at the med school will be as fruitful as Hippocrates’ pedagogical practices.
But to return to Greenspan’s introduction. He opens with the Holmes quote and then, to elucidate the dynamic nature of medical therapy, Greenspan turns not to facts and figures, or scientific observation.
No. Greenspan tells us a story.
He tells us the story of Ignes Simmelweiss, a 19th-century Hungarian obstetrician who dramatically reduced the rate of mortality in new mothers, through the simple act of hand washing.
Simmelweiss’s supervisor ridiculed him for his attention to hygiene, and forced him out of the hospital. Greenspan goes on to say that “Simmelweiss was subsequently confined to a mental institution, and, by some accounts, ironically died of infection” (xi).
Here is irony, a key element of narrative, harnessed by Robert E. Greenspan, M.D., to help readers understand that the narrative of medicine is not strictly linear. It does not march solemnly toward its logical conclusion.
We can imagine poor Dr. Simmelweiss, plunging his hands into a vat of chlorinated lime solution before turning to his patient, a woman with swollen belly, screaming through clenched teeth, screaming through contractions. But before Simmelweiss can ease the baby from its mother’s loins, his chief bursts through the doorway, grabs the good doctor by his lab coat and hauls him from the room, shouting, “chlorine is no match for childbed fever!”
But enough embellishment of Greenspan’s ironic narrative.
On to Hippocrates!
Unfortunately the page introducing Hippocrates is preceded by a note that I absolutely must share with you: the study of anatomy was first written about in Egypt in the early 16th century BCE. Egyptians of the day were prohibited from studying organ systems in any depth, due to religious restrictions, but it was thought that “vessels carried not only blood but tears, mucus, urine, semen and air (the word artery meaning “air tube” in Greek)” (4). How far we have come since the days of Tutankhamun! Did Egyptians have any knowledge of the plaid exterior of muscles?
But I am sensitive to your impatience, gentle reader. Let us move without further ado to the man described by Robert Greenspan as the father of medicine.
Hippocrates of Cos (460-377 BCE), according to Greenspan, elevated the medical care practice from the realm of magic and religion, ensuring that patients were treated with logic and common sense. He advocated for the diligent study of the body, and scorned the idea that tumors and coughs were planted inside humans by the volatile rulers of Olympus.
Hippocrates was a stickler for language, drawing a line in the Grecian sand between knowledge and speculation: “To know,” posited Hippocrates, “is science, but merely to believe one knows is ignorance” (4). On the island of Cos, the founding father of medicine developed his famous code of ethics (although it seems his role in authoring the oath is disputed).
(Not even a digression but a few quick facts about Cos: four kilometers from the western coast of Turkey; shaped like the clawed forearm of a velociraptor; the place where Syrian toddler Alan Kurdi came to rest.)
Reading the Hippocratic Oath, I notice that it begins with the echo of an epic, with its own sort of evocation of the muse: “I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses that, according to my ability and judgment, I will keep this oath and contract.” The oath goes on to outline the duties of a pupil to a teacher, and then emphasizes the need to do no harm to patients. It also recommends avoiding the seduction of the patient, and advocates for patient confidentiality. In the same breath as Hippocrates asks physicians not to assist in euthanasia, he requires them not to assist a woman with an abortion.
Now here is part of the oath that is probably not mentioned by Marcus Welby or Gregory House.
The oath ends with:
“If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.”
Which makes me wonder, given the compass-like presence of Hippocrates in the atrium of the Health Sciences Center, how students and faculty feel about this oath. How they feel about the student-teacher relationship; the responsibility to do no harm, and to treat patients with respect. I can only imagine that these are highly complex relationships and responsibilities. Are these not challenging promises to keep?
I am grateful that I have the next 20 weeks to explore those questions.
See you at Hippocrates!