The Art of Doctor in the Time of Plague

We claim an art to medicine that complements its science, but historically we have ignored that assertion – almost exclusively – in our attempt to enhance the science in medicine. I believe we must correct this imbalance if we are to be physicians in the full sense. One approach to righting this balance is to study artists, particularly those who see mankind from a special point of view, much the way that physicians study women and men or even populations affected by diseases. If we look at artists who perceive their role as “physicians,” we may discover how, as artists, to round out our roles in society.
What is art, and how does it inform the physician in the complex work of caring and healing? An artist, like a scientist, depicts a world. Be it completely imaginary, carefully realistic, or delightfully impressionistic, art illumines and interprets a part of the human venture. In an 1894 essay on Leonardo da Vinci, Paul Valery noted the commonality between art and science, and the importance of those visions in the mind, which inform the work of both. He wrote, “Most people see with their intellects much more often than with their eyes. Instead of colored spaces, they become aware of concepts . . . . They perceive with a dictionary rather than with the retina ” In a 1919 reflection on this essay, he defined the function of art: “A work of art should always teach us that we had not seen what we see.
For the physician this translates into seeing and hearing what lies hidden behind the apparent, searching for clues to understanding of patient and self and clarifying the meaning of disease for us as persons. The complete physician learns and appropriates the mind set of the artist who, as an interpreter and creator, reveals us to ourselves. The way of the artist as writer is displayed often by tangential means:

by myth, fable or metaphor. These are powerful means to the end of lifting the veil, revealing ourselves to us. A metaphor is a word or phrase that represents something else in words we can understand more readily. Concepts and grand stratagems are clothed in language and relations that we will recognize. For example, life is: a pilgrimage, a brief candle, a Chain of Being, a gift or a stage where we act out our play. The word, plague, is powerful as metaphor. For physician and patients alike plague evokes both the terror and wonder that a merciless and indiscriminate attack by pestilence would bring.

Until 10 years ago the word “plague” called to mind the Black Death, which swept through Europe in the 14th century. The arrival of the acquired immunodeficiency syndrome (AIDS) has revived the word as we contemplate an international epidemic of a disease that, to this time, is untreatable. We have many detailed studies of the medieval bubonic plague, which document its horror for noble and peasant, divine and doctor, who waited in fear and trembling for its telltale symptoms and signs. Assumed to be infectious, the cause and the animal vectors were as unknown as its therapy, and those at risk placed desperate confidence in amulets, incantations and the ministrations of doctors, which often were more harmful than helpful. The responses, infamous or admirable, of public officials, royalty, physicians and clergy are repeated today and suggest how we may react to the unprecedented demands of pestilence. The art of the doctor is paramount in the time of plague. Are there other “plagues” in our time that require our best response? Can artists teach us what the art of the physician should be in the hour of pestilence?
I have chosen three novelists, representing three different cultures, who were implicitly aware of the sickness in their societies and the ways those diseases affected the individuals about whom they wrote. Their works, spanning a century of European history, used plague as metaphor, as a word to address the momentous events undermining their social orders and demanding a response. Charles Dickens, Hermann Hesse and Albert Camus analysed core issues of their time, using the reference “plague” to dramatize the political, economic or moral evils they saw. Each man wrote at a time of deep and disturbing social disruption and transformation. Each prescribed different remedies for the ills of the day but held little hope for effective treatment or prevention of further assaults. Their plagues were ubiquitous, a gathering force to test skills and endurance. The novels that describe them are Little Dorrit, Narcissus and Goldmund and The Plague. Two of these works reflect loss of hope in the authors’ century, 1850 to 1950, for any movement of spirit, religious reformation, or power or conscience that could improve the lot of those who suffered. In the third, the artist offers hope that the plague can be controlled through fulfilment of the self defined by a transcendent Reality.

Little Dorrit
Dickens’ writings abound in allusions to biblical parables, narratives and sayings easily recognized by his readers. Little Dorrit, the darkest and most profoundly divided of Dickens’ novels, has a clear foundation in the book of Ecclesiastes. The opening lines of this Old Testament sermon are familiar: “Vanity of vanities, says the Preacher, vanity of vanities! All is vanity.” The author has searched prophetic vision, psalmist hope and teachings of Wisdom. All are rejected in the search for what is not vanity. Victorian novelists had a secure source for their writings on vanity in John Bunyan’s The Pilgrim’s Progress. Written two centuries earlier, in the 1670s, this great allegory created Vanity Fair for its readers.

Then I saw in my dream, that when they were got out of the wilderness, they presently saw a town before them, and the name of the town is Vanity; and at the town there is a fair kept, called Vanity Fair; it is kept all the year long; it beareth the name of Vanity Fair, because the town where it is kept is lighter than vanity; it is also because all that is there sold, or that cometh hither, is vanity. As is the saying of the wise, all that cometh is vanity.

It is the Vanity Fair of his day that Dickens attacked in Little Dorrit, presenting the consequences for English society of the plague of his day: industrialization with its lust for wealth and its bureaucracy, visitation upon the people for their greed and disregard of others. The Industrial Revolution, the most important social change of the 19th century, created a large class of urban poor and a middle class for whom wealth was a sign of grace. The most deadly evidence of vanity was the lust for wealth without regard for the poor whose labour made it possible. In chapter 13 of “Book the Second,” entitled, “The progress of an epidemic,” Dickens establishes the metaphor of plague.

That it is at least as difficult to stay a moral infection as a physical one; that such a disease will spread with the malignity and rapidity of the Plague; that the contagion, when it has once made head, will spare no pursuit or condition, but will lay hold on people in the soundest health, and become developed in the most unlikely constitutions: is a fact as firmly established by experience as that we human creatures breathe an atmosphere. A blessing beyond appreciation would be conferred upon mankind, f the tainted, in whose weakness or wickedness these virulent disorders are bred, could be instantly seized and placed in close confinement (not to say summarily smothered) before the poison is communicable.

The second symptom of the plague of Dickens’ day was the malfunctioning bureaucracy.

The Circumlocution Office was (as everybody knows without being told) the most important Department under Government…. What ever was required to be done, the Circumlocution Office was beforehand with all the public departments in the art of perceiving – HOW NOT TO DO IT…. In short, all the business of the country went through the Circumlocution Office, except that never came out of it; and its name was Legion.

Those who thought that the business of government was TO DO IT were overwhelmed by Government and never heard from again.
The characters in Little Dorrit respond to their plague the way their forebears did to the Black Death. Some left for the continent to live in a foreign land, carrying the accoutrements of their homeland. Others, like the prominent physician Thomas Sydenham during the 1665 plague in London, retired to country estates the better to care for their wealthy private practices. Those in power in government and business were helpless in their ignorance and self-seeking, unable or unwilling to intervene. The poor, the imprisoned and those committed to their care stayed and ministered even when the outcome of their affliction was predictably disastrous.
“One of the features of English liberalism in the nineteenth century, which most distinguished it from its counterparts in other countries of Europe, was the habitual use of Christian language.” Reform movements were so characterized. Dickens considered himself a religious man but was unable to accept traditional Christian beliefs. He affirmed the temper of the New Testament, accepting Jesus as a teacher and an example of how we should live with each other. However, faith in a God understood as person and incarnate was impossible for him. The Church and its confessions, creeds and sacraments were sources of his ridicule and contempt, as were those who mouthed words of faith without demonstrating action derived from that faith.
The closing down of all social life on Sunday was considered idolatry by Dickens. The poor could have no social life on the Sabbath while the rich, served by them, enjoyed the day according to their desires. The imposition of hollow religious regulations was, of itself, a sickness. The despondent and melancholy city on Sunday is described by a returning traveller, the hero of Little Dorrit.

In every thoroughfare, up almost every alley, and down almost every turning, some doleful bell was throbbing, jerking, tolling, as if the Plague were in the city and dead-carts were going round. Everything was bolted and barred that could possibly furnish relief to an overworked people….

The spectre of the effects of industrialization and the powerlessness of government, church and upper classes to help the poor placed Dickens in a state near to despair. The desolation of the urban masses appalled him. The connection between the spiritual and the material was undeniable for Dickens: confession of faith without action could not move him. Himself devoid of a religious faith to act as motive force to treat the ills so apparent, he could only exhort others to do good works for their own sake. He was left with a social gospel to drive reform: a gospel with little power to enact that reform.
There is subdued hope in Little Dorrit and it appears in two persons. The first is Amy Dorrit, child of the Marshalsea prison. She is a projection of Dickens’ idealization of the healing woman and the embodiment of his New Testament corrective for the harsh judgemental Calvinism, the missionary evangelism, and the new biblical criticism of his time. Surrounded by light as she stands in a doorway, she resembles Jesus as a model to be emulated, not only in deeds done but in appearance and effects on others, one whose origin seems, at times, to be heavenly.
Arthur Clennan is in prison and Little Dorrit visits him.

… [W]hen the door of his room seemed to open to a light touch, and, after a moment’s pause, a quiet figure seemed to stand there, with a black mantle on it. It seemed to draw the mantle off and drop it on the ground, and then it seemed to be his Little Dorrit….He roused himself and cried out. And then he saw, in the loving, pitying, sorrowing dear face, as in a mirror how changed he was…. Little Dorrit, a living presence, called him by his name.

Not only the description of her suggests Jesus; what Christ is and does to the believer -call by name – is described. Little Dorrit represents the path for rescue of the cast-offs and the marginal persons in a sick society. Acceptance of others and charity, which is the fruit of love, are Dickens’ prescriptions, his gospel of salvation.
The second person in this religious novel is unique. Dickens places three men close to the villain, Merdle. For an author so renowned for inventiveness of names of characters, it is fascinating to know them only by profession: Bishop, Bar and Physician. The first two are ridiculed by our author; not so, Physician. In fact, Physician is shown to the reader in language and in deed as a Christ figure. With no reference to belief, confession or faith, Physician lives out the life that can save the age. Without apparent family or intimate friends, Physician makes his rounds in the city.

Few ways of life were hidden from Physician, and he was oftener in darker places than even Bishop. There were brilliant ladies.., who would have been shocked to find themselves so close to him if they could have known on what sights those thoughtful eyes of his had rested within an hour or so, and near to whose beds, and under what roofs, his composed figure had stood. But Physician was a composed man, who performed neither on his own trumpet, not on the trumpet of other people…. [H]is equality of compassion was no more disturbed than the Divine Master of all healing was. He went, like the rain, among the just and unjust, doing all the good he could, and neither proclaimed it in the synagogues nor at the corner of streets. . . . Where he was, something real was.

Physician is not the wisdom-seeking Preacher of Ecclesiastes. Purely altruistic, he is a confessor for all without judgement and a healer with the highest ethical standards of confidentiality and benevolence. He stands beyond the ordinary. His isolation from family life, his unquestioned devotion to the sick poor and his presence among persons shunned by polite society confirm his identification with Jesus as one of those who does God’s work. “Who is my mother, and who are my brothers?” And stretching out his hand toward his disciples, he said, “Here are my mother and brothers, and sister, and mother.”(Matthew 12: 48b-50) The art of the doctor in the time of plague, when science has proven inadequate, is a life lived for others without regard for qualifiers such as race, social standing, creed, gender or personal habits at odds with those of the doctor. Dickens had difficulty finding a motive force for living out the life of the Divine Healer without a sustaining religious faith that would empower the work. Although the novel ends with a modified sense of hope and with affection, it offers an ambivalent recipe for our social salvation: works without faith.

Narcissus and Goldmund
War, as a devastation upon the people, is one of the great plagues of all time. Our current epidemic began with the Great War of 1914-1918. Its influence on the arts of painting, music and literature was impressive. Hermann Hesse , a German whose first novel was published in 1904, saw the internal emptiness and external chaos of war as a plague, and the events in Germany in the first third of this century as leading to horror. Narcissus and Goldmund, published in 1930, is a medieval allegory set in the years of the Black Death, the metaphor used by Hesse to represent the plague of war. In one of the novel’s more moving scenes, Goldmund meets the Jewess, Rebecca, the sole survivor of a family killed by Christians because Jews were believed to have brought the plague. The parallel with our century is clear.
Hesse was raised in a strongly pietistic Protestant family, was a seminarian briefly but turned to Eastern religious thought and to Jungian psychology, itself having a strong Eastern and metaphysical bent. For him, the war caused an awakening to reality in this world, to the tragedy of life and spirit we experience. Hesse rejected a traditional belief in God, but also rejected the existential position that we were thrown into nothingness. His faith integrated the paradox of rational logic and cause-and-effect relations with the cosmic experience of an ultimate and absolute Reality.
The healing of the split between the ideal and reality, which Dickens’ art tried to effect by good works, Hesse attempted, using art as the method. In Narcissus and Goldmund, the central theme is the Jungian understanding of the male-intellectual and the female-artist parts of ourselves, which must be united to bring forth the true Self. If we are to be truly healed -made whole – we must fuse the two halves of our personalities: the intellectual and the natural or sensual sides. Goldmund muses,

All existence seems based on duality, on contrast. Either one was a man or one was a woman,… either a thinking person or a feeling person – no one could breathe in at the same time as he breathed out, be a man as well as a woman, experience freedom as well as order combine instinct and mind.

For Hesse, the role of the artist is to show us ways of holding these two realities in creative tension as we face the varied plagues of our day. One without the other leaves us unfulfilled and incomplete.
Placing this novel in the Middle Ages allows Hesse to use the strength of the Church and its learned teachers, and the developing schools of painting and sculpture, to set the stage for an awakening, a common element in his work. Narcissus is an ascetic monk committed to the life of the spirit and the mind. He recognizes in the new student, Goldmund, his opposite, one who can find himself only by going out into the world to do his work as an artist. This world is one of erotic sensuality, of death and of suffering: the world of the Black Death. Again, plague is used to represent something else, the horror of war in this century. Hesse uses this setting to clarify the realms of spirit and mind, their interdependence and the final victory of life finding its completion in art.

[A]rt was a union of the father and mother worlds, of mind and blood…. [E]very obviously genuine work of art had this dangerous, smiling double face, was male-female, a merging of instinct and pure spirituality…. In art, Goldmund saw the possibility of reconciling his deepest contradictions, or at least of expressing newly and magnificently the split in his nature.

The reader becomes aware of being both Narcissus and Goldmund. We are each the ascetic intellectual and the artistic spirit in search of fulfilment in Nature/Mother/Eve. Only in art, only as an artist, does Hesse believe that we can bring forth enduring work, which lives in the time of the plague, even though we might perish in it. The artist is the interpreter, the creator who reveals us to ourselves. This revelation, that the two parts are complementary not antagonistic, is the stuff of this metaphoric novel. Hesse takes these two parts of the reader on the three-stage journey basic to his work. The beginning of the story is in the intellectual mode: Narcissus, the bright and beautiful teacher, sends Goldmund off to learn of life.

We are not meant to come together not anymore than sun and moon were meant to come together or sea and land. We are sun and moon, dear friend; we are sea and land. It is not our purpose to become each other; it is to recognize each other to learn to see the other and honor him for what he is; each the other’s opposite and compliment.

Goldmund enters the world of the sensualist and tries, without success, to create the perfect statue of Mother/Madonna/Eve. He returns to join Narcissus, bringing the two parts of us together, a synthesis of the whole person.
Our art in the time of the plague is to confront the epidemic, deriving the power to do so from our integrity as persons who bind mind and spirit together to inform each other. The possibility of wholeness in the healer, who holds art and science in creative tension, may stem the plagues we shall certainly see. But there is no final resolution, no final peace. Goldmund notes, “Oh, there is peace of course, but not anything that lives with us constantly and never leaves us. There is only the peace that must be won again and again, each new day of our lives…. [Life] is struggle and sacrifice like every decent life . .” Hesse’s dark novel ends with Goldmund’s return to the monastery and to the man – the mind – that loves him. Goldmund’s search for the Mother, the source of art and love and life, is over. Death for him will not be the end, but the completion of his life of art.

The Plague
Hesse read the significance of the Great War with utter seriousness, and he shifted his art to reflect that plague. By the 1930s the devastation to be wrought by Nazi Germany already was apparent. At that time a critical observer of the European scene appeared in French Algeria: Albert Camus. Born in poverty, hampered by pulmonary tuberculosis, he was a worshipper of the sensual life of the Mediterranean, a devotee of Greek thought.
Camus rejected philosophy in favour of art as his way of living out his life. In his acceptance of the Nobel Prize in 1957, he noted that art was essential for him because it excluded no one, allowing him to live on a footing with all. He said,

To me, art is not a solitary delight. It is a means of stirring the greatest number of men by providing them with a privileged image of our common joys and woes…. [T]rue artists scorn no thing. They force themselves to understand instead of judging.

As with Dickens’ Physician, judgement is not a function of the good doctor.
Camus had the sensibilities of the pagan Greek, not those of the Judeo-Christian culture in which he lived. His plays and novels show a starkness and a lack of detail suggestive of Greek drama. The experiences of the body in its innocent harmony with cyclical nature, its delightful sensuality, its erosion by time, and our circumscribed destiny ending in death were the sources for his evolving thought on the nature of our existence. He accepted the omnipresence of evil: the unjust suffering of the world drove his work. He joined others, such as Dostoyevsky, in declining to accept a God in whose creation children suffered and died.
Nietzsche, in the 1880s, found God dead in the lives and works of his contemporaries. The death of God was also a central given for Camus. However, the loss of morality and a sense of nothingness “out there” – basic beliefs of nihilism – Camus rejected because they offered no hope for our future. The freedom, which nihilists claimed, Camus saw as yet another Absolute that replaced the God that was dead. Instead of nihilism, Camus took the absurdity of life, the sure knowledge of death and the loss of a transcendent Being as starting points for artists, who would liberate us from abstraction and place us in the world of the present. Here we see ourselves in a new light with a new awareness of the self. We are at the beginning of our lives in our realization of the collapse of a cosmic setting based upon traditional faith. For Camus, and for us in our understanding of the physician as artist, the experiences of life are the foundation stones of our work. “The artist is wedded to the concrete’ and the life of ideas for Camus is always the life of actual human beings struggling to give meaning and dignity to their lives.” The absurdity of our lives, once grasped in its totality, leads us to revolt, to become rebels in this world: we become vital beings. Camus wrote, in The Rebel,

With the experience of the absurd, suffering is individual. Beginning with the first movement of revolt, it becomes conscious of being collective…. The pain, which was experienced by a single man, becomes a collective plague.

Camus’ novel of pestilence was published in English in 1948. It was a novel about imprisonment, his entrapment in France during the German occupation that prevented his return to North Africa and to his Wife and family. The ache of separation and the longing for union with loved ones – the experience of exile -is, for Camus, a metaphor for our experience of the death of God. He wrote that, with this insight,

the time of exile begins, the endless search for justification, the aimless nostalgia, “the most painful, the most heart-breaking question, that of the heart, which asks itself: where can I feel at home?”

Dr. Bernard Rieux, the central character and supposed narrator of The Plague, reminds us of Physician in Little Dorrit. A moral man, alert to the nearly overwhelming needs of the victims of the plague, which struck Oran in 194-, he is available and comforting even at hours of greatest fatigue. Rieux is the foil against which are tested philosophical, political and religious explanations of the plague. Rieux is the true healer, one who attends his patients, refusing to make judgements on any aspect of their lives. His work is “to defend mankind against death, without losing sight of the fact that all victory is but temporary, and that sooner or later death will triumph.” Rieux has profound sympathy for his sick fellow-citizens, knowing that all are in exile, all are threatened by a plague, which brings death. The sympathy and companionship he gives and receives supports him in his work.
The priest, Paneloux, presents a Christian position, which prescribes guilt, self-condemnation and passive acceptance of suffering. The horrible death of a child forces Rieux to restate, in his own words, Ivan Karamzov’s position. “And until my dying day I shall refuse to love a scheme of things in which children are put to torture.”18 For Camus, Paneloux represents the “root moral failure of Christianity. It is built upon the acceptance of the death of innocence and is thus the ultimate negation of revolt. ”
Tarrou is another exile outside the human community. Hoping for saintliness, willing to engage the plague, he finds his life is a contradiction brought on by his inability simply to accept the human condition. He, like Paneloux, would be a saint, albeit without God, free of any association with the things of this world that bring on the plague. We cannot deny that evil lies within us and can bring the best of our work to terrible ends. Like Paneloux, he dies.
Grand, a minor clerk in the municipal government, is a hero. He represents Camus’ deep appreciation for the nobility expressed by ordinary people struggling to make sense of their lives in times of catastrophe. Suffering in silence and without complaint, maintaining dignity and evincing love, Grand does what needs to be done. Dr. Rieux observes,

Grand was the embodiment of the quiet courage that inspired.., the narrator commends to his readers.. this insignificant and obscure hero who had to his credit only a little goodness of heart and a seemingly absurd ideal.

For Camus, the human condition of absurdity called for a clear commitment to the common good. Dr. Rieux represents Camus’ position, realizing, he says,

the bleak sterility of a life without illusion….[H]ard it must be to live only with what one knows and what one remembers, cut of from what one hopes for

The physician, who is daily called upon to perform tasks without grandeur has remained in the very midst of the plague…. [W]ithin him nothing has changed, he has extended himself faithfully with an abstention that secures him against all false self glorification and keeps him within the bounds of his ideal: to be a man.

Any hope for a human community will depend upon a shared consciousness of our common condition evaluated in truth. Unless this happens, our tragedy will never end. Without community and a firm commitment of each to all, the plague will return, again and again.
As the novel ends, the plague has gone. Rieux walks the streets of the city where reunited lovers clarify for him the answer we are given when we hope. “They knew that now if there is one thing one can always yearn for, and sometimes attain, it is human love. ”
As this powerful narrative draws to a close,

Rieux resolved to compile this chronicle, so that he should not be one of those who hold their peace but should bear witness in favor of those plague-stricken people; so that some memorial of the injustice and outrage’ done them might endure, and to state quite simply what we learn in times of pestilence: that there are more things to admire in men than to despise.
Nonetheless, he knew that the tale he had to tell could not be one of final victory. It could only be the record of what had to be done, and what assuredly would have to be done again in the never ending fight against terror… by all who, while unable to be saints but refusing to bow down to pestilences, strive their utmost to be healers.

Each of these authors has, as one of his aims, the diagnosis of an illness in our society through his power as an artist to instruct us. Artists as serious as these aim also to heal the sickness they have depicted. By using our long and fearful experiences with plague as metaphor, they illumine social, economic and political “diseases,” which call for a commitment to be with and for the stricken. Our authors searched for sources of strength for the healer to attend the victim. Their work traces sharp changes over the past century in the ways we think about spiritual and religious foundations for the acts and commitments of our lives, a century that saw a fading of traditional and institutional faith in God as empowerment for sustained and dedicated service to the frighteningly large numbers of sick.
Dickens, denying a traditional Christian faith that had been called upon for so many centuries, had only the pleas for a common morality to back his hope for ending the economic plague of his day. The failure of bureaucracy and the wealthy to correct widespread injustice left this sentimental and intellectual genius angry and desperate. There was no impetus to change a social and economic structure so beneficial to those who engineered it and profited from it, financially and socially. For those in power, there was no plague. The art of Physician was being present to those who sought his comfort and consolation.
Hesse confronted the plague of his day -the horror of the reality of war – with an art that called for recognition of the deep divisions in our selves that distort our sensibilities, hurt others and leave us lonely and empty of that richness of spirit that can transform us and our world. Hesse responded to his awareness of a spirit that called for his coming to completion as an artist by envisioning the union of male and female, nature and intellect, into a newly created person. Disregarding the formal pietism of his time, he looked instead to new psychologic insights into our need, individual and social, for a sense of a transcendent Reality that gives coherence to our common life. Hesse responded to a call from beyond or deeply within himself that, unknowable in ordinary ways, nevertheless enlightens the meaning of life.
Over the years, artists have so enriched the concept of plague, both as actuality and as metaphor, that Camus can depict a bubonic plague with complete realism. This expanded use of the metaphor is a stunning example of the artist’s skill in calling to our attention the horrors of our century. He reveals to the reader the infectious illnesses of his day – alienation, loss of spiritual values, fascism – as a real event, a plague. Camus said of it, “The Plague.., has as its evident content the struggle of the European resistance against Nazism.” For him, these plagues are evidence of the absurdity of our lives. Refusing to accede to fatalism, he called instead for revolt in the name of the community of the afflicted; he believed this to be a proper response, one which provides a locus for the work of one’s life and the power to do it. He saw hope for salvation, the intercession of an omnipotent creator, the blessings of a life in a place other than this earth, as futile imaginings, which lead us away from our duties to become ourselves through rebellion against evil.
Whatever one makes of these varied visions of the role of art and the artist in the time of plague, there is evident in each a movement of the heart to understand the self in its myriad parts and to bring these together in a new person capable of being with and for the victims. Plagues may subside, but they lie in waiting. The Plague closes with these words:

And, indeed, as he listened to the cries of joy rising from the town, Rieux remembered that such joy is always imperiled. He 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 in rats again and send them forth to die in a happy city.
These artists have used their healing arts in their own small ways, realizing, as do physicians, that neither individuals nor society will ever be completely healed. However, in addition to treating the sick, we look forward with some confidence to the prevention of illness and maintenance of health. As doctors we must become ever more sensitive to the contexts in which disease presents itself. We know we cannot cure all disease and make everyone well. We have to see and understand our patients in the society and the environment where we live, love, work and communicate. Ideas, hopes and ideals are elements in health care. Only as we broaden our awareness of the nature of the healing arts and the total world where these are practised, shall we truly become healers. The physician should seek to perfect the art of knowing the self and the other and translate that knowledge into acts for those in care; we must be with and for the victims. The strength to do this will come from varied sources but will come only to those conscious of the existence of plague and their responsibility to confront it in community with all of us. Artists can teach us to see correctly what we are looking at and increase our awareness of the multiple facets of human ills.

As a physician and chaplain in a medical school, I am privileged to watch the development of medical students through their 4 years, listening to their accounts of their education. The beginning of clinical rotations in the third year has a marked effect on some students’ understanding of what doctors do. The eagerness of first-year students to care for the sick and the suffering, their expectations for serious involvement with patients and their families and their understanding that medicine is both an art and a science receive a considerable shock when they are exposed to house staff and attending physicians, who have little time and seemingly little interest in the totality of a person with a disease. The sharp focus of medical staff on diagnosis and treatment, usually in a tertiary care setting, offers little training for managing the care of persons with other than somatic complaints. University hospital settings provide students with little opportunity to understand the “plagues,” that are present and thriving in their city. The impact of poverty and race receive scant attention in our teachings about what it means to be on the margin in an industrialized society whose values are not necessarily humane.
When they meet him, patients recognize Dickens’ Physician as easily as they recognize the doctor well versed in disease but with minimal feeling for what illness is like. The increasing use patients make of unorthodox therapies and diagnostic techniques testifies to the weakness in the art of medicine of physicians untrained in comprehensive care of fellow travellers on the road we shall all take. Students need assurance that their teachers and tutors can help them learn the art of being a doctor in the times of the plagues which are, even now, showing forth in the world. There is no substitute for a broad education in the arts -literature, music and painting – as a road to learning what it means to be a person. Artists can teach us what the art teaches.

Allan Mermann

Publicado por Adriana Scarpin

Bibliófila, ailurófila, cinéfila e anarcafeminista. Really. Podem me encontrar também aqui:

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