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Victor Hugo, Les Miserables

Gary Wills, Lincoln at Gettysburg

Stephen Greenblatt, Will of the World

Donna Tartt, The Goldfinch

James Martin, Jesus: A Pilgrimage


The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.


The English Major in Medicine, Or: I Wander Lonely As a Cloud

I once was an English major. From a BA in English and American Studies I went (after a brief sojourn in advertising copywriting) into the big house, the MD factory. And I never regretted my undergraduate choice; never for a moment thought my English degree was either a hinderance or a disadvantage in the world of science.

(At least not after the first six weeks, which was biochemistry. But even then, while my chemistry colleagues sat bored in what was for them a review, I was stimulated by the thought that for the first time in my scientific studies, I was learning something theoretical that I would use in practice.)

I could write a book (and maybe I should) about the value of a literary education in the life of a physician. But for today, here is the Cliffnotes version (and no, in college I NEVER resorted to Cliffnotes): 

  1. Literature teaches empathy. Empathy is a good thing in healthcare. And a scarce commodity.
  2. Years of reading about the lives of people in different times and with different values gives you a deeper insight into people from other walks of life. And if you are an ethical doctor, you must deal with every kind of person you can possibly imagine.
  3. It never hurts that your medical notes are clearly written and grammatically correct.
  4. Every patient has a story to tell. A doc who understands this listens well and pulls the elements of the story together into a coherent whole, something we fiction-heads call a theme but doctors mistakenly call a diagnosis.
  5. Shakespeare was the greatest psychiatrist in world history. If you can take apart Hamlet you can understand any patient. (A similar argument could be made for Captain Ahab. Or Isabel Archer. Oh, how I loved Isabel Archer.)
  6. You can make ethical mistakes in real life, or you can read novels about people who have ruined themselves instead and learn not to do what they did (recommendation: Appointment in Samarra by John O'Hara). Personally I find learning from others' stupidity the better of the two options. But I seem to stand in the minority here. (And for those who wonder if the study of history serves that purpose, too, I would say: Not entirely. History, honestly taught, is too muddy for clear ethical lessons. Literature, which has eyes to see inside individual minds, does that better.)
  7. Medical schools don't give a crap what you major in, so why not major in something that is fun? I swear it is true. No one ever, ever asked me about my major when I interviewed at medical schools. Nobody cared. I even think they were relieved to not have to interview biology major number 1369.
  8. When you finish a long, hard day up to your neck in human suffering, you can read Ulysses instead of the New England Journal of Medicine. This, my friends, is the greatest joy of all, the one for which I am daily thankful.

(One day, maybe I will write a book entitled, How James Joyce Made Me a Better Doctor. Anyone want to pre-order?)

Photo of Henry James from 1910 from Wikipedia.




What We Think Is New, Never Is

From The Son, by Phillip Meyers:

March 10, 1916 -- Yesterday Pancho Villa crossed the border into New Mexico, killing twenty. Today, hardly a white man to be seen without a pistol or slung rifle, even to buy groceries.

The Germans have promised to reinforce Mexican troops with German infantry should they choose to cross the border. Whole town in a frenzy; we are only ten miles from the river.

I do not point out there is little likelihood of the Kaiser sending troops to McCullough Springs when he is losing them ten thousand a day in France. I do not point out that the number of Americans killed in Columbus is the same as the number of Tejanos shot in bar ditches on any given night in South Texas. I do not point these things out because everyone seems happy with the news of this new threat; neighbors who didn't speak are suddenly friendly, wives have new reason to make love with their husbands, disobedient children do their schoolwork and come home early to dinner.

The Son is fiction, but Pancho Villa's raid is not -- I remember learning about it as a child -- and the reaction of the Americans in the town of McCullough is also well grounded in fact.

It is the folly of the immature to think that what they are experiencing has never been experienced by anyone before. If fact, America has been upset by the threat of terrorism before, as this passage attests. Moreover, people who have no ability to hurt us have used that threat to sucker us before, too. The Kaiser, no less, did what ISIS does now, almost a hundred years ago.

I could to write a PhD thesis about this, but it is possible through intuition to see to the bottom of this problem without spending quite so much time. Overreaction is a very ancient response to terrorism. Even the very oldest book in Western literature, Homer's Iliad, is about this problem. The Iliad tells the story of what the Greeks do when a group of Trojan marauders steal the wife of one of its kings. Destroy a good bit of the known world seems to be the answer.

It makes me wonder. If the Bush administration knew its Homer, would it have paused before going ahead in Iraq? After all, the Greeks defeated Troy, but at the loss of Achilles, Petroclus, Ajax, and thousands of Greek soldiers in the prime of life. Ultimately their action resulted in the total destruction of Troy, which probably didn't benefit the Greeks in the long run either. It was the very mixed results and the high price the Greeks paid for victory that gives Homer's Iliad the ring of truth.

A great work of art doesn't force an ending. It recognizes that events play out in unforeseen ways, and that humans pay for their choices, even when they make the right ones.

People who don't know their fiction make big mistakes. Because, as a critic once said, fiction is a huge time saver. Only by putting yourself in the minds of many people, living and dead, can you have the breath of experiences that allow you to contend with life. You couldn't possibly live long enough to learn all the moral and social dilemmas that are out there on your own. Fiction does that for you.

Good writers know predictable plots make bad fiction. Predictable plots cheat the reader of experiencing the moral complexities that allow for growth. That is what Phillips is showing in this passage in The Son: The townsfolk, acting like bad authors of a bad novel, write a conclusion to the Villa raid, one that is not grounded in reality, and end up looking stupid.

Every decent writer knows that a predictable plot leads to absurd outcomes, outcomes that defy life experience, outcomes that don't feel right because they are too controlled. What we have in The Son is a population that manufactures its own myth to seek comfort in (that taking a gun to the grocery store will protect America from Villa), a myth that leads them to be manipulated, and made a fool of, by the Kaiser of Germany.

Fiction says life is not predictable and the truth is not obvious. Like Texans 100 years ago who were fooled by the Kaiser, people today respond to terrorism and threats of violence by foolishly arming themselves to the teeth against an enemy unlikely to harm them, and as a result fall into a false sense of security. Like the citizens of McCullough, they think carrying a gun is the talisman that protects.

Predictable behavior leads to absurd outcomes, just as predictable plots lead to absurd endings. Finding the truth means looking beyond the obvious. Good fiction teaches us this.



The Super Bowl has got to be the most worthless event of the year if your hometown team isn't playing. Consider:

1. If you miss the game, there will be endless recaps for the next week, and then both highlights and the whole game will play on the NFL network for months.

2. The halftime show will suck. That's because young musicians have no talent, they just look good on video. When they get the old guys, you've heard all their stuff before, and they sounded much better when they were young.

3. The commercials will be recapped and replayed on network news (yes, that's what passes for news these days), so there is no reason to watch if for the commercials any more. The commercials are on YouTube anyway.

4. It is not likely to be a good game. Most Super Bowls aren't. Most regular games aren't either, but the difference is I usually have a team to root for, so the outcome matters to me whether it is close or not. Which leads me to...

5. Both teams suck. I'd rather watch a 3 hour interview with Sarah Palin about her favorite Russian novels than see either side win.

Daniel Boorstin called events like the Super Bowl pseudo-events. That is, events that are not news in the sense that they are spontaneous events; instead they are events planned out specifically to attract news coverage. Boorstin argued that pseudo-events should be distrusted, since they are staged specifically to shape public opinion and behavior, and not because they are important in themselves. People who are not careful about pseudo-events, Boorstin cautioned, risk being manipulated by them.


The Ecstasy of St. Teresa

Some people go Italy and come back bellowing that if they never saw the inside of another cathedral for the rest of their lives, that would be fine with them.

Not I. I could see another one tomorrow and tomorrow again; there would never be enough churches to satisfy me. I find the church the most sublime and inspiring of human structures. And in many cases, especially in Italy, churches are the home to some of the finest works of art in all the world.

On my trip to Italy last summer, I saw some of these. There was of course the Pieta, Michelangelo's magnificent sculpture in St. Peter's Basilica in the Vatican. There were the beautiful medieval mosaics in the Basilica of Our Lady in Trastevere. Or Carvaggaio's astonishing cycle of paintings on the life of St. Matthew in the Contarelli Chapel of San Luigi die Francesi (St. Louis King of France).

But among every group of goods there is always a best. For me, the best was my visit to the Santa Maria della Vittoria church in Rome, where I saw the Ecstasy of Saint Teresa by the Baroque master Gian Lorenzo Bernini. The sculpture draws inspiration from the diary of St. Teresa of Avila, the relevant passage displayed on a marker below the piece. St. Teresa, a sixteenth century mystic, describes a vision that came to her during prayer: An angel appeared before her brandishing a spear of gold, which he proceeded to plunge into the saint's chest:

He appeared to me to be thrusting it at times into my heart, and to pierce my very entrails; when he drew it out, he seemed to draw them out also, and to leave me all on fire with a great love of God. The pain was so great, that it made me moan; and yet so surpassing was the sweetness of this excessive pain, that I could not wish to be rid of it.

Bernini's sculpture depicts the moment just after the angel has pulled the spear from Teresa's chest. The angel hovers above her, the arrow relaxing in his hand, it's miraculous power having met its purpose. St. Teresa's head swoons back, her face transfigured in ineffable, ecstatic you. Her body appears pushed to its very limits, a corporal being feeling as much of the glory of God as a human can feel without being torn apart. I can almost see the very cells in her body swollen to the point of bursting with happiness. The angel, looking on, has a look of sympathetic knowingness -- yes, Teresa, this is what it is like, this is complete joy, this is knowing God and God's love in all of its completeness. Even Teresa's nun's habit tells a story, swirling and disheveled, it mirrors the shock of disarming ecstasy, the sense of being completely overwhelmed.

The Ecstasy is different from most of the other works I saw in Rome. Michelangelo's works are cool and confident -- think of David, calmly facing Goliath, or the Pieta, which depicts a mother mourning her dead son, the eyes of Mary gazing away from Jesus towards an inner peace: God will somehow make this right. Carravaggio is usually darker and brooding. Raphael is vibrant and noble, but his paintings are composed -- never the loss of senses or control that Bernini displays here. The Ecstasy is pure fire and heaven's light, it is the very picture of joy, if joy can be cast into stone.

Some art historians have said that the glory of the sculpture lies in what is not depicted. Teresa looks up, and above the statue is a stream of golden rays from heaven represented by a burst of rods, suggesting that the greatest joy, the spiritual energy of the artwork, comes for above in heaven and not from the angel or the saint.

Maybe so. But I see in the sculpture itself diving glory embedded in physical being, the body completely taken by the power of infinite joy. Santa Maria, after all, is a Catholic church, and Catholicism teaches that body and spirit reside together. Jesus was divine and human at the same time; we humans will die and one day return, body and soul resurrected, spirit and biology together. I don't think Bernini meant to show the separation of spirit and body, but its complete union. And he succeeded, to the extent that a human being can succeed in such a task.

In Italy, most of the churches with major artwork have lights above them, to illuminate the art in the gloom inevitably inhabiting the side chapels of churches built long before electricity. To make the lights work, you put a euro into a box and the light comes on for a few minutes, providing enough light to fully appreciate the artwork. I stood at the foot of this chapel, emptying my pockets of all the loose change I had, as transfixed by a work of art as I have ever been.

Anything I could say beyond this about the Ecstasy of St. Teresa would be a regurgitation of Art 101. About how art represents the emotions and thoughts we all have about ourselves. About how it models our hopes and dreams. About how it embodies, and inspires, our desire for human perfection.

And it would all be true. And this: When a person approaches a work of art, one must do so with a willingness to be changed. Not all art will change you -- certainly not every work of art I have encountered has changed me. But many have, and a few have touched me so deeply that everything I see afterwards is somehow observed in its light. The Ecstasy teaches joy. How to experience it, and how to look for it, and most importantly, through St. Teresa's example, how not to be afraid of it when it finds you at last.

Happy New Year.


Kent Haruf

It has been a few weeks, but I would be remiss if I failed to mark the passing of novelist Kent Haruf, author of the 1999 bestseller Plainsong.

Mississippi Public Television has a program called The Writers, an intermittent series of interviews of writers with Mississippi connections. It was on The Writers that I first encountered Haruf, a soft-spoken, blue-jeaned and cowboy-booted author whose opinions about fiction writing fascinated me.

So I looked up Plainsong and read it. The novel takes place in a contemporary but fictional Colorado town, and tells the story of a high school teacher, the breakup of his marriage, and the new sense of family he develops when he arranges for the care and protection of a pregnant student of his who is thrown out of her home by her alcoholic mother.

Plainsong is the kind of novel most of us writers dream of writing -- well-crafted, a pleasure to read, even more pleasing to ponder. It has a pastoral tone, even though some of the events were suspenseful, and, at its bottom, an edifying regard for human life. When I read, I am looking for humanism, a sense of compassion for people and their situations that makes me feel more like a person. Not all books do this. Many modernist books specialize in alienation, something I think is very opposed to the purpose of good art. Haruf was very good at writing about what it means to be human.

According to his New York Times obiturary, he died of complications from lung disease in the shed behind his home, the place where he wrote his fiction. No better way to go than while sitting down to write, I say.

Haruf believed in getting the words down on the page quickly and without self-censoring. He thought the way to write was to express one's ideas in as raw a form as possible, without second thoughts, while the idea was still fresh.

To accomplish this end, he would sit down at a manual typewriter and write with a cap pulled over his eyes. Unable to see even the page, he would write in stream of consciousness pattern until he had met his word quota for the day. Editing he left for later. Sometimes the raw product was good, sometimes it was bad, but it always helped him sound the depths of his characters, providiing an intimacy that translated into every sentence that made it into print.

I could never take uncensored writing to that extreme, but I like the idea of it, the pure devotion to creation of the words and sentences.

Goodbye, Kent, and thank you for the words you have spun out for us.