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"I sometimes longed for a doctor to tell me that I might be normal again."
Anyone who has been sick for a prolonged period may remember thinking something similar.
When Nobel prize-winning novelist Saul Bellow found himself in Boston University Hospital two years ago recuperating from a life-threatening case of food poisoning contracted while vacationing in the Caribbean, the longing for recovery--for a return to normalcy--would prove to be nearly as strong as the longing for mere survival.
Recounting that experience as a patient at last month's conference of the Council of Medical Specialty Societies on ethics in health care, Bellow offered a literate perspective on sickness and a poignant illustration of a dilemma that is at the heart of modern biomedical ethics: the dichotomy between caring and curing.
An outstanding team of physicians in the hospital's intensive care unit ushered Bellow away from death. Once his survival was assured, however, who would be concerned about his recovery, the return of his personhood?
It is a question that resonates in discussions about the changing ethical landscape of American medicine. As curative medicine continues to push back death and master disease, what has happened to the caring traditions that sustained medicine before it became proficient at helping people merely to "survive"?
Bellow, released from the ICU but severely depleted from his close encounter with death, was fortunate.
"The one physician who came to see me regularly was Dr. X, the senior neurologist," Bellow recounted.
It was Dr. X who would prove to be more than a curative technician, who saw the patient as more than a sick organ system. It was Dr. X who engaged the author and encouraged him to continue planning for the course he was scheduled to teach at the university. Dr. X even chauffeured Bellow from the hospital to his appointed lectures.
"Dr. X did not think I was bound for a chronic care facility," Bellow said. "He sized me up as capable of making a comeback. I wonder what medical practice would be like if doctors were to dismiss such intuitions?
"Like a skillful scout, Dr. X pressed his ear to the wall. Often this would result in nothing but a dirty ear, but now and then you might hear a far-off locomotive. That far-off locomotive is recovery. Survival is, after all, only a prerequisite. It is the indispensable condition for resuming life.
"But recovery is what the patient wants," Bellow told physicians at the conference. "The team of doctors can keep you this side of death, but what the patient learns is that he needs someone to talk to. . .a help in his time of need.
"I have rejected the temptation to tell a convention of doctors how to behave with their patients," Bellow remarked. "No one can tell them what to do or how to limit the emotional ground they are bound to surrender when patients die. . . .You can't possibly tell adults to be caring, compassionate, and sensitive, to enter into intimacies."
He concluded: "I am deeply grateful to my wife and to the doctors and nurses who saved me in intensive care. But I wonder whether I would have been able to come back without Dr. X. I have given him a lot of thought, and this is what I think: The doctor's outlook is humane, but his training is in science, and science does not see nature as having a soul. But Dr. X, whether he was aware of it or not, did have a soul. . . .[S]o he came early in the morning, late at night, and on the weekends. Nothing is more disheartening than a sickness late in life when your capacity for recovery is getting dim. [Yet] he understood my condition in the widest sense--beyond blood pressure, beyond the loss of muscle mass, beyond the nerve damage.
"I can't say that Dr. X understood the source of his own understanding, or that he was conscious of it, but that is the difference between his kind of work and my kind of work."
(Psychiatric News, May 16, 1997)