Three works by William Carlos Williams

On May 14, the Medical Humanities Reading Group looked at three works by the physician-poet William Carlos Williams, the short story “The Use of Force,” the autobiographical excerpt “The Practice,” and the poem “The Birth.”

Two themes captured the group’s attention, one quite specific, one more general. First, many wanted to challenge the narrator’s behavior in the “The Use of Force.” There, the narrator, a general practice physician, is called to diagnose a feverish young girl. When she refuses to open her mouth, preventing him from determining whether she is suffering from diphtheria, he finally forces her jaws apart using a spoon. Was the harsh treatment necessary? Was the general practitioner prepared to deal with the special needs of the child? And what was motivating the doctor? Although the group — and the narrator — recognized the possibility that force might have been called for by concerns about the spread of the disease and the need for diagnosis, Williams’s character took himself to be driven by anger, but a sense of rivalry and competition with the girl. And what does it say about the piece as a bit of constructed fiction that the doctor, motivated by a drive to subdue the girl, turned out to be right in his suspicion?

Then group also discussed the doctor’s life — how Williams must have been as a person, as a father, as a husband, while he attempted to be both a poet and a physician, and how the practice of medicine is changing from the sort of family practice Williams depicts in these writings to a more corporate practice today. “The Practice” captured Williams’s focus on poetry to the exclusion of everything. His family was denied attention (as group members noted from secondary readings about Williams), and medical practice served as material source for his writing, both in financial terms and in subject-matter terms. The demands on Williams’s time led to a discussion of how the life he led, as the dedicated physician for a neighborhood, reflects a sort of practice which has effectively disappeared from the United States.

Carel’s “Illness”

On April 2 the Medical Humanities Reading Group discussed a book by Havi Carel called Illness.  Carel is a philosopher in the UK as well as a patient with LAM, a chronic and severe lung disease.  Her book was written about her diagnosis and experience of the disease while the disease was still considered life-threatening (in 2008).

In the book, Carel contrasts naturalistic approaches to illness and treatment with a more philosophical approach which she develops, drawing on the tradition of phenomenology.  Despite her academic pedigree and philosophical approach, the book is refreshingly candid and personal.  It includes many anecdotes and experiences as they happened and felt to the author herself, and as a result Illness makes for both very compelling and quite edifying reading.

The book’s open tone and frank style prompted many personal observations and disclosures from members of our discussion group, as well.  Our literature experts—the English teachers among us—informed us that this kind of response can be called “text-to-self” observation (as opposed to “text-to-world” observation).  After everyone had a chance to share their response to and any queries about the text, the group focused on issues of sociality, empathy, and medical practice.

Discussion overwhelmingly centered around what one could do—in the difficult circumstances of having or having to help someone with such an illness—to be a better friend, a better doctor, or just a better person.  Happily, there is now some treatment for LAM, so Carel’s situation, and the situation of many other women with LAM, has improved.  But the treatment is not a cure, and even getting some respite in the form of this treatment requires proper diagnosis as well as access to medical care.

Aronson’s “A History of the Present Illness”

On March 12, Dena Rifkin led discussion of Louise Aronson’s A History of the Present Illness.  Aronson’s book is a wonderful collection of fictional short stories just out in paperback in January 2014.  Two stories in particular from the collection were discussed at length: “Blurred Boundary Disorder” and “Giving Good Death.”  Discussion focused on themes of class, race, and other kinds of boundaries, as well as on the particular experiences of being a doctor in a large urban center.  The group also compared Aronson’s fiction to other examples of much more classic doctor-writing that the group has discussed in the past—such as Hawthorne, Chekov, and Bulgakov.

Bulgakov’s “The Steel Windpipe,” Kafka’s “A Country Doctor,” and Chekhov’s “A Doctor’s Visit”

For our February 12 meeting of the Medical Humanities Reading Group, we looked at three short stories:  Bulgakov’s “The Steel Windpipe,” Kafka’s “A Country Doctor,” and Chekhov’s “A Doctor’s Visit.” These three strikingly different stories of country doctors led to three interesting discussions of the personal relationships that doctors develop.

We started with the Bulgakov story of a young, newly minted physician who is faced with an emergency surgery he has never before performed. The group picked out two themes to discuss. First, we discussed the way the doctor interacted with the other characters, especially the way he led the young girl’s family through making the decision to submit her to surgery and the way he made use of his assistants, especially the fainting feldsher. We also discussed the tension of being a new doctor, fresh from training (which can never prepare a young doctor for everything), and working on one’s own. Our doctors relayed some of their own first-day stories — it seems Bulgakov well captured the anxiety and tension of facing those first few patients alone.

We then turned to Kafka’s “A Country Doctor.” Many in the groups found Kafka’s narrative hard to follow — and harder to understand. But we tried on an interpretation of the story where the characters — especially the groom who threatens the doctor’s Rose and the boy who the doctor is summoned to treat — stand in for elements of the doctor’s personality, seeing the story as like a dream the doctor has where his anxieties are personified. The story then can seem like a way to tease apart the doctor himself, to see the way the doctor’s relationship to himself as a person can seem fraught.

We finished with the Chekhov story. In addition to its economic and class themes, that story touches on the integral role empathy can play in enabling doctors to treat patients. The doctor’s judgment as an outsider of the factory workers and their conditions and his judgment of the ill young woman as unsophisticated and unattractive interferes with his ability to treat her. He is able to see her as she actually is only when he discovers her to be intelligent and interesting.

Anatole Broyard’s “Intoxicated by My Illness” and Brian Fies’s “Mom’s Cancer”

The January 8 Medical Humanities Research Group opened 2014 with the discussion of two illness memoirs. The first, Anatole Broyard’s short essay “Intoxicated by My Illness,” recounts the author’s surprising response to a diagnosis of prostate cancer. “I thought that time had tapped me on the shoulder, that I had been given a real deadline at last.” Awareness of time ticking – like a taximeter – fills Broyard with a “hot flash of ontological awareness.”

A literary essayist and New York Times book reviewer, Broyard had witnessed and written about his father’s own struggle with prostate cancer in an essay published in 1954. Broyard now turns his literary attention to his own illness.

The lyricism and intelligence of Broyard’s writing struck nearly everyone. Several participants noted the classic theme of illness functioning to raise awareness of not only of death, but also of life. Broyard describes the heightened “joy” of the sick man. What emerges from suffering is “revelation.” Like Tolstoy’s Ivan Illyich, Broyard finds in illness something he did not find in health: gratitude in simply having a body that functions, appreciation for what formerly went unnoticed.

Some in the group disliked the tone of self-satisfaction in the essay. Broyard, one member commented, suggests that he has entered a land that others have yet to recognize or understand, e.g., “I know better now. I see everything with a summarizing eye.” Others wondered whether the author was fully honest about his experience. Is anyone really this happy about a cancer diagnosis?

The cheerful, chipper style of the essay led to analysis of Broyard’s expectations of the cancer patient. Like certain other narratives of serious or chronic ill health, “Intoxicated by My Illness” reflects a heroics of illness. Cancer patients are no longer “victims,” but “survivors.” Diagnosis is a turning point, bringing with it existential clarity, good humor, and the willful overcoming of indisposition. While Broyard mentions that the elation he feels is just a phase, the essay itself leaves little room for daily indignities, loss, pain, or the fear of an uncertain future. He confesses to the “sheepishness” he would feel if he didn’t finish the book he’d promised himself and the world. Despite illness, even cancer, the patient must meet such demands with valor and optimism. This posture fits well, participants noted, with an American narrative of overcoming: the immigrant experience, the Horatio Alger story, the injured athlete who nonetheless wins the race, and so on. Another member pointed to the potentially negative split between what others may expect and what the patient herself may want or find herself able to attain.

The second memoir, Brian Fies’ Mom’s Cancer, shares with the Broyard an upbeat, uplifting tone. Group participants enjoyed the book, even those who had not previously read graphic novels. Discussion began with several examples of Fies’ masterful use of the visual. Cartoon panels grasp the fragmentation of medical treatment: bend this; flex that. They also expose the slow but inexorable loss of hair and posture during chemotherapy.

Mom’s Cancer tells the story of the entire family: the patient, her three adult children, and a distant ex-husband. It also explores issues of blame (“we told her to quit smoking”), the struggle between hope and honesty (“doesn’t she understand 5%?”), and family dynamics (“If he calls, don’t tell him”).

Some limitations of the book, particularly in the context of medical education, also came to light. Fies makes no mention of finances or their impact on treatment choices (his mother had good insurance). Nor does the book explore the patient’s obvious depression during treatment. That said, all agreed that Mom’s Cancer brought much to the discussion of illness and its impact.

Susan Sontag’s “Illness as Metaphor”

In December, we discussed Susan Sontag’s “Illness as Metaphor” and juxtaposed this with her son David Rieff’s account of Sontag’s death.  Sontag lashes out against the use of literary metaphors for illnesses, particularly the ‘blame the sufferer’ metaphors where cancer is a result of a certain personality.  Sontag’s essay itself could be used as an annotatable reference to most of the last 2 centuries of literature about tuberculosis and cancer, and we debated how much literary knowledge one has to have in order to appreciate Sontag’s arguments.  Sontag herself had cancer when she wrote the essay, and it is a sort of polemic against making illness into anything other than itself — in favor instead of separating the person entirely from the illness.

We discussed the ongoing use of metaphorical language in the clinical realm, and various participants had different takes on how ubiquitous this usage is or should be.  Cancer, it was generally felt, did have a certain ‘aura’ about it that other diseases did not have.

Sontag herself had an overwhelming fear of death and pursued the most aggressive therapies in lieu of accepting her third cancer as incurable.  This set up a situation in which she died in a mode of extreme suffering.  Her son’s essay details the pain this led to for her and for her loved ones as well.  This led to discussing the ‘good death’ and whether this is mainly for the ill person or for those who surround them.  We also talked about whether metaphors can interfere, or support, the ill person through their final illness.

Abraham Verghese’s “The Tennis Partner”

For our second meeting of the Fall term, we read Abraham Verghese’s The Tennis Partner. Verghese writes about his relationship with David Smith, a medical student under Verghese’s supervision while he was practicing medicine in El Paso, Texas. The two men bond on the tennis court, Verghese an avid amateur and Smith a former professional, and that allows them a friendship beyond the working hospital. The book then follows their relationship as Smith suffers a relapse of his drug addiction.

Our discussion of the book was lively and engaged. As is our custom, we began by allowing each member of the group a few minutes of time to offer a few comments on the book, without interruption. Many members of the group related this book to other texts by Verghese, including his My Own Country about his time working in Johnson City, Tennessee. The group was also impressed by Verghese’s felicity with diagnosis and by his ability to capture so many facts, medical and otherwise, that factor into diagnosis.

That said, the group was fairly critical of Verghese. Many members of the group questioned Verghese’s self-awareness. The group compared Verghese’s involvement with Smith to his involvement with his wife. (The marriage eventually ended in divorce.) The descriptions of Verghese’s interactions with Smith were emotionally rich and reflective, and, with some exception, Verghese’s descriptions of his failing marriage seemed brief and dispassionate.

The group also expressed skepticism about the manner in which Verghese conducted his relationship with Smith. Verghese was both Smith’s instructor and his supervisor, and so Verghese was responsible for Smith’s development as a medical professional and also the treatment of Smith’s patients. The group was concerned about Verghese’s facile approach to expanding his relationship with Smith outside of the hospital, especially as the two became more emotionally connected. This led the group to discuss what sorts of professional obligations and considerations medical faculty face, especially with regard to developing personal relationships with students. The group also discussed whether Verghese handled Smith’s drug addiction appropriately, with many concerned that Verghese seemed to allow his concern for Smith as a friend and student to outweigh his concern for the appropriate care of Smith’s patients. There was a lively (and productive!) division in the group as to how Verghese should have handled Smith, though it seemed clear that there was no easy and clear approach that could have resolved all of Verghese’s obligations.

Mary Shelley’s “Frankenstein”

After taking a short hiatus over the summer, the Medical Humanities Reading Group reconvened for the start of the 2013–2014 academic year.  Meetings will again be held throughout the year on the second Wednesday of each month at 6pm in the Philosophy Department Lounge on the 7th floor of the Humanities and Social Sciences Building.  Our first meeting this fall was held on October 9th, and the topic of discussion was Mary Shelley’s classic story Frankenstein, first published in 1818.

Discussion on Wednesday night was fantastic as usual.  We started out with introductions, since though many former participants had returned, we also had several new faces.  The group continues to consist of people from a broad range of professions: university grads, faculty, and staff; doctors and medical students; philosophers and psychologists; english teachers and lit profs; surgeons and accupuncturists.  The breadth of life and work experience among the participants makes for an incredible scope of perspectives and contributions during discussion.

As is our tradition, the group began discussion of the reading by giving everyone in attendance a chance to share, uninterrupted, their first impressions and persistent questions from reading the text.  Many themes were raised throughout these comments, including: the fantastical elements of the narrative, with hints of early sci-fi; the affect of alienation on development; the importance of appearance to social and cultural reception; strains of alchemism, reductionism, and vitalism in the science of the period; and the portrayal of tension between different moral imperatives such as the greater good, the discovery of knowledge, and the keeping of promises.

An observation that more than one reader shared was just how astounding it was that Mary Shelley could write such a culturally insightful, expertly crafted, and chillingly compelling novel at the age of only 19.  The group discussed some of the author’s life history as a means to gaining some insight into the genesis and method of her achievement.  I’ll try to reproduce some of the incredible history we discussed below.

Mary Shelley was born in 1797, the daughter of Mary Wollstonecraft (feminist and author of The Vindication of the RIghts of Women) and William Godwin (a famous novelist and political philosopher in his day).  Unfortunately, her mother died from complications giving birth to her—the placenta tore, became infected, and Mary Wollstonecraft died of septicemia 11 days after her daughter’s birth.  (According to the doctors in our group, this was known at the time as ‘purple fever’, and was a scourge of humanity for millennia, until doctors learned to wash their hands before treating women in labor).

Mary herself also faced plenty of complications related to childbirth throughout her young life.  She met and fell in love with Percy Shelley, already a famous poet and a devotee of her father, when she was just 15.  Percy was already married, but Mary lost their first child at the age of 17, in April of 1814.  The baby was born two months premature, and died only two weeks later.  Purportedly, Percy spurned the infant, shocked by its appearance, and abandoned Mary at her bedside.  He subsequently began an affair with her half-sister, Claire Clairmont, but made up with Mary shortly thereafter.  Mary and Percy eloped to the Continent later that year—and Claire went with them.

In the summer of 1816 Mary and Percy summered with Lord Byron (the poet) and John Polidori (an English writer and physician) in the Swiss Alps.  One day at a picnic the four writers challenged each other: who could pen the best horror story?  A few weeks later, Mary wrote Frankenstein.  Later that year, Percy’s wife Harriet killed herself, and Percy and Mary immediately married.  (Mary’s half sister Fanny Imlay had also killed herself that fall, after a long depression that began with her desolation at having been left behind when Mary and Claire absconded with Percy.)  Mary lost a second child, and a third, before giving birth to her fourth, last, and only surviving child, Percy Florence.  (Mary’s third child died after Percy dragged his family to Venice to meet up with Claire, now Byron’s mistress and mother of his child, who was sick.  Mary’s child promptly caught the illness from Claire’s and died.)

But I’ve skipped ahead.  Apropos of the personal drama, Frankenstein was first published anonymously two years after Mary wrote the story, in 1818.  Percy wrote and signed an introduction to this first edition of the novel.  In the second edition, published in 1823, Mary Shelley’s name was printed, revealing her as the author to the public.  By this point her husband Percy had already died, in 1922, in a boating incident.  It is still uncertain whether his drowning was an accident, suicide, or murder.  His and Mary’s son, Percy Florence, eventually inherited the Shelley family’s earldom.  Mary Shelley never remarried or had any other children, and she died of a brain tumor in 1851 at the age of 53.

And to all this back to the novel itself: in Mary Shelley’s Frankenstein, an ambitious young scientist named Victor Frankenstein fashions a creature, hewn from corpses claimed from the graveyard, and imbues it with life.  Upon its (re)annimation, Victor is disgusted by his feat rather than triumphant, and flees his laboratory in shock and horror.  His creature is left behind to understand and enculturate itself.  Repeatedly spurned by its creator and others traumatized by its appearance, the monster turns on Victor, and they engage in a battle of life and death that ranges across continents.

Some have speculated that Victor’s horror upon viewing his creation, and his subsequent abandonment of it, are based on Percy Shelley’s reaction to Mary’s first premature infant, and his abandonment of them both.  Percy often used the pen name Victor when publishing anonymously, and that’s also the name that Mary chose for her protagonist.  Regardless of this possible source of inspiration for the story, it simply cannot be denied that Mary Shelley’s creation is a work of genius with enduring power and timeless relevance.

Siddhartha Mukherjee’s “The Emperor of All Maladies: A Biography of Cancer

On June 12, Mary Devereaux led discussion of The Emperor of All Maladies.  The group read various selections from the extremely large book: the author’s note and prologue; part one (Of blacke cholor, without boyling); part four (Prevention Is the Cure); and the last chapter (Atossa’s War).  Discussants generally agreed that the book was excellent both as a historical and a conceptual treatment of the subject on cancer.  Several participants confessed to having read the entire book, rather than only the selections, simply because it was just so good.

A Collection of Pieces by Female Authors (Sylvia Plath, Eudora Welty, and Virginia Woolf)

On May 8th, Dena Rifkin led discussion of three pieces of literature written by female authors about the experience of being a patient, caretaker, or observer of illness.  The group read and then discussed a one-page poem by Sylvia Plath called “Face Lift”; a short story by Eudora Welty called “A Worn Path”;  and an essay by Virginia Woolf called “On Being Ill.”  Discussion was stimulating as usual and focused on themes of vulnerability, discrimination, and metaphor, as well as on the fantastic prose of all three writers.