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Article Title

Sighs Matter

Last week, a student confided with the class that a doctor berated her for “having tears in her eyes” following a patient’s untimely death. I told her that she just got the “Dean Wolcott Welcome to Medical School” speech. Dr. Wolcott was dean of the medical school in the movie Patch Adams.1 In the movie, Dean Wolcott informs the freshman class, “Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We’re going to make doctors out of you.”2

In a strangely foreboding scene from the film, Patch, played by the late Robin Williams, contemplates suicide. He provokes God with the following speech, “So what now, huh? What do you want from me? You create man. Man suffers enormous amounts of pain. Man dies. Maybe you should have had just a few more brainstorming sessions prior to creation. You rested on the seventh day. Maybe you should’ve spent that day on compassion.”2

The demonstration of God’s compassion depends on people, and as caregivers, we show compassion by caring for our patients. The word care is from the Old English caru, meaning, “sorrow, grief, [or] burdens of mind, [with] serious mental attention.”3 From Hippocrates to Marcus Welby, MD, caregivers were motivated by a heartfelt empathy for those in pain or suffering.

When did the practice of medicine decide that showing emotion was unnecessary, and not only unnecessary, but detrimental to providing health care? I tackled this topic in a roundabout way many years ago while working on my thesis at Penn State. I was examining the evolution of biomechanics, specifically, how the technology of human gait analysis reflected prevailing philosophical beliefs. Objective measurements of human gait were among the first bona fide scientific studies of human anatomy and physiology. They were the first collaborative efforts of scientific researchers, conducted long before cadaver dissection, and certainly long before computerized models. In 1834, Ernst and Wilhelm Weber published the first scientific analysis of human gait.4 The Weber brothers’ mechanistic approach laid the groundwork for the physical science of biomechanics. Walking, dancing, skipping, and leaping for joy was reduced to objectively measured moments of inertia and the calculation of inanimate forces. “Like water moving over a wheel” was the way Ernest Weber described it.5 Emotions blurred the objective eye of the researcher. “The aim of beauty need not be considered, since beauty of movement is merely the efficacy in which these movements occur.”6

Medical engineers found ways to apply the first and second laws of thermodynamics to human anatomy and physiology, as well as biochemistry, histology, and even psychology. Physicians followed the mechanistic foundations laid by physiologists, and viewed the body as a clockwork machine, no more than the sum of its parts, with each part analyzed objectively and subject to the laws of cause and effect. Some caregivers may believe that medical ethics can be reduced to a simple algebraic equation of medical indications for treatment + documentation of informed consent. The more caregivers objectify patient relationships, the easier it is for them to see patients as objects, subject to the same forces as any other manmade object.

The birth of the mechanistic view of medicine correlates with the industrial revolution. The concept of the body as a machine motivated researchers to study and enhance occupational, athletic, and military performance. The founder of positivism, Auguste Comte (1789 – 1857), believed that the study of all human functions should be based on scientific laws discovered through experimentation, observation, and logic.6 The machine became the metaphor for life. Clinical diagnosis became scientific, and the physical science of medicine replaced the art of practicing medicine. It was no longer necessary to explain vital forces and assess or display emotional attitudes and behavior.

My kinesiology thesis began with two passages that describe the human gait. The first description is by Paul Valéry (1923):

A simple walk, the simplest linking of steps!

She seems to be paying space with lovely acts of pure and equal value,

To be striking with her heel sounding effigies of movement.

She seems to be numbering and counting in coins of pure gold

What we squander carelessly in the vulgar change of steps

When we walk about our common occasions.7

And, the second description of the human gait is by Otto Fischer, (1904):

2 - φ = Dm + Ds+ De.8

Medical engineers like Fischer and clinicians who eschew emotional expression ignore the fact that there are at least two kinds of emotion. One kind of emotion is sensual and sentimental and can distract a researcher or caregiver from his or her goal, introduce conflicts of interest, and interfere with therapeutic efficacy. The other kind of emotion, expressed in Paul Valéry’s description of walking, stands in awe and sighs in agreement with nature at the miracle of life, its holiness and fleeting beauty. The first type of emotion is best expressed through sympathy cards and flowers. The second kind of emotion can only be expressed in tears that are shed from looking directly into the dazzling bright light of life.

Who knows, maybe 50 years from now, medical diagnosis and care plans will be entirely in realm of computers like Watson, and the role of the caregiver will be restored to manifesting empathy and compassion - the sighs that matter.9

References

  1. Patch Adams (1998)
  2. Ibid
  3. Online Etymology Dictionary. Available from http://www.etymonline.com/index.php?term=care
  4. Weber, W. , Weber, E. Mechanics of the Human Walking Apparatus, (P. Maquet and R. Furlong, Trans.). Berlin: Springer-Verlag; 1992
  5. Ibid (E. Weber and W. Weber, 2836/1992p, p vii).
  6. Ibid
  7. Comte, A. The Positive Philosophy of Auguste Comte. 2000. London: Batoche Books. Available from http://socserv2.mcmaster.ca/~econ/ugcm/3ll3/comte/Philosophy1.pdf
  8. Valéry, P. (1977). Selected Writings of Paul Valery. New York: New Directions.
  9. Braune, W., Fischer, On the Center of Mass of the Human Body, (P. Maquet and R. Furlong, Trans.). Berlin: Springer-Verlag; 1984.
  10. Say Hello to Watson. Available from http://www.ibm.com/smarterplanet/us/en/ibmwatson/

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