The Pain, the Patient, and Subjectivity
WILLIAM CUTTER
SHMA.COM
I wrote the following essay more than six years ago.
Today, the relationship between the fragility of the patient in a medical encounter and the concern about
how our health care is delivered to the broad swath of
American people appear ever more connected. We
know, now, that patients in the privacy of the doctor’s office feel less fragile when attention is paid to
their narrative; and we also know that the increasing
numbers of our citizens who worry if they will receive
even basic care will feel less fragile if health care were
a right rather than a privilege in our country. My hope
six years ago, and now, is that we realize that no matter how we interpret Jewish law or lore, we might all
agree that Judaism must address the anxieties that
are a consequence of fragility. In both the macro and
micro sense, we can learn to speak from our pain.
We hear a lot about the disenfranchise- ment of patients. Patients seem to suf- fer a double insult: medical expenses
are out of control, and we don’t get enough attention from our doctors when we’re suffering.
But doctors are also disenfranchised. They tell us
that they can’t make it in this economy if they
spend too much time with patients, and they
have lost some control over their once singular
profession.
The narrative story of patients is subjective.
The word “subjective” places the ill person at the
center of his or her experience. Doctors are the
subject of another story, and they too need to
have their stories heard.
Patients have been telling stories for a long
time. While they are eager to tell stories to their
doctors, doctors are sometimes too impatient to
hear those stories. Three instances will illustrate
this point. Sherwin Nuland, prize-winning author
of How We Die and Yale surgeon, has suggested
that too many doctors look at the patient’s illness
as a problem to be solved rather than seeing a person to be healed. Lewis Thomas, the former dean
of American public doctors and president of
Memorial Sloan Kettering hospital, once worried
that medical students lacked experience with illness. His suggestion to inject medical students
with a virus in order to appreciate the feelings associated with illness was prophetic; numerous stories by doctors about their own health experiences
have surfaced in recent years. Along with Oliver
Sachs, who usually narrates fantastic stories about
his most interesting cases, and Jerome Groopman,
who sticks closer to the day-to-day, a young physician named Geoffrey Kurland recently wrote a
book about his experience with leukemia. He discovered that, until his own illness, he never understood the stories his patients were telling him.
These story-telling doctors have had significant
influence on medical education. New programs
have crept into medical training at many of our
most important medical schools; at Columbia’s
Medical School, medical professionals are learning
more about narration.
Healing lies with doctors and other caregivers
who have the time and ability to hear the story. In
every aspect of the health encounter, a tension exists between a doctor, called to a briefer discourse
by a need for clarity, and a patient, inclined to ambient and ambiguous descriptions. JTS Professor
David Roskies describes this polarity in a recent
discussion of Walter Benjamin: the opposition of
the moral universe of experience with the alienated world of facts. At the center of the moral universe of experience resides a patient; his or her
illness associated with the alienated world of facts.
While the doctor decides where to situate himself
or herself — between narrative and fact — the patient may have no choice.
Patients’ stories often, not always, have a redemptive character; but they always place the individual at the center of episodes at a time when
that individual may be moving to the margins of
the world they inhabit. Thus even an account that
relates a downward spiral, even a tale whose fragmentations defy coherence, may have the healing quality of valorizing a life. And the unfolding
narrative may help the patient think about her
own life and the opportunities to reconstruct it
once her crisis has passed.
Where else would a patient tell this “unique”
tale? While the medical professional experiences
prodding, poking, anxiety, and disappointment as
routine clinical experiences, they (the probings
and anxieties) are unique to the patient who
seeks two seemingly contradictory goals: to be
part of one contiguous illness story — entering
the sharing community of the ill — and to stand
out as an individual whose story is worth telling.
I entered the world of the sick nearly twenty-five years ago when I had my first of several coronary episodes. A mild heart attack resulted in long
hospital stays, bypass surgeries, and other interventions. I have been scared in the middle of the
night by burly paramedics, and lived with days of
uncertainty about my future; I have leaped and
jogged and sailed — and, yes, written my way to
unimagined enthusiasm and joy. My family has
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William Cutter is Professor
of Education and Hebrew
Literature, and Paul and Trudi
Steinberg Professor of Human
Relations, at the Los Angeles
campus of HUC-JIR. He is also
Director of the Kalsman Institute
on Judaism and Health.
