Literary humanists have always believed that stories are what we trade and tell to make sense of the world. I would like to relate a powerful story that has a memorable message and has served as fodder for much personal introspection. It is sad, unfortunate, and perhaps unbelievable, yet true. It applies specifically to physicians and health care workers who may overlook the imperative to do no harm. It delves into how we can dangerously “disconnect” from anyone under our care, be it physical, emotional, or spiritual.
My story begins in my early days as a physician. On a night on call, my superior took me aside and explained the theory behind an experiment that was about to take place. Simply put, it was hoped that if an asymptomatic HIV-positive patient could be warmed to an extremely high body temperature, the HIV virus in his body might be killed in vivo and the patient cured of AIDS. In those years we did not have some of the powerful anti-viral agents we use today in the treatment of HIV disease.
The experiment began with a young, well-looking man walking through the hospital doors. Members of his family accompanied him and sat supportively while a consent form was completed. With little melodrama, they quietly said their farewells. Blood work was taken, IV’s started, and a central line inserted. Then he donned a wetsuit.
For the entire night, this patient wore the wetsuit. Since his skin pores were unable to drain, his body temperature began to rise. Each hour we took blood tests to monitor his progress chemically. As monitors flashed and beeped, his proteins denatured in the hot blood and he developed a dangerous bleeding disorder called disseminated intravascular coagulation. I transfused blood products in an effort to reverse the process but was unsuccessful. The man who had looked and felt fine a few hours earlier slowly exsanguinated in front of me. I was helpless, and by change of shift the next morning, he was dead.
My thoughts often return to the heat of that tragic night, when my sweat blended with his as I vainly tried to save a man who had trusted us. Many years later I am still trying to work out some of the answers. Recently I was inspired by a concept that sheds some light on the central dilemma of our story. It is the idea of “connectedness” or holiness in our lives. To explain it, I must recount another much older story.
In the Book of Exodus, we read that as Moses prepared to ascend Mount Sinai, God revealed himself for the first time to the people of Israel. A Midrashic (allegorical) interpretation of this event by the early Jewish sages notes that God arrived in a chariot accompanied by lightning and thunder. This chariot bore four different images, including a calf, and was splendid and glorious. The people were awestruck by the fiery display, focusing not on God Himself, but rather on His wondrous vehicle. Later, when Moses ascended to fetch the Ten Commandments, people fashioned their own “god” from molten gold, in the form of a calf. Their focus on the “external” image of God and their idolatry is what ignited God’s fury. The people were thus condemned to wander in the desert for forty years.
The importance and significance of this transgression is vital to an understanding of our everyday relationships. The Hebrew term “avodah zara” means “worship of the strange or disconnected part” and is commonly used to signify idolatry. In Judaism, avodah zara is one of only 3 cardinal commandments in relation to which a Jew should choose death rather than transgression. If applied more globally, it means there is danger when our attention is focused on superficialities instead of deeper realities and ethical responsibilities. One expression of this interpersonal imperative lies in the physician-patient relationship, which vests complete trust in life-and-death decisions.
There is an enormous challenge to resist the “strange or disconnected parts” in our modern world. How many of us own a TV, computer, cell phone, pager, access to the Internet, personal digital assistants, and the many other technological wonders of our era? In the race to apply incredible technology to our lives, we have undoubtedly left behind equally valuable moments in our every day. The phone calls us away from the book we are reading with our child. The pager distracts us from a conversation. TV is watched to an almost pathological degree, resulting in an epidemic of obesity. Multitudes are literally addicted to the Internet, a virtual surrogate for face-to-face interaction between humans. Family time around the kitchen table and “down time” when life just happens spontaneously are increasingly shortchanged.
How we connect with one another impacts us globally on every level. As a recent ad for the Toronto Star puts it: “You may have eyes to see, but do you have vision?” or “You may read, but do you communicate?” Human understanding and empathy, in addition to our clinical skills, are critical in the healing profession. At a more spiritual level, and for each of us, this connection with one another brings wholeness into our own lives.
In retrospect, I now recognize attributes which, had they not been lacking in that young and less assertive physician, might well have saved her trusting patient’s life. Courage would have propelled her to confront her superiors regarding the morality of the research study. Independent inquiry would have inspired new ways to solve the dilemma of this challenging clinical scenario either by ending the study prematurely or by exploring alternatives to the in vivo experiment. Finally, inner strength would have allowed her to reach out to her patient as he confronted death, even if there was nothing more that could have been done to save him.