I’ve just finished my second medical memoir, which I’m calling it Healing by Intent. So I’m posting a few extracts here on my website and on my Facebook site. The last one I posted three weeks ago – Professional Grief – was about the tough issue all we caregivers face, that of dealing with our own undischarged pain and distress in our work – something that can very often build up inside us, to our patients’ and our own detriment.
Now I’m posting an extract from the prologue to Healing by Intent, which is about how I ended up with the book’s title. Here goes…
Wounds—the ones to our bodies, that is—heal by either first (primary) or second intention. First intent leaves no tissue loss, so there’s no scar, or a very skinny one. Second intent means the wound’s edges are too far apart to come together cleanly. Healing takes longer, and leaves a lasting and visible scar. But either way, it’s still a miraculous thing.
That word, healing, has its origin in wounds— physical, psychological, spiritual, or all three together. We experience healing from our earliest childhood: a loving touch, a “kiss to make it better”, a murmur of maternal lullaby. It means, at its simplest, returning to health. But healer, used (as it mostly is) to refer to doctors and nurses and the like, is a misnomer. To heal is an intransitive verb: when wounded, we do our own healing, or try to; it’s not others who heal us—even if we health professionals often fall into the trap of thinking we do. “God heals, and the doctor takes the fee,” said Benjamin Franklin. He might better have said that we heal ourselves through God’s will.
Good relationships between patients and doctors, however, definitely affect how well and how quickly an ill person heals. This role for doctors, especially in the presence of incurable illness, is a form of placebo. The Merriam-Webster dictionary defines placebo as ‘an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance’. This is a very narrow description. Ted Kaptchuk, professor of medicine at Harvard, applauds doctors who themselves act as placebos, knowing that healing comes with a caregiver’s nurture towards the one cared for. Dr Kaptchuk found a deeply caring physician could give a ‘placebo-pill’ to a patient and tell them its ingredients were totally inactive, yet the patients still got better when they took it. They were experiencing the powerful feeling of being in loving and honest hands. This is true healing at work—healing by intent.
My forty-year career in academic medicine—from 1966 to 2005—more or less coincided with the miraculous improvement in treating children with cancer. But the thrill of being part of that extraordinary success, of working with a steady succession of effective new drugs and other therapies, paled before the God-given intimacy of being present with a child and family as they came to trust me, to feel safe in pouring out their feelings. Nothing in medical school prepares you for that kind of revelation. My career in medicine gave me far more joy and fulfillment than failure and pain. But learning to balance the joy and the sadness—that was the trick.
When it comes to treating people with the same illness, they are usually grouped together to receive the same protocol. But if any given disease is readily categorized, every single person with that disease remains unique; they all have different stories. Robert Fulghum in his book All I Ever Needed to Know I Learned in Kindergarten, describes the Storyteller’s Creed: imagination, myth, dreams, hope, and love are more powerful than knowledge, facts, experience, grief, and death. The words I would hear at the bedside were not those overheard at the supermarket check-out line. Bedside conversations can build bridges, close gaps.
I wrote my earlier medical memoir, Journeys with a Thousand Heroes: A Child Oncologist’s Story, as a chronicle. It started with my mother’s death when I was twelve, and ended with my retirement fifty-three years later. The stories in this new one are in no such historical order, but the two books do have this in common: they both tell stories through dialogue, even when only half-remembered, and with a little poetic license woven in.
Everyone has a story; everyone is a story. But having spent my working life at the bedsides of gravely ill children, I have come to know that children mostly experience life’s particularities more fully and richly than do we adults. A few weeks back, I got an email, then a phone call, from the father of a boy I had treated for cancer almost thirty years ago. His son is now almost thirty, studying in seminary, and very soon to enter the ministry. The pictures I have of him as an infant bring back the most shadowy memories – and that is what I’m left with: the miracle of a little boy’s life saved, just one in an ongoing parade down the years.
But such stories are living things—and they live on. Anatole Broyard wrote in Intoxicated by my Illness, his memoir about living and dying with prostate cancer, that we need to become storytellers when we are ill, that we should tell our stories as “antibodies against illness and pain”—a form of healing that is beyond the reach of technology and pharmacology. So I have written the stories in Healing by Intent, first, to uncover the root of my own professional joy and fulfillment; second, to suspend my memories in time, in my quest to understand what it means to be healed; third, to help the givers and receivers of care to draw closer, to trust each other more; fourth, to indulge my insatiable urge to create (Matthew Fox calls creativity “the best thing our species has going for it”); and last, to honor my chosen profession, which has rewarded me so deeply, with these stories that I have told with the best words I could find.
Are these stories true-to-life? The answer is that every anecdote, every conversation, has been strained through the sieve of my memory, coming out more condensed and in some ways less messy. Because medicine is by its nature a messy profession. So if my words don’t exactly honour ‘the facts and nothing but the facts’, let’s hope that they do honour art: the art of medicine.
I tried through my career as teacher, researcher, and caregiver to marry art with science in healing—and to never neglect the art of humour. A teenage patient of mine once scolded me, ‘Lighten up, Doc—I don’t need serious doctors around here!’—putting into words what many shyer patients may often have thought. To Anatole Broyard, as he lay in his hospital bed hooked simultaneously to an IV and a urinary catheter, came ‘an irresistible desire to make jokes’. He cried out for ‘a witty doctor who could appreciate the comedy as well as the tragedy of my illness’. Throughout the epidemic in the 1600s of Yersinia Pestis—the Black Death—Venice still found cause to celebrate its time-honoured public celebration—lo carnevale Veneziano. The plague doctors donned their bird-beaks full of dried flowers and spices to visit the sick looking like pure commedia dell’arte characters. A riotously funny sight—and surely a healing one for their patients as much as for themselves. Laughter can be a wonderful antidote to the discouragement, isolation, even despair, that we all feel in the face of distressing and overwhelming events.