Arnold Weinstein - A Scream Goes Through The House (32 page)

And Jesus went on from there and passed along the Sea of Galilee. And he went up into the hills, and sat down there. And great crowds came to him, bringing with them the lame, the maimed, the blind, the dumb, and many others, and they put them at his feet, and he healed them, so that the throng wondered, when they saw the dumb speaking, the maimed whole, the lame walking, and the blind seeing; and they glorified the God of Israel. (Matt. 15:29-31)

And we all know that his gift is moral not scientific: he heals by dint of spiritual power, not medical training. It seems fitting to consider the
loving
doctor for a moment, after passing in review so many of literature's cold, heartless, and exploitative types. In "The Surgeon as Priest," Richard Selzer has given us a fascinating picture of the doctor as spiritual hero in his account of Yeshi Dhonden, the personal physician to the

Dalai Lama, making the rounds in Selzer's hospital. In the episode in question, we have the starkest possible of scenes: a fatigued, chronically ill patient lying supine and a physician in safran and maroon gown. No words pass between them; nor does any complex physiological investigation (probing, knocking, squeezing) take place. All we see is a physician taking a woman's pulse. But this he does for a full half hour, "suspended above the patient like some exotic golden bird with wings, holding the pulse of the woman beneath his fingers, cradling her hand in his" (34).

Selzer (and presumably the other Western doctors) is stunned by the depth, intensity, and sheer length of this most routinized of all initial procedures; Selzer calls it "palpitation raised to the art of ritual." As Selzer observes this act of extraordinary intimacy—"his fingertips receiving the voice of her sick body through the rhythm and throb she offers through her wrist"—he feels a sudden pang of
envy,
not of Yeshi Dhonden but of the patient who has been truly
received,
leading Selzer to the realization that he who has palpitated over a hundred thousand pulses has not truly felt a single one. Yeshi Dhonden concludes his examination by whipping up and then inhaling the urine specimen. Later, in the conference room, the Dalai Lama's physician speaks to the American doctors:

He speaks of winds coursing through the body of the woman, currents that break against barriers, eddying. These vortices are in her blood, he says. The last spendings of an imperfect heart. Between the chambers of her heart, long, long before she was born, a wind had come and blown open a deep gate that must never be opened. Through it charge the full waters of her river, as the mountain stream cascades in the springtime, battering, knocking loose the land, and flooding her breath. (35)

Finally, the "western" diagnosis is requested: "Congenital heart disease . . . Interventricular septal defect, with resultant heart failure."

I have discussed this story with other doctors who express both skepticism and even a sense of anger at the claims made by Selzer here. I am not in a position to judge the medical propriety of Yeshi Dhon-den's procedure and pronouncements, but one is certainly struck by several key features of Selzer's account. The description of this woman's somatic disorder in the rich language of winds, gates, eddies, waters, and cascades achieves a kind of grandeur and vibrancy that make the bioscience terminology seem impoverished and inert. The woman is described by Selzer as a person with chronic illness, a person doubtless accustomed to the routinized visits by hospital staff, used to seeing and hearing herself as diseased (but also in some key sense,
unseen
and
unheard).
To be sure, she herself does not overhear Dhonden's report, but I feel that his splendid series of elemental metaphors, figures we tend to associate with exotic places, is a welcome intensification and enlargement, a way of saying that the human body is more majestic and miraculous and even cosmic than our typical medical vocabulary allows.

Beyond the language itself, however, it is the intense, quasi-religious, almost shockingly intimate bond between diagnostic physician and supine patient that most strikes us here. Selzer is not seeking to indict the routinizing of medical rounds, nor does he imply that the Westerners have it wrong, but all his admiration is focused on the rich, pregnant, dense
exchange
that takes place between doctor and patient, a form of
reading
that is at utter odds with the Foucauldian "scientific gaze," inasmuch as its analytic acumen is shown as inseparable from (deriving from?) a closeness that is visceral, existential, indeed spiritual. One might respond that both Yeshi Dhonden and the Western doctor reach the same diagnosis, but what Selzer is showing us is that only one of them reaches the patient.

And beyond that, Selzer is moved, perhaps even threatened, by this quasi-affective model of knowledge gleaned entirely from intimate touching, listening, and smelling. No medical imaging or blood work needed here: just a sufficiently intense one-on-one. Of course Yeshi

Dhonden has his own science, a science that is doubtless so profound and mastered that the simplest forms of human connection, if conducted with requisite concentration, labor, and care, will enable him to read the body he is holding, is receiving. It is hard to imagine a more benign version of diagnosis: the scientific gaze, based on distance and ocular testimony, is replaced by a no less analytic model, but one that inheres in physical contact bordering on fusion (it hardly seems exaggerated to call it that, given the response of the patient, awakened out of her torpor by the immediacy, intimacy, and [one wants to say] charity of this encounter). It is well to remember that Paul's parable of "looking through a glass darkly" explicitly codes ultimate light and knowledge as "charity."

The doctor-patient relation is at the very core of medicine as a humane practice, and yet, much of this chapter has focused on just how much damage (as well as benefit) the diagnostic gaze can bring to that relation. But love and charity are sometimes found where we don't expect them, and for that reason I would like to revisit, briefly, the disastrous situation of Kafka's country doctor. In particular, I want to return one final time to that bed where the doctor lies naked next to his patient. If you are a doctor, I would guess that this prospect fills you with dread. (Doctors have told me that this ghasdy story constitutes their worst nightmare.) We have seen that this doctor can control nothing: the horses appear, the groom appears, the wound appears: so unlike the authority and control that most of us laypeople associate with physicians. Yet, there is wisdom as well as punishment in this story. Kafka seems to be showing us, with rare power and surreal images, a story of radical
leveling,
a fable of equality. The doctor is stripped of his accoutrements and protective gear; he is not all that different from the "poor forked creature" that Edgar becomes in
King Lear,
and Lear's hard-earned wisdom at play's end consists in seeing that being a king and being a poor forked creature are the same thing.

Can we not go one step further? Isn't Kafka suggesting that the great diagnostic challenge, the riddle of the wound—the fate of flesh that

marks the human creature as far back as Philoctetes—can only be understood along just these lines? That you cannot fathom the wound, heal your patient, until you have lain down naked on the bed with him. One might claim that we see here the purest form of Kafka's metamorphosis: to understand the other, you must become the other. The doctor must, at some level, become the patient. It is a severe lesson, not likely to be popular with physicians, at odds with the prestige of modern medicine, yet suffused with the light of human charity.

MARRYING YOUR PATIENT

Charity,
caritas,
a form of spiritual love, even though keyed (here) to the body, has no libidinal dimension whatsoever. As I suggested in my account of Hawthorne, the diagnostic relationship can indeed be unmistakably charged with displaced sexuality; as we saw in William Carlos Williams's tale of the child who refused to open her mouth for him, affect and libido had their way there as well in the doctor's vehement charge. And Kafka's country doctor is awash in libido.

But what happens when the diagnostician experiences, directly, not subliminally,
eros
instead of
caritas
? When the doctor-patient bond is sexualized? All of us know that this can happen, that physicians can be involved with the patients they treat. And we know something of the damage that can result, for both parties: the ruin of a reputation and career for one, the insidious and exploitative presence of desire (where there should be distance) for the other. It is easy enough to claim that the doctor-patient relationship is violated by such transgressions (as are the lawyer-client or the teacher-student relationships), but what is harder is to ponder the diagnostic paradigm itself along these lines. How much tenderness is right? Does diagnosis inevitably conceal a cluster of emotional tugs, forces? When does concern shade into something hungrier? What are the results?

I'd like to point to two remarkable literary texts that deal with these murky matters, one of them a sibylline, pithy short tale, the other a fa-

mous novel: Sherwood Anderson's "Paper Pills" and F. Scott Fitzgerald's
Tender Is the Night.
Anderson's story, drawn from
Winesburg, Ohio,
is, in my view, as perfect and fascinating a piece of writing as we have in American literature. It exhibits to perfection what art and literature have to offer us when we think of nitty-gritty issues, such as sickness, death, and dying, not because of any overt philosophical message, but rather because Anderson seems to have caught (in his four-page piece) the whole beast live: our desire for love, our need for doctors, the fate of flesh, the life of the community.

If his story initially seems a riddle, it is because the dynamics of birthing and dying, sickness and desire, person and place, are unclear even to the cleverest of us, even though we sense that they are the potent forces that punctuate our existence. Hence, the actual story constitutes a diagnostic challenge to its readers: how to make sense of its parts, its metaphors, its strange events? Anderson's hero, Doctor Reefy, is described as a man in whom "there were the seeds of something very fine" (35). Why
seeds?
Listen to the story:

The story of Doctor Reefy and the courtship of the tall dark girl who became his wife and left her money to him is a very curious story. It is delicious, like the twisted little apples that grow in the orchards of Winesburg. In the fall one walks in the orchards and the ground is hard with frost underfoot. The apples have been taken from the trees by the pickers. They have been put in barrels and shipped to the cities where they will be eaten in apartments that are filled with books, magazines, furniture and people. On the trees are only a few gnarled apples that the pickers have rejected. They look like the knuckles of Doctor Reefy's hands. One nibbles at them and they are delicious. Into a round little place at the side of the apple has been gathered all of its sweetness. One runs from tree to tree over the frosted ground picking the gnarled, twisted apples and filling his pockets with them. Only the few know the sweetness of the twisted apples. (36)

This story about apples and seeds harks back to Genesis, to one of the oldest fables we know about carnal knowledge, also redolent of sweetness and delicious apples. And we need to understand that
seeding
is a kind of spawning, a spawning that can be ideational and verbal as well as biological. Note how Anderson's prose moves in every direction at once, so that the "nibbling" in the passage refers backward to Reefy's knuckles as well as forward to the "little round place" in the apple. But then nibbling shades off into something considerably fiercer as Anderson evokes the tall dark girl's earlier love life:

For a time the tall dark girl thought she would marry the jeweler's son. For hours she sat in silence listening as he talked to her and then she began to be afraid of something. Beneath his talk of virginity she began to think there was a lust greater than in all the others. At times it seemed to her that as he talked he was holding her body in his hands. She imagined him turning it slowly about in the white hands and staring at it. At night she dreamed that he had bitten into her body, and that his jaws were dripping. She had the dream three times, then she became in a family way to the one who said nothing at all but who in the moment of his passion actually did bite her shoulder so that for days the marks of his teeth showed. (37-38)

Desire fuels everything: it lurks under the fine talk about virginity, it animates dreams, it is ravenous for flesh. With sure instincts, Anderson then moves from these teeth marks to still another episode of blood and teeth, forcing us to wonder if perhaps blood and teeth might be nodal points of a story or a life, might be sites where flow and penetration happen, where we actually taste life and other people. The reader simply has to roll with the punches, to grasp the corporeal logic here.

In the office of the doctor there is a woman, the wife of the man who kept the bookstore in Winesburg. Like all old-fashioned country practitioners, Doctor Reefy pulled teeth, and the woman who

waited held a handkerchief to her teeth and groaned. Her husband was with her and when the tooth was taken out they both screamed and blood ran down on the woman's white dress. The tall dark girl did not pay any attention. When the woman and the man had gone, the doctor smiled. "I will take you driving into the country with me," he said. (38)

Perhaps you wonder why I cite this story, since it may seem incoherent, all over the map. I would suggest that Anderson's manner is poetic, an affair of metaphors and figures that link the disparate parts together. Anderson does not choose this method because he shies away from saying anything direcdy, but because the things he wants to say can be said in only this way. What are those things? Seeds produce life; biting into apples and into flesh produces sweetness, but also life, and perhaps blood and death as well; sex and birthing may each entail groaning and blood on a white dress. We know that the tall dark girl was "in a family way," and also that she became the doctor's wife, left him money, and died.