Summing Up

Medical folks are by nature students and also generous teachers. "See one. Do one. Teach one." I hope to be forgiven for succumbing to the call to teach (or perhaps "preach") one more time in this summing up.

Following the imperative given by Tullio Seraphim to Maria Callas, for understanding "look to the music," I think first of my work with our family letters of a hundred and more years. With each reading I become struck anew with the depth of love, gentle tolerant humor and empathy that flowed among the various members of the circle of family and friends. Through permutations of place and relationship the correspondence is filled with warmth and closeness sustained through the bond of communication.

I have also found the music in those with whom I worked. It has been my destiny to spend the most of my life journey in intimacy with other souls, not related as family, – with "strangers." I have experienced the power of human interaction structured by professional ethics. And I have found a kind of kinship. In my case this occurred within the study and practice of medicine.

I have considered the traditional professions to be institutions of humanism. As described recently by a friend; "They are callings to serve." One can find recognition of the concerns of traditional professions in the founding documents of the United States government; the right to fair treatment in the face of accusations of misdeeds, the right to succor for spiritual angst and a right to care of physical needs when enfeebled.

Representations extending far backward into pre-history are evidence of an embedded, now intuitive, understanding among social creatures, a "contract" to attend to certain "rights" of other "selves." Imperfect and weighted by sexual competition, fear and life threatening need, nevertheless the "contract" is there. Originating in organic imperatives for social organization it forms the structure of an "ethical" core rooted in trust. To understand the power one has only to observe the behavior at wilderness watering holes or birds nesting and feeding or a domestic melange of cats and dogs; and to know it has been there. This was not recently developed by an ethnocentric deity or human intellectual elite.

Belying those who interpret his research to define species success as driven only by competition and personal self-interest Charles Darwin observed that the development of "sympathy" for life outside the individual was necessary for, even the minimal, sexual reproduction to be successful. Darwin was throughout his life very much aware of the operation of what we now call empathy and its role in permitting life to evolve. Sharing common needs; many if not all of the inhabitants on this planet would fail to flourish with out it.

At the beginning of the third Christian millennium physicians have at hand remarkable scientific discoveries and developments in technology. The taint of shame from association with the defective becomes muted if not obliterated by miraculous remedies and expectations of more yet to come.

But one must pause and reflect on the dangers of bypassing the challenges to the soul through hubris; placing faith in technology; and removing life altering decision making to entities far from the beside.  A most precious consequence of putting into practice the humanist Hippocratic principles was my coming to understand the healing value and correctness of decisions made in compassionate presence at the bedside. Derived in empathy, this "kindness of strangers." is that which preserves our collective "humaneness."

Common experience and sense tell us that detachment, distance if you will, has a degrading influence on the more refined of human sensibilities such as commitment, benevolence, empathy and, as well, the capacity for love and complicated relationships. The military and indeed business management have for centuries recognized it in their fire walls of bureaucracy separating from decision making authority those coming in direct contact with the descending levels of workers or the customer.  Normal human motivations to deal fairly and compassionately are muted. Loyalties are displaced from those served to individuals within the bureaucratic hierarchy. The Hastings Institute some years ago published a brilliant study on the effects of the practice on medical care; What Could have Saved George Worthy?

I recall one of my professors, an orthopedic surgeon, stating the greatest motivation for performing in the interest of the patient is for that patient to live next door. The surgeon who has erred will be confronted with the evidence in his patient's limp every day. On this day as I go to the grocery I must pass a yard filled with the possessions of an evicted family, whether by bank foreclosure or default on rent payment I don't know.  Will the CEO of Lehman Brothers see such evidence of his policies?  I don't think so.

During the Great Depression Woody Guthrie wrote the song So Long It's Been Good to Know You representing the belief by the Dust Bowlers that the world was ending. I suppose now in 2008 as even greater economic insecurity looms the full impact of dislocations and disruptions of family could take even firmer hold and civil life will fail. But I simply don't believe it. 

I counsel to look to the music; not to retreat into the parochialism of fear driven gene affinity and gated communities, but. to discover the assets in kinship with all life. I am convinced direction is there, that we carry within our human souls all that we will be and all we need. Where empathy and the modulating power of the intimate human relationship can operate. "Things turn out." 

As the circle closes and I reflect on the many details of life I shared with so many. As the child looking to nature, later in life I find my music through those whom I served as best I could; and now by knowing the writings of my predecessors.

The Hippocratic Oath is the final page of this paper.
A UU Sunday Service presentation also addresses directly the Hippocratic tradition. I was given the first Sunday after the invasion of Iraq.
The Doctors and the Holocaust
For some years I have been troubled by prominently egregious betrayals of trust by institutions and individuals committed to the professional ethic, in particular in medicine. This is an essay, which was originally a part of this testimony that I have moved to another section. 
Supply Side economics and the social contract
This is political and ideological and mostly personal opinion. If provocative, perhaps also innovative thought will be stimulated.

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