The Memories Linger On

"Philosopher Left to Muse on Ridicule Over a Hoax." That was the title of a New York Times article (Carvajal 2010) about a famous philosopher who had cited in his new book the Paraguayan lectures of Jean-Baptiste Botul, a sham philosopher widely known to be the satirical creation of Frédéric Pagès, a witty journalist.

"Mr. Botul's school of thought is called Botulism, his followers are botuliennes and they debate such weighty theories as the metaphysics of flab. As they describe it, Mr. Botul's astonishing ideas ranged from phenomenology to cheese, sausages, women's breasts, and the transport of valises during the 1930s," the paper reported (Carvajal 2010, A4) .

Reading the article led me to laugh out loud, to share it across the breakfast table with my wife, and then—uncharacteristically for me—to forward the piece via e-mail to a wide range of friends.

It was only later, when one of my friends sent me an appreciative reply, that the significance of the article, my laughter, and my advertising the humor became clear.

Fifty years ago, when I was a medical intern on the acute women's ward of a hospital, I had a patient who died of botulism. She and her husband had both been admitted to the hospital with severe gastrointestinal distress, but were then separated as was customary at that time to wards for different genders. None of us on staff on either ward could make an accurate diagnosis until, sadly, one of them died. Then, with post mortem examination and further tests possible, the diagnosis came to light so that the other could be saved. The experience felt like the horrible irony in a Borges story.

Remembering that episode revealed to me why, over fifty years later, I felt so delighted to see botulism treated as a joke. And it was why I so very quickly wanted to tell my wife and my friends. It was as if I were saying, "See, I didn't kill my patient (which was how her death due to our failure to make an accurate diagnosis had felt to me)! See, it was all just a joke."

I cannot recall having thought of that particular patient in the decades since I left clinical medicine for a career in psychoanalysis. Yet clearly, the pain and guilt had stayed alive and active.

This is not a tale of idiosyncratic sensitivity and guilt on my part. I have worked analytically with too many physicians to think that my concern for patient responsibility is in any way unique to me. It simply is the way that most doctors—or at least most doctors I know—are.

Also, in my limited medical career, I had faced many deaths. While death can never truly be minimized, the fact is that not only had that sadly lost woman been my patient for less than three full days, but also that I had been the lowest ranking of the cluster of doctors responsible for her care. Yet unbeknownst to me, my engagement with her had never ended.

Does it not seem likely that such would also be the situation when the doctor-patient involvement is that profoundly emotional engagement of sharing psychoanalytic work, work that lasts many years and includes experiencing the broad range of human emotions?

I have previously reported (1996) a specimen instance in which I spoke to a socially withdrawn patient of how he presented himself to the world by remarking that he refused to "decorate" himself for the public.

Surprised by my choice of words, I reflected on them that evening. I was astonished then to recall a young woman patient from fifteen years earlier who never seemed to connect with the appropriate young men she said she desired. One summer afternoon, sitting by the pool of her apartment development, she was approached by an attractive young man. He introduced himself and said that he had just moved to town, that he now had his very first apartment, that he never had decorated an apartment, and that he needed help. My young patient replied...