My Brother, My Keeper, My Self?

MY BROTHER, MY KEEPER, MY SELF? ALAN C. MERMANN* My remarks are directed primarily to students in medicine—although by no means restricted to them. But my first concerns are for those whose careers and personal lives are tied to the lives of others in the practice of the art and the science of medicine. I am in major agreement with Henry David Thoreau that youth have little of true value to learn from their elders. He wrote, "You may say the wisest thing you can, old man, ... I hear an irresistible voice which invites me away from all that. One generation abandons the enterprises of another like stranded vessels " [1, p. 266]. Nevertheless, there are occasions when warning signals can be sent and received. We can be alerted to dangers ahead. It is not always necessary to repeat the tragedies of the past. As a way of getting into my thesis, let me describe two scenes which may be common experiences for many of us. I am walking across town, to a bookstore, say, on a delightful day. As I come to the corner, I am approached by a man who, Ijust know, is going to ask me for a handout. Shuffling, toadying, collar turned up, maybe having had a bit too much to drink—I may give him some change, or, more likely, I will just stare stonily ahead. But, what am I feeling? Most certainly, anger: why doesn't someone like that get ajob, stop drinking, and salvage what he can ofhis life? My righteousness just rises right up along with what I consider my perfectly legitimate judgment. How can these bag people just wander around the streets, sleeping in shelters, getting free meals at soup kitchens , panhandling their way through life on returnable bottles and cans? On my better days I may ponder about our high-tech society that has this effect on persons. My second scene is more variegated. It could be at the bedside of a two-packs-a-day person with lung cancer; perhaps in the emergency This paper is adapted from an address with the same title given January 28, 1986, at Yale School of Medicine for the Program for Humanities in Medicine. *Clinical professor of pediatrics and chaplain, Yale School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510.© 1987 by the University of Chicago. All rights reserved. 003 1-5982/87/3002-0527$0 1 .00 290 I Akin C. Mermann ¦ My Brother, My Keeper, My Self? room where an intravenous drug user is being admitted to the hospital for the umpteenth time; it could be in a restaurant where I watch an obese person savor a third dessert; it could be any number of situations in which I am angry, critical, sarcastic, demeaning, hostile, frightened, or embarrassed. My words are addressed to those for whom these so-called negative feelings are a reality of living. How can we incorporate these feelings into our selves so that we may show forth a person of integrity who has brought together the cognitive, the social, the imaginative, and the physical elements of life into a whole? The author of an American scripture, Thoreau, put it this way in the opening of Waiden. "I would fain say something, not so much concerning the Chinese and Sandwich Islanders as you who read these pages, who are said to live in New England; something about your condition, especially your outward condition or circumstances in this world, in this town, what it is, whether it is necessary that it be as bad as it is, whether it cannot be improved as well as not" [1, p. 259]. I raise the question of the bad circumstances of life here because common experience suggests that many physicians are dissatisfied with medicine as a career, find their patients to be burdensome, and resent the demands that medical practice imposes. Many physicians are depressed or despondent, bewildered and disappointed in the ways their lives have turned out. The full life does not seem to have materialized despite the superior education and training received in their early years. William Osier, in a 1897 essay, "Internal Medicine as a Vocation," warned us...