“Staying a While” by Mark Kissler – Medical Student
By Mark Kissler
February 27th, 2014
Mark Kissler, Baylor College of Medicine, Medical Student
Revised Feb. 2014
I revisited Craig A. Irvine’s The Other Side of Silence this winter, my neurons still humming from weeks of intensive study for a cumulative exam. I took it down in one big gulp; seeking, somewhere in the lines, the Point. Scanning quickly through the pages, I underlined and made marginal notes, until I got to the three stars that separated a narrative riff from the preceding philosophical text. Then, drawn into the story, I found that Craig had done once again what he and others had done repeatedly in their classrooms: urged me simply to move slowly. I wondered at my own velocity, chastised as a child who was found running through the house despite repeated requests, running simply to catch my own head. And I was chastised, I think, before it was too late: at the cusp of the start of my clinical education, my reading became a reminder to experience medicine not as an endpoint, but as a practice.
Alasdair MacIntyre is familiar with, what he calls, “the goods internal to practice.” These goods, he writes, are obtained through a pursuit in itself; they are goods that are distinct from external metrics of success and achievement. The medical student—myself included—can be a perfect example of someone who forsakes internal goods for external ones. Buffeted along from lecture to lecture, we are tempted to seek out only those disparate shreds that, when regurgitated, will yield the highest reward. The simple structural pressure of the assessments, the constant feeling of inundation, the consciousness of passing time, threatens to become the prime mover in all of our lives. Of course, this is no excuse. No structure, no program, can be expected to do the work for us: the work of slowing down, of experiencing the thing itself, not just hurrying it along to its completion. We know this, and are caught in the flux all the same.
In the race to gather facts and concepts, we participate wholeheartedly in the totalizing power of medicine: the way that it defines lives and bodies in terms of itself. When a person enters the hospital, he often sheds a narrative understanding of himself; the patient feels her uniqueness replaced by numbers and abstractions, her face and figure overlaid with physiological nonsense. Medicine strips down, breaks apart, and exerts itself—“What good is knowledge if we cannot use it to do something?” it asks. Irvine urges us to resist this totalization. He proposes that we place two totalizing disciplines parallel to one another—in this case, literature and medicine. This serves to remind us that neither is whole, of itself—in particular, literature expresses what medicine cannot. By slowing down and looking after stories, we turn away from the idols of efficiency and effectiveness (“the two great metaphysical and moral principles of modernity”). In their place, we substitute a real relationship. It is not rightly a relationship that is rewarded by goods external to practice, by grades or accolades or advancement, but only by that which is internal to it. Love, as they say, is its own reward.
In a world fueled by efficiency and effectiveness, we must remember stories. Not just any story: for what Irvine and MacIntyre speak of are not frivolous accounts nor are they morality tales. The best stories, the ones we seek and tell and re-tell, are parables: stories with truth that reaches us only when we walk along the path they trace. I made my first cut in anatomy lab as my grandfather declined in health, suffering from myelofibrosis far longer than his physicians expected. He passed away as I began clinics on the neonatal floor of the county hospital. Holding these things in my head and heart, simultaneously with patient encounters, with changing relationships, with the extraordinary passage of the mundane, did not yield a lesson, but may eventually yield a purpose. There are stories and then there are stories, and even a way of listening that makes us open to their dynamic truth. Wendell Berry writes, “The Zen student, the poet, the husband, the wife—none knows with certainty what he or she is staying for, but all know the likelihood that they will be staying ‘a while’: to find out what they are staying for. And it is the faith of all of these disciplines that they will not stay to find that they should not have stayed.”
It is true that by staying a while, we become strange to medicine, strange to the discipline “stupid with, in thrall to, its own reflection.” But if we are strange to it, perhaps we do not have to participate so fully in its totalization of our intellect and the bodies and lives of our patients. We might even attain that blissful state so rare in the pursuit of this education: forgetting, for a moment, ourselves.
Links from above:
“The two great metaphysical and moral principles of modernity”
“Stupid with, in thrall to, its own reflection”