In America, we have always taken it as an article of faith that we 'battle' cancer; we attack it with knives, we poison it with chemotherapy or we blast it with radiation. If we are fortunate, we 'beat' the cancer. If not, we are posthumously praised for having 'succumbed after a long battle.'
I still find the best way to understand a hospitalized patient whose care I am taking over is not by staring at the computer screen but by going to see the patient; it's only at the bedside that I can figure out what is important.
Rituals, anthropologists will tell us, are about transformation. The rituals we use for marriage, baptism or inaugurating a president are as elaborate as they are because we associate the ritual with a major life passage, the crossing of a critical threshold, or in other words, with transformation.
The flip side of suicide is that it leaves a lingering question in the minds of the people who survived. It's like a cancer that's metastasized. The suicide is the cancer and the metastasis is all these people saying, Why? Why? Why?
What we need in medical schools is not to teach empathy, as much as to preserve it - the process of learning huge volumes of information about disease, of learning a specialized language, can ironically make one lose sight of the patient one came to serve; empathy can be replaced by cynicism.
I've never bought this idea of taking a therapeutic distance. If I see a student or house staff cry, I take great faith in that. That's a great person; they're going to be a great doctor.
My deceased patients have taught me over the years to believe in the glass half full, to make good use of the time we have, to be generous - that was their lesson for the Uber-mind, and it was free. 'Do that,' they said, 'and then perhaps death shall have no dominion.'
I think we learn from medicine everywhere that it is, at its heart, a human endeavor, requiring good science but also a limitless curiosity and interest in your fellow human being, and that the physician-patient relationship is key; all else follows from it.
Certainly when I got to medical school, I had role models of the kind of physicians I wanted to be. I had an uncle who, looking back, was probably not the most-educated physician around, but he carried it off so well.
There are moments as a teacher when I'm conscious that I'm trotting out the same exact phrase my professor used with me years ago. It's an eerie feeling, as if my old mentor is not just in the room, but in my shoes, using me as his mouthpiece.
As a young physician in the mid-'80s, caring for people who had contracted H.I.V., I lost two of my patients to suicide at a time when the virus was doing very little harm to them. I have always thought of them as having been killed by a metaphor, by the burden of secrecy and shame associated with the disease.
For one who has an interest in the body as text, airports are treasure troves of information. It seems almost un-American to enjoy delays, and perhaps enjoy is not the best word, but certainly a delayed flight, if it does nothing else, allows one the opportunity to make prolonged observations about one's fellow travelers.
I joke, but only half joke, that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.
I'm the first to admit that the resolution of a hand feeling the belly doesn't compare with the resolution of a CAT scan scanning the belly, but only my hand can say that it hurts at this spot and not at this spot. Only my hand can say that.
Modern society has evolved to the point where we counter the old-fashioned fatalism surrounding the word 'cancer' by embracing the idea of the Uber-mind - that our will possesses nearly supernatural powers.
My sense is that the wonderful technology that we have to visualize the inside of the body often leaves physicians feeling that the exam is a waste of time and so they may shortchange the ritual.
I was taking care of people my age who were dying. The constant feeling, hearing from them, was that life is transient and can end very quickly, so don't postpone your dreams.
There's something universal about illness... Whether you like it, at some level all patients are saying, 'Daddy, Mommy, help me, tell me it's going to be alright.'
I think America is really in denial about the degree to which residents, particularly foreign medical graduates, man the county hospitals of this country, and but for their services, I'm not sure how exactly we could manage.
I think we can see how blessed we are in America to have access to the kind of health care we do if we are insured, and even if uninsured, how there is a safety net. Now, as to the problem of how much health care costs and how we reform health care ... it is another story altogether.