Philosophical musings on the inauguration of a new year
The Roman god Janus – who stands with two faces, one looking back at the difficult times where we have been and the other gazing with some trepidation into the New Year – serves as the muse for this piece. Janus always reminds me of the debatable Latin maxim: post somnium ergo propter somnium – sequences prove consequences. This modification of the standard post hoc doctrine has its philosophical shortfalls, but come on now, it’s just another year.
Or is it? As I’ve written before, the only constant is change. 2016 will be the last year for this column. And so I’m going to try to make them count.
There is very little to ground our souls except our thoughts. If we only had more than our insights to justify our views. One of my heroes, as you know, is Woody Allen. In the movie Annie Hall he portrays himself in line at a prototypical artsy movie house in New York as he gets into an argument with some academic professional twit on the works of Marshal McLuhan. The twit says: “I teach a class at Columbia on TV, media and civil culture. So I think my insights into McLuhan have a great deal of validity.” “Oh, do you?” replies Allen. “Well, I happen to have Mr. McLuhan right here.” Alan then produces the actual elderly sage from behind a placard. “I heard what you were saying,” says McLuhan to the stunned professor. “You know nothing of my work.” Oh, yes, take that you insufferable nerd. I love this scene. Allen pulls out the ultimate authority commenting on his own works. I wish I could do that with everyone from Christ to Shakespeare. But alas, we are all stuck with our informed opinions, noting that some are more informed than others.
Every year I lay out several subjects of which I wish to improve my learning. This year, in order to get a better handle on some of today’s toughest issues, I intend to study what is truly encompassed by the term “religious freedom.” Relevance to emergency medicine? Simple. Everyone is going to die and way too many come to us as the place to shuffle off this mortal coil. Your job – of guiding patient and family as Virgil did to Dante – is an incredibly important one. There comes a time when your care is more important than your medication. There are, as they say, no atheists in foxholes. And there are no families who do not have some belief structure they turn to in times of ultimate stress. To those interested in the topic, I recommend Father Richard John Neuhaus’s 1984 bestseller, The Naked Public Square: Religion and Democracy in America. I’m going to reread this along with the arguments accompanying the March 1996 United States 9th Circuit Court of Appeals decision, which upheld the patient’s right to physician assisted suicide as protected by the Equal Protection Section of the 14th Amendment. Heavy stuff no matter how you cut it. But no real issues are light and easy.
Freedom of religion and its “exercise” should not be interpreted as freedom from religion. G.K. Chesterton (another favorite) commented: “Religious liberty might be supposed to mean that everyone is free to discuss religion. In actual practice in America, it now means almost no one is allowed to even mention it.” Physicians who write-off the majority of Americans as deluded, God-fearing barbarians have a problem. When you oppose – or worse yet, ignore – a patient’s belief structures, you have also excluded the deepest core of their identity and inner being. In a phrase… not our job. Defining what our work really includes is much tougher.
Of course, to understand our identity, we always need to look to the past, to where we began. Let’s go all the way back to 1648. Since the Treaty of Westphalia, human affairs in the Western hemisphere have been dominated by the concept of the nation state. We try you in the nation state. We execute you in the nation state. We reward you in the nation state. It’s how we view the world.
But the Second World War started the slow but unstoppable march forward, when the marketplace began to challenge the power of all states as we know them. Coca Cola has more economic power in the Caribbean than the elected legislatures. The term Banana Republic and the Dole Corporation have become synonymous. We are watching every day the withering away of the state in a much different way than Marx predicted. The U.S., never big on class as a way of sorting people, has led this cultural revolution with the introduction of identity politics. We don’t care who your family is. No titles. No principalities. We just want to know how much cash you can bring to the table and what we can do with it. The world has caught this disease. News flash: The war is over. Capitalism won. And everybody except Bernie Sanders agrees.
The question for medicine is: What did we actually win? Before we start singing a technocratic-Adam Smith version of Internationale, what does it mean to us, those taking care of the sick? Most people do not care about Kant and Hegel (as evidenced by my column) but are extremely interested in how they’re doing financially. 2016 has been declared by Pope Francis the Jubilee Year of Mercy and nobody knows what that means. Warren Buffet has declared 2016: The year of capital aggregation, mergers and profits and everybody knows what he means.
For those who are interested in the distribution of all goods and services, I suggest a book to at least kick off your discussions: Capital In The 21st Century by Thomas Piketty. I can disagree with nearly every sentence in the book, but he has raised the right issue, which is: What do we now do with the cash we have in the bank?
What does this mean in terms of healthcare and emergency care in the rapidly shifting world? What’s real? What’s just crap? Why does Switzerland have better healthcare at one-third the cost of the United States? Where did we go wrong? And what do we need to do about it? How do we balance big science and big business to produce a product that has some benefit to the general public? How do we deal with the scientific community that has been hijacked? In Eisenhower’s farewell speech he warned of the scientific-technology industrial complex, which would declare a knowledge base superior to that of us common people, which they would use to shove products down our throats. (And yes, I am talking about Tamiflu.)
But maybe I bit off more than I can … well, you know. In 2016, I turn 70, and I am beginning to question my relevance. The residents are all smarter than me, so why should they listen? The science expands as my brain shrinks. But there may be something that I can do as we go forward in this New Year, where I might find some purpose.
I was never cut out to be a counselor. Somehow the job fell into my lap. I have no training, no degree, no credentials of any type. I just have two extra chairs in my office and I’m a sucker for someone who says they want help.
A young woman entered my office recently and took up one of these chairs.
“What can I help you with?” I asked her.
“I hate my life. I hate my job. I don’t know what to do,” she quipped, with a sardonic smile. She is, I’m certain, a fine doctor, bright, educated, talented and severely depressed. So what’s wrong? What’s the fatal flaw? How come she can no longer see the joy in what we do for a living? How can this be happening? She’s from a wealthy family. She went to the Ivies and did a year in Teach For America before heading to med school. She did a name residency and has been working for ten years, guarding her free time, pressing to find the Holy Grail of her generation – the sacred work-life balance. There is nothing crazy or over-extended about her existence. And yet there she was, in my chair.
As the conversation progressed she told me about hating midnight shifts, wrestling drunks at 2:00 A.M. and endless computer and paperwork. Strains of Peggy Lee singing “Is That All There Is?” were playing in my head. She had lost the adventure of the practice. She had to deal with the fact that most poor people aren’t noble, and that there is no harder job than seeing your seventh work-related low back pain and still delivering a genuine, empathetic exam. It’s the hardest job in medicine. I defy anyone to find something tougher.
As we got into the discussions as to what made for a good shift, I realized I was adding too many words. We could get to answers next time. Today what she wanted was just to talk, to cry, to feel, to be in a place without judgment, relating to a person who knows what the job is like. Before you ask, I told her I was going to write this in my next piece. She had no problem with that. In exchange she promised not to comment on my tears.
The hour-and-a-half went by. We have a meager plan. Just some ideas still being explored, but it’s something. As she left, she thanked me profusely for my time – not for my advice, not for my ideas, but for my time. I was given a great honor that day. She shared her feelings with me. I never make New Year’s resolutions. I make commitments. So for 2016, I will talk less and just listen more. A hard job for me but this may be the most useful avocation for the old.
As I reviewed our meeting, I realized what she came in asking for was a new job. What she really needs is a new perspective on the job that she has. Finding meaning in what we do every day is what makes us complete. And sometimes, protecting our perfect work-life balance is the worst thing we can do to become truly committed to an idea or a cause.
Seniores priores — the right of the elderly