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The judgment dilemma
Perspectives
From literature to medicine The judgment dilemma Samuel Shem’s satirical novel House of God (1978) placed a magnifying glass on the callousness of medical training and hospital life. Although he exaggerated the toxic nature of the physician–patient relationship, he captured startling elements of hospital culture, such as physicians’ use of phrases like “lol in nad” (little old lady in no apparent distress) and “gomer” (get out of my emergency room)—terms that are still a part of the medical lexicon. House of God also exposed physicians’ tendency to make judgments about patients seconds after meeting them. Rapid appraisals such as “drug seeker” and “chronic complainer” can be seen as a professional birthright, passed down to medical students to help them recognise patterns in the stories patients tell. But teaching students to focus on patterns has the unintended effect of encouraging them to overlook each patient’s individuality. The use of reductive character types is not limited to medicine, of course; they can be found in popular films and plot-driven genre fiction, such as war stories. In the World
330
War 2 novel All the Light We Cannot See (2014), however, Anthony Doerr encourages readers to question the familiar stock figures of “good” and “evil” that populate so many novels in this genre and challenges us to focus instead on his characters’ complexities. He asks readers to contemplate the rich inner lives of others, lives that often remain unseen and unknown. Doerr’s novel, set in France and Germany in the years leading up to and during World War 2, recounts the lives of two children— Werner Pfennig, a brilliant German orphan and Marie-Laure LeBlanc, a blind and adventurous French girl who joins the Resistance. Although separated by geopolitical forces, their lives are connected by an unseen light—radio waves. Werner, an orphan from a German mining town, is a prodigy with radio technology. When his ability to repair and reconfigure radios is recognised, he is admitted to an elite preparatory school for the Hitler Youth and then faces the first of many ethical choices. Should he accept an education and join the Nazis, or succumb to the fate of every other boy in his town—death in the coal mines? Although Werner chooses Nazism and Marie-Laure chooses the Resistance, Doerr’s subtle description of their inner lives prevents readers from viewing them simply as an evil Nazi and a noble hero. Werner is neither wholly bad nor wholly good. In school, he joins a group that tortures a prisoner and passively watches the abuse of his best friend. But later he refuses to disclose the location of the French Resistance’s radio hub and rescues Marie-Laure. At the same time, Marie-Laure insists that she is less courageous than her circumstances make her
seem: “When I lost my sight”, she tells Werner, “people said I was brave. When my father left, people said I was brave. But it is not bravery; I have no choice. I wake up and live my life. Don’t you do the same?” Perhaps Marie-Laure is not a hero, as she argues, or maybe some forms of heroism are actually about enduring the circumstances of ordinary life. Some critics found Doerr’s decision to humanise a Nazi soldier to be a creative shortcoming. By attending to Werner’s humanity, Doerr could seem to excuse Nazi atrocities. This judgment misses the essence of Doerr’s project. Like other literary realists, he avoids reductive character types in favour of writing portraying the depth and ambiguity of his characters. Werner’s ethical achievements should be recognised, but they do not absolve him of his ethical failures. At times, medical settings, like war stories, seem to be populated by recognisable character types. The tendency towards easy reliance on common stereotypes is one reason why reading and discussing novels like Doerr’s can be helpful in medical education. Such works invite readers to attend to the unseen; they imply that every patient’s life could fill a novel. Thus, they remind medical students and practitioners that although medical archetypes can sometimes be useful, it can be dangerous to rely on initial assumptions when only a fragment of a patient’s story is available.
*Daniel Marchalik, Ann Jurecic Department of Urology and Literature and Medicine Track, Georgetown University School of Medicine, Washington, DC 20007, USA (DM); and Department of English, Rutgers University, New Brunswick, NJ, USA (AJ) [email protected]
www.thelancet.com Vol 387 January 23, 2016
From literature to medicine The judgment dilemma Samuel Shem’s satirical novel House of God (1978) placed a magnifying glass on the callousness of medical training and hospital life. Although he exaggerated the toxic nature of the physician–patient relationship, he captured startling elements of hospital culture, such as physicians’ use of phrases like “lol in nad” (little old lady in no apparent distress) and “gomer” (get out of my emergency room)—terms that are still a part of the medical lexicon. House of God also exposed physicians’ tendency to make judgments about patients seconds after meeting them. Rapid appraisals such as “drug seeker” and “chronic complainer” can be seen as a professional birthright, passed down to medical students to help them recognise patterns in the stories patients tell. But teaching students to focus on patterns has the unintended effect of encouraging them to overlook each patient’s individuality. The use of reductive character types is not limited to medicine, of course; they can be found in popular films and plot-driven genre fiction, such as war stories. In the World
330
War 2 novel All the Light We Cannot See (2014), however, Anthony Doerr encourages readers to question the familiar stock figures of “good” and “evil” that populate so many novels in this genre and challenges us to focus instead on his characters’ complexities. He asks readers to contemplate the rich inner lives of others, lives that often remain unseen and unknown. Doerr’s novel, set in France and Germany in the years leading up to and during World War 2, recounts the lives of two children— Werner Pfennig, a brilliant German orphan and Marie-Laure LeBlanc, a blind and adventurous French girl who joins the Resistance. Although separated by geopolitical forces, their lives are connected by an unseen light—radio waves. Werner, an orphan from a German mining town, is a prodigy with radio technology. When his ability to repair and reconfigure radios is recognised, he is admitted to an elite preparatory school for the Hitler Youth and then faces the first of many ethical choices. Should he accept an education and join the Nazis, or succumb to the fate of every other boy in his town—death in the coal mines? Although Werner chooses Nazism and Marie-Laure chooses the Resistance, Doerr’s subtle description of their inner lives prevents readers from viewing them simply as an evil Nazi and a noble hero. Werner is neither wholly bad nor wholly good. In school, he joins a group that tortures a prisoner and passively watches the abuse of his best friend. But later he refuses to disclose the location of the French Resistance’s radio hub and rescues Marie-Laure. At the same time, Marie-Laure insists that she is less courageous than her circumstances make her
seem: “When I lost my sight”, she tells Werner, “people said I was brave. When my father left, people said I was brave. But it is not bravery; I have no choice. I wake up and live my life. Don’t you do the same?” Perhaps Marie-Laure is not a hero, as she argues, or maybe some forms of heroism are actually about enduring the circumstances of ordinary life. Some critics found Doerr’s decision to humanise a Nazi soldier to be a creative shortcoming. By attending to Werner’s humanity, Doerr could seem to excuse Nazi atrocities. This judgment misses the essence of Doerr’s project. Like other literary realists, he avoids reductive character types in favour of writing portraying the depth and ambiguity of his characters. Werner’s ethical achievements should be recognised, but they do not absolve him of his ethical failures. At times, medical settings, like war stories, seem to be populated by recognisable character types. The tendency towards easy reliance on common stereotypes is one reason why reading and discussing novels like Doerr’s can be helpful in medical education. Such works invite readers to attend to the unseen; they imply that every patient’s life could fill a novel. Thus, they remind medical students and practitioners that although medical archetypes can sometimes be useful, it can be dangerous to rely on initial assumptions when only a fragment of a patient’s story is available.
*Daniel Marchalik, Ann Jurecic Department of Urology and Literature and Medicine Track, Georgetown University School of Medicine, Washington, DC 20007, USA (DM); and Department of English, Rutgers University, New Brunswick, NJ, USA (AJ) [email protected]
www.thelancet.com Vol 387 January 23, 2016