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Veronique L Roger
DISSECTING ROOM
LIFELINE Veronique L Roger Veronique L Roger graduated from the University of Saint Antoine, Medical School in Paris trained in medicine and cardiology in France and in the USA, and is now a consultant in the Division of Cardiovascular Diseases at the Mayo Clinic in Rochester, Minnesota, USA. Her research focuses on cardiovascular disease epidemiology and on community surveillance approaches to analyse disease incidence and outcomes. Which event has had most effect on your work, and why? My visit to the Mayo Clinic in the mid 1980s. As a young physician, I marvelled at the way medicine was practised and lived at Mayo. This is how Rochester became my home almost 20 years later. What is the best piece of advice you have received, and from whom? R A Gutmann, a prominent French physician told me when I was starting my residency, “never get discouraged”. More than 20 years later, this is still the best advice that I have received. What complementary therapies have you tried? Did they work? Running, chocolate, and red wine seem to work for me! What is your favourite book and why? A book by the French philosopher Francois Chatelet, the title of which could be translated as Chronicle of Lost Ideas. It relates in how ideas evolve as one grows while also constituting an unfailing tribute to hope and passion. What is your worst habit? Some say that I can be stubborn, but I call it perseverance. What part of your work gives you the most pleasure? Cardiology continues to be a source of real satisfaction to me. When you are called in the middle of the night to take care of an acutely ill patient, you sometimes sense that you made a difference, albeit small. These are rare and thrilling moments that always remind me of why I liked cardiology in the first place. Do you believe in monogamy? Yes, because alternatives seem impractical!
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Death—no fear n unlikely topic for this column perhaps; just as odd as Poulenc’s Dialogues of the Carmelites turning into one of the very few hits of international modern opera. A play by Georges Bernanos, this opera is made up of conversations between nuns. But Poulenc interlaces the talk with some gutwrenching Puccini-like set pieces, most memorably in the big final scene of the Sisters going to the guillotine one by one. Before that, the Mother Superior dies a horrible death in her invalid’s bed. “God has become a shadow! I’ve reflected on death each day of my life, yet now it doesn’t seem to strengthen me at all”, she screams. Her end is a Christian substitution-death, and is explained to the fear-stricken young Blanche: “As in a cloakroom the man gives you one coat for another, yes, I think her death belonged to another. It was a death much too small for our Mother; so small the sleeves barely reached down to her elbows. We do not die for ourselves alone, but for one another—who knows?” Which turns out to be true, very movingly: at the end the fragile Blanche walks calmly as the last of the Sisters to the guillotine, singing “Deo Patri sit gloria”. Thud. Religious motive, the engine of so much western art, is by no means a no-go area for unbelievers. Death, the joyful goal of Christian life, as in so many of Bach’s cantatas, is glorious territory for all. But unbelievers are on a hook. Without an after-life, what is there apart from temporal opportunism? It is not easy to get across that “live each day as if it were your last” can be construed on the basis of decency as readily as that of egoism. Instead of calculating reward in heaven, unbelievers can say “I shall do this thing today decently and with concern for others because I, not God, will it so”. A spirited
A
stance, in short, if not spiritual. Bernanos and Poulenc have one view on the good death in their opera. I believe (here we go) that we can be our own Sisters. The ideal good death is sudden, unexpected, and timely, and perhaps beyond our choosing. Yet if we do not die for ourselves alone— the spirited humanist agenda above—we can surely will a fatalistic quietus. In Albert Camus’ The Plague, Dr Rieux sits by the death-bed of his friend Tarrou, who has fallen to the plague epidemic in its last days: “Tarrou had lived a life riddled with contradictions, and had never known hope’s solace. Did that explain his aspiration towards saintliness, his quest of peace by service in the cause of others? Actually Rieux had no idea of the answer to that question, and it mattered little. The only picture of Tarrou he would always have would be the picture of a man who firmly gripped the steering-wheel of his car when driving, or else the picture of that stalwart body, now lying motionless. Knowing meant that: a living warmth, and a picture of death.”
Earlier, Tarrou had said “I don’t want to die, and I shall put up a fight. But if I lose the match, I want to make a good end of it”. We shall all lose the match, and need to consider how to make a good end of it. To do so, we do not have to turn, like Bernanos and Poulenc, to an outside agency to relieve us of the burden. Religion provides misty-eyed solace for passengers, for Mother Superiors who, however admirable, are avowedly sheep. Gripping the steering-wheel, in courage, decency, and no hope, is another way to a good end. Thomas Sherwood
THE LANCET • Vol 358 • August 4, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
LIFELINE Veronique L Roger Veronique L Roger graduated from the University of Saint Antoine, Medical School in Paris trained in medicine and cardiology in France and in the USA, and is now a consultant in the Division of Cardiovascular Diseases at the Mayo Clinic in Rochester, Minnesota, USA. Her research focuses on cardiovascular disease epidemiology and on community surveillance approaches to analyse disease incidence and outcomes. Which event has had most effect on your work, and why? My visit to the Mayo Clinic in the mid 1980s. As a young physician, I marvelled at the way medicine was practised and lived at Mayo. This is how Rochester became my home almost 20 years later. What is the best piece of advice you have received, and from whom? R A Gutmann, a prominent French physician told me when I was starting my residency, “never get discouraged”. More than 20 years later, this is still the best advice that I have received. What complementary therapies have you tried? Did they work? Running, chocolate, and red wine seem to work for me! What is your favourite book and why? A book by the French philosopher Francois Chatelet, the title of which could be translated as Chronicle of Lost Ideas. It relates in how ideas evolve as one grows while also constituting an unfailing tribute to hope and passion. What is your worst habit? Some say that I can be stubborn, but I call it perseverance. What part of your work gives you the most pleasure? Cardiology continues to be a source of real satisfaction to me. When you are called in the middle of the night to take care of an acutely ill patient, you sometimes sense that you made a difference, albeit small. These are rare and thrilling moments that always remind me of why I liked cardiology in the first place. Do you believe in monogamy? Yes, because alternatives seem impractical!
430
Death—no fear n unlikely topic for this column perhaps; just as odd as Poulenc’s Dialogues of the Carmelites turning into one of the very few hits of international modern opera. A play by Georges Bernanos, this opera is made up of conversations between nuns. But Poulenc interlaces the talk with some gutwrenching Puccini-like set pieces, most memorably in the big final scene of the Sisters going to the guillotine one by one. Before that, the Mother Superior dies a horrible death in her invalid’s bed. “God has become a shadow! I’ve reflected on death each day of my life, yet now it doesn’t seem to strengthen me at all”, she screams. Her end is a Christian substitution-death, and is explained to the fear-stricken young Blanche: “As in a cloakroom the man gives you one coat for another, yes, I think her death belonged to another. It was a death much too small for our Mother; so small the sleeves barely reached down to her elbows. We do not die for ourselves alone, but for one another—who knows?” Which turns out to be true, very movingly: at the end the fragile Blanche walks calmly as the last of the Sisters to the guillotine, singing “Deo Patri sit gloria”. Thud. Religious motive, the engine of so much western art, is by no means a no-go area for unbelievers. Death, the joyful goal of Christian life, as in so many of Bach’s cantatas, is glorious territory for all. But unbelievers are on a hook. Without an after-life, what is there apart from temporal opportunism? It is not easy to get across that “live each day as if it were your last” can be construed on the basis of decency as readily as that of egoism. Instead of calculating reward in heaven, unbelievers can say “I shall do this thing today decently and with concern for others because I, not God, will it so”. A spirited
A
stance, in short, if not spiritual. Bernanos and Poulenc have one view on the good death in their opera. I believe (here we go) that we can be our own Sisters. The ideal good death is sudden, unexpected, and timely, and perhaps beyond our choosing. Yet if we do not die for ourselves alone— the spirited humanist agenda above—we can surely will a fatalistic quietus. In Albert Camus’ The Plague, Dr Rieux sits by the death-bed of his friend Tarrou, who has fallen to the plague epidemic in its last days: “Tarrou had lived a life riddled with contradictions, and had never known hope’s solace. Did that explain his aspiration towards saintliness, his quest of peace by service in the cause of others? Actually Rieux had no idea of the answer to that question, and it mattered little. The only picture of Tarrou he would always have would be the picture of a man who firmly gripped the steering-wheel of his car when driving, or else the picture of that stalwart body, now lying motionless. Knowing meant that: a living warmth, and a picture of death.”
Earlier, Tarrou had said “I don’t want to die, and I shall put up a fight. But if I lose the match, I want to make a good end of it”. We shall all lose the match, and need to consider how to make a good end of it. To do so, we do not have to turn, like Bernanos and Poulenc, to an outside agency to relieve us of the burden. Religion provides misty-eyed solace for passengers, for Mother Superiors who, however admirable, are avowedly sheep. Gripping the steering-wheel, in courage, decency, and no hope, is another way to a good end. Thomas Sherwood
THE LANCET • Vol 358 • August 4, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.