Thursday, May 31, 2018

Living with a Wild God


Any Good Books
June, 2018

Living with a Wild God: A Non-believer's Search for the Truth about Everything
Barbara Ehrenreich (Twelve, 2014)

When Barbara Ehrenreich was a girl, she was not religious. Her bent, both personally and by family tradition, was toward radical rationalism; this book, a not-quite-memoir, could have been titled "I Was a Teen-Age Solipsist." In Living with a Wild God, Ehrenreich revisits her journals from that time, which she'd kept through four decades and a dozen or so moves, "because," she says, "if I have any core identity, any central theme that has survived all the apparent changes of subject, the secret of it lies with her."

As an adult, Ehrenreich is a writer and an activist, always on the side of the economically down-trodden, and this, she comes by honestly: her family emerged from Butte, Montana, a mining and smelting town in the middle of Big Sky country. Her father got out of the mines by pursuing the study of metallurgy, and then parleyed his good looks and ability to hold his liquor into a series of upwardly mobile management jobs. This entailed repeatedly uprooting his family, through Pittsburgh and various spots in New York and Massachusetts, before their arrival in Southern California.

The family's tradition of hard-headed atheism also sprang from Butte. "I was born to atheism and raised in it, by people who had derived their own atheism from a proud tradition of working-class rejection of authority in all its forms, whether vested in bosses or priests, gods or demons." So when the fourteen-year-olds around her were going through religious training, Barbara was on her own with the Big Questions, like 'why are we here?' and 'why do we die?' She was also wrestling with a secret. Starting about a year before the journal begins, she had begun to have moments of direct experience, unmitigated by words or thoughts. 
 
The nearest name for this seems to be 'dissociation'; Ehrenreich satisfied herself that it was neither a religious experience nor a sign of insanity. In what was probably a very good decision, she almost never discussed her episodes with others: the more accurate her description, the more it would have made her sound insane. The unpredictability of her episodes was worrisome, and made avoiding the psychedelic drugs of the day the obvious choice: "For some of us, at some times, participation on the dullest, lowest-common-denominator version of 'reality' is not compromise or a defeat; it is an accomplishment." 
 
Having devoted her college years to the study of chemistry and physics, Ehrenreich went on to graduate school in New York. It was there, in 1965, that the larger world, at last, broke in on her ruminations. The war in Southeast Asia changed everything, as reports trickled back of atrocities in the jungle. "...now that I had begun to love the protective armor of solipsism, there was less to shield me from accounts of bayonets cutting through the bellies of pregnant Vietnamese women or napalm-dispensing helicopters swooping down over children. Once the imagination learns how to construct an image of another person's subjectivity–however sloppy and improvised that image may be–it's hard to get it to stop." 
 
She never quite gets to the answers her teenage self was looking for; life got in the way. She got married and had children; she continued to find things out and write things down, producing nearly two dozen books to date. So the answer to sixteen-year-old Barbara's question to her future self, "What have you learned since you wrote this?" is missing some things that girl would have liked to know. Neuroscience would have been very interesting to her, and philosophy as well. What she did learn, though, about engagement with the world, matters a lot: we are members of a species, in a network of life. Other people are real, and their suffering matters.

Friday, May 4, 2018

Slow Medicine


Slow Medicine: The Way to Healing
Victoria Sweet (2017, Riverhead Books)

We last heard from Victoria Sweet, M.D., in her 2012 book God's Hotel, about the charity hospital in San Francisco where she had practiced Slow Medicine for some twenty years. She has continued to meditate on what makes 'the practice of medicine' distinct from 'the delivery of health care'; not surprisingly, the latter suffers in the comparison. She's doing her part to help the pendulum to swing the other way, so that sick people can be healed as well as cured.

That's not to say that she does not give due respect to the modern methods of medicine. She tells one remarkable story of saving a man's life because she had simple surgical instruments with her on a hike through Nepal. Blood tests and imaging systems will always have their place as extensions of the physician's senses. Intensive care units can keep a body ticking over, sometimes longer than makes any sense.

Parts of Slow Medicine put me in mind of Perri Klass, whose memoir of a medical education was memorably titled A Not Entirely Benign Procedure. Sweet's progress through med school, internship, and residency had what seems to me an unusual number of detours, all of them fruitful. Her original intention was to become a Jungian analyst, hoping to meet the most interesting philosophical questions. "Medicine asked the wrong questions –What is causing that ear pain?–practical questions, not deep and interesting questions. But it did have answers, and I preferred answers to questions."

But she's quite open-minded about where she gets answers. Chinese medicine's model of the body bears little relation to what she learned at medical school, but in some circumstances it seemed to work better. She also became interested enough in the teachings of Hildegard of Bingen to acquire a second doctorate, in medical history. But also, always, Harrison's Principles of Internal Medicine, its 2,600 pages well-thumbed.

And always, first, the physical examination, meeting the patient with sight and sound and touch. Given time to examine a patient and read carefully through his record, the doctor can build a story about what's wrong, run tests to be sure, and make a plan to treat it. Essential to the plan is a judgement about what is urgent to treat, and what can be left to watchful waiting. Sweet's study of Hildegard suggests that the patient has the same drive for life and growth that a plant in a garden has, which the doctor/gardener needs to seek out and make way for. "I found myself practicing a kind of Fast Medicine and Slow Medicine together–at many different levels. At the level of actual time, of course, but even more, at the level of style. Mechanic and gardener. Focused and diffuse. The parts and the whole."

In addition to Klass, this book resonates within the tradition of Oliver Sacks, Jerome Groopman, and Atul Gawande. On some level, Sweet loves her patients. "I liked watching them improve, reconstitute, heal. Day by day, their minds clearing, their limbs strengthening, their wounds reconstituting. Not everyone got well, but almost everyone got better, and it was the same pleasure as watching a film go backward. The pieces of the broken vase coming together, jumping back up on the table, the spilled water collecting and running back inside, the tossed flowers righting themselves and reassembling until the vase of flowers is whole again."

The tools of modern medicine are impressive, and sometimes life-saving, but that doesn't mean that our bodies are machines. It's not too much to hope that our doctors will be craftsmen, or gardeners, and not just mechanics.


May 2018