PART ONE
Physicians Must Be Altruistic
PHYSICIANS must be compassionate and empathetic in caring for patients, and must be trustworthy and truthful in all their professional dealings. They must bring to the study and practice of medicine those character traits, attitudes, and values that underpin ethical and beneficent medical care. They must understand the history of medicine, the nature of medicineâs social compact, the ethical precepts of the medical profession, and their obligations under law. At all times they must act with integrity, honesty, and respect for patientsâ privacy, and respect for the dignity of patients as persons. In all of their interactions with patients, they must seek to understand the meaning of the patientsâ stories in the context of the patientsâ beliefs and family and cultural values. They must avoid being judgmental when the patientsâ beliefs and values conflict with their own. They must continue to care for dying patients even when the disease-specific therapy is no longer available or desired.
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Rosalind Warren
OUTPATIENT
In this wry opening selection, a middle-aged hypnotist named Luisa, suspecting that she might have bronchitis, goes to the doctor for a checkup. When the examination is both âdehumanizing and demoralizing,â Luisa decides to use her profession to teach her doctor a thing or two about âethical and beneficentâ care.
ROSALIND WARREN is an attorney living in Philadelphia. She has had stories published in Crosscurrents, Fantasy and Science Fiction , and Seventeen.
The waiting room is crowded. Mothers watch fidgety children, couples sit together on drab sofas, adult children talk in soothing voices to elderly parents. Everyone in the waiting room has someone with them. Luisa has come alone.
âNew patient?â the receptionist asks. Luisa nods.
The receptionist hands her a clipboard that holds a form. âYouâll have to fill this out,â she says. When Luisa returns it a few moments later, the receptionist looks it over. âYou havenât filled in your occupation,â she says.
âHypnotist,â says Luisa.
âOh?â The receptionist meets Luisaâs eyes. Theyâre unusual eyes. Clear blue, almost violet. They often remind people of deep bodies of water.
dp n="23" folio="4" ?âItâs the family business,â says Luisa. âBoth my parents were hypnotists. As were two of my grandparents.â
âHow lovely,â says the receptionist.
âThe doctor will see me right away,â says Luisa, still looking into the receptionistâs eyes. She enunciates each word slowly and carefully.
âBut we call people in the order they arrive.â
âI arrived first,â says Luisa.
âYou arrived first,â agrees the receptionist.
Luisa has barely glanced at Life magazineâs special Winter Olympics issue when a nurse calls her name. She follows the nurse down a corridor to a small examining room. The nurse hands her the usual skimpy garment, telling Luisa to remove her clothes and put it on. When the nurse leaves, Luisa strips, puts the thing on, and sits down on the edge of the examination table. Itâs cool. Almost immediately she has goose bumps.
Luisa doesnât look great in the drab shapeless garment, but she looks better than most. She is of an indeterminate age. Certainly past forty. She would probably be described as âwell preserved.â She is tall and strong-looking and has longish red hair. Not beautiful but striking. The nurse comes back in and smiles when she notices that Luisaâs fingernails and toenails are painted cherryblossom pink.
âStand on the scale,â she instructs. Luisa gets on the scale, and the nurse adjusts the indicator back and forth, minutely, until it finally rests on 130.
âOne hundred thirty,â she says.
Luisa turns to look at her. âWhat about my eyes?â she asks.
âHmmm?â the nurse says, writing. She looks up and meets Luisaâs eyes. âOh!â she says. She gazes at Luisa for a moment. âTheyâre such a nice color,â she says.
âReally?â asks Luisa. âTell the truth.â
âTheyâre a little weird.â
âScary?â asks Luisa.
âNope.â The nurse smiles. âI like them.â
Luisa smiles. âI weigh one fifty-seven,â she says. The nurse glances down at her clipboard and frowns. She erases the 130 and writes 157.
âBut I carry it well,â says Luisa. âDonât I?â
âYou certainly do,â says the nurse. âNow I have to take your blood pressure.â She straps the arm band on, pumps it up, and looks at it. âOne hundred ten over sixty,â she says.
âOne twenty over seventy,â Luisa says. The nurse gazes at her blankly. âIâm sorry,â says Luisa. âBut these silly games are quite harmless, and theyâre crucial if Iâm to stay in practice. Iâll stop if it disturbs you.â
The nurse smiles. âIt doesnât disturb me.â She writes 120 over 70 on Luisaâs chart. âI think itâs interesting.â
âWhat happens now?â Luisa asks.
âYou wait for Dr. Heller.â
âI probably donât even need Dr. Heller,â says Luisa. âIâm ninety percent sure Iâve got bronchitis. Everyone in my family has bronchitis. Everyone on my block has bronchitis. But I canât just write myself out a prescription for antibiotics, can I?â
âNo,â says the nurse. âYou canât.â
âWhatâs Dr. Heller like?â Luisa asks.
âHeâs very nice.â
âTell the truth.â
âHeâs a complete jerk,â says the nurse. Then she looks startled, and they both burst out laughing.
âBut heâs a very competent doctor,â the nurse says. âHe can diagnose your bronchitis as well as the next doc.â
âThanks for putting up with me,â says Luisa. âYou will feel happy for the rest of the day. You will walk around thinking life is a piece of cake.â
âI certainly look forward to that,â says the nurse.
Luisa snaps her fingers. The nurse blinks, then moves quickly to the door. âDr. Heller will be right with you,â she says as she leaves. She has left the clipboard with Luisaâs chart on the table, and Luisa quickly changes her weight and blood pressure to the correct numbers.
Time passes. Ten minutes. Twenty minutes. Nothing happens. The nurse had left her with the impression that the doctor would be right in. Clearly, he wonât be. There is nothing to distract her. She should have brought her magazine with her. She imagines parading out into the waiting room dressed as she is to retrieve her copy of Life. She decides against it.
She looks around the room. Itâs a generic examination room. No windows. No pictures or photos. Nothing interesting or unusual to hold her attention. Luisa hasnât much interest in things, anyway. Things rarely hold surprises; people do.
Another twenty minutes pass. Luisa is beginning to think theyâve forgotten all about her. Sheâs starting to feel woozy. It angers her. Sitting here half dressed is the last thing she needs. She knows that in examining rooms up and down this hallway sick people sit in skimpy hospital garments waiting for the doctor. Itâs more convenient for him this way. She tries to calm herself. This treatment isnât life-threatening, she tells herself. It may be dehumanizing and demoralizing, but it wonât kill you. They only do it this way because they can get away with it.
Finally the door opens and a big man in a white coat breezes in. Heâs in his mid-thirties, large and bearded. He looks like a lumberjack. His blue eyes are intelligent but not particularly kind. He moves in a rush.
âWell, Luisa,â he says loudly, glancing down at the clipboard, âIâm Dr. Heller. Whatâs the trouble?â
âSorry to keep you waiting,â says Luisa.
âHmmm?â he says, scanning her chart.
âI said I was sorry to keep you waiting.â
He looks up at her. âSymptoms?â he asks.
âFever,â she says. âSore throat. Bad cough. I think I have bronchitis.â
âIâm the doctor,â he says, making notations on her chart. He places his stethoscope on her back. âCough!â he barks.
Luisa coughs as he moves his stethoscope about on her back and then her chest. His movements are all precise and quick, and his touch is firm and cold. He looks into the distance, concentrating. He doesnât look at her.
âIt began two weeks ago,â Luisa says. âI woke up with a bad sore throat. Three days later I began running a slight fever.â She stops. He isnât listening.
âHow much pain have you caused your patients by not listening to them?â she asks quietly.
âHmmm?â He takes a thermometer from a drawer. âOpen,â he says, angling the thermometer toward her mouth. Luisa pushes it away.
âListen to me!â she says.
He stops and looks at her, his eyes dark and angry. Their eyes meet. Itâs a struggle. But Luisa is angry.
âYou will slow down and give me a good, thorough examination,â she says finally. âYou will take your time, pay attention, and explain the reason for each procedure. You will listen to me when I speak. Not only am I older than you and deserving of your respect for no other reason, but I live in this body. I may know something about it that can help you.â
The doctor gazes at her, unblinking.
âIâm not just a body with an illness,â says Luisa. âIâm a person. You care about my feelings.â
âI care about your feelings,â he says. He sounds doubtful.
But he continues the examination at a much slower, kinder pace, and Luisa is surprised at how good he is. His cold hands even seem to warm up slightly. But itâs clear that heâs fighting the impulse to race through the exam and get on to the next patient.
âWhy are you in such a hurry?â she asks.
âI have so many patients. I hate to keep them waiting.â
âYou donât care about that. Tell the truth.â
âYouâve got a fabulous body,â he says. âI love older women with big breasts.â
âNot about that,â she laughs. âWhy are you in such a hurry?â
âThis way I stay in control.â
âWhat if you arenât in control?â
âI have to be in control.â
âWhy?â
âIâm the doctor.â
âAnd youâre the doctor because you have to stay in control,â says Luisa. âRight?â
âYes,â he says. âI do like your eyes. Theyâre . . .â
âWhat?â
âCalming.â
He finishes the examination. âYou have bronchitis,â he says. âIâm writing you a prescription for 500 mg of ampicillin.â
âWhat would make you listen to your patients?â she asks. âWhat would make you care?â
âNothing,â he says. He is writing the prescription. âTake this four times daily with plenty of water.â He hands it to her and turns toward the door.
âWait,â she says.
He stops. âTake your clothes off,â she says. He turns around and stares into her eyes. He begins to unbutton his shirt.
dp n="27" folio="8" ?As he removes his clothing, Luisa puts hers back on. By the time heâs naked, sheâs fully clothed. He stands there looking very pale. He has goose bumps. She hands him the hospital garment. He puts it on.
âYou will sit here and wait,â she says, âuntil the nurse comes looking for you. Youâll see what itâs like.â
He sits down on the edge of the examination table and sighs.
She pauses at the door. âWhen the nurse comes, youâll forget about me.â
âIâll forget about you.â He sounds happy about that.
âBut youâll never forget the next half hour.â
As Luisa leaves the room, she sees the nurse heading toward her with a clipboard. âDr. Heller is in the examining room,â she tells the nurse. âHe asked not to be disturbed for at least a half hour. But he wanted you to explain to the patients who are waiting that thereâll be a delay. And to apologize.â
âThatâs new,â says the nurse.
âThatâs right,â says Luisa. She meets the nurseâs eyes. âHave an interesting day,â she says.
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Albert Schweitzer
from FIRST SERMON ON REVERENCE FOR LIFE
In an era marked by celebrity-driven fund-raising, Albert Schweitzerâs name has become synonymous with sustained humanitarian effort on behalf of othersâeffort that eschews the limelight for a practical ethics based on help and love. Awarded the Nobel Peace Prize in 1952, Schweitzer is best known for his journeys to Africa, where he practiced medicine and established hospitals; Schweitzer also held degrees in philosophy and theology. In his own time, Schweitzer was regularly featured in magazines like Time and Life. Today Schweitzerâs legacy is less familiar, and, by modern standards, aspects of his life are viewed as suspect by some: his patronizing, if not racist, attitudes toward some of his African patients and the moodiness those who went to work with him sometimes encountered. Perhaps this is all the more reason today to consider the words of one who understood himself only too well, who wrote about his own limits and who struggled to connect thought, word, and deed in his writing and in his service to others.
This excerpt is taken from the first of twelve sermons Schweitzer preached between February and April 1919 in Strasbourg, France, at Saint Nicolai Church. In this sermon Schweitzer first defined his well-known phrase âreverence for life.â The subtitle of the sermon is âWhat Does It Mean to Be Good?â
ALBERT SCHWEITZERâS (1875â1965) Sermons on Reverence for Life were compiled into a book, translated by David Larrimore Holland, titled A Place for Revelation. Schweitzerâs 1947 anthology The Spiritual Life has recently been reissued.
Desire for knowledge! You may seek to explore everything around you, you may push to the farthest limits of human knowledge, but in the end you will always strike upon something that is unfathomable. It is called life. And this mystery is so inexplicable that it renders the difference between knowledge and ignorance complet...