Last week saw the deaths of three notable Americans:
Joe Murray–a surgeon who performed the first successful kidney transplant. Murray had struggled with the scientific problem of rejection that occurs when skin or organs transplanted from one individual to another are attacked by the new host’s immune system. Through good fortune and a stroke of insight, a patient dying of kidney failure was lucky enough to have an identical twin brother willing to donate one of his kidneys. Voila: with the same genes and immune system–the transplant was “tolerated.” It took decades longer to develop medications that would allow for cross tolerance of organ transplants in patients without genetically identical donors. Dr. Murray received a Nobel Prize for his work in 1990.
Marvin Miller–a labor lawyer, Miller was a controversial figure in American and baseball history. His success at getting major leaguers to unionize and collectively bargain totally turned the tables on the ‘reserve clause’–the owners’ system of keeping players as chattel for their entire careers and deciding what they could be paid. His innovation created free agency, allowing players to migrate to other teams and offer their services to the highest bidder. His work also led to the astronomical sums that ballplayers currently enjoy (the minimum annual salary of a major league baseball player is near $500,000, with an average of more than $3 million). Miller was despised by the owners and some fans, because union strikes have frequently interrupted baseball seasons. Though his legacy on the game is undeniable, he’s been shunned from the ultimate accolade, enshrinement in the Baseball Hall of Fame.
Zig Ziglar–a motivational speaker who wrote more than thirty books, Ziglar was a ‘typical’ American success story via re-invention of the self. He’d been a salesman until his early forties when he was “saved.” He combined his zeal for Christian morals with irrepressible optimism and salesmanship. He gave seminars and spread his brand all over the world, even sharing the stage on occasion with world leaders. Injured after a 2007 fall, he spent his latter years talking and writing about living with illness–bringing his insights and perspective on aging to his multiple audiences.
I was thinking about these three men, and what we can learn from each of their examples. Then I came across an article by Samuel Shem, the pen name of a psychiatrist who wrote an irreverent novel about medical internship in the 1970s called House of God. The book sold millions of copies, and has been compared to Heller’s Catch-22 as a work trying to find sanity in an insane world (surviving internship as compared to surviving war).
In the current article, Shem reflects on life and medicine nearly 35 years after the book’s publication. Even if you’ve never read it, he shares some real insight about survival, and further, the meaning of life. It’s his theme of connection that I realized tied the three pioneers together. And makes a fitting epitaph. Here’s Shem’s wisdom, distilled into four new “laws,” added to those from his novel:
In The House of God there were 13 “Laws.” I would now add these four:
Law 14 : Connection comes first. This applies not only in medicine, but in any of your significant relationships. If you are connected, you can talk about anything, and deal with anything; if you’re not connected, you can’t talk about anything, or deal with anything. Isolation is deadly, connection heals.
One of the worries in how the new generation of doctors practice medicine is their use of computers. If you have a laptop or smart phone between you and your patient, you are much less likely to create a good, mutual connection. You will miss the subtle signs of the history, of the person. With a screen between you, there is no chance for mutuality, and the connection has qualities of distance, coolness, rank, authority, and even disinterest. The “smart” digital appendages can make you, in human-connection terms, a “dumb” doctor.
This, as more and more studies suggest, can lead — hand in hand with the tyranny of algorithms and other “quality/efficiency/cost-containers” — to more tests, more errors and medical mistakes, lower quality care, and higher costs to all.
Law 15 : Learn empathy. Put yourself in the other person’s shoes, feelingly. When you find someone who shows empathy, follow, watch, and learn.
Law 16 : Speak up. If you see a wrong in the medical system, speak out and up. It is not only important to call attention the wrongs in the system, it is essential for your survival as a human being.
Law 17 : Learn your trade, in the world. Your patient is never only the patient, but the family, friends, community, history, the climate, where the water comes from and where the garbage goes. Your patient is the world.