personal canons

Medicine, Literature and Canons 1

Realms of Gold:Medicine, The Arts and a Personal Canon

OttawaApril 19, 2009

David J. Elpern, M.D.12 Meadow Street

Williamstown, MA 01267Email [email protected]

Why Read?By

Mark EdmundsonDistinguished Teaching Professor

University of Virginia


William Carlos WilliamsAsphodel: That greeny

flower

Look atwhat passes for the new.You will not find it there but in despised poems.It is difficultto get the news from poemsyet men die miserably every dayfor lackof what is found there.


Robertson Davies: The Cunning Man (1994)

More humanism and less science. That’s what medicine needs.But humanism is hard work, and so much of science is just Tinkertoy.


In the beginning…


Osler and the Bed-Side Library


A liberal education may be had at a very slight cost of time and money. Before going to sleep read for half an hour, and in the morning have a book open on your dressing table. You will be surprised how much can be accomplished in the course of a year. I have put down a list of ten books… There are many others; studied carefully these will help in [your] inner education.

William Osler (1849 - 1919)


Osler’s Bedside Library for Medical Studentscirca 1895

I. Old and New TestamentsII. ShakespeareIII. MontaigneIV. Plutarch’s LivesV. Marcus AureliusVI. Religio MediciVII. Epictetus VIII. Don QuixoteIX. EmersonX. Oliver Wendell Holmes - Breakfast-Table Series


Great Writers

Who Inspired

a

Great Physician

Book LaunchOsler Library

MontrealOctober 2009


Canon: choice of books, films, music, art for our personal and professional growth. “What shall the individual who desires to read attempt to read since he can’t read everything?”

A Physician’s Canon


My Personal Canon 2009

I. The Complete Poems of Emily DickinsonII. Harvey Cushing: The Life of William Osler III. Viktor Frankl: Man’s Search for MeaningIV. Ivan Illich: Medical NemesisV. F. W. Peabody: The Care of the PatientVI. George Eliot: MiddlemarchVII. Steven Hsi: Closing the Chart VIII. Wit (Film with Emma Thompson)IX. The New York Times Online X. Audible.com


The soul selects her own Society -Then shuts the Door -To her divine Majority -Present no more -

Unmoved - she notes the Chariots - pausing -At her low Gate -Unmoved - an Emperor be kneelingUpon her Mat -

I've known her - from an ample nation -Choose One -Then - close the Valves of her attention -Like Stone -

The Soul Selects Her Own Society


Surgeons must be very carefulWhen they take the knife!Underneath their fine incisionsStirs the Culprit - Life!

On Medicine


Cushing’s Life of Osler

Won the Pulitzer Prize in 1926A wonderful introduction to a modern medical hero.Invaluable Olser ResourceGo to www.davidelpern.com for quotes

http://www.davidelpern.com/


Cushing’s Life of Osler

The practice of medicine is an art, not a trade; a calling, not a business: a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, the wise upon the foolish. William Osler


Viktor Frankl (1905 -1997)


Man’s Search for Meaning

Nietzsche's words, “He who has a why to live can bear with almost any how,” could be the guiding motto. One had to give them a why - an aim - for their lives, in order to strengthen them to bear the terrible how of their existence. Woe to him who saw no sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost.


Man’s Search for Meaning

The central theme of existentialism: to live is to suffer, to survive is to find meaning in the suffering. If there is a purpose in life at all, there must be a purpose in suffering and a purpose in dying. But no man can tell another what this purpose is. Each must find out for himself, and must accept the responsibility that his answer prescribes…


The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis [is] the name for this new epidemic.

Medical Nemesis (1976)


Illich’s Medical NemesisIatrogenic medicine reinforces a morbid society in which social control of the population by the medical system turns into a principal economic activity.

The most handy measure of the medicalization of life is the share taken out of a typical yearly income to be spent under doctor’s orders.


Francis Weld Peabody1881-1927

The Caring PhysicianThe Life of Dr. F.W. Peabody

Ogelsby PaulThe Countway LibraryBoston, Massachusetts

1991


Peabody’s Care of the Patient

The good physician knows his patients through and through…Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the most essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.


Lydgate’s Lament

"Apropos of what you said about wearing harness, I made up my mind some time ago to do with as little of it as possible. That was why I determined not to try anything in London, for a good many years. I didn't like what I saw when I was studying there--so much empty bigwiggism, and trickery. In the country, people have less pretension.


Middlemarch “Finale”

Who can quit young lives after being long in company with them, and not desire to know what befell them in their after-years? For the fragment of a life, however typical, is not the sample of an even web: promises may not be kept, and an ardent outset may be followed by declension; latent powers may find their long-waited opportunity; a past error may urge a grand retrieval.


Closing the ChartThere is a place in our busy lives for spending a little time with a dying patient. When I have taken such time, I have seen painful things and good things. My patients have expressed their anger and their hopes to me. And I hoped with them, for a cure, and for an end to their pain, and for peace. They faced death as I had faced it. We had nothing to lose by laughing -- my patients were a joy to be with and I cherish the time I spent with them.


Wit takes place in a University Hospital Cancer Center. The main character, Vivian Bearing, Ph.D., is a John Donne scholar who has stage IV ovarian cancer. Much of the action takes place in the last few days/hours of her life, with flashbacks to weeks, months, even years before interspersed throughout the performance.

Wit, the Film (2001) 99 minutesDirector, Mike Nichols, Starring Emma Thompson


Wit, the Film (2001) Based on Donne’s Sonnet

Death be not proud, though some have called thee

Mighty and dreadfull, for, thou art not so, For, those, whom thou think'st, thou dost overthrow,

Die not, poore death, nor yet canst thou kill me. … Thou art slave to Fate, Chance, kings, and desperate menAnd dost with poyson, warre, and sicknesse dwell,

And poppie, or charmes can make us sleepe as well,

And better then thy stroake; why swell'st thou then;

One short sleepe past, wee wake eternally, And death shall be no more; death, thou shalt die.


The New York Times Journal of Humane Medicine

• Online access is Free• Health Section Tuesdays• Book and Movie Reviews• Obituaries• Op-Ed• The Arts

A Full Service Personal University

www.nytimes.com


Screen or Not? What Those Prostate Studies Mean

March 24, 2009


Screen or Not? What Those Prostate Studies Mean

March 24, 2009

P.S.A. testing increases a man’s risk of being treated for a cancer that would never have harmed him in the first place. For every man helped by P.S.A. screening, at least 48 received unnecessary treatment that increased risk for impotency and incontinence. Dr. Brawley, CMO of the American Cancer Society, summed up the data this way: “The test is about 50 times more likely to ruin your life than it is to save your life.”


Cases: Comforter and Comforted in an Unfolding Mystery

March 31, 2009

by Nell Burger Kirst

This extraordinary essay by a fourth year medical student discussed the nature of caregiving much better than any textook or “scholarly” article.


Education on the Run


Keats: Chapman’s Homer

Much have I travell'd in the realms of gold,And many goodly states and kingdoms seen;Round many western islands have I beenWhich bards in fealty to Apollo hold.…Then felt I like some watcher of the skiesWhen a new planet swims into his ken; Or like stout Cortez when with eagle eyesHe star'd at the Pacific-and all his menLook'd at each other with a wild surmise-Silent, upon a peak in Darien.


Aloha and Mahalo

personal canons

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