Individuals and types

In a retrospective review of the origins of Antoine Saint-Exupéry’s Little Prince, Edward Rothstein observes that the children’s book might be ultimately “less about individuals and more about types.” It is an aviator’s perspective, sweeping across the landscape, only mildly hampered by earthly ties and human requirements, being guided by the stars. On the other hand, the message of the character of the fox is “far more grounded, empathetic, more concerned with others.”

“Saint-Exupéry may have often been caught between these two perspectives,” Rothstein writes. “He fought against detachment but also relished it, fleeing for atmospheric vistas whenever possible.”

There, briefly stated, you have the same dilemma faced daily by thousands of clinicians in medical practice.

At the outset medical education consists largely of learning how to recognize and diagnose illness. Students are taught to look for disease patterns, clinical signs that when taken together as a whole point to one specific medical malady. Unfortunately this method cultivates an attitude toward human beings as disease entities. Students, residents and even attending physicians are apt to refer to “the cholecystectomy in Room 508,” “the schizophrenic in 212,” “the diabetic in ketoacidosis in the ED.”

Such shorthand nomenclature provides a synopsis of the clinical condition and by implication, a plan for treating it. Yet if we are not careful, referring to patients as diagnostic entities or classifying them as types allows us to dehumanize them. If we come to regard patients as mere disease entities, we are less likely to suffer emotional attachment, more likely to maintain our clinical objectivity; but at what cost?

Patients who perceive that their providers are not interested in them tend to linger longer in the throes of illness than those who feel validated and nurtured as individuals. It has been shown that providing terminally ill patients with good palliative care dramatically improves the quality of life during their waning months.

At some point in their medical education it would behoove clinicians to move toward an attitude of empathy, to take a compassionate stance in dealing with patients entrusted to their care.

Perhaps that is what Saint-Exupéry’s Little Prince has to teach us grownup clinicians who have chosen a career in medical practice.

In the words of the fox: “Here is my secret. It is very simple. One only sees rightly with the heart. The essential is invisible to the eye.”

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The ability to see

“Here is my secret. It’s very simple. One only sees rightly with the heart. The essential is invisible to the eye.” Antoine St. Exupéry in The Little Prince

In keeping with the theme of this year’s annual gathering of the Thoreau Society — Thoreau’s Environmental Ethos — Aldersgate United Methodist minister Greg Martin proposed a new ecologic paradigm for the 21st century. Using Thoreau’s poetic description of Walden Pond as the eye of the earth for a touchstone, Martin developed the idea that we need to cultivate an essential ecological lens through which we can begin to view the planet as a living, breathing organism, one to be cared for rather than exploited.

As the late Bradley Dean, editor of Thoreau’s posthumously published Wild Fruits, has suggested: “If we can realize that we are mysteriously related to matter, we will act to preserve the world because human beings protect what we love or feel related to.”

“[Walden] is earth’s eye,” Thoreau writes, “looking into which the beholder measures the depth of his own nature.”

In “The Ponds” chapter of Walden Thoreau builds upon this poetic vision of Walden. “The fluviatile trees next the shore are the slender eyelashes which fringe it, and the wooded hills and cliffs around are its overhanging brows.”

Thoreau describes the Walden water as “a vitreous greenish blue…like those patches of the winter sky seen through cloud vistas in the west before sundown.” “Walden is blue at one time and green at another, even from the same point of view…Such is the color of its iris.” (my italics)

In the midst of such poetic prose Thoreau interjects scientific observations. In one paragraph he records the temperature of the pond on a given day (the sixth of March, 1846) as 42 degrees, “one degree colder than the water of the one of the coldness wells in the village just drawn.” He comments on the rise and fall of the water level, noting that it corresponds to that of nearby Flint’s and White Pond. He describes the sandy terrain of the bottom near the shore, and publishes his soundings of its depths.

Thus Thoreau the writer couples his poetic vision with that of a scientist. Each perspective nourishes the other. At times it is difficult to separate the two.

At the end of Martin’s presentation a man in the middle of the audience remarked that he had always been of the same mind. “I am a physicist,” he said. “When I do science, I rely heavily upon my poetic insight. Those of us engaged in scientific research treasure the sense of mystery; it pricks our curiosity and generates a sense of awe for the unknown. Any scientist worth his salt will tell you the same. You can’t do one without the other.”

As I turned in my seat to better hear his remarks, I noticed his head cocked to one side with his chin slightly elevated. Even though we sat in the cool basement of the Masonic Lodge, he wore dark glasses.

As the workshop disbanded and disbursed I noticed this man shuffling along hesitantly behind the woman he had been sitting next to. His extended hand clung to her sleeve.

It was only then that I realized that this scientist who was capable of seeing what Thoreau saw was blind.

Sometimes the ability to see is not dependent solely upon our eyes.