'For My Small Ailments'

Empathy, in some quarters, is becoming quite fashionable. Clearly, my doctor has been benefiting from professional development. When he enters the examination room we shake hands, he moves a chair to face me and sits almost knee-to-knee. This is to eliminate any suggestion of hierarchical intimidation. He looks me in the eye when I answer his questions and nods his head approvingly. I don’t mean to make fun of the guy but he’s a middle-aged physician acting like an earnest, eager-to-please resident. It’s faintly comical but I appreciate the effort. It beats the alternative – the doctor who appears impatient, distracted, bored or even contemptuous. Years ago, I expressed to a doctor my displeasure at undergoing a digital rectal exam of the prostate. His response, without a trace of irony or wit: “You better hope you stay out of prison.” Good advice, Doc.

While researching a story I’m putting together at work, I reviewed several medical journals and happened unexpectedly on “Clinical Empathy for the Surgical Patient: Lessons From W.H. Auden’s Prose and Poetry,” published in 2021 in Annals of Surgery. Before they get to Auden, the authors endorse the practice of “‘emotional resonance’ with a patient’s symptoms and suffering [and] the action of ‘checking back’ with the patient to confirm or correct this shared understanding.”

 

Auden’s father was a physician and the poet often expressed interest in medicine and respect for good doctors. In 1932 he published the long poem The Orators: An English Study, from which the authors of the journal article extract “Letter to a Wound,” in which the speaker addresses his wound as though it were a jealous lover. His visit to the doctor doesn’t go well. “The surgeon,” our authors write, “his only source of hope, excused himself from the narrator’s experience of suffering. In contemporary terms, the surgeon failed to co-author the narrative of illness with the patient and the narrator is dominated and defeated by the narrative of this experience.” In the vernacular, the surgeon is an uncaring jerk. “Letter to a Wound” is a failed satire, not a good poem.

 

In 1969, Auden published “The Art of Healing,” dedicated to his recently dead personal physician and friend, Dr. David Protetch. In the ninth stanza he writes:

 

“For my small ailments

you, who were mortally sick,

prescribed with success:

my major vices,

my mad addictions, you left

to my own conscience.”

 

Protetch represents the opposite approach to treating patients from the one described in “Letter to a Wound.” “Dr. Protetch’s understanding that he cannot fully comprehend or cure the most intimate of his patient’s torments,” the authors write, “is the essence of clinical empathy—the choice to surrender and support, rather than overpower and control the patient’s narrative of illness.” That “narrative” business is a little heavy-handed, a lapse into academicese, but we get the idea. As a patient, I want treatment suggested, not mandated. The best doctors’ touch is simultaneously light and authoritative – one of several reasons why I generally prefer nurses to doctors. Under the entry for “Medicine” in A Certain World: A Commonplace Book (1970), Auden writes:

 

“I can remember my father, who was a physician, quoting to me when I was a young boy an aphorism by Sir William Osler: ‘Care more for the individual patient than for the special features of his disease.’ In other words, a doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.”

 

Auden was born on this date, February 21, in 1907 and died in 1973 at age sixty-six.