which has its value, and but one. Does it help you over the hard places?
Does it aid you to see clearly and to bear patiently? Does it truly
nourish character, and tenderly but, firmly set you where you can gain a
larger view of the uses of pain and distress? That is the truest
sympathy. Does it leave you feebler with mere pity? Does it accentuate
pain and grief by simply dwelling on it with barren words? I leave you
to say what that is. We have a certain gentle disrespect among us for
the doctor who is described as, oh! so sympathetic,--the man who goes
about his work with a pocket-full of banal phrases calculated to soothe
and comfort the cravings of the wretched. The sick and feeble take
gladly these imitation crumbs cast from the full table of the strong.
But sometimes people of firm character revolt at such petty and
economical charity. I heard a vigorous old Quaker lady say once, after a
consultation, "Thee will do me a kindness not to ask me to see that man
again. Thee knows that I don't like my feelings poulticed."
The question of the truthfulness of physicians is one often raised. It
troubles the consultant far more than it does the family doctor, and
perhaps few who are not of us understand our difficulties in this
direction. Every patient has his or her standard of truth, and by it is
apt to try the perplexed physician. Some of the cases which arise are
curiously interesting, and perhaps nowhere better than in the
physician's office or at the bedside do we see sharply developed the
peculiarities of character as to this matter of truth in many of its
aspects. There is the patient who asks you to tell him the whole truth
as to his case. Does he really want to know? Very often he does not. If
you tell him, you sentence him. You do not shorten his life, you only
add to its misery. Or perhaps his wife has written to you, "On no
account tell my husband that he cannot get well. He dwells now on every
sign of failing health, and you will make him wretched." You parry his
question and try to help him. If he is resolute, he returns on you with
a query so positive that you must answer frankly. His wife was right.
You have done him an injury. There is the other man who insists at the
start that you must on no account tell him if he cannot get well. You
inform some relative of his condition. But perhaps he ought to know. He
contemplates some work or travel which he should not undertake. You say
so, and he replies, "But you have not told me that I am seriously ill."
Such is sick human nature.
The people who really want to know if they will die of some given
disease are few in number. Those who pretend they want to know are more
common. Those who should not know are frequent enough, and among them
one is troubled to do what seems right and to say in answer to their
questions what is true.
Wise women choose their doctors and trust them. The wisest ask the
fewest questions. The terrible patients are nervous women with long
memories, who question much where answers are difficult, and who put
together one's answers from time to time and torment themselves and the
physician with the apparent inconsistencies they detect. Another form of
trouble arises with the woman whose standards are of unearthly altitude.
This is the woman who thinks herself deceived if she does not know what
you are giving her, or who, if without telling her you substitute an
innocent drug for a hurtful one which she may have learned to take too
largely, thinks that you are untruthful in the use of such a method. And
you would indeed be wrong if you were of opinion that to tell her the
whole truth, and invite her to break the habit by her own act, were
available means. I certainly do not think that you have any right
(indeed, I would not even discuss this) to take active means to make her
think she is taking, say opium, when you are only giving her something
which tastes like it. If she asks, you must answer. But she may not, or
does not, and yet when she is well again and learns that the physician
preferred to act without her knowledge because he distrusted her power
to help, she is very likely, if she chance to be a certain kind of
woman, to say that he has been untruthful. Happily, such cases must be
rare, and yet I know of some which have been the source of much
annoyance to sensitive men. Thorough trust and full understanding is the
way to avoid such difficulties. A nervous woman should be made to
comprehend at the outset that the physician means to have his way
unhampered by the subtle distinctions with which bedridden women are apt
to trouble those who most desire to help them.
I omitted above an allusion to the most unpleasant inquirers, those who
are either on the verge of insanity or are victims of that singular
malady, hypochrondriasis. A patient clearly staggering to and fro on the
border line of sanity consults you. Here is a wilful, terrified being,
eager to know the truth. "Am I becoming insane? Will I end in an
asylum?" How can you answer? You see clearly, are sure the worst is
coming. What shall you do with this morbid, scared, obstinate child-man?
You put aside his questions, but you have here a person quite or nearly
sane to-day, resolute to hear, afraid to learn the truth he dreads. I
leave my reader with this patient, and my stated knowledge and my
shifted responsibility. "Doctor, if I am going to be insane, I will kill
myself." Good reader, pray dispose of this case. Or take the ease of a
confirmed hypochondriac. He is miserable, has a hundred ailments,
watches the weather, studies the barometer, has queer delusions as to
diets, clothes, and his own inability to walk. The least hint of a
belief that he is not as well as he was a week ago, or even a too close
examination, leaves him with a new malady, and he, too, is a sharp
questioner. As a rule, he has no perceptible changes in his tissues. But
if he has some real malady,--it may be a grave one on which he has built
a larger sense of misery than there was need for, and the case is common
enough,--how shall you answer him? It is a less difficult case than the
other, and I gladly leave him also to my consultant reader's acquired
knowledge and to his personal sense of the value of truth.
Physicians are often blamed for not sooner warning a family of the fact
that, in some case he and it are anxiously watching, death is
inevitable. As to this the doctor has very mingled feelings. Sometimes
he lacks courage, sometimes he is not sure enough to speak. A weak man
fears that he will lose his patient and some quack be called in, and
thus lessen the little chance yet left. Most of us can recall painful
interviews in which a relative insisted on a definite opinion, which we
were unable to give. As to cases where there is little or no doubt left,
perfect frankness should be, and is, I think, our rule, but no one knows
better, or as well as we, how numberless are the chances of escape for
cases which seem to be at their worst. Hence a part of the reluctance
the physician has to pronounce a verdict of fatal character.
There is another matter of moment as to cases known to be hastening to a
fatal conclusion. The responsibility of withholding this knowledge from
the patient is usually shifted on to the shoulders of relatives or
friends. The medical adviser reports to them his opinion and leaves with
them the power to act.
He is often asked if to know that death seems certain makes less the
chance of recovery or shortens the lessening number of the days of life
yet left. It has often fallen to my sad lot, as to that of many of my
medical brothers, to have to tell a patient that he is to die. Some
isolated man asks it. Some lonely hospital patient has just reasons for
knowing early or late in his disease the truth as the doctor sees it. I
have never been able to feel certain that in any case of acute or
hopeless illness to know surely what lay before a sick man did
distinctly shorten his life. I have seen many people in apparent health
made ill by the shock of emotion,--by fear, grief, anger, jealousy.
Diseased persons feel less, or show less in a physical way, the results
we might expect to see from even the most rudely conveyed intelligence
as to their probable future.
It was not my wish to enter into a long discussion of all the qualities
which go to make up the ideal physician. I desired chiefly to consider
his principal needs, to point out in big defence certain of his
embarrassments, and to leave the reader with some sense of help towards
knowing whether his adviser was such as he should be in the more
important qualities which go to make the true physician. There are other
and minor matters which are not without their relative gravity in his
life. Some are desirable but not truly essential, and yet help or hurt
him much. Whether he is gentle and well-mannered, is socially agreeable,
or as to this negative, influences much the choice of the woman on whom,
as a rule, comes finally the decision of who her family physician shall
be. Too often she is caught by the outside show of manners, and sets
aside an abler and plainer man, who has more really the true manners of
the heart, yet lacks the power to make himself pleasant. Desirable it
is, of course, to be what so many of the best physicians have been,
refined and tactful gentlemen, and also charming companions. But a man
may be a most competent, clear-headed, honest, scrupulously careful
doctor, and yet be plain, ill-dressed, and uninteresting, and all this
it is as well to understand. The mass of professional opinion is not so
easily pleased as are individual patients. It decides pretty early in
any large community, and classifies its members accurately, reversing
very often the verdict of the juries of matrons, who do so much to make
or mar our early fates. Soon or late it sifts the mass, knows who are
the thorough, trustworthy, competent, hard-headed practitioners, who are
the timid, who the too daring, who ride hobbies, and who trust too much
to drugs. Soon, too, it distinguishes those on whom it can call in
emergencies, and the highest class of men who have the great gift of
discovery and the genius of observation.
From the public we can look for no such justice, and our professional
manners forbid us to speak of our brethren, save among ourselves, with
perfect freedom. As a profession, it is my sincere conviction that in
our adherence to a high code of moral law, and in the general honesty
with which we do our work, no other profession can be compared with
ours. Our temptations, small and large, negative and positive, are many
and constant, and yet I am quite sure that no like group of men affords
as few illustrations of grave moral weaknesses. It is commonplace to say
that our lives are one long training in charity, self-abandonment, all
forms of self-restraint. The doctor will smile at my thinking it needful
to even state the fact. He begins among the poor; all his life, in or
out of hospitals, he keeps touch of them always. He sells that which men
can neither weigh nor measure, and this sets him over all professions,
save one, and far above all forms of mere business. He is bound in honor
to profit by no patent, to disclose all he has learned, and to give
freely and without reward of his best care to all others of his
profession who may be sick. What such a life makes of a man is largely a
question of original character, but in no other form of occupation is
there such constant food useful to develop all that is best and noblest.
Popular opinion has been prone to decide that the physician who is
anything else than this is a person not to be trusted. The old axiom is
too often quoted as concerns us, "Jack of all trades, master of none."
But there are enough men who have the power to be master of many trades
and passed master of one. It is a question of applicative energy. Few
men in early life can do much more than is needed to learn our art and
its sister sciences; but, as time goes on, there are many who can add to
it other pursuits which greatly benefit them in a wide sense, and
enlarge and strengthen their mental powers, or pleasantly contribute to
the joys of life, and so even to the growth of a man's moral nature. The
wise physician, who is fond of etching or botany, the brush, or the
chisel or the pen, or who is given to science, does well to keep these
things a little in the background until he is securely seated in the
saddle of professional success. Then usually he may feel free to
reasonably follow out his tastes, and to write, or in any other way
insist on freedom to use or make public his results. If only he has the
competent fund of persistent industry to draw upon, he will be not the
worse, but the better, physician for such enlargement of his pursuits as
I refer to, for we may feel sure that in my profession there is room for
the direct or indirect use of every possible accomplishment.
CONVALESCENCE.
To my mind, there is nothing more pleasant than the gradual return to
health after some revolutionary disease which has removed a goodly
portion of the material out of which is formed our bodily frame. Nature
does this happy work deftly in most cases, where, at least, no grave
organic mischief has been left by the malady; and in the process we get
such pleasantness as comes always from the easy exercise of healthy
function. The change from good to better day by day is in itself
delightful, and if you have been so happy, when well, as to have loved
and served many, now is the good time when bun and biscuit come back to
you,--shapely loaves of tenderness and gracious service. Flowers and
books, and folks good and cheery to talk to, arrive day after day, and
have for you a new zest which they had not in fuller health. Old tastes
return and mild delights become luxuries, as if the new tissues in nerve
and brain were not sated, like those of the older body in which they are
taking their places.
When you are acutely ill, the doctor is business-like and gravely kind;
you want him in a way, are even anxious to see him for the relief he may
bring, or the reassurance. But when you begin to feel as if you were a
creature reborn, when you are safe and keenly enjoying the return of
health, then it is that the morning visit is so delightful. You look for
his coming and count on the daily chat. Should he chance to be what many
of my medical brothers are,--educated, accomplished, with wide artistic
and mental sympathies,--he brings a strong, breezy freshness of the
outer world with him into the monastic life of the sick-room. One does
not escape from being a patient because of being also a physician, and
for my part I am glad to confess my sense of enjoyment in such visits,
and how I have longed to keep my doctor at my side and to decoy him into
a protracted stay. The convalescence he observes is for him, too, a
pleasant thing. He has and should have pride in some distinct rescue, or
in the fact that he has been able to stand by, with little interference,
and see the disease run its normal course. I once watched a famous
surgeon just after he had done a life-saving operation by dim
candle-light. He stood smiling as the child's breath came back, and kept
nodding his head with pleasant sense of his own competence. He was most
like a Newfoundland dog I once had the luck to see pull out a small
child from the water and on to a raft. When we came up, the dog was
wagging his tail and standing beside the child with sense of
self-approval in every hair. The man wagged his head; the dog wagged his
tail. Each liked well what he had done.
Thus it is that these half-hours by the convalescent's couch are full of
subtle flattery for the doctor, and are apt to evolve the social best of
him, as he notes the daily gain in strength and color, and listens, a
tranquil despot, to one's pleas for this freedom or that indulgence. He
turns over your books, suggests others, and, trained by a thousand such
interviews, is likely enough a man interesting on many sides.
You selfishly enjoy his visit, not suspecting that you, too, are
ignorantly helpful. He has been in sadder homes to-day, has been sorely
tried, has had to tell grim truths, is tired, mind and body. The visit
he makes you is for him a pleasant oasis: not all convalescents are
agreeable. He goes away refreshed.
Most doctors have their share, and more, of illness, and are not, as I
have seen stated, exempt from falling a prey to contagious maladies.
Indeed, our records sadly show that this is not the case. Perhaps there
is value for them and their future patients in the fact that they have
been in turn patient and doctor and have served in both camps. Like
other sick folks, the physician, as I know, looks forward, when ill, to
the "morning visits" quite as anxiously as do any of those who have at
times awaited his own coming.
That medical poet who has the joyous art of sending a ripple of mirth
across the faces of the Anglo-Saxon world recognizes this fact in a
cheerful poem, called "The Morning Visit," and to which I gladly refer
any of my readers who would like to know from the lips of Oliver Wendell
Holmes what manner of delightful patient he must have been. I can fancy
that he lost for his doctor many a pleasant hour.
It has seemed to me as if this wonderful remaking and regrowing of the
tissues might be likened to a swift change from the weak childhood of
disease to a sudden manhood of mind and body, in which is something of
mysterious development elsewhere unmatched in life. Death has been
minutely busy with your tissues, and millions of dead molecules are
being restored in such better condition that not only are you become new
in the best sense,--renewed, as we say,--but have gotten power to grow
again, and, after your terrible typhoid or yellow fever, may win a
half-inch or so in the next six months,--a doubtful advantage for some
of us, but a curious and sure sign of great integral change.
The Greeks had a notion that once in seven years we are totally changed,
the man of seven years back having in this time undergone an entire
reconstruction. We know now that life is a constant death and a
renewing,--that our every-day nutrition involves millions of molecular
deaths and as many millions of births,--although to liken that which is
so exquisitely managed, so undisturbingly done, to the coarser phenomena
of death and birth is in a measure misleading.
Diseases such as typhoid fever, or a sharp local lung-trouble like
pneumonia, really do make these minute changes approximate in abruptness
to death. You weigh, let us say, one hundred and eighty pounds, and you
drop in three weeks of a fever to one hundred and thirty pounds. The
rest of you is dead. You have lost, as men say, fifty pounds, but your
debt to disease, or to the blunders of civilization, for it is a case of
creditor behind creditor, is paid. Your capital is much diminished, but
you have come out of the trial with an amazing renovation of energy.
This is the happy convalescence of the wholesome man. The other, the
unlucky, fellow, does not get as safely through the cleansing bankruptcy
of disease. The vicious, unlucky, or gouty grandfather appears on the
books of that court in mysterious ways; his sins are pathologically
visited on his child's child in this time of testing strain.
In the happy rush towards useful health, of a convalescence undisturbed
by drawbacks, it is pleasant to think, as one lies mending, of the good
day to come when my friend, recovering from typhoid or smallpox, shall
send for his legal adviser and desire him as usual to bring suit against
the city for damages and loss of time.
A little girl coughed in my face a hideous breath of membraneous decay.
I felt at once a conviction of having been hit. Two days later I was
down with her malady. She herself and two more of her family owed their
disease to the overflow of a neighbor's cesspool, and to them--poor,
careless folk--Death dealt out a yet sterner retribution. There was a
semi-civilized community beyond both. Should one go to law about it and
test the matter of ultimate responsibility?
The amiability of convalescence is against it. One feels at peace with
all the world, and so lies still, and reflects, "like souls that balance
joy and pain," as to whether, on the whole, the matter has not had its
valuable side. Certainly it has brought experiences not otherwise
attainable.
Of the deeper and more serious insights a man gathers in the close
approach of death and the swift, delicious return to safety and
enlarging powers I hardly care to speak. To a physician, it is simply
invaluable to have known in his own person pain, and to have been at
close quarters with his constant enemy, and come off only wounded from
the contest. In the anxiety about you is read anew what you look upon in
other households every day, and perhaps with a too accustomed eye. And
as to pain, I am almost ready to say that the physician who has not felt
it is imperfectly educated. It were easy to dwell on this aspect of
convalescence, but the mental state of one on the way to health is not
favorable to connected thought. It is more grateful to lie in the sun,
at the window, and watch the snow-birds on the ice-clad maples across
the way, and now and then, day after day, to jot down the thoughts that
hop about one's brain like the friendly birds on the mail-clad twigs.
I make no apology for the disconnectedness of my reflections, but turn
gladly to my records of the joyous and less grave observations which the
passing hours brought me. Much as I have seen of disease and recoveries
in all manner of men and women, the chance to observe them in my own
person presented me with many little novel facts of interest. I find in
my brief notes of this well-remembered time many records of the
extraordinary acuteness won for a while by the senses.
Not dubious, but, alas! brief, is the gain which the sensorium acquires
in this delightfully instructive passage out of death's shadow into
certain sunshine. In my own case there was a rapid exfoliation, as we
call it, of the skin, a loss and renewal of the outer layer of the
cuticle. As a result of this, the sense of touch became for a while more
acute, and was at times unpleasantly delicate. This seemed to me, as I
first thought of its cause, a mere mechanical result, but I incline to
suspect now that it was in a measure due to a true increase in capacity
to feel, because I found also that the sister sense of pain was
heightened. Slight things hurt me, and a rather gentle pinch gave undue
discomfort. No doubt a part of this was owing to my having taken a good
deal of opium, and then abruptly laid it aside. As I have elsewhere
stated, this is apt to leave the nerves oversensitive for a season. The
sense of hearing seemed to me to be less wide awake. I did not hear
better, but high notes were for a while most unpleasant. The sense of
taste grew singularly appreciative for a time, and made every meal a
joyful occasion. The simplest food had distinct flavors. As for a glass
of old Madeira,--a demijohned veteran of many ripening summers,--I
recall to this day with astonishment the wonderful thing it was, and how
it went over the tongue in a sort of procession of tastes, and what
changeful bouquets it left in my mouth,--a strange variety of varying
impressions, like the play of colors. In these days of more unspiritual
health and coarser sense I am almost ashamed to say what pleasure I
found in a dish of terrapin.
The function of smell became for me a source both of annoyance and,
later on, of pleasure. I smelt things no one else could, and more things
than I now can. The spring came early, and once out of doors the
swiftly-flitting hours of sensory acuteness brought to me on every
breeze nameless odors which have no being to the common sense,--a sweet,
faint confusion of scents, some slight, some too intense,--a gamut of
odors. Usually I have an imperfect capacity to apprehend smells, unless
they are very positive, and it was a curious lesson to learn how intense
for the time a not perfect function may become. Recent researches have
shown that a drug like mercaptan may be used to test the limit of
olfactory appreciation. We have thus come to know that the capacity to
perceive an odor is more delicate than our ability to recognize light.
Probably it is an inconceivable delicacy of the sense of smell more than
anything else which enables animals to find their way in the manner
which seems to us so utterly mysterious. Yet, even in human beings, and
not alone in a fortunate convalescence, do we see startling
illustrations of the possibilities of this form of sensorial acuteness.
I know of a woman who can by the smell at once tell the worn gloves of
the several people with whom she is most familiar, and I also recall a
clever choreic lad of fourteen who could distinguish when blindfold the
handkerchiefs of his mother, his father, or himself, just after they
have been washed and ironed. This test has been made over and over, to
my satisfaction and surprise.