While learning “The Sailor’s Tango” from Happy End, a Weimar-era play with songs by Bertold Brecht and Kurt Weill for performances this winter, I recently discovered a major obstacle that had inhibited my full realization of this musical mini-drama. Within the span of a few lines, I would have to evoke and enact the most frightening experience possible: confrontation with the most fearsome, shattering, and terrifying thing in all of life—death.
“Der Matrosen-Tango” tells the story of humble sailors, the lowest ranking men aboard the German ships of the 1920’s. They return from shore leave, bragging about the booze, cigars, and girls left behind. Laughing at God and religion, they depart for Burma, only to meet their fate amidst the whirlwinds of a tropical typhoon. Their last-minute prayers are unanswered as they witness their ship destroyed, drifting down to a watery grave. A “sea of blue” will be their home for all eternity.
Naturally, it’s a rare privilege to learn a Brecht/Weill song, even for someone who directed The Threepenny Opera as a 19 year-old Yale undergraduate. Their music collaboration produced masterpieces whose hypnotic harmonics and intense drama are uniquely haunting. I too have been haunted by “The Sailor’s Tango” and not just by its subtle dance rhythms and literally hair-raising words. A very dear Yale friend, Glenn Mure, a brilliant actor and singer, included this number in a 1986 cabaret program for his closest friends immediately after he was diagnosed as HIV-positive. The horrifying pleadings of the sailor took on an extraliterary significance that still give me chills.
During my years as a medical student, extern, intern, resident, and emergency room attending physician I saw by my estimation approximately 3000 people die in front of me. Almost all doctors have crossed that same battlefield. Some of those people had lived long, happy lives. Others were cut down in their youth. Some were victims of accidents or unforeseen health crises. Others were infants, children, or adolescents who never experienced the beauties of health, friendship, and joy. How did these experiences steel me in a resolve to fight disease and help people in need? I don’t think I will ever know.
Now I find myself reliving the deaths of close friends, family members, and even some strangers as I channel the primal terror that a doomed fictional sailor experiences—compacted into 20 seconds of the Brecht/Weill song. A lifetime of death, as it were, passes through my mind. As does my reaction to this incessant fear caused by the inexorable forces of nature and illness. When I first started to witness multiple cardiac arrests during a typical day in a large Brooklyn hospital—despite heroic measures and amazing dedication by humanitarian physicians, nurses, and assistants—I realized that I needed to live each day fully, caring for others and enjoying my favorite things, namely friends, theater, and music.
When I perform “The Sailor’s Tango” I will be once again staring at death, and it won’t be the last time.
Thursday, October 29, 2009
Friday, October 23, 2009
What is the Worst Illness in the World?
What is the worst illness in the world?
I was reminded of that rhetorical question this week when I examined a patient rapidly losing her vision from retinal hemorrhages and a central retinal vein thrombosis. She had struggled with poor vision in one eye and now has lost almost total vision in both eyes, only being able to perceive shapes and light. Amazingly, although 86 she has no other chronic illnesses and has never taken any prescription medicine.
Naturally this patient is overwhelmed by the sudden development of this affliction. Now she must become reliant on neighbors and friends for her daily activities, and her security and independence have been permanently changed. She humorously pretends to consider suicide but wouldn’t be able to ascend the Brooklyn Bridge on her own.
As a physician, I am repeatedly faced with the difficult task of giving consolation and courage to people such as this wonderful woman. What can you tell them? Throughout 30 years as a doctor and a healer, I have had the singularly unpleasant responsibility to tell family members that a grandparent, relative, friend, lover, spouse, or child is dead. My training for this terrible task came from years of exposure to humanistic psychology, not from medical textbooks. One needs to be especially empathetic because we will all eventually be on the receiving end of such news.
When I lay recuperating from ulcer surgery in 1991 at St. Claire’s Hospital, tubes everywhere, I began to feel sorry for myself. That lasted about ten minutes when I realized that I was in a hospice unit and my neighbors were terminal patients. I imagined going to their bedsides and asking if someone would want to trade places with me. You know the answer: anyone dying of cancer or another frightening illness would welcome the opportunity to erase their disease and substitute a totally healed gastric ulcer. I stopped this foolish and selfish thinking immediately.
Illness brings out our worst fears and challenges our inner strength and stability. Personal myths such as “I never get sick” can be shattered in seconds. Yet, I have seen patients with pancreatic cancer accept their fate. In contrast, I have seen a young patient newly diagnosed with mild asthma commit suicide in his hospital room.
Physicians are not merely diagnosticians, clinicians, tradesmen, or surgical technicians. We deal not only with human bodies but diverse reactions to bodily trauma and incapacitation. Interestingly, a given individual may have multiple different responses to illness at different times. Elisabeth Kübler-Ross discusses this eloquently in On Death and Dying. Even seemingly mundane illnesses such as diabetes or hypertension can elicit diverse reactions ranging from denial and depression to total loss of self-control.
What did I tell the lovely 86 year-old who was now confronting a future of darkness? I recycled my own experience at St. Claire’s and told her to visit a nursing home or hospice and ask patients if they would trade places with her. After a moment of reflection, the patient smiled and decided instead to visit the Lighthouse and the Jewish Home for the Blind. They would be able to provide the necessary support system for her daily activities and routines. She will supply her own courage.
I often ask patients and myself: “What is the worst illness in the world?” The answer is the same every time: “It’s the one that you have.”
I was reminded of that rhetorical question this week when I examined a patient rapidly losing her vision from retinal hemorrhages and a central retinal vein thrombosis. She had struggled with poor vision in one eye and now has lost almost total vision in both eyes, only being able to perceive shapes and light. Amazingly, although 86 she has no other chronic illnesses and has never taken any prescription medicine.
Naturally this patient is overwhelmed by the sudden development of this affliction. Now she must become reliant on neighbors and friends for her daily activities, and her security and independence have been permanently changed. She humorously pretends to consider suicide but wouldn’t be able to ascend the Brooklyn Bridge on her own.
As a physician, I am repeatedly faced with the difficult task of giving consolation and courage to people such as this wonderful woman. What can you tell them? Throughout 30 years as a doctor and a healer, I have had the singularly unpleasant responsibility to tell family members that a grandparent, relative, friend, lover, spouse, or child is dead. My training for this terrible task came from years of exposure to humanistic psychology, not from medical textbooks. One needs to be especially empathetic because we will all eventually be on the receiving end of such news.
When I lay recuperating from ulcer surgery in 1991 at St. Claire’s Hospital, tubes everywhere, I began to feel sorry for myself. That lasted about ten minutes when I realized that I was in a hospice unit and my neighbors were terminal patients. I imagined going to their bedsides and asking if someone would want to trade places with me. You know the answer: anyone dying of cancer or another frightening illness would welcome the opportunity to erase their disease and substitute a totally healed gastric ulcer. I stopped this foolish and selfish thinking immediately.
Illness brings out our worst fears and challenges our inner strength and stability. Personal myths such as “I never get sick” can be shattered in seconds. Yet, I have seen patients with pancreatic cancer accept their fate. In contrast, I have seen a young patient newly diagnosed with mild asthma commit suicide in his hospital room.
Physicians are not merely diagnosticians, clinicians, tradesmen, or surgical technicians. We deal not only with human bodies but diverse reactions to bodily trauma and incapacitation. Interestingly, a given individual may have multiple different responses to illness at different times. Elisabeth Kübler-Ross discusses this eloquently in On Death and Dying. Even seemingly mundane illnesses such as diabetes or hypertension can elicit diverse reactions ranging from denial and depression to total loss of self-control.
What did I tell the lovely 86 year-old who was now confronting a future of darkness? I recycled my own experience at St. Claire’s and told her to visit a nursing home or hospice and ask patients if they would trade places with her. After a moment of reflection, the patient smiled and decided instead to visit the Lighthouse and the Jewish Home for the Blind. They would be able to provide the necessary support system for her daily activities and routines. She will supply her own courage.
I often ask patients and myself: “What is the worst illness in the world?” The answer is the same every time: “It’s the one that you have.”
Thursday, October 1, 2009
A Pig in a Poke
Which illnesses frighten you the most? Leprosy, with its disfiguring skin and facial changes? Tuberculosis, depicted in the theater by frail, pale young women coughing up blood onto their bed linens? Perhaps high blood pressure, which has the following signs and symptoms…[none]?
Let’s face it: infectious diseases are inherently the most terrifying. The thought of viruses, bacteria, protozoa, or parasites invading our body parts and invisibly spreading toxins remains a child-like fear throughout our lives. The Bubonic Plague (poetically rendered as “The Black Death”) is perhaps the prototype, although centuries have passed since rats swarmed through London. Of late you’ve no doubt heard of the influenza epidemic of 1918, the most infamous public health catastrophe of the 20th century.
Even in recent years, infectious diseases, unlike many more common illnesses, seem to grab the headlines, producing a somewhat distorted view of American health emergencies. Television viewers are apparently numb to the endless litany of articles on obesity and overweight, extremely unhealthy conditions that affect 67% of the adult population. A personal myth seems to be: “If there are commercials about diabetic medications and blood testers, diabetes really can’t be much more dangerous than athlete’s foot.”
On the other hand, mention a new or revived infectious disease on the air and you’re guaranteed an attentive audience. SARS, an extremely rare type of bird-flu, resulted in mass-media hysteria in 2003. Every station covered the story as if a new plague had arrived—the humble author of Dr. Fischer’s Little Book of Big Medical Emergencies did almost 50 separate interviews on the topic! [but he’s not complaining]. Remember West Nile Encephalitis? That caused more panic several summers ago than Elizabeth Taylor’s performance as Cleopatra. And how about “Mad Cow Disease”? I assume that McDonalds hasn’t changed its menu.
Diabetes, hypertension, high cholesterol (and 40 other conditions in 9 organ systems directly related to obesity) don’t grab headlines because of “over-exposure”, although these are the most prevalent threats to anyone’s health at present. Contrast this with wall-to-wall coverage of swine flu: although 25% of the pediatric population is obese, “concerned” parents are rushing their children to local emergency rooms for evaluation and treatment of a transitory infectious disease. Swine flu lasts approximately two weeks. Diabetes and obesity can reduce life expectancy by four or more years. Which seems more serious to you?
In 1976 swine flu became front page news after an outbreak at Fort Dix. A mass inoculation program was rapidly put into effect as thousands of people swarmed to medical offices and hospitals to protect themselves against certain death. Unfortunately, the opposite occurred, as can be illustrated by the story of Stuart Fischer, medical student at Maimonides Hospital. As a dedicated health care worker, I was lucky enough to receive swine flu vaccination thanks to the generosity of the hospital administration. Upon returning home right after the injection, I put on the television news and saw that the entire inoculation program had been abruptly terminated that day.
As it turned out, the vaccination provoked an illness called Guillien-Barre Syndrome. At its worst, this resulted in respiratory arrest and sudden death. Such was the fate of 25 otherwise healthy individuals. In fact more people died from the vaccination than from swine flu itself. Needless to say, I have been extremely suspicious of government health programs since then and have not taken or recommended any flu vaccinations, unless the individual has severe pre-existing cardiovascular conditions.
Influenza epidemics are a fact of life, a necessary evil in a world filled with microbes of every type. Periodically our immune systems need a workout just like our muscles do. If we need a vaccination for every known infectious disease, how will we be ready to fight off other health challenges? Cancer, for example, may be partially due to viral infections.
Now that Americans have been made aware of an impending crisis in healthcare (due to obesity) and health insurance (due to overrun costs) we may need to consider cost-effectiveness on a national level. Simply put, and not unlike your budgeting household expenses, should we be spending millions of tax dollars on a recurrent, seasonal mild infectious disease or utilizing the money for hospital clinics, nursing homes, low cost medication, prenatal care, and ambulances?
By all means, protect yourself and your family as best as possible from viral respiratory illnesses every year. Practically this means hand washing, sanitizing surfaces, avoiding ill people, and covering your mouth when sneezing or coughing. But keep a sense of perspective. Swine flu and its mischievous friends will outlast us all. On the other hand, obesity will shorten your life. Don’t buy a pig in a poke.
Let’s face it: infectious diseases are inherently the most terrifying. The thought of viruses, bacteria, protozoa, or parasites invading our body parts and invisibly spreading toxins remains a child-like fear throughout our lives. The Bubonic Plague (poetically rendered as “The Black Death”) is perhaps the prototype, although centuries have passed since rats swarmed through London. Of late you’ve no doubt heard of the influenza epidemic of 1918, the most infamous public health catastrophe of the 20th century.
Even in recent years, infectious diseases, unlike many more common illnesses, seem to grab the headlines, producing a somewhat distorted view of American health emergencies. Television viewers are apparently numb to the endless litany of articles on obesity and overweight, extremely unhealthy conditions that affect 67% of the adult population. A personal myth seems to be: “If there are commercials about diabetic medications and blood testers, diabetes really can’t be much more dangerous than athlete’s foot.”
On the other hand, mention a new or revived infectious disease on the air and you’re guaranteed an attentive audience. SARS, an extremely rare type of bird-flu, resulted in mass-media hysteria in 2003. Every station covered the story as if a new plague had arrived—the humble author of Dr. Fischer’s Little Book of Big Medical Emergencies did almost 50 separate interviews on the topic! [but he’s not complaining]. Remember West Nile Encephalitis? That caused more panic several summers ago than Elizabeth Taylor’s performance as Cleopatra. And how about “Mad Cow Disease”? I assume that McDonalds hasn’t changed its menu.
Diabetes, hypertension, high cholesterol (and 40 other conditions in 9 organ systems directly related to obesity) don’t grab headlines because of “over-exposure”, although these are the most prevalent threats to anyone’s health at present. Contrast this with wall-to-wall coverage of swine flu: although 25% of the pediatric population is obese, “concerned” parents are rushing their children to local emergency rooms for evaluation and treatment of a transitory infectious disease. Swine flu lasts approximately two weeks. Diabetes and obesity can reduce life expectancy by four or more years. Which seems more serious to you?
In 1976 swine flu became front page news after an outbreak at Fort Dix. A mass inoculation program was rapidly put into effect as thousands of people swarmed to medical offices and hospitals to protect themselves against certain death. Unfortunately, the opposite occurred, as can be illustrated by the story of Stuart Fischer, medical student at Maimonides Hospital. As a dedicated health care worker, I was lucky enough to receive swine flu vaccination thanks to the generosity of the hospital administration. Upon returning home right after the injection, I put on the television news and saw that the entire inoculation program had been abruptly terminated that day.
As it turned out, the vaccination provoked an illness called Guillien-Barre Syndrome. At its worst, this resulted in respiratory arrest and sudden death. Such was the fate of 25 otherwise healthy individuals. In fact more people died from the vaccination than from swine flu itself. Needless to say, I have been extremely suspicious of government health programs since then and have not taken or recommended any flu vaccinations, unless the individual has severe pre-existing cardiovascular conditions.
Influenza epidemics are a fact of life, a necessary evil in a world filled with microbes of every type. Periodically our immune systems need a workout just like our muscles do. If we need a vaccination for every known infectious disease, how will we be ready to fight off other health challenges? Cancer, for example, may be partially due to viral infections.
Now that Americans have been made aware of an impending crisis in healthcare (due to obesity) and health insurance (due to overrun costs) we may need to consider cost-effectiveness on a national level. Simply put, and not unlike your budgeting household expenses, should we be spending millions of tax dollars on a recurrent, seasonal mild infectious disease or utilizing the money for hospital clinics, nursing homes, low cost medication, prenatal care, and ambulances?
By all means, protect yourself and your family as best as possible from viral respiratory illnesses every year. Practically this means hand washing, sanitizing surfaces, avoiding ill people, and covering your mouth when sneezing or coughing. But keep a sense of perspective. Swine flu and its mischievous friends will outlast us all. On the other hand, obesity will shorten your life. Don’t buy a pig in a poke.
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