TABLE OF CONTENTS
Introduction: A Hospitable Welcome - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0001
[fundamental medicine, medical generosity, grace, illness, disability, diagnoses, surgery, consolation]
This chapter considers fundamental medicine: face-to-face encounters between people who are suffering bodily ills and other people who need both the skills to relieve this suffering and the grace to welcome those who suffer. Medical generosity lies in that latter quality—the grace to welcome those who suffer. The chapter's conviction is that at the start of the twenty-first century, the foremost task of responding to illness and disability is not by devising new treatments. The challenge is to increase the generosity with which it offers the medical skill that has been attained. Pharmaceuticals and surgeries, diagnostic techniques and institutional provision of services are crucial tools of medical work, but here the chapter leaves these in the background. Before and after fundamental medicine offers diagnoses, drugs, and surgery to those who suffer, it should offer consolation. To offer consolation is an act of generosity. (pages 1 - 11)
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Lost in the Tunnel - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0002
[tunnel, Enid Rhodes Peschel, Richard Peschel, illness, Barbara Rosenblum, institutional medicine, The Tunnel, breast cancer]
This chapter discusses “The Tunnel,” which appears in a little book with a provocative title, When a Doctor Hates a Patient and Other Chapters in a Young Physician's Life, coauthored by the late Enid Rhodes Peschel, who was codirector of the medical humanities program at Yale Medical School, and Richard Peschel, a radiologist. Each chapter begins with a story told in the first person by Richard Peschel, describing some incident in his medical residency and early career. Enid Peschel then discusses various literary texts that expand the issues in Richard's story. The tunnel is an evocative metaphor of the experience of being ill. Stories of being diagnosed as having a life-threatening or life-altering illness. Barbara Rosenblum suggests being in a psychic tunnel as she evokes her receiving a diagnosis of breast cancer. The tunnel is an equally evocative metaphor for institutional medicine: the organizational and physical structures within which care is offered. (pages 12 - 29)
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The Dialogical Stoic - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0003
[Stoicism, illness, care, Sam Crane, dialogue, reality, Dialogical Stoic, experiential reality]
This chapter examines Stoicism and dialogical thought, beginning with two reflections on illness and a story of care. The first is from personal experience of illness, and the second returns to Sam Crane to describe the experience of giving care. The chapter turns from the experience of illness to the experience of offering care. One of Sam Crane's stories of caring for Aidan illustrates the complementary necessity of Stoicism and dialogue. Crane expresses his communion with Aidan—the physical intimacy is tangible. He is also engaging in a form of Stoic spiritual exercise. He controls his attention to the reality outside himself, and he shapes how he understands his relation to this reality. The Dialogical Stoic may be a philosophical oxymoron, but it can be an experiential reality. (pages 30 - 54)
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The Generosity of the Ill - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0004
[Albert Schweitzer, illness, sense of obligation, Stoicism, Mikhail Bakhtin, moral perfectionism]
Albert Schweitzer imagines illness in the Stoic manner that this chapter's epigraph expresses: he transforms the illness that was the obstacle in his way into the calling that sets him on the way. In this passage, Schweitzer separates what is inner from what is exterior, finds freedom in the inner, and seeks to be beyond susceptibility to disturbance caused by the external. Schweitzer's sense of obligation may begin in an eternal Stoicism, but he does not remain within the “internal dialogicality” that Mikhail Bakhtin considers characteristic of the Stoics. The phrase “moral perfectionism” sounds heavy to contemporary ears; it seems to impose a burden, like Schweitzer's fellowship of those who bear the mark of pain. Such phrases do assert a radical ideal of responsibility, and the line between inspiring and burdening may necessarily be a fine one. (pages 55 - 77)
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Physicians' Generosity - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0005
[physicians, Anatole Broyard, Abraham Verghese, Rafael Campo, Lori Alvord, David Hilfiker, managed care, AIDS, physician autonomy, medical power]
This chapter reflects on stories by physicians who want what Anatole Broyard wants: for their relationships with their patients to be beautiful in some way. The chapter chooses four physicians—Abraham Verghese, Rafael Campo, Lori Alvord, and David Hilfiker. These doctors reached their career potential long after physicians regularly made house calls, and long enough after the sky's-the-limit medical boom of the 1960s and 1970s, when the professional power of medicine may have enjoyed its historical zenith. Their medical world is epitomized by two phenomena that became prominent in the 1980s: managed care and AIDS. The circumscription of physician autonomy effected by managed care is exacerbated by the uncertainty of the AIDS pandemic, which has stretched the limits of medicine's capacity to care and become a metaphor of the limits of medical power, or hubris, to control disease. (pages 78 - 105)
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“So that I can carry on” - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0006
[generosity, Miriam Lambert, suffering, ethnography, Anna Towers, death, palliative care, hospitalization]
This chapter tells the story of a palliative care nurse, Linda, and the generosity of the care she offers. Linda, speaking in a brief interview excerpt, describes her relationship with a patient named Miriam Lambert, whose suffering could not be relieved as well as what Linda wants to believe she and her colleagues usually can provide for people who are dying. Linda speaks within the immediacy of the work she describes; she does not write, edit, and revise. Her story evokes the chaos of generosity while it is being practiced, yet she carries on. One can recognize the generosity of her perseverance only when one feels the chaos of her work. Linda's story is told as one part of an ethnography of Miriam Lambert's final hospitalization and death narrated by Anna Towers, a palliative care physician in Montreal. (pages 106 - 122)
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Unfinalized Generosity - Arthur W. Frank
DOI: 10.7208/chicago/9780226260259.003.0007
[human life, generosity, dialogue, modern organizational life, artificial person, moral relationship, administrative problem]
This chapter explores the premise that in order to live a human life, people need the generosity of their fellow humans. Generosity offers something different in each of these stories, but it always begins in dialogue: speaking with someone, not about them; entering a space between each other, in which they remain other, alter, but in which they each offer themselves to be changed by the other. When generosity is lacking, that is not because humans have suddenly lost their capacity for it. Modern organizational life, both governmental and corporate, has proliferated a style of being human that was once restricted. This style is the artificial person, and as real as its other values are it transforms generosity from a moral relationship into an administrative problem. (pages 123 - 144)
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Acknowledgments
Notes
Index
