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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2005

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Surgery

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Stephen Jordan - 15 Jun 2005 00:21 GMT
This is copied at great expense ($12) from the current JAMA  ;-)

Subject is heart surgery, but it could apply to this crew as well:

Jacqueline Hackel, PhD
Oakland, California

JAMA. 2005;293:2838.

Surely you will agree: A stranger proposes to render you unconscious, to
force a camera down your throat, to cut open your sternum, or, perhaps, to
wield the knife under your breast. You, too, would want to
flee—screaming—wouldn’t you? Warming to the havoc, the stranger says he
will place your heart on a life-support system while he cuts it open. He
says when you awaken you may no longer have a fully human heart. You may
have a heart partially composed of cow pericardium. A scenario worthy of
The Twilight Zone! You will agree that if this is not science fiction, then
it is battery or torture.

I stare at my assailant—an elfin figure—and wonder what I need from him so
that his identity can morph from perpetrator into civilized surgeon.

What do I need from myself so I can sign the document that will transform
this mayhem into a legitimate medical procedure? I continue to look at him
across the desk and wonder what it means to say, "I am a human being," if
my life depends on possessing an essential spare bovine part. I try to
quell the chaotic feelings inside me. You will agree . . . surrender to
this mutilation is madness.

I try to focus on the gracefully framed quote from Maimonides, "Prayer for
a Physician," that is wedged among a flotilla of diplomas. I cannot focus
my attention on Maimonides’ (or anyone else’s) words. I must find something
personal; something fully human about this stranger; something that will
make it possible to yield to his plan. . . to voluntarily place my heart—my
life—in his hands.

I grope for some thread of connection between us. What if I can’t find it?
I notice my heart doing its syncopated dance. Then I offer that my
grandparents fled Europe in the 1930s to his native country; that they
often spoke of the beauty of Buenos Aires and how much they missed it when
they relocated. He breaks into a smile as he talks about his beloved city.
He starts to laugh as he tells me the city has the best ice cream in the
world. "Better than Paris?" I say. He looks directly at me and delight
transforms his face as he replies, "Better than Paris."

He has ceased to be an adversary. I have discovered the way to his heart as
surely as he knows the surgical road to mine.
Stephen Jordan - 17 Jun 2005 00:56 GMT
On June 14, I posted an essay by Dr. Jacqueline Hackel (upthread).

In the piece, she wrote, "I try to focus on the gracefully framed quote
from Maimonides, 'Prayer for a Physician'......"

Actually, it's "Prayer *of* a physician, and it goes like this:

Daily Prayer Of A Physician
("Prayer of Moses Maimonides") 1793?

[Attributed to Moses Maimonides, a twelfth-century Jewish physician in
Egypt,
but probably written by Marcus Herz, a German physician, pupil of Immanual
Kant, and physician to Moses Mendelssohn. First appeared in print in 1793.]

"Almighty God, Thou has created the human body with infinite wisdom. Ten
thousand times ten thousand organs hast Thou combined in it that act
unceasingly and harmoniously to preserve the whole in all its beauty the
body which is the envelope of the immortal soul. They are ever acting in
perfect order, agreement and accord. Yet, when the frailty of matter or the
unbridling of passions deranges this order or interrupts this accord,
then forces clash and the body crumbles into the primal dust from which
it came.
Thou sendest to man diseases as beneficent messengers to foretell
approaching danger and to urge him to avert it.

"Thou has blest Thine earth, Thy rivers and Thy mountains with healing
substances; they enable Thy creatures to alleviate their sufferings and to
heal their illnesses. Thou hast endowed man with the wisdom to relieve
the suffering of his brother, to recognize his disorders, to extract the
healing substances, to discover their powers and to prepare and to apply
them to suit every ill. In Thine Eternal Providence Thou hast chosen me
to watch over the life and health of Thy creatures. I am now about to
apply myself to the duties of my profession. Support me, Almighty God,
in these great labors that they may benefit mankind, for without Thy
help not even the least thing will succeed.

"Inspire me with love for my art and for Thy creatures. Do not allow
thirst for profit, ambition for renown and admiration, to interfere with
my profession, for these are the enemies of truth and of love for
mankind and they can lead astray in the great task of attending to the
welfare of Thy creatures. Preserve the strength of my body and of my
soul that they ever be ready to cheerfully help and support rich and
poor, good and bad, enemy as well as friend. In the sufferer let me see
only the human being. Illumine my mind that it recognize what presents
itself and that it may comprehend what is absent or hidden. Let it not
fail to see what is visible, but do not permit it to arrogate to itself
the power to see what cannot be seen, for delicate and indefinite are
the bounds of the great art of caring for the lives and health of Thy
creatures. Let me never be absent-minded. May no strange thoughts divert
my attention at the bedside of the sick, or disturb my mind in its
silent labors, for great and sacred are the thoughtful deliberations
required to preserve the lives and health of Thy creatures.

"Grant that my patients have confidence in me and my art and follow my
directions and my counsel. Remove from their midst all charlatans and
the whole host of officious relatives and know-all nurses, cruel people
who arrogantly frustrate the wisest purposes of our art and often lead
Thy creatures to their death.

'Should those who are wiser than I wish to improve and instruct me, let
my soul gratefully follow their guidance; for vast is the extent of our
art. Should conceited fools, however, censure me, then let love for my
profession steel me against them, so that I remain steadfast without
regard for age, for reputation, or for honor, because surrender would
bring to Thy creatures sickness and death.

"Imbue my soul with gentleness and calmness when older colleagues, proud
of their age, wish to displace me or to scorn me or disdainfully to
teach me. May even this be of advantage to me, for they know many things
of which I am ignorant, but let not their arrogance give me pain. For
they are old and old age is not master of the passions. I also hope to
attain old age upon this earth, before Thee, Almighty God!

"Let me be contented in everything except in the great science of my
profession. Never allow the thought to arise in me that I have attained
to sufficient knowledge, but vouchsafe to me the strength, the leisure
and the ambition ever to extend my knowledge. For art is great, but the
mind of man is ever expanding.

"Almighty God! Thou hast chosen me in Thy mercy to watch over the life
and death of Thy creatures. I now apply myself to my profession. Support
me in this great task so that it may benefit mankind, for without Thy
help not even the least thing will succeed."

 [Translated by Harry Friedenwald. Bulletin of the Johns Hopkins
Hospital 28 (1917): 260-261 .]

Regards,

Steve J
 
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