In his book The Allegory of Love, C.S. Lewis wrote, "Humanity does not pass through phases as a train passes through stations: being alive, it has the privilege of always moving yet never leaving anything behind. Whatever we have been, in some sort we are still." Indeed, this is true in the world of medicine, for though technology and treatments continue to move ahead, we never really leave our infirmities behind. Each new generation of physicians must interpret current medical therapies in light of our perpetual physical illnesses and our varied emotional responses to them.

Consider the situation in Great Britain and America a few centuries ago. As Michael Flannery notes in the introduction to his finely prepared critical edition of Nicholas Culpeper's The English Physician, even then—as today—there were alternative medical treatments for those who opposed "mainstream medicine's attempts to create a monopoly through restrictive licensing and other regulatory measures." Thus Culpeper (1616-1654) collected various pharmaceutical and botanical treatments to publish in books so that every man could be his own physician. Culpeper's goal was not to pass on medical wisdom from one generation of physicians to the next but rather to make treatments accessible to each new generation of people, who could serve as their own physicians.

Naturally, Culpeper's disdain for the medical establishment and his alternative therapies brought him scorn from the medical community. Looking backwards with the benefit of medical progress, it is indeed difficult not to smile when we read through some of the remedies in The English Physician. I doubt the American Academy of Pediatrics, for example, would approve of Culpeper's treatment for the cough in children: "Take 1 Ounce of Hog's Grease, half an Ounce of Garlick, bruise and stamp them together, and anoint the Soles of the Feet at Night warm, & then bind a Plaister thereof on the Soles." For the "falling sickness," the reader is enjoined to "take that part of a Woman's Skull, that groweth on the hinder part of the Head (it is whiter than the rest of the Skull) beat it very fine to powder, and give the party as much as a Pea at a time in Syrup of Violets." (It is not stated if harvesting a woman's posterior skull should be done when the donor is alive or dead.) As I was reading Richard Dawkins' The God Delusion, I mused: would fighting fire with fire (or in this case vitriol with vitriol), followed by a dose of grace, be helpful in calming a near apoplectic hatred for religion? "Apoplexy to Cure: Take of the best Aqua-vitæ well rectified from Phlegm one Pint, Oil of Vitriol one Spoonful, mix them and let him drink thereof one Spoonful first in the Morning, and another last at Night. Then let him Sweat in a Stove twice a week, and every time therein bathe him with Oleaginous Balsom. This is Excellent."

The English Physician sallied forth in 1708 from the press of one Nicholas Boone in Boston, the very first medical book ever printed in the British North American colonies. This was not a genuine Culpeper production but rather the reprinting of a book of various remedies attributed to him that appeared in London in 1690 (36 years after Culpeper's death) under the title Physical Receipts, or The New English Physician. In its long life The English Physician became many a printer's cash cow, for it "filled a much-needed gap in health care for the poor—at only 3 pence per copy, written in plain English, with many simple and easily prepared remedies."

Although many a book is still printed in order to make "every man his own physician," the more accepted practice is for physicians to pass on clinical pearls of wisdom from one generation to the next. Thus, for example, Richard Selzer's Letters to a Young Doctor, first published more than twenty-five years ago, consists of a series of chapters ostensibly written to someone beginning specialty training in the field of surgery. This was Selzer's attempt to answer the question he had been asked so often, "What is it like to lay open the body of a fellow human being?" It's a mulligan stew of a book with some chapters consisting of medical stories gleaned from his years of practice, others on matters obliquely related to medicine, and still others written without discernible purpose that I can only label as "weird." Still, he does write with a light touch that at times left me shaking with laughter: in writing about how surgeons have their own fetishes for a particular surgical instrument or way of doing things during the combat of surgery to vanquish disease, he notes, "An even older tradition insisted that the victor in combat devour the heart, brain or testicles of his vanquished foe. By this ingestion the winner took upon himself the courage, strength and sexual prowess of his enemy. I shall say no more about this save that such behavior is altogether inappropriate at a teaching hospital."

Selzer's Letters to a Young Doctor is not so much a book of advice to a budding surgeon in training as it is a collection of vignettes that show what being a doctor involves and what being a patient is like. This is basically the goal of Dr. Perri Klass in her book Treatment Kind and Fair: Letters to a Young Doctor. Klass' book is a collection of reflections based on actual patients she has treated as a pediatrician, written as a series of letters to her medical school-bound son. The book consists of a preface and ten letters of moderate length that are coherent, practical, not without humor, and printed in an easily readable font. Klass, a pediatrician and author of a number of books, including several works of fiction, discusses everything from the changing facets of medical treatment to patient confidentiality, balancing work with life outside the hospital, death and dying, making mistakes, and other assorted topics. It is just the kind of book that would be useful to anyone considering a career in medicine or to those already in training, and intriguing to those outside the field of medicine who want a glimpse of what it's like on the inside. Klass is even frank enough to record what her college-aged daughter said after proofreading the manuscript: "It comes off a little like a congratulatory feel-good piece to make everyone who's chosen to be a doctor feel great about how wonderful and important their job is, and to be honest I'm not someone who's really eager to be convinced of that." Treatment Kind and Fair is a wise book and a quick read, easily recommended.

If I were asked to add to the counsel of Culpeper, Selzer, Klass, Atul Gawande, William Nolen, and many others who have written about medicine, what would I say? Among other things, I think I would write about medicine's struggle with the seven deadly sins. Some writing doctors (one thinks of Samuel Shem in The House of God) do depict the moral depravity among physicians, but overall few doctors write about how easy it is to lose one's moral compass in medicine. When patients and hospital staff all address you as "doctor" on a daily basis, follow your orders, and solicit your opinions as an authority figure, pride has a way of inflating the ego that can lead to an unhealthy sense of importance, with disastrous consequences for yourself and those around you. For some, pride leads to wrath when they don't get what they feel they deserve, and they throw adult forms of temper tantrums. Lust is an ever-present temptation (often succumbed to) in what is still a male-dominated profession, where co-workers often find themselves in intense, intimate situations (e.g., the emergency room or operating room) with members of the opposite sex. Gluttony might take the form of overeating (not uncommon in people who make a good salary but often don't make time to exercise or eat well) or wasteful prodigality (throwing away perfectly good, unused/ reusable products, a practice I saw in every American hospital I ever worked in). Sloth is not physical so much as it is intellectual among doctors: the laziness to not examine or study their belief system, their religion, with the same vigor with which they study medical textbooks and articles. Socrates injunction "know thyself" is often ignored. At times envy rears its head among successful people who scrutinize each other's accomplishments. Finally, greed plays a major role in how medicine is practiced in capitalist societies, especially in the United States, where competition for making more money is keen. (I've sometimes thought that a helpful lecture for first-year medical students would be titled, "All the really horrible, rotten, dastardly things you all are going to do to each other over the next several decades because of greed.")

Sin, however, is hardly unique to the medical profession, and there are plenty of non-medical books that address this. (The Bible certainly has a word or two to say about the matter.) So apart from talk about temptation, what counsel is there for aspiring medical professionals? Well, there is the advice that comes from talking with experienced doctors. There are also numerous books that show the challenges and pitfalls of medicine. For my money, Perri Klass' Treatment Kind and Fair is probably the best place to start.

David Graham is a physician working in Ecuador.

Copyright © 2008 by the author or Christianity Today/Books & Culture magazine.
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