The Aesthetic Dimension of Medicine

It’s now the fourth week of my two clinical years here at UTMB, and I find myself traversing the corridors of John Sealy Hospital and Jennie Sealy Hospital pretty frequently in order to be where I’m supposed to be. In Jennie Sealy, which was completed only two years ago, one cannot but admire the sleek floors, the expansive windows which allow natural light to pour forth and illuminate the indoor scenery, the sublime views of Galveston and the Gulf Coast afforded by the higher floors, the cozy spaciousness of the patients’ rooms, the various works of art that pepper the hallways, and the overall attention to architectural detail that makes the hospital feel about as luxurious as any hospital can reasonably be.

Why is it that Jennie Sealy and many other American hospitals that are either new or newly refurbished are beautiful? A simple, economic answer is that beauty is a good way of luring in those with medical needs. After all, you would, all things considered, prefer to visit a fancy hospital rather than a dilapidated one if you had an urgent medical issue. A more charitable answer is that hospitals are designed to be beautiful because beauty makes us feel comfortable within our environment. When I gaze upward, on a clear night, to admire what philosopher Immanuel Kant affectionately called “the starry heavens above me,” I feel at home within this endlessly large and sometimes alienating universe of ours. Similarly, patients and their families may feel less uncomfortable within hospitals if they are surrounded by beauty both inside and outside the building.

Regardless of why a lot of hospitals are pretty darn beautiful, it’s become clear to me as of late that beauty has a close and virtually inseparable relationship with medicine. And no, I am not just referring to the fact that there is such a thing as aesthetic medicine. I suppose a judiciously requested and correctly performed tummy tuck never made anyone less beautiful, but the relationship between medicine and beauty extends far beyond the confines of the merely cosmetic.

I’ve already suggested that the physical setting in which medicine takes place––whether it’s a hospital, a clinic, or even a parking lot––can be beautiful, but this strikes me as one of the least significant and most contingent ways in which beauty and medicine are related. Far more important is the presence of beauty in a strong doctor-patient relationship. It might seem odd to locate beauty in relationships, but I think intuition supports the idea that this is possible. If it weren’t possible, we wouldn’t be able to say that a couple celebrating their 60th year of marriage is beautiful, or that a large, tightly knit family is beautiful, or that the friendship of two individuals with vastly different upbringings is beautiful. (Fanciful examples of such friendships include that of Hogarth and the Iron Giant in The Iron Giant, or that of Boo and Sulley in Monsters, Inc.) We do say these things, so beauty must be found in some relationships. Or if this argument doesn’t persuade you, consider any of the dozens of videos in which a military mother/father surprises their children with a hug after being separated from them for months or years by overseas active duty. Are these moments of reunion not beautiful? Surely they are. But what makes them beautiful, if not that the beauty of the parent-child relationship is positively resplendent once the element of physical presence, which was absent from the relationship for some time, has finally been reintroduced?

I could fish for other arguments, but I’ll settle for those two. In any case, it is my opinion that what makes a particular doctor-patient relationship beautiful is the degree to which the doctor genuinely cares about and respects the patient, and the patient does the same towards the doctor. A beautiful doctor-patient relationship, in other words, is bidirectional rather than unidirectional, and can even be described as a friendship of sorts.

There’s no airtight argument I can offer in defense of these claims, but I can venture a thought experiment. Imagine, to the best of your abilities, that you’re a ghost floating among exam rooms in a clinic belonging to a group practice. You’re able to witness three doctor-patient encounters, each involving a different doctor and patient. In the first encounter, both the doctor and the patient are initially friendly, but as the encounter continues the doctor becomes subtly but progressively condescending in his questions and comments. In the second encounter, the doctor makes a gentle effort to persuade the patient to give up his years-long habit of smoking, but the patient, for whatever reason, becomes very upset by the doctor’s recommendations and eventually storms out of the room while denouncing, with a colorful and impressive variety of expletives, the “intolerance” of the doctor. In the final encounter, the doctor and the patient greet one another kindly, ask how the other’s family is doing, exchange ideas on how the patient can make the lifestyle changes needed to lose weight and lower her blood sugar level, and end the encounter with the utmost cordiality.

So which of these encounters has the most aesthetic merit? Surely not the first one: the behavior of the doctor, which perhaps stems from a sense of superiority over the patient, makes it very challenging for us to find beauty in this scene. The second encounter is hardly better, as it ends in emotional shipwreck and possibly a termination of the whole doctor-patient relationship. This leaves the final encounter, in which the doctor and the patient, who work harmoniously as a team to address the patient’s health needs, have what can justifiably be called a beautiful relationship. There may not be an obvious amount of beauty here, but it is likely present to at least some degree.

Based on my observations in both the hospital and the clinic, I would contend that the beauty inherent to a particular doctor-patient relationship depends upon a large number of factors. These include––to identify just a few examples––the length of the relationship (generally the longer, the more beautiful), the number of improvements to the patient’s health that have been achieved during the relationship (generally the greater the number, the more beautiful), and the extent to which the doctor and patient differ with regard to their age, education level, and cultural norms (generally the greater the extent, the more beautiful).

Looking beyond the doctor-patient relationship now, we can see that beauty resides within several other aspects of medicine. As I have learned during my limited time in the operating room, good teamwork, which includes good communication, is beautiful. So are acts of great kindness on the part of healthcare workers, as well as on the part of patients and their families. There is something beautiful, for example, about a patient who remains calm and friendly as she is told by her doctor that her most recent MRI was performed incorrectly and so will need to be ordered again. In the same vein, I think it is beautiful whenever a healthcare worker is able to learn from their mistakes, whether clinical or emotional, and is subsequently able to improve their character. Perhaps an attending physician realizes, a few days after berating one of her residents over a minor lapse in clinical judgment, that excessive anger only tears others down without building them back up.

Or perhaps they don’t. Where there is beauty, there is also ugliness. Ugliness, as the opposite of beauty, makes it either difficult or impossible to appreciate beauty when the two realities are found in the same space. Its presence tends to draw our attention and fill us with undesirable emotions such as disgust.

These claims are as true in medicine as they are in the rest of life. Hospitals and clinics grow old and creaky; doctor-patient relationships fail; there is bad teamwork among healthcare workers; there are acts of great ill-will in healthcare settings; healthcare workers may not only fail to become more kind, understanding, and sympathetic, but may even grow meaner, more closed-minded, and devoid of sympathy. All of these things can and do happen.

But there is greater ugliness still, and it takes the forms of maltreatment, disease, and death. There is nothing beautiful about a 9-year-old girl losing her life to leukemia following a prolonged course of aggressive chemotherapy. The girl’s will to live may be beautiful, as can the support of her friends and family, but her actual illness is absolutely not. The same goes for any number of medical horrors: the child who dies of a vaccine-preventable illness; the elderly gentleman who suffers 3rd-degree burns to 60% of his body’s surface; the teenager with borderline personality disorder who presents to the emergency room with half of her face blown off by a gun she used to attempt suicide; the homeless man who needs his leg amputated because he couldn’t afford to treat his diabetes mellitus; the mother and fetus who die together from a massive placental abruption; the young man in a developing nation who succumbs to leprosy after being disfigured beyond all recognition by the disease; the young woman in a developing nation who dies of rabies following a 2-week course of psychosis and excruciating muscle spasms; the surgeon who refined his techniques by operating on enslaved black women without the use of anesthesia; the doctors who inoculated black residents of rural Alabama with T. pallidum (the cause of syphilis), and then withheld treatment for 40 years in order to observe the natural progression of the disease. Truly, there is ugliness in medicine.

Happily, healthcare workers need not sit idly by and simply hope that ugliness does not eventually snuff out all of the beauty there is in their field. We should, instead, seek to foster beauty while containing ugliness to the greatest extent possible. This doesn’t imply that we ought to be constructing $500,000,000 hospitals left and right (that would be impractical and likely unhelpful); only that we should be mindful of beauty and how our thoughts and actions in the clinic can either enhance or impede its flourishing. Beauty may initially seem tangential to the primary purposes of medicine, but on closer inspection, it is not: it can prove markedly therapeutic to the sick, and, as many throughout the ages have testified, it can empower and ennoble us all. It is something that those of us in healthcare should not neglect.

 

 

-David

bayless

 

 

 

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