Physician and patient

by Worthington Hooker

Perhaps it will be said that there is conclusive evidence, that the tendency of the practice of medicine and surgery is to harden and destroy feeling, in the fact itself, that, when the physician comes to act, his natural sensibilities give place to the mere excitement attending the different steps of that action. In reply to this I say, that it is an error to suppose, that because feeling is relieved for the moment by diversion of the mind into another channel, it is of course hardened, or destroyed. Feeling may and does resume its hold when the action ceases; and, if the action ends in relief, it manifests itself in a different form—in a joyful and triumphant, in place of a sad and anxious sympathy. And this change in the character of the sympathy has a tendency to strengthen rather than lessen the natural sensibilities of the heart. He who has year after year sympathized with his patients in their sufferings, and then has rejoiced with them in their deliverance—a deliverance of which he has himself been instrumental—must be possessed both of a more deep, and a more active sympathy, than when he began his career of usefulness. This result is in consonance with the laws of our nature. While the mere sight of suffering, without any attempt to relieve it, often repeated, manifestly blunts the sensibilities, and hardens the heart; it is, on the other hand, the invariable effect of the effort to remove the distresses of our fellow men, to make our sensibilities more deep and more tender. Our interest in the effort, our joy in its success, our lamentation over its failure, the common cause which we make with the poor sufferer, tend to produce this effect.

In this connection I will notice an error which is very common. Persons who are not accustomed to look at wounds, or witness scenes of sufferings, are apt when they do so to have certain effects produced upon the physical system, which are so well known, that I need not describe them. The error consists in supposing them to be evidences of feeling and sympathy, and the process of overcoming them to be necessarily a hardening process. They are effects produced in the nervous system, and have a mere incidental, and not an essential connection with the moral sensibilities. It is well known that all are not equally susceptible of these effects, and the degree of susceptibility is far from being an index of the degree of sympathy in each individual. I have known many men, who had little of true tenderness and kindness of feeling, faint away at the sight of blood, while others with hearts overflowing with tenderness, and a hand ever extended in active sympathy to the needy and suffering, under the same circumstances were entirely unaffected. The possession of this susceptibility has therefore no necessary relation, to the moral character. They who exhibit it are commonly spoken of as being ‘tender-hearted,’ and yet there is nothing in this quality which is inconsistent with the most wanton cruelty, or the most abandoned vice. Neither has this susceptibility any necessary relation to physical courage; much less to moral courage. Many, who possess it to a great degree, have nevertheless uncommon physical courage, so that though they would turn pale at the sight of a cut finger, they would face the cannon’s mouth without fear, and in the excitement of battle, the flow of blood and the groans of the wounded, would be unheeded. While on the contrary, there are many, who are unaffected by the sight of blood and suffering, in whom the idea of personal danger would at once blanch the face and make the knees to tremble.

It is the conquest which the physician obtains over this nervous susceptibility, of which I have been speaking, that has given rise to the erroneous impression, that the practice of medicine and surgery necessarily subjects the heart to a hardening process. But you have seen, that while he is acquiring this self-control, his sympathy with suffering is becoming all the time deeper and livelier, by the exercise of that active benevolence to which his profession calls him. It is only the physician who refuses to yield to this call, and pursues his profession as a mere trade for self-aggrandizement, that blunts his sensibilities, and hardens his heart.

Sustaining then, as the physician does, so intimate a relationship to his patients, and sympathizing so deeply, as they feel that he does, with them in their trials, and sufferings, and joys, his opportunities for influencing those around him for good or for ill must be greater than fall to the lot of most of those who occupy commanding stations in society. He cannot avoid exerting a wide and an effectual influence. It can be said emphatically of him, that every act which he does, every word that he drops, is seed which will surely produce fruit, and it is seed which he sows with a broad cast. The advice which he gives, the opinions which he expresses, and the example which he sets, have a double force from the fact, that the intimacy and sympathy which exist between him and his patients unlock the heart, and his influence finds no repulse in entering there.

Every man has more influence in his own little community at home by his own fireside, than he has abroad in the great community around him. Familiarity, mutual confidence, and sympathy, are the obvious causes of this. But the physician may in a measure, as you have seen, be said to be at home everywhere, by everybody’s fireside, in the mansion and in the cottage, in the garnished chamber of the wealthy, and in the humble and comfortless garret of the poor. It is a matter of every day’s occurrence, that he should be at home in all these varied scenes, and he acquires a tact in accommodating himself to them, and to the endless diversity of character which they present. Wherever he goes he enters the family circle, as I have before said, without that formality which attends the reception of other visitors. He is received ordinarily without any preparation, and at any hour when necessity calls for it. He sees his patients, too, in every variety of situation, and in just those circumstances which are calculated to develope and exhibit character. He sees them in their unguarded moments, and when sufferings and trials of every variety, from the great calamity down to the most trivial disappointment, are acting upon them as tests, searching and sure. He sees much that glitters before the world become the merest dross in the sick chamber; and he sees too the gold shining bright in the crucible of affliction. He sees human passion in every form and condition; implacable hatred and love stronger than death; fallen virtue, and virtue tried and proved; mental and moral strength inconceivable, and childish imbecility in the once mighty and great; hope beaming bright with heavenly lustre, and ghastly fear and black despair; unbounded power of endurance, and the crushing of the once buoyant spirit by even light calamities—every feeling, or passion, or quality, or condition, that can be imagined, in every possible variety of phase and degree, is displayed to his view.

No one then has better and more various opportunities for studying human character than the physician: and he adds every day from this source to the storehouse of his experience. I need not spend time to prove, that this knowledge of character thus acquired confers upon him a means of influence which he otherwise could not have. It not only gives him a tact in influencing men generally; but in individual cases, the revelations of thought and feeling which he has witnessed at the fireside or in the sick room, made in the free and unguarded moment, under the application of faithful tests, afford him such an insight into the character, that he knows just what chord to strike, to produce the effect which he desires. He needs not to feel his way to the heart. He has already learned it. He knows just what motives will act with the most certainty, and needs not to make any random experiments.

What responsibility then rests upon the physician! How careful should he be in the expression of his opinions! At what high ends should he aim in his daily example! How important that he should be right upon the great moral questions which agitate the community, and that his morality should be strictly that of the Bible!

Too often is it the case, that the physician, who professes to be governed by principle, exerts no such commanding influence, as his relations to his fellow men enable him to do; but, as a matter of policy, avoids committing himself decidedly and openly upon those subjects which occasion any diversity of opinion in the community. Those who thus for selfish ends fail to meet the full responsibilities of their station, do not, indeed, like the unprincipled, undertake to please everybody (a contemptible course, and commonly a profitless one) but they at least make it a main point to displease no one. In so doing, it is true, they make no direct attack upon principle, and inflict no positive injury upon the moral interests of society; but they are guilty of a sacrifice of principle, and they neglect to do the good which it is in their power to do. Suffice it to say, that while the physician should not court opposition by any needless attacks upon the opinions and prejudices of others, for this would impair his usefulness, a dignified and firm expression of his sentiments, and a decided influence for good upon every great moral question, we have a right to expect from one who has so great a share, as the physician necessarily has, in moulding the character of society.

Take, for example, the great moral question of Temperance, which has for so many years agitated the community, and upon which there has been so great a difference of opinion. It is difficult to conceive that a physician, possessed of the ordinary feelings of humanity, should fail to be decided on this subject, either in his opinions, or his influence. No man has had so varied and extensive opportunities of witnessing the ravages of intemperance. It is not an occasional visit that he has made to the miserable home of the drunkard. It is not occasionally that he has heard from trembling lips the tale of woe, and seen its painful and often hideous signs. It has been with him an almost every day occurrence. Misery on every hand has made its appeal to him. And if he has allowed his desire for popularity to hinder him from heeding such touching and frequent appeals, it is not too much to say to him, that he has been shamefully recreant to the dictates of humanity, and that he will have to render a large account of neglected opportunities of doing good.[44]

No one has more frequent opportunities than the physician for acting as a peace-maker, an office which is very much needed, but which few are inclined to take. There are always many, who are willing to act as peace-makers in gross and palpable cases, when an actual quarrel has burst out, and threatens a great and manifest damage to the community, who yet may do nothing to repress the petty jealousies and the slight contentions, which are generally the cause of the greater commotions that heave up the very foundations of society. But the true peace-maker is doing his work at the fountain head, at the very beginnings of strife—not only when urgent occasions call for it, but from day to day, in every circle, by every fireside that he visits. Every day he sees the risings of ill-feeling, envy, jealousy, and discontent; and he calms them down by an influence so gentle and charm-like, that it is scarcely observed. A small thing, a word, a look, may often put out the spark which is about to light the destructive train. How few there are in this world of jealousy and contention, who are ready to utter that word, or bestow that look, and how many who will fan the spark of strife into a blaze, or will at least let it alone, and take no pains to put it out.