It took me 35 years of practicing medicine and a PhD in medical history to learn that sometimes it is better to treat a sick patient the way a gardener nurtures an ailing plant than the way a mechanic fixes a broken machine.
Our modern idea is that the body is a machine; disease is a mechanical breakdown, and the doctor’s job is to find and then repair or replace the broken part. It is a powerful, successful model, but after I’d practiced medicine for several years I realized that not everything fit into it. And I went on a quest for another, more inclusive way of thinking about the body.
Eventually I stumbled upon a surprising book— “Hildegard of Bingen’s Medicine.” Hildegard was a 12th century nun, mystic, and medical practitioner, and her book gave me the second point of view I’d been seeking. Her idea was that the body was more like a plant than a machine.
It is quite a different approach.
A plant grows, develops, and heals. A machine doesn’t. When a machine breaks down, someone has to fix it. But when a plant is injured, it repairs itself. Hildegard called this power of self-healing, viriditas—“greening power”—from the Latin viridis, green, and she believed that humans possessed it, too. She was not alone; most pre-modern doctors assumed that the body had an innate healing power—the vis medicatrix naturae—which a doctor should cultivate.
So when Hildegard approached a patient, she did not concentrate on what was broken. She concentrated on her patient’s viriditas. How strong was it? What was depleting it? How could she fortify it? Thenshe modified the environment inside and outside her patient: what he ate and drank; what medicines he took; how much rest and exercise he had; how much sleep; how much activity; how much noise and how much quiet. She did this slowly, bit by bit. Then she waited to see what would happen.
I studied Hildegard’s medicine for years and finally wrote my PhD on it.
In the meantime I was practicing medicine at a very unusual place in San Francisco. Laguna Honda Hospital was on 62 acres of land and had 1,178 patients. Originally it had been the San Francisco Almshouse and in many ways it still was the city’s almshouse, which meant that we took care of everyone in the city who needed medical care for more than a few weeks.
It was a fascinating place. I had complicated patients with unusual diseases and they stayed for weeks, months, and even years. Since we were over the hill to the poorhouse literally, no one paid us any attention. And sometimes with a difficult case I would ask myself: How would Hildegard have looked at this patient? What would she have done?
What I discovered was that the two ways of looking at the body—the modern and the premodern, the Fast and the Slow, as a machine to be repaired and as a plant to be tended—are both effective when they areapplied to the right patient at the right time. For illnesses that come on suddenly—an inflamed appendix, a rip-roaring infection, a car accident, a heart attack—it is best to think like a mechanic—boldly, reductively. What is broken? What should I do to fix it? Desperate illnesses require desperate remedies.
But not-desperate illnesses do better with not-desperate remedies. Diseases that come on slowly—chronic infections, complex medical conditions, the aftermath of the appendectomy, the heart attack, the chemotherapy—are best approached like a gardener, asking myself as Hildegard would have done, not what is broken but what is working? What are my patient’s strengths and how can I support them? What can I do to nurture viriditas, the natural power of healing?
It is not a dramatic or heroic medicine. It is fussing and fiddling; examining and re-examining a patient; doing a little of this, and a little of that. It is Slow Medicine, but used at the right time, for the right patient, and in the right conditions, it works amazingly well.
Victoria Sweet is the author of “God’s Hotel <http://www.amazon.com/Gods-Hotel-Hospital-Pilgrimage-Medicine/dp/1594488436/ref=sr_1_1?ie=UTF8&qid=1335376503&sr=8-1> ” and has been a physician at San Francisco’s Laguna Honda Hospital for more than 20 years. An associate clinical professor of medicine at the University of California, San Francisco, she holds an M.D. from the University of California, Irvine, as well as a Ph.D. in history and social medicine.
When is a doctor more like a gardener than a mechanic? by Victoria Sweet
Read 2959 times
Published in article
Leave a comment
Make sure you enter the (*) required information where indicated.
Basic HTML code is allowed.