 
                         20060126.00

     I was much chagrined, years ago, in the days when
doctors were less afraid of malpractice suits than they are
now, when at medical conferences "interesting cases" were
discussed: histories of unfortunate patients with whose
diagnosis and treatment everything seemed to go wrong, ending
in human catastrophe, and the audience of physicians
responded to the mounting desperation of the situation with
recurrent bouts of laughter, as if the physician were a
comedian and the patient his stooge.  I am uncertain about
the ethics/esthetics of such black humor, mindful of
Shakespeare's comparable resort to the macabre in Macbeth and
Hamlet and Lear.

     In my own medical practice I have over the years learned
to confront very tragic situations with patients who were
incurably ill. I have tried to help such patients by
explaining to them what I understood about their disease, by
imagining myself in their situation, by telling thems what I
think, how I feel, react and decide under difficult
circumstances; confident that although I could offer no
physical cure, the spirit is capable of overcoming sorrow,
freeing itself from suffering by adapting and assimilating
itself to reality, if only the physician with his scientific
pretensions would not stand in the way.

     By the same token, I have been uncomfortable in being
physician advisor to "glaucoma groups," where a number of
patients were assembled by the social worker, intending that
they should relate to each other their experiences with
glaucoma.  It is thought that such discussions would relieve
patients' anxieties; but I was perplexed by the
misunderstanding that invariably came to light, that was
reinforced by the discussion's participants and that, given
the social setting, was impervious to correction.

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Copyright 2006, Ernst Jochen Meyer
