A Creative Nature to Health

Ellen Kroop-Martin’s short story, “Paths,” describes a situation in which the patient’s action goes directly against the treatment plan. The inexperienced, baffled intern can only look away in dejection, feeling as if her honest efforts were wasted. In this story of conflict, absent of resolution, she faces the natural limitations of a caretaker in the clinical space. Martin’s story thus illustrates the collaborative undertaking of health- a corporeal state created and maintained by the minds of both patient and practitioner.

In the story, the patient, a Mr W., refuses the advice of his healthcare team. Exasperated at his indifference, they watch helplessly as his condition wanes. “His body was simply too wasted,” writes the intern. In his resistance, Mr. W positions himself against the healthcare team. He remains inert- resolved in a state of physical deterioration. He tolerates the intern’s interventions only to later sit outside in his wheelchair for a smoke.

To be equipped with all the clinical confidence of the School is perhaps all the more unsettling- the intern observes what she believes to be ethically wrong and risk-negligent, biased by the emphatic Voice of Medical Reason. Implied by this is the invalidation of all else that does not comply with the standards and expectations of health (of healthy individuals) as ordained by the School. So will the appalled intern watch the ill patient holding up a pack of cigarettes.

He is not listening, she may think. He is ruining his health, she may lament with frustration. In her disbelief, she illustrates the idea of a medically-endorsed “right” behavior. For in this case, it is his acts that are deemed “wrong”- his behaviors work against the methods and goals of her subduing (yet well-intentioned) plan.

In this patient-provider dynamic, the exercise of power is clear. In seeking control over his declining health and ailing body, she had not - in her conception of Mr. W as a patient - considered the space for his agency. Perhaps we, too, find ourselves perplexed by Mr. W.

Smoking is bad, we may think. He should not be smoking, being so gravely ill, we may lament with frustration. And yet in the end, it is him alone who suffers in the throes of illness and contemplates his mortality. We could only dare to imagine what life lay behind his eyes, all the stories his hands could tell us about where he’d been- about who he was.

Though clinical confidence would claim otherwise, his condition will remain enigmatic to those who never occupy his body and traverse his history.

Nonetheless, the doctors and nurses buzz with frustration. “How can I manage a man who has defied other, more experienced and capable physicians?” asks the intern. Here, Martin brings us to interrogate the power dynamics involved in the formulation of a treatment plan, and the presence of control (and its reciprocal loss) within the hospital environment.

This is a point in the story where we must acknowledge that, in the clinical setting, the facilitation of healing requires the patient’s cooperation. Health is thus co-created. Together, the patient and provider resolve to adhere to a highly specific, agreed-upon plan.

The intern’s resolve rings with self-assured pride: “I got him a trapeze. I got him a physical therapist. I got him a wheelchair,” she writes. And yet, all the resources in the world could not change the health outcome without the direct and active involvement of the patient.

The depersonalized clinical body is thus complicated- offset by the agency of the patient. Alone will Mr. W suffer through illness and a failing body; alone will he undergo the treatment plan and live with its consequences. In this way, the impact on the practitioner and the understanding can only ever be indirect.

In this way, Mr. W behaves in ways that go against (beyond) the parameters that medical advice permits. It was his path to take.

In the case where medical training defines his act as risk-negligent, we see how difference exists not as a binary opposition- but merely reflects a different life and idiosyncratic values. So will the patient, Mr. W, wish to “sit with the boys” outdoors, and have a smoke.

In the story, we see how following a plan, rather than enacting a specific outcome, can be the means to supporting the patient’s choice. We cannot control the decisions that other people make, despite our own moral and stringent ethical reason; never was it our (or the intern’s) prerogative to make value judgments and impose them as universal rule.

In the face of illness and suffering, both patient and provider must face the abyss together.

The truth remains that in the event of life, suffering, illness and death, the path is the patient’s alone. Perhaps the healthcare worker can only ever hold the patient’s hand, acknowledging their limitations and empathically realizing the isolation experienced in illness. We find the beauty, then, in the story of the intern who was moved to action, showing up for Mr. W in extraordinary ways. And in standing beside him, equipping him with the resources that she knew best, she’d given him the option to choose.

- Tabitha H.

Contributors: Sophia Z., Kai N., Yalit G., Raymond K., Eunsu L., Nisma S., Rachel G.