Thinking Beyond: Contextualization in Healthcare

Josephine Miles’ absurdist poem, “The Doctor,” depicts rats as patients in the Clinical setting. As readers, we are brought to interrogate the patient-provider relation and what the disembodiment of the patient in medicine suggests in the context of care.

The poem’s cut-and-dry tone mirrors the apathy of the experimental Clinic. With grating simplicity, the doctor observes and measures the rat, looking for “real answers'' as they appear objectively to the observer’s visual sense. We see the Clinical Gaze as it makes its way across the patient’s vulnerable, exposed body.

Miles makes a clear distinction between individual experience (the patient’s truth) and the universal “truth” so exalted by the sciences. There is “no problem as to which / Is temper and which is true,” the protagonist notes. In the eyes of an objective-seeking science that shuns the particular, the patient’s illness experience is posed as a lesser (less verifiable, less actionable) truth. This is the ominous silencing that occurs in the medical systematization (compartmentalization) of the body and of human experience.

Singularity is squandered and the individual goes unrecognized; patient identity consumes, assuming the anonymity (the inhumanity) of a mere lab rat.

“What a rat feels, he will do,” the speaker furthers. And yet, this is a gross oversimplification; the assumption that “real answers” lie in objective observation is a fallacy that evades the particularity of human condition. The true feelings of a rat are forever unknown, despite symptoms being taken as signifiers. (The same will go for humans.) The truth of another is never known in all its candor. Outsiders can only conjecture the truth (true feelings, true pain)- but this is perhaps a violence unto itself.

Perhaps we can only bring ourselves to conclude that the patient’s disempowerment could be mitigated by the bedside manner of the doctor. If the doctor recognizes the person behind the patient- perhaps talking of Willie Mays or the weather (as the poem mentions), they become not a mere agent of illness, but a historical, complex individual, rich in life.

Hence, the poem of a doctor measuring the paw twitch of a rat becomes personal: perhaps the story of a doctor measuring the severity of a hand tremor of a patient suffering from Parkinson’s Disease. The poem of a doctor charting the weight loss of a rat becomes personal: perhaps the story of a patient diagnosed with Stage IV Metastatic Ovarian Cancer, undergoing appetite changes due to chemotherapy with hepatotoxic antineoplastics. In the lab emerges a narrative of personhood and survival in the face of illness.

It is those entrusted with the facilitation of care who must be moved to action by understanding the context of humanity behind the pathology of disease- to recognize and pay respect to the fact that the patient exists in a much larger, beautifully complex context. Only by caring for humanity can true care reach its potential. For it was Dr. Francis Peabody who said, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”

- Tabitha H.

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