In 1985 Gabriel Garcia Marquez made a speech in Havana. His words would later be transcribed under the title “Word for a New Millennium” and included in his book “I’m Not Here to Give a Speech”. A notable figure of Latin-American magical realism, Márquez come to state that “The idea that science concerns only scientists is as antiscientific as it is anti-poetic to pretend that poetry concerns only poets.”
I first read this statement many years ago come at a time when I felt overwhelmed by work and had very little time to read, watch movies or visit exhibitions. I lived surrounded by people that dedicated themselves exclusively to science. Time dedicated to other activities, including art, was scarce and considered superfluous. Influenced by this notion, I became increasingly immersed in the world that I had chosen as my profession and eventually accepted the idea that scientists should concern themselves with science, leaving poetry to actual poets. And, as one would expect this thought anguished me deeply.
It felt as if an invisible wall separated science from art to keep the former from being contaminated by the imaginative character of the latter. Oliver Sacks, a British writer and neurologist, conveyed just this feeling in his autobiography when describing his first trimester in medical school:
“There was a physical and social separation (…) Spending a lot of time studying neuropsychology was fun and even exciting but I increasingly felt as if something was missing in my life.”
At a certain point during my academic path I was invited to choose one of three paths: “science”, “arts” or “humanities”, as they were colloquially called. Following the path of science seemed to require renegading art or even renouncing the notion of humanity. I was expected to follow the “path of science”. We are were taught that at the far end of this path lay true intelligence, intellect, progress. Society requires scientific advancement and the community specialized technicians in different areas. Where did literature, sculpture, philosophy or painting fit in modern society? I learned physics, chemistry, biology, geology and math; along the way I memorized countless formulas, laws and layers that I can no longer recite. To many, philosophy was a bore and Portuguese an unnecessary duty.
Oliver Sacks writing
When I started studying and, some time later, practicing Medicine I felt that I would have to forget art forever. Medicine felt a complex science, filled with its own laws and formulas. There was always something left to learn and someone who just knew a bit more and left one feeling like a failure.
The digestive system was a whole interactive universe of organs, histological layers and difficult pathological processes. Above all, I feared saying something that was unforgivably wrong, afraid of mispronouncing a scientific term, of using the English nomenclature where the French would be more appropriate. Reading for pleasure was considered a luxury, a superfluous pleasure one could (and should) ignore.
What did change, then? Perhaps in my intimate thoughts I secretly knew it would be impossible for me to leave art for good. Even if medical encyclopedias and surgical videos had taken the place of fiction books and Malick, Bergman and Nolan’s films, something must have laid dormant inside, waiting. Thankfully, I was lucky enough to meet two people who allowed me to shift back my perspective.
On my fifth year of medical school I faced one of the most complex and demanding specialties: Internal Medicine. The mere mention of Internal Medicine seemed to evoke a subtle and persistent chill. If Medicine were Geography, Internal Medicine would be a conglomerate of countries with an impossibly vast area that was extremely difficult to explore, let alone conquer. All I could imagine were hospital corridors filled with old people, bodies filled to the brim with problems and illnesses. I In my mind, specialists in this area were grim elders who served as a distant goalpost that students should aim for – it was with this mental image that I first entered the office of my Internal Medicine professor. It was an old office, just like I had imagined. Its walls, covered with shelves of thick, worn out books, surrounded his wooden desk. On it laid scribbles and pens of various colors that had been used to explain complex clinical processes. After arriving, our professor asked us to sit down, a request to which we promptly complied. His face seemed friendly but by this time we had learned to be suspicious of initial impressions. “So, do any of you know the history behind this room we find ourselves in?”, he asked. A wave of reflection passed us by: this was probably a loaded question, one with a trick answer that we couldn’t figure out. “Nothing? Let me tell you about it.” He then proceeded to transmit us stories that culminated in important scientific breakthroughs, real or fictional, he spoke of books, people, clinical cases that he had witnessed. That semester was soon over but I will never forget the excitement of those sessions.
Years later, just after finishing college, I spent a year in a small city in the north of Portugal completing a mandatory medical internship. In that city, I spent three months on a primary health care center located right next to one of the most beautiful Portuguese rivers. At that time, I believed my future would include becoming a hospital specialist, but those months would eventually convince to become a family doctor. And I did so because of my tutor at the time, who taught me something very difficult to apprehend just by reading or attending classes: the power of stories, of active listening, of empathy. Even if I didn’t know it at the time, his words demonstrated his holistic understanding of patients. During breaks, we would discuss art, stories and travelling; I’d listen closely to him and in turn he would care about my objectives, dreams and experiences. His listening skills, empathic responses and storytelling ability helped me make a final decision to become a primary care physician and for that I’ll always be thankful to him.
The importance of stories is a fundamental building block of human beings and, by extension, of healthcare professionals. It is easy to forget that everyone has a life story, especially in everyday situations where time is scarce. Art taught me to interpret and getting in touch with different ways of thinking and feeling. We’re all afraid of feeling – I believe art helps us not only to feel but also to comprehend. Active understanding and empathy are traits that one develops under the guidance of art. All different art forms – photography, painting, literature or cinema – forces us to contact realities different from one’s own and to develop our emphatic understanding. Roger Ebert, a film critic, once expressed that:
“For me, the movies are like a machine that generates empathy. If it’s a great movie, it lets you understand a little bit more about what it’s like to be a different gender, a different race, a different age, a different economic class, a different nationality, a different profession, different hopes, aspirations, dreams and fears.”
My internal medicine professor taught me the value of stories. With his serene and paused voice, he taught me that behind great scientific discoveries and medical progress lay people, contexts and sometimes chance. My general practice tutor taught me the same in a closer interaction with patients; he taught me the importance of interacting with people and validating their emotions. Without knowing it, they both helped understand the value of Art in Medicine.
When I started to work, I found myself inside a consultation room, surrounded by white walls and accompanied by a few objects sitting on my desk: a computer screen, a mouse, keyboard and a blood pressure meter. And in front of me lay a more intimidating object: an empty chair. Many people would come to sit upon that chair with an endless possibility of symptoms, complaints and reasons to seek help.
It’s difficult to convey how lonely it is to work in a consultation room. Health professionals work in a team and primary healthcare is no exception; and yet most of our work is spent inside a room alone with a patient and sometimes his family. I soon discovered that what motivated many consultations was not directly related to physical or psychological complaints. Rather, they involved familial, financial or social issues. I still remember the fear I felt when I performed my first consultations alone – fear of breaking bad news or dealing with strong emotions like sadness, anger, anguish.
Every time I’m asked how art has helped me to understand certain topics related to medicine, science or the interaction between medical professionals and patients, I’m always reminded of certain books, movies or even music albums. Literature has always had a special place in my life and certain pieces have made a big impression in my thinking. “Beware of Pity”, written in 1939 by Stefan Zweig, served as a great way to distinguish empathy, pity and compassion. Similarly, “The Death of Ivan Ilyich”, the famous literary piece of fiction by Tólstoi, is relevant to doctors, given its approach to medical paternalism and how illness is experienced by the individual. Its story revolves around the life and death of Ivan Ilyich, a famous Russian judge that tries to maintain his status amidst a competitive society. Life takes its normal course until the moment the protagonist suffers a fall while fixing his curtains, which results in a minor back injury. Most characters surrounding Ivan are oblivious to his feelings: his fragility, pain, powerlessness and fear of dying. This miscomprehension on their part lead to his isolation and development of frustration, sadness and discouragement. His family made constant negative remarks and doctors frequently made judgements about his symptoms (“patients sometimes dream up this sort of nonsense; but we have to forgive them”) and quickly changed the subject to avoid facing his suffering. All, except for his son and his servant Guerassime, ignored the suffering that the illness inflicted in him.
No matter the art form, they all help me overcome the loneliness inherent to my work. After a particularly challenging appointment, I often feel the need to be in silence and fully absorb the emotions that were expressed. However, this is often impossible due to time constraints and art serves as a sort of reflection, a kind of self-analysis that I’m not allowed at my workplace.
The importance of narrative medicine is increasingly mentioned. While not exactly a new concept, it attempts to improve the recognition of suffering and its interpretation. João Lobo Antunes, a famous Portuguese neurosurgeon, repeatedly advocated the importance of this subject:
“A new breeze soothes a body that believes itself to be solid in knowledge and skills. I’m referring to Narrative Medicine, an area that I gladly welcomed due to its ideas and principles, which I’ve long defended and taught. Many of my writings, which I modestly designated as essays, are filled with stories that distill examples of what is singularly human in the artform of treating. These are the building blocks with which I keep building my hidden curriculum and that enhance the fictional treasure trove that I’ve accumulated since my childhood.”
Today still, art helps me. I frequently come back to stories - both fiction and non-fiction. It gives me great joy knowing Gabriel García Márquez was not alone in exploring the relationship between science and art. Fernando Pessoa, a Portuguese writer, wrote that “Science describe things as they are; art as they are felt, as one feels that they are.” Other scientists have made their remarks about this subject. Carl Sagan, an American astrophysicist that died in 1996, defended the power of imagination in science and Albert Einstein stated that “When I examine myself and my methods of thought, I come to the conclusion that the gift of fantasy has meant more to me than any talent for abstract, positive thinking.”
In science, proof is always required. It’s necessary to be sure that a certain intervention is beneficial both for patients and medical professionals alike. Some studies have tried to demonstrate that artistic interventions could bring a positive impact to certain conditions and improve communication with patients by transmitting facilitating the transmission of empathy. Regardless, it feels urgent to cultivate humanity and empathy. And art is the tool that will allow us to accomplish that. They’re not independent entities but rather complementary. I can imagine both areas as two old friend arguing at the end of a long day, as they observe light prolonging through eternity.
