Shiur Theatre: Maimonides and Galen, Act Two

Continuing from Act One here, this is Act Two...

ACT II – APPROACH TO PRACTICING MEDICINE

Desks are empty

NARRATOR: After drinking coffee and touring the hospital, Maimonides and Galen return for the continuation of their interview.

Maimonides and Galen enter; the President has not yet returned to the room. The two men eye each other.

G: What is this "idolatry" charge of yours, anyway?

M: Oh, nothing.

G: Speak up, or be silent; you cannot do both.

M: Very well. It is my belief that this universe was created at a defined moment in time, by a single, indivisible, omnipotent, incorporeal G-d, who is worshipped only via the rituals he defined for that purpose. Your idol, this "god of medicine", is silly and not for truly intelligent human beings.

G: We have little quarrel with you. We know there is a Divine Creator, by dint of the existence of the universe, just as we know there is an animal soul by dint of the way human beings function. We believe this Creator is good and just, and formed everything in its ideal substance and shape to serve its purpose. We simply don't take your excessive steps of defining a world after this one, and an immortality of the soul, lacking evidence as we are.

M: Then you believe in the Gd of Moses?

G (dismissive tone): With some (ahem) upgrades. We don’t make the mistake of the Jews, contending that Gd may create anything from anything. Your ancestors failed to understand the true complexity of creation – each entity must be formed of certain materials, to perform a certain function. One cannot simply turn a stone into a serpent, or a fingernail into an eyebrow. All is formed from specific materials, for specific ends, and all exists to fulfill that end toward which it was formed.

M: And this entity you term a god of medicine?

G: Is the god of medicine.

M: Empowered by the overall Creator, as a sort of malach to carry out a task?

G: We did not allow anyone to pin us down on this in our own day, we certainly won't start now. The Muslims and Christians felt comfortable with our teachings, enough so that they incorporated us into their traditions; why can't you Jews do the same?

President walks in at this point

M (getting in a last dig): I always imagined meeting you… but I thought you would be taller. (smirks) Or wiser.

P: Now then. For the second half of our interview, I'd like to discuss your approach to practicing medicine. Let me start with you, Dr. Maimonides: What do you believe is the most important contribution of a physician?

M: Rabbi Chanina said, "Ninety nine people die of colds, and only one at the Divine command."[1] And he underestimated it; only one in a thousand persons dies a natural death.[2] The rest die early because of ignorant or aberrant behavior. I believe the doctor's mission is to spread medical knowledge, so that people will eat, exercise and generally conduct their lives in an educated way.

P: I see. (scribbles a note, mumbling "big on preventive medicine") And how should a physician train?

M: It is quite similar to the study of Torah: One must work hard, study and regularly review the work of others.[3]

G: While spending twelve hours studying that archaic law of Moses, naturally.

M: Indeed, doctor. And at the same time one must engage in experimentation, as a way to test one's ideas and formulate new ones.

P: And clinically, how should a physician approach a patient?

M: Much as he should approach someone who asks a question regarding Jewish law. He must consider the patient, and not only the disease, for each case is different; one should never say, "This disease is similar to that other one," or "I have seen my elders treat this condition in this way."[4] He should confer with colleagues. And he must gain the confidence of the patient, or the patient will reject the course of treatment when it proves difficult or distasteful.[5]

P: (scribbles another note, mumbling "patient-centred care") What sort of hours should the physician keep?

M: It is known that I recommended a moderate lifestyle, allowing eight hours each night for sleep-[6]

P: (sigh) If only.

M: I must admit that I did not honour my own recommendation. In my regular schedule, I would not return to Fustat until the afternoon. Then I was almost dying with hunger, but I would find the antechambers filled with people, both Jews and non-Jews, nobles and common people, judges and policemen, friends and foes – a mixed multitude, awaiting the time of my return. I would dismount from my animal, wash my hands, go forth to my patients and entreat them to bear with me while I partook of some slight refreshment, the only meal I would take in the 24 hours. Then I would go forth to attend to my patients, and write prescriptions and directions for their various ailments. Patients would go in and out until nightfall, and sometimes even, I solemnly assure you, until two hours or more in the night. I would converse with and prescribe for them while lying down from sheer fatigue; and when night fell I was so exhausted that I could scarcely speak.[7]

G: A martyr, indeed. You would have made a fine Christian.

M: Better a Christian than a pagan serf of Asclepius.

P: I see. (scribbles another note, mumbling "totally committed". Then asks, fawning somewhat:)Tell me something I've always wondered about: Did you see yourself as a Rabbi and a physician, or did the two parts of your life interact?

M: As I said earlier, I consider the study and practice of medicine a religious imperative. First, the Talmud itself speaks of studying the deeds of Divine creation,[8] which refers to natural knowledge and in-depth study of the origins of existence.[9] It was not for nothing that I included a description of the cosmos in my Laws of the Fundamentals of Torah! And studying nature will bring a person to love Gd.[10] Why, no prophet is capable of prophecy until he acquires all of the levels of knowledge.[11]

P: But that's general science – what about medicine?

M: All the more so! I have written that the study of medicine is one of the greatest forms of worship of Gd![12]  And if one is lazy and does not study medicine, and one becomes ill, or one is unable to aid others who are ill, then one has sabotaged the service of the Divine, for one cannot serve Gd when he is ill![13]

P: Did you then deduce your medicine from Jewish tradition?

G: That would be a laugh!

M: Certainly not. My techniques are influenced by the techniques used in studying Torah, but I altered the Talmud's recommendations repeatedly as needed in order to reflect my own medical experience. I also wrote for a non-Jewish audience; I informed the reader that matzah is most harmful,[14] and the flesh of the swine is the most beneficial animal meat.[15]

P: I see. (scribbles another note, mumbling "ideological, but not too much") And Dr. Galen – Dr. Maimonides spoke at length about a physician's dedication, what would you say?

G: Certainly, a physician must scorn money and material pleasures – personally, we never took fees, although we did accept gifts from grateful patients - and he must work hard. He must invest in extensive research – we routinely studied the bodies of primates, and did all manner of experimentation in arenas upon animals living and dead, as well as upon gladiators, to learn more.

P: (scribbles another note, mumbling "dissecting live animals as entertainment") And what would you say a physician must learn as part of his training?

G: Everything, really. One element which is often overlooked is philosophy and logic – a physician who would diagnose and prescribe must understand the paths of deduction and argumentation. But he must not become as the Sophists, pretentious pursuers of style; he must deal in substance. We must be superior to them.

P: I see. (scribbles another note, mumbling "superiority complex") Rabbi Maimonides emphasized a clinical practice which takes into account the patient's unique state, and which earns the trust of the patient. Would you disagree?

G: Disagree? He drew on our teachings for all that he declared to you! But I would add that the physician should also be pharmacist; we created our own medicines, including our much-vaunted theriac, from plant and animal extracts.

M (mischievous grin): You slipped, Galen.

G (annoyed): What do you mean?

M: You said "I" instead of "we" there. Forget your ego for a moment? Is that possible?

Galen glares.

P: One last question for you – You've been accused of being something of a showboat, for your public debates and your vivisections before audiences, even for your style of referring to yourself in the plural. (Maimonides snickers) How do you respond to this critique?

G: It's all nonsense. We debated and wrote and published at the insistence of others, and to cure the world of the ignorance of our inferiors. I routinely challenged rivals to public showdowns to see whose cures would work, not for our glory but for the sake of public education. [The President looks very skeptical.] These charges come from the jealous fools, likely the same fools who wrote erroneous articles and books and claimed they were mine. We had to write up a catalog of our texts in order to debunk these numerous forgeries.

P: And your reputation for a lack of humility, and a general cantankerousness?

G: We are who we are.

[President looks toward Maimonides]

M: If you are asking me, I believe that the physician must be modest; he is not the true cause of the cure. Do not assume that I am the one into whose hands you should deliver your soul and body for treatment. May the Lord be my witness that I know for certain about myself that I too am among those who are deficient in this art, [who] stand in awe of it, and who find it difficult to achieve its goal.[16]

P: (admiringly) A rather more humble position.

M: As required by the Torah; in all of one's traits one must strive for Aristotle's Golden Mean, but regarding rage and regarding arrogance one must go to the extreme to avoid such ugliness.

P: And do you agree with Dr. Galen regarding fees?

M: The entire concept of medicine stems from our obligation to restore people's health to them, just as surely as we are obligated to restore people's property to them.[17] Certainly, a physician must provide for his family – but when caring for indigent patients, a physician is obligated to treat the needy, and to help them afford healthier residences where warranted, and to provide them with the ability to purchase medicine.[18]

G: We must object. It appears to us that you have been demonstrating increased bias toward this student of Moses throughout our time together. He is our inferior in every way – junior, less original, less published, and, I must note, addicted to religious beliefs he cannot substantiate.

M (voice rising): Dr. Galen, I deferred to you many times in my paltry writings, attributing accuracy to you when you were accurate and disagreeing only when I felt it necessary.  But when it comes to religion, you are far from an expert. In fact, I believe you are ill. Indeed, there is one disease which is so common that I think that no one can escape it, except a rare individual, even during long periods of time. This disease can be of greater or lesser severity, like other physical and spiritual illnesses. The illness to which I refer consists of the fact that every individual person considers himself more perfect than he really is, and desires and lusts that all that enters his mind should possess perfection, without effort and fatigue. In reality, Dr. Galen, you are as imperfect as the rest of us, and it is reflected in your philosophy and religion.

G (furious): Never, in our entire distinguished medical career, have we been so insulted. Madame President, if this is what you accept here as intelligent discourse, then we must take our leave now.

P: Actually, I tend to think he's right on the mark.

G: Then leave I must! (walks out abruptly)

P: Oh, dear. I'm sorry, but I need to go after him; we cannot have him blundering about the building. I apologize. (races out; Maimonides rises to go as well)

Act Three next...

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[1] Bava Metzia 107b

[2] This is cited from Moreh haNevuchim, but I have been unable to find it inside

[3] Book on Asthma, Chapter 13

[4] Ibid., andsee Berachos 19a

[5] Commentary on Hippocrates's Aphorisms pg. 14-15

[6] Mishneh Torah, Hilchot Deios 4:4

[7] Letter of Maimonides

[8] Chagigah 2:1

[9] Peirush haMishnayos ibid.

[10] Mishneh Torah, Hilchot Yesodei haTorah 4:12

[11] Shemonah Perakim 7

[12] Shemonah Perakim 5

[13] Mishneh Torah, Hilchot Deios 4:1

[14] Medical Aphorisms 20:16

[15] Ibid 20:19

[16] On Asthma 13:27

[17] Peirush haMishnayos, Nedarim 4:4

[18] Commentary on the Aphorisms of Hippocrates pg. 14-15