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...
[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
