to reduce those wave motions as much as possible. The modern physician must be sure of self and of science, and optimistic that the science will conquer disease. It would be foolish to think otherwise. Yet, around this world of control and certainty, uncertainty lingers and tragedy lurks. In the real world, treatments fail and death prevails. I am not proposing that the physicians become pessimists and doubters. Who, after all, would seek help from a gloomy, indecisive doctor? I only suggest that their scientific and therapeutic optimism can reach the receptors in their patient’s minds and hearts when they, at the same time, deeply appreciate that the therapeutic aim may be beyond their power. Any genuine hope has meaning only against an acknowledgment of tragedy and uncertainty. Indeed, I believe that only a deep appreciation of this dark side can, to recall Sir William’s primitive endocrinology, “lubricate” the mind and heart of those who engage in the work of medicine, making them move in synchrony with the minds and hearts of those for whom they care. I praise the efforts to introduce medical students to literature, or, as Sir William would have said, humane letters. Its message will be absorbed by some and subtly change their view of the science and practice. However, that message is constantly threatened and repudiated by the culture in which we live today. We live during a time in which technological and organizational prowess claims to overcome tragedy, although we see tragedy unfold around us every day. Medicine taught in school all too frequently communicates the belief that we can have the power to overcome it, if we only expand our scientific understanding of its causes. Sir William ended his lecture with reflections on the Great War just ended, in which he had suffered the personal tragedy of losing a beloved son. He concludes, “Let us not be discouraged. The direction of our vision is everything, and after weltering four years in chaos, poor stricken humanity still nurses an unconquerable hope . . . witness of the power of ideals to captivate the mind.” It is the genius of the humanities to link tragedy and hope,
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uncertainty and certainty, and this is the essence of great medicine. In the last lines, he quotes Hippocrates, “where there is love of the art, there is love of humanity.” Those who love their practice of medicine must love humanity precisely in its tragic fragility and fearful uncertainty. The humanities consistently reveal to us that love of humanity can prevail amid tragedy, and this is how medicine must be practiced. Albert Jonsen, PhD, is codirector of the Program in Medicine and Human Values (PMHV) at CPMC, original chief of the division of medical ethics at UCSF, professor emeritus of ethics in medicine at the University of Washington, the only honorary non-MD member of the SFMS, and author of many landmark books and articles. Note: This essay is a version of a lecture originally delivered at the Humanities in Medicine Joint Conference, New York Academy of Medicine/Royal Society of Medicine, October 7, 2009.
A Poem Osler An eye whose magic wakes the hidden springs Of slumbering fancy in the weary mind. A tongue that dances with the ready word That like an arrow, seeks its chosen goal, And piercing all the barriers of care, Opens the way to warming rays of hope. A presence like the freshening breeze that as It passes, sweeps the poisoned cloud aside. An ear that ’mid the discords of the day, Swings to the basic harmonies of life. A heart whose alchemy transforms the dross Of dull suspicion to the gold of love. A spirit like the fragrance of some flower That lingers round the spot that this has graced, To tell us that although the rose be plucked And spread its perfume throughout distant halls, The vestige of its sweetness quickens still The conscience of the precinct where it bloomed.
William Sydney Thayer
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