These Are the Duties of a Physician

A fascinating article from the March, 1939, issue of Johns Hopkins’ Bulletin of the History of Medicine recounts the rediscovery of the large stone fragments of a mysterious ancient monument. Originally erected in the ancient Greek sanctuary of Asclepius, the monument stood on the beautiful southern slope of the Acropolis. Once reassembled and decoded, these fragments opened a window into the world of our physician colleagues in another age.

 

At times, it's so tempting to look at all the pressures on us as physicians, nurses, and other healers today -- the electronic record, financial and time pressures, modern malpractice litigation -- and assume that the reality of medical practice is qualitatively different from what it once was. You know what, though? The more I think about it, the less I believe that to be so.

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In this post, the third of four related to the terrible truth of physician suicide and how we might prevent it, I’d like to take a step back. I want to move away from our time and place and try to view our work in the larger context of human experience once again.

Some things have certainly changed. But underneath it all, there lies this beautiful, timeless core common to the work of healers across cultures and millennia, from the stone age village shaman to the modern radiation oncologist. I want for us to try to tap into that experience, to drink from that well.

 

 

Back to March, 1939

Once lovingly reunited, the fragments of this ancient monument revealed an epitaph to an Athenian physician, one of our forerunners.  This poem purveys ageless advice. “Cure with moral courage” and “(do so) equally” “for we are all brothers.”

What really moves me, though, is the poem’s crystalline opening:

“These are the duties of a physician ...”

Let's pause right there. Given that we’re among friends, I want us to be completely honest with one another. If I asked you what your first duty might be as a 21st-century physician, or nurse, or any other healer, what would you say?  For that matter, what would I say if you asked me?

First, do no harm? Maybe.

Patients first? Possibly.

To be fully present, listening until my patient tells me what is wrong? Perhaps.

 

But no. At least according to this Greek poet, none of those is right.

"These are the duties of a physician: first, ... to heal his mind..."

 

Wow.

First, to heal my mind?

Realistically, would any of us say that?

 

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Wondering Who This Was

Aren't you left wondering who this unidentified physician was, that this should be their epitaph?  Were these this person’s teachings, such that they should bookmark the end of their life?

Spiritually speaking, the southern slope of the Acropolis was very powerful real estate. The presence of this enormous, laboriously crafted monument suggests that this person’s life must have been very interesting. Interesting, of course, being almost never synonymous with easy.

Our forerunners in every era must have struggled spiritually and emotionally just like we do in the face of difficult outcomes. Do you find yourself daydreaming about what this ancestor witnessed or lived directly? Did they learn the necessity of healing the physician-mind the hard way?

 

Filling in Some Gaps

“These are the duties of a physician: first, … to heal his mind..." (or hers, for that matter -- apparently, despite significant obstacles to their education, there were ancient Greek women in medicine).

This opening statement is most often quoted with the ellipses I've included there, which left me wondering what was behind those little dot-dot-dots. As it turns out, something a bit cryptic but absolutely worth exploring.

The full epitaph actually begins, “These are the duties of a physician: first, the Paeonian chants and to heal his mind...”

 

What were Paeonian chants?

From what I deduced after a brief foray about the internet,  Paeonian chants were a physician's morning prayers. These ritual requests for healing, hymns of thanksgiving, and prayers to avert evil were offered first to Apollo, later to Asclepius. While they seem to have intially sprung up ad hoc -- in times of war, say -- they later appear to have become a daily feature of ancient Greek life among the healing community.

As a word-lover, I was intrigued to learn that Paeon (to whom these paeans were offered) was the physician of the Greek gods. In Homer’s Iliad, he appears equipped with herbal lore, and over time, his name is associated with Apollo. A complex god of music, light, and healing, Apollo will father a son, Asclepius. Himself a physician-god whose rod remains our symbol to this day and in whose temple this ancient monument rested, Asclepius will also come to be called Paeon.

 

 Asclepius and Hygieia, Rijksmuseum, Amsterdam, Netherlands. Although art scholars say Hygieia is pouring a libation of wine to honor her father, I think it looks like he's preparing to wash hands.

Asclepius and Hygieia, Rijksmuseum, Amsterdam, Netherlands. Although art scholars say Hygieia is pouring a libation of wine to honor her father, I think it looks like he's preparing to wash hands.

 

Asclepius, god of healing, did not practice alone.

He had five daughters, each divine in her own right:

  • Hygieia, goddess of cleanliness

  • Iaso, of the process of recuperation

  • Aceso, of the healing process

  • Aglaea, of the glow of health, and

  • Panacea, of universal remedy (of which, as we know, there are none!).

Two sons, Machaon and Podalirius, both surgeons in the Trojan War, rolled up their sleeves to give birth to traumatology.  "War is wretched," said  John McCain, "beyond description..." I'm sure that was as true in ancient Greece as it is today. I think I'm going to have to scour the Iliad now to see what Homer knew about second victims.

 

 

What Does This Mean for Us?

I hope you’re hanging in there with me. Without the final ellipsis, the entire first line of our poem goes like this:

“These are the duties of a physician: first, the Paeonian chants and to heal his (sic) mind and to give assistance to himself before giving it to anyone (else).”

 Asclepius with his serpent-entwined staff, Archeological Museum of Epidaurus, Greece. He definitely looks like he consumes a Mediterranean diet and gets his exercise, doesn't he?

Asclepius with his serpent-entwined staff, Archeological Museum of Epidaurus, Greece. He definitely looks like he consumes a Mediterranean diet and gets his exercise, doesn't he?

 

For all our progress in medicine, this text clearly says that the ancient Greeks understood three crucial things, which I must confess I sometimes struggle to remember:

First, that morning light and music are highly salutary!

Second, that a healer's spirit is central. While the notion of Paeonian chants as a daily prerequisite to the art of healing may sound superstitious to us, a few unchanging truths are hidden in that reference:

  1. The human body has secrets as yet known only to “the gods” and the cosmos, and certainly always will. How much more is that true for any individual human organism confronted with disease, and any individual healer confronted with a complicated situation. Obstacles and surprises will arise in the course of healing. Like it or not, we humans have only very limited control.

  2. These obstacles and surprises will sometimes injure us. Physician-mind (or any healer’s mind) will require regular healing as an absolute prerequisite to our art.

  3. Some form of spiritual practice may function as a useful form of preventive maintenance which helps to keep our hearts intact and in alignment with the complex reality of what we do. It may also provide a tool for healing once our work has provoked injury, which it will. This spiritual practice may come in the form of meditation, prayer, yoga, contact with a religious or spiritual community, time with a loved one, or contemplation among the trees, the waves, and the stars. In my view, anything which serves to connect you or me with the sense that we are part of something much, much larger than ourselves counts as a spiritual practice. Certainly, the work of a healer is, by that definition, a spiritual path in and of itself; for many of us, our work connects us to that something much larger than ourselves. However, we must have something other than the path of our work to protect and heal us when our work goes wrong. Finding and cultivating the spiritual path which suits us may be a prerequisite to surviving the slings and arrows inherent to our work.

 

 Bust of Asclepius, Museo dei Marmi, Florence, Italy

Bust of Asclepius, Museo dei Marmi, Florence, Italy

Third, this poem clearly states that we are of little use to anyone until we have taken care of ourselves. This is the one that I trip over most. Every other piece of advice which this epitaph offers -- to heal with courage, to eschew erotic relations with patients, to treat our patients equally without regard to wealth or class -- is secondary to healing our own mind. Cultivating that side of our health in a preventive way, and restoring it when injury occurs -- which it will if we practice medicine long enough! -- must always and repeatedly come first.

As you contemplate this, I challenge you to begin to look around at your own life and those of your colleagues. Ask yourself, as I am asking myself, are you providing your mind with the preventive maintenance it requires daily? Are you actively seeking to notice and to heal it when it is injured? Are we on the lookout for those causes of injury and their effects on others? Are we as a medical, nursing, and broader healing community prepared to create the structures required to ensure that all of us, "First... heal (our) minds?" I'd love to hear your thoughts.

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