Sunday, January 29, 2006

the accidental patient

A couple of years ago I met a recently-ordained minister, a hospital chaplain here in Iowa City. We have a tertiary teaching hospital here, one of a few large hospitals in Iowa, so there are patients who come a hundred miles or more for treatment, and their families often come along. She said she'd been struck by the number of patients -- and their families -- who were dead certain they were sick because they'd done something wrong. Morally wrong, sin wrong, not pack-a-day wrong or unlucky-choice-of-parents wrong. Over the course of her first few months, if I recall her story, she'd learned to stop trying to explain medically why they were sick, and instead tried to persuade them in religious terms that they were blameless. Also that it was appropriate to shift their concern from self-incrimination and faultseeking to healing.

It's a common conception of illness, I think. More usual than not. It's punishment, or at the very least a sort of gracelessness, and I think many of us attach cosmic significance to our own major illnesses. It's a terrific time for pact-making: If I beat this, I'll ______. Forever. I'll reform, I'll do good deeds, I'll straighten up and fly right. And you hear people talk about recovery in religious terms with great seriousness: God spared me for a reason. There's no mention in there of, say, lucky biochemistry, or being sick at the right time in medical history. Or accident. The accidental mutation, the accidental cascade trigger.

I wonder what would change, socially and storywise, if we mainly conceived of illness as simple, even accidental, mechanical failure. I'm not sure it would necessarily make us kinder to either ourselves or other sick people. There would be, for instance, no readymade story for reform and aiding the sinner. I think of how we look at people who have lousy cars and houses; would we still avoid sick people, feeling that they've got some taint of loserdom or that they're irresponsible managers? I could see how, say, in a William-Gass sort of cold midwestern house, with a sagging braless old maid and the uncomfortable relative who's staying a while, a long illness might lose a sense that somehow, in the silent-treatment vastness of the small town and surrounding, the sick woman might have done something wrong. Something important, maybe, though no one except maybe some infuriatingly overreaching minister would even try to tell her what, or when, or the scale of it. Instead it might carry the same feel, resignation, shame, as the rotting porch foundation she can't afford to have fixed this year, again. I imagine that could be. Only with the porch foundation, someone might inflict or bestow charity on her, fix the thing while she was away. With a tumor, well, not so likely.

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