Rachel Naomi Remen is the co-founder and medical director of the Commonweal Cancer Help Program in Bolinas, California, and is currently a clinical professor of family and community medicine at San Francisco School of Medicine. She is the author of My Grandfather’s Blessings, from which this essay is taken, and the best-selling book Kitchen Table Wisdom.
A second-year medical student at the beginning of her study of pathology examines a human heart with a congenitally malformed anterior coronary artery. Rachel Naomi Remen makes this examination the basis of her cautionary story about the balance between scientific objectivity and responding “from the heart.”
Almost fifty-eight years ago, I attended preschool in the little park around the corner from our apartment in upper Manhattan. As the shy and timid only child of older parents it had taken me a long time to feel safe in the company of other children, and my mother or my nana often sat on a bench within eyesight to give me the courage to remain in the group.
Eventually I was able to stay there alone. One day close to Halloween my nana left me at the park, and I spent the morning with the other four-year-olds making masks. Close to noon the teachers threaded string through our creations and helped us to put them on. I had never worn a mask and I was entranced.
About this time, mothers began arriving to pick up their children, and as soon as I saw my own mother walking toward the class I stood and waved to her. She did not respond in any way. She stopped just inside the door, her eyes searching the room. Suddenly I realized that she did not know who I was and I began to cry, terrified. All her efforts to soothe me and explain why she had nor recognized me failed to comfort me. I simply could not understand why she had not known me. I knew who I was with my mask on. Why didn’t she? I never went back to the nursery school again. I felt too invisible, too alone, too vulnerable.
Most of us wear masks. We may have worn them so long that we have forgotten we have put them on. Sometimes our culture may even demand we wear them.
A young woman named LaVera toid me of something that happened when she was a first year medical student. Those were anxious times, and it was not uncommon for people to work and study eighteen hours a day for weeks on end. In the evenmg, members of her class were in the habit of releasing the day’s tension by playing basketball on the court in the basement of the medical students residence. No one kept score, and people would drop in and out of the game for fifteen minutes or a half hour – however long it was before their anxiety about needing to study took them back upstairs to their desks. Often the game went on for hours, and the two teams that called it quits had no players in common with the teams that had started the game.
About four months into the year, in the midst of one of these games, one of her classmates had suddenly collapsed and died surrounded by other freshman students who had no Idea how to help him. He was twenty-one years old.
Although many of the students were deeply shaken by the event, nothing further was said about the matter. The school made no opportunity to acknowledge either the tragedy of the dead or the feelings of the class. The young man’s belongings had been packed up and sent to his parents who lived in another state. No one from his class or from the school had attended his funeral, which was held near his home.
The pace of the first year was intense and the competition fierce. Despite their chock and distress, the members of the class simply went on. Few talked about their classmate even at first, and by the spring of the year, the incident seemed almost forgotten.
At the beginning of their second year, the class began the study of pathology. In one of the laboratory sessions on congenital anomalies the instructor began passing around trays, each holding a preserved human specimen that demonstrated a specific birth defect. Wearing gloves, the students examined each specimen and then passed it on.
One of these specimens was a heart with a congenitally malformed anterior coronary artery. As it was being passed hand to hand through the class, the instructor commented in a casual way that it was the heart of the young man who had died the year before.
Without lifting her head, LaVera looked out of the corner of her eye. No one around her seemed to react. All her classmates wore expressions of detached scientific interest. A wave of panic rose up in her until she realized that she, too, was wearing a mask of professional detachment. No one could possibly know the terrible distress she was feeling. She was flooded with relief. She remembers thinking she was going to be able to DO this. She was going to be able to becomes a real physician.
LaVera closed her eyes as she finished her story and sat in silence for a moment, She rocked back and forth slightly and began to cry.
After more than thirty-five years as a physician, I have found at last that it is possible to be a professional and live from the heart. This was not something I learned in medical school.
Medical training instills a certain scientific objectivity or distance. Other perspectives may become suspect. In particular, the perspective of the heart is seen as unprofessional or even dangerous. The heart with its capacity to connect us to others may somehow mar our judgment and make us incompetent. Such training changes us. We may need to heal from it. It has taken me years to realize that being a human being is not unprofessional.
My training encouraged me to give away vital parts of myself in the belief that this would make me of greater service to others. In the end I found that abandoning my humanity in order to become of service made me vulnerable to burnout, cynicism, numbness, loneliness, and depression. Abandoning the heart weakens us.
The heart has the power to transform experience. No matter what we do, finding fulfillment may require learning to cultivate the heart and its capacity for meaning in the same way that we are now taught to pursue knowledge or expertise. We will need to connect intimately to the life around us. Knowledge alone will not help us to live well or serve well. We will need to take off our masks in order to do that.
1. What do you think the author meant when she used the term “heart”?
2. What does “heart” personally mean to you, and will you preserve it as you begin your journey in medicine?