Vol. III, Spring 1987Vol. V, Spring 1989

mom fish   Asher Milgrom
geriatrics   Asher Milgrom
Our Lady of the Tank   Peter Draper
Stories from the Depression   Marla Friend
What would the old man say to the young boy   Mary Bliesmer
Time Passes   Mary Bliesmer
Good Death   Steven H. Kroft
Bare Mary   Dipali Apte
Mr. O's Blue Eyes   R. Scott Velders
Love Song to Beatrice   Mark S. Hantoot
Sanitarium World   Feiruz Shehadi
Fascia   Julie Pease
The Dance of Death   Hans Holbein
Rebuttal to Holbein   Doris Vidaver
On the Death of a Family Cat   Tom Vaughn
On the Porch   Tom Vaughn
On Brittle Knees   Jeff Ross
Photograph:  Science and Censorship   Camille Rea
Blinded   Sharon L. Hame
Odor   Daniel J. Brauner
Firstborn   John LoVetere
Death of a Loved One   Mary C. Ayesse
Socrates' Last Moments   Ken Serio
Going Home   Frank Papatheofanis
Letting Go   Frank Papatheofanis
Pediatric Nursing   Sheryl L. Wiegand
A Child Died Today   Sheryl L. Wiegand
Physician, Enlighten Yourslef!   Hyman Muslin, Jonathan Lewis
Acknowledgements

mom fish

Asher Milgrom, second-year student
University of Chicago
Pritzker School of Medicine

geriatrics

Asher Milgrom, second-year student
University of Chicago
Pritzker School School of Medicine
second place prize winner

Our Lady of the Tank

Peter Draper, second year student
UIC College of Medicine

Stories from the Depression

All week I carefully hoard new tidbits to tell him. Then on Thursday nights I call, and my reward is listening to his voice brighten when he hears me on the phone.

"Hello Marla, how's medical school?"

I have to shout for him to hear my reply; he's been going deaf for years.

"Fine Grandpa! This week we saw slides of miliary tuberculosis!"

"Miliary TB? I lost a patient once to miliary TB. It was before we had antibiotics. She was just a little girl!"

My grandfather graduated from McGill University Medical School in 1928. He practiced medicine in Milwaukee during the Depression. The stories he tells about those days are wonderful to hear Once a patient paid him for a house call with a cow! My grandmother', with visions of 6 a.m. inilkings in her imminent future, made him return it. On another occasion a family paid his one-dollar fee all in pennies. My grandmother made him return this, too, saying that she absolutely refused to take anyone's last cent. And once a young couple who had no means of payment whatsoever offered my grandfather dance lessons instead. Grandma decided that this was all right, and that night all of her brothers and sisters dropped in to learn the Box Step.

My grandfather's favorite story, however, is about an evening spent in the pathology laboratory when he was still a student. It was extremely late and he was alone in the lab. As he hunched over his microscope, intently studying the slides, his professor walked in and saw him. The professor walked over to my grandfather, patted him on the back, and said "Good boy."

Now these may sound like simple words of praise to you and me, but to my grandfather their value is immeasurable. One hundred payments collected, an entire barn filled with cows, and even dance lessons from Fred Astaire himself could not compare in worth to my grandfather's pride at these two words! In fact, my grandfather is so moved when he tells this story that his eyes fill with tears.

"Grandpa, I got the pamphlet on ovarian cancer you sent me. It looks interesting! I'll use it when we study urogenital pathology next week."

"Good Girl!"

Marla Friend, second year student
UIC College of Medicine

What would the old man say to the young boy

Mary Bliesmer
R.N., M.P.H., graduate student
Rush University College of Nursing

Time passes

Mary Bliesmer
R.N., M.P.H., graduate student
Rush University College of Nursing

Good Death

"I'm sorry."

I'he words pulsated, meaningless, through the endless expanse of him, caressing and colliding with the silence until nothing remained. They whispered a promise of light ...

"I know what you're thinking, Jenny."

... but there was only darkness. There was something he could not be, somewhere he could not know, and they were locked in the tomb at the bottom of his soul. He surrounded it and felt it, like a stone in the belly of his consciousness, but he could not penetrate it. But ...

"Please, mother, don't ... "

... the sounds melted out of it, bellowing gently of a passage into that strange, hard place. If he could follow the wisps of memory that orbited the sounds, back to their source, would he find the 'light? He merged with the words, gently restraining them until he reverberated along with them. He felt himself beginning to collapse. But the hard place was not collapsing; in fact it was growing within his diminishing space. He shrunk further and faster, in a noiseless crescendo until he imploded while the hard place exploded and OH GOD, IT WAS RIPPING THROUGH HIM AND

he abruptly became aware of himself and the sounds around him.

"Don't you understand what's happening here, mother?"

"Jenny, please stop. There was no other choice."

"How are you two doing?"
"We're all right. Really. Please, could you just leave us alone with him?"
"Yes, of course. There's a nurse just outside the door if there's any problem."
"Thank you, doctor."

"God help us."

"Jenny, I know how much you love him. I love him, too."

"Mother, I can't stand this anymore. I wish he would stop breathing. How much longer could it possibly take?"

"The doctor said that once he was taken off the support equipment he might keep breathing for quite a while. There's no way to tell how long."

"Mother, we've killed him."
"No! Don't say that! Don't you dare even think that. Your father died when that bullet entered his skull. This is not him. That's just the empty shell of what was once him. He would not have wanted us to just keep his body alive for no reason when there was nothing left of him. Do you hear me? He would not have wanted it!"

"Mother, how can we possible know for sure that there's nothing left?"

he was there. But it was such a small piece of light. How could he ever get himself inside of it? But he couldn't turn back now, so he grasped the indistinct edges of the light and squeezed himself through with miraculous ease and suddenly was engulfed in a light as pure as joy, and he laughed.
But his laughter was short lived, for he became aware that, despite the light, he still could not see. He was confused, and his confusion turned into brutal dissappointment. He felt himself expanding, diffusing softly outward. It diluted his despair, so he did not resist.
For what he thought was the light of his salvation was merely the darkness inside out.

Steven H. Kroft, second year student
UIC College of Medicine
first place prize winner

BARE MARY

Dipali V. Apte
Medical Scholars Program
University of Illinois College of Medicine
Urbana-Champaign

Mr. O's Blue Eyes

R. Scott Velders, third-year student
University of Illinois College of Medicine
Peoria

Love Song to Beatrice

[EDITOR'S NOTE: The following piece is a fragment of a longer story which our limited budget prevented us from printing in full. We regret our inability to present "Love Song to Beatrice" in its entirety and hope that future funding will not make such excerpting necessary.]

I

The first thing you notice stepping off the elevator on the seventh floor is the smell. It seems to hit in waves, pouring its way through the hall air like molasses, until it hardens in your lungs. The smell is also, oddly enough, the very first thing you get used to, and the last thing you forget.
The layout of the laboratory floor was pretty much as I had expected. There were ten dissecting rooms, each with four stations of four students. Each of the rooms was equipped with specimen jars, sinks, blackboards and several skeletons, and I was part of a group placed nearest the door as you walked in. I thought this irritating at first—it didn't appeal to me being so visible. But once I learned about the ventilation in the room, I came to view being near the door as a great gift of fate.
I turned twenty-eight five months before I began medical school, and had worked for six years as a writer for an advertising agency in New York City, I had a good marriage, and felt I was finally beginning to settle into some kind of fitful adulthood. But I had never liked my work. I've always been a wonderful liar, but I hated to lie in print, and found advertising a sour, cynical business. Since I had been a biology student in college, I thought medicine might be a somewhat less jaded alternative, and decided, with a little help from my wife, to leave the city and spend four years at a school in her hometown, Chicago.
The day I quit the ad agency was one of the most satisfying of my life. Never again would I wrack my brain, digging down for some passable fib about some less-than-passable product, putting every bit of energy I had into tricking some defenseless consumer into buying something he didn't need. Nonetheless, I had with one enrollment managed to transform myself from one of the youngest copy chiefs on Madison Avenue into the only person within earshot who had ever heard of gas lines or Spiro Agnew. I felt like a relic, a living link to the past, pulling at a long gray beard as I recounted the legend of how a disgraced Richard Nixon had left the White House lawn with a broad smile and a wave of his hand.
"He was a victim of the liberal press,' snapped a young shunt from across the room. (A shunt is a student in the six-year continuum program, who was beginning medical school after only two years of college.)
"Don't you read the magazines? He's coming back." He grinned and turned, victorious in his yellow Izod and I felt even more like a fossil.
Of course, I wasn't the oldest member of my class. There were a number of what were called the "elderly"—business people, lawyers and others who had for some reason decided to make a change, some of whom were significantly older than I was. But none of them were in my lab room, and they might just as well have been in China, since this was where I was to spend the vast bulk of my time, locked in helplessly with the smell and the shunts, and with Beatrice.
I didn't meet my three lab partners until the first day of gross anatomy. I was, predictably, the oldest of the group, but things weren't as bad as they might have been, and I was thankful for that. Adrian was twenty-five, a tallish blonde with clear eyes and a quiet, no-nonsense demeanor. Zachary was one of the many Orientals in the class, a little on the short side and very enthusiastic, and looked to be just out of college, as was Ray, a scruffy, slightly overweight fellow from the South. I can't say I expected I would become fast friends with any of them, but at least there was no one under twenty.
On that first day, we all came together ready to make waves, work clothes and textbooks in hand, a brigade of the eager and the ignorant. While there wasno outright hostility between us, there was a spark—something untrusting andcompetitive that kept each of us welled-up inside, worrying about how good theothers would be. For something near thirty minutes, we sat, the four of us, bleating occasionally, but mostly just eyeing each other impressively, like convicts, until Zachary spit a bolt between his teeth.
"Maybe we should get changed."
There was an awkward silence. I thought of Bob & Carol & Ted & Alice, which f had seen only a few months before, rented from a video shop on Eighth Street in Manhattan. My wife and I had had sex afterward that night, and it made me feel lurid. And now, this was it. In the better interest of healing, we would all strip and engage in some ritualistic hanky-panky, here, in the lab, amidst all the glass and stainless steel.
But nothing of the sort happened. The room simply filled with a lot of paunch, an occasional sideways glance, and nothing very jolly. In all modesty, I felt I compared well enough with the men in my group, given a fair handicap, and Adrian showed not the slightest hint of embarrassment, as if she had been through it all before. The real excitement, it turned out, was across the room in the group next to mine. There, in all her glory, was a female shunt, bare-breasted, with only a pair of Calvin Klein briefs between her and decency, standing over her desk, causally folding her blouse. She was built like a model and not a soul watched her, man or woman, not a soul deigned to care, as every eye in the house burned fire red in its socket.
Just as she slipped her arms through the top of a bright blue T-shirt and let it fall slowly down her back, an older black man wearing a battered white coat walked, limping, into the room and stopped right behind me. I say this presumptively, as I never heard him, and I certainly didn't see the megaphone he must have carried between his teeth.
"Callahan, Cane, Chao, and Chapman?"
I turned, feet on the floor, my brains plastered a quarter inch thick on the top of my skull, and nodded briefly. Adrian did the same, followed by Zachary and Ray.
Mel, as we would soon learn, was the key to happiness, if not success in gross anatomy lab. He control-led the keys, the bones, and all the day-to-day unpleasantness of the place. Mel was the link that held together decades of medical freshmen, half babysitter, half analyst, and he was roundly respected for the good will he generated. Met was, in gross anatomy, the man who officially cut the ribbon.
He made a few checks on a clipboard he was carrying, then crossed to a small, square, stainless steel latch door attached near, the floor to my group's work table. He opened it and pulled out a long, low table on wheels, also stainless steel, on which rested a human figure, covered with a damp, white cotton cloth which was itself covered with a clear, thick plastic sheet. Mel positioned the table so it sat near the center of the work area, then used a long steel pole to lift it UP, dS if raising his car to change a tire, pumping with familiar, boredom. Once the table top was waist-high, he locked the lift mechanism, replaced the pole and pulled a small sheet of paper from his clipboard. With a piece of Scotch tape, he fastened the paper to a gas jet above the sink, and it fluttered in what sorry breeze there was in the room. He then looked up at me briefly, a moment of shared age, I'm sure, then left for the next station Lo repeat the routine. Once he had left, the four of us, erstwhile partners, nervous in brightly colored T-shirts and sweatpants and shorts, gathered around the piece of paper.
"Sixty-nine-year-old females Cause of death, pulmonary failure."
Ray glared at the figure on the table, then turned quickly away and crossed back to his desk in obvious discomfort, our first indication of what was to come. Zachary, his face full of excitement, read the piece of paper several times, made a few notes on a yellow pad, then turned around and headed for the door.
"I'll get some gloves."
Adrian was the only one sitting. She looked oddly serene, almost detached, staring at her dissecting manual and drinking a Coke that seemed very much out of place. I felt like I was in the middle of a whirling circus, somewhere near the freak show- an outsider come to see what all the fuss was about, and I suddenly had no idea what business I could possibly have in a room like this. The smell was overpowering, relentless. I felt a little dizzy and should have sat down, but I couldn't take my eyes from the table. I took a step closer and felt a little worse. I could taste Adrian's Coke, mixing with the thick air, sickly sweet in my chest. I was right up against the steel table, sweating like a boxer, and the room began to spin, slowly. I rested my fingers on the plastic and the stillness below surprised me. The hardness seemed wrong, I expected something softer. Under the cotton cloth, I could see a landscape, hints of a rise here, a shallowness beside it, features in a bag tied tight at the neck. There was a face, her face, under all that wrapping. I know now the vents weren't working and the room closed in on me. I felt a single drop from my forehead hit the plastic and sizzle and, though no one knew at the time, I passed out for just a moment.

II

The first man I ever slept with was a very tall homosexual. This caused me tremendous concern at first, but in time I realized it was not uncommon among adolescent women interested in the dance.
We met when we were both ten years old. I remember thinking him handsome in some silly way even then, pushing me in a swing in my parents' backyard. By twelve, we had taken to writing secret diaries together, putting down all the ugly truth about our friends and teachers. By the time we were sixteen, we had both studied dance privately for several years. I thought he was better than I was, and that may be why I decided he should be the first, though, when the time came, I don't think I actually decided at all. It simply happened.
You have to realize, in those days, I was absolutely beside myself with sex. The only thought I ever had was who, and when. Would it be on a bed, or in a field? On a beach? Would it be at night? Would I be completely undressed? How long could I hold out? I'm afraid I was scarcely lucid by the time the school year ended and we were cast together as dance partners in a performance concert. It was our last rehearsal, just hours before opening night. We had Just been through the routine, and were sitting a few feet apart on the hard, slat-wood floor. The room was very hot, and I felt exhilarated and a little light-headed from the workout. I looked over at him, sprawled with his legs wide apart, leaning upright against a wall, and it occurred to me for the first time just how revealing our costumes were. I could see every muscle, every curve, rising and filling with each breath as if nothing covered them. I felt naked and preoccupied. I suppose I was staring, but suddenly he turned, startled, I think, and looked up at me. It was a sizing up, as if he were seeing me for the first time as an adult, as a woman. I could feel his mind working and I began to reel inside. I had trouble catching the wind in the room. I sat breathing, breathing, thinking about how good he looked.Then, he moved. I felt it like adrenaline surging, power inmy direction. I moved with him and we met in the middle.After that there is only soft skin and closed eyes, and then images disappear, only sensations left.
I recall he didn't look embarrassed afterward, as many men do. Instead, my next memory is of us dancing together for all our friends and family. I was certain everyone knew what had happened because, that evening, we moved together as a single voice, without effort or identity. When it was over, we held hands and bowed together, giddy and confident before the applause. It was the most exciting night I'd ever had, and that's when I knew I was going to be a dancer all my life.

III

We began actually cutting that first day in anatomy, removing all the skin and subcutaneous fat from neck to buttocks, and as far out as the elbows. To do this meant turning the cadaver on its stomach, which shouldn't have been a difficult thing. The cadaver was lying face up, arms locked by its side, and it was decided that two of us would lift and turn at the shoulders, the other two at the ankles. Since Adrian and I were immediate desk neighbors, we volunteered to take charge of the lower extremities, leaving the much heavier torso to the two remaining men.
I took up my position beside Adrian, smiling firmly, never letting on just how repulsive the thought of grabbing hard onto this ankle would be. We were ready, all except for Ray, who just remained at his desk, wincing, his dark eyes pinpoint.
"You don't really expect me to touch it, do you?"
The three of us stood a moment, as if making sure we had all heard the same thing. Adrian looked up at me, then at Ray.
"Yes, Ray, I think it's fair to say we do."
He laughed, a little defensively, but without a trace of compromise.
"It's disgusting. I'll never have to do that."
"What?" Adrian snapped at him, showing a temper I didn't think she had.
"Cut up a dead body. Only pathologists do that. I'll never have to."
He continued to smile, then sat at his desk and folded his arms, as if to let Adrian know she could disapprove all she liked, but he was immobile. Nonetheless, she continued to stare, disbelief filling her eyes, until Zachary spoke up.
"It's okay, the three of us can manage all right."
Theoretically, it meant nothing to me whether or not Ray wanted to touch the cadaver, I just wanted to get the turn over with. On the other hand, it was clear that Adrian found his queasiness extremely irritating, and didn't mind letting the entire group know. Between Zachary and myself, I was the larger so, under duress, I agreed to handle the shoulders myself. We positioned ourselves once again and Adrian, half her attention still focused on Ray, counted for us.
"One, two, three, now."
It was like an explosion.
In retrospect, I now know I made two key mistakes. First, I had dramatically under-estimated the weight of even a small, formalin-preserved cadaver. Second, I didn't take into account how slippery the inner white cloth would be against the cold skin. So, while I had in fact managed to turn the thing, I had also allowed it to fall with the weight of a great rhino, crashing and bouncing on the bare stainless steel, spraying 'Juice,' as we would learn to call this unique blend of formalin, blood, and fat, all over myself.
It was undeniably the most grotesque experience of my life. There was juice in my eyes, juice dripping from my chin and ears. There was juice in my hair, and seeping through my clothes onto the skin of my chest. And there was juice on my tongue, which I had instinctively stuck out when I heaved to lift.
I stood there, dripping, wanting with every bone and nerve in my body to jump up and down, screaming with disgust, spitting in-to the air until every ounce of fluid was expelled. That's what I wanted to do, but I just dripped. may I please have a paper towel?" I asked.
Zachary handed me two paper towels from the wall dispenser, and I wiped my face. Adrian went to the sink and washed her hands, instinctively, still shooting visual bullets at Ray. He smiled back at her, like a reflector, his eyes now widened into slits, then turned to me.
"See? What did I tell you?"
It was Zachary who made the first cut. He'd been chomping at the bit, and Adrian and I thought it only fair he be allowed to go first. He made a clean, easy line from the base of the neck down to the small of the back. There was no ooze, no juice, and we decided to let him continue. Following the dissecting manual exactly, he made further cuts across the tops of both shoulders, in circles around the biceps and triceps, and from the mid-back sideways to the table top at the level of the lower shoulder blades and lower back. Once this was done, Adrian and I began to peel back the tough skin in large flaps, slowly exposing a shining layer of solid, yellow fat. Zachary read from the dissector.
"In the underlying subcutaneous tusse, locate the greater occipital nerve and the accompanying occipital artery. The nerve pierces the trapezium muscle about three centimeters inferioTatera-I to the inion. The artery lies lateral to the nerve ..."
The thing that struck me most about the body in front of me was how much everything looked alike. Fat, muscle, nerve—nothing was distinct. Somehow I had expected each structure to throw itself at you, as if already color coded. Suddenly, I found something promising.
"I think I have it."
Adrian peered into the morass at my forceps, then shook her head.
"That's just fascia. You're not deep enough."
I glared up at her, embarrassed, wondering how the hell she could be so sure of herself. A moment later, Zachary spoke.
"What about this?"
Again, Adrian leaned over, this time squinting.
"I think that's it."
I wanted to crawl into my glove.
"How can you tell it isn't fascia," I challenged her, my voice cracking.
"Fascia creaks, nerves twang,' she responded as she pulled the string-like structure taut and plucked it. It sang to her. She then smiled at me, without victory and, for the first time in days, I felt very young.
Through all of this, Ray remained at his desk, reading his own dissector as if in an easy chair on a sunwner porch, completely oblivious to any conversation or discovery of ours. Several times I wondered what was going through his mind. Did he intend to ignore us the entire semester? Would he be allowed to do that? Each time my mind wandered, either Adrian or Zachary would find another required nerve or blood vessel, and I would be brought back to work.
And work it was. We would have to learn the name, location, and function of everything we found, many hundreds of muscles, bones, nerve roots, arteries, veins, ligaments, and organs. By the end of the first day, we had found all but a couple of the structures we needed, not bad given we were a person shy. There was a tremendous sense of accomplishment and, though we had been working only one afternoon, by the time we were ready to pack it in, pieces of skin and fat spattered on the floor or left soaking on the dissecting table, the smell seemed less pungent, the job less overwhelming, and the body on the table before us a little less human.

Mark S. Hantoot, third year student
Northwestern University Medical School

Sanitarium World

Feiruz Shehadi, N.A.
Admissions and Records Officer III
College of Architecture, Art and Urban Planning
University of Illinois, Chicago

Fascia

Julie Pease, first year student
UIC College of Medicine

Rebuttal to Holbein

Go to Illustration
Doris Vidaver
Co-director, Humanities Program
Rush University

first published in The Literary Review, XVI:I.
reprinted with author's permission.

On the Death of a Family Cat

August 1986
Tom Vaughan, M.D.
Chicago

copyrighted by author, Family Matters
reprinted with permission

On the porch

July 1986
Tom Vaughan, M.D
Chicago

copyrighted by the author, Nuclear Winter
reprinted with permission

On Brittle Knees

I wrote these lyrics in September 1981 to accompany a song which I composed several years earlier. The lyrics were inspired both by my Pediatric rotation and by the wonderful efforts of the Children's Miracle Network Telethon here in Peoria. I am currently working with the telethon coordinator to record the song as a tribute. While the lyrics lack emphasis without musical accompaniment, I feel they still convey my meaning. —J.R.

Jeff Ross, fourth year student
University of Illinois College of Medicine
Peoria

Blinded

I wrote this poems as a response to what was I was seeing happen to students during their first year of medical school. I saw their attention and lives entirely focus on school itself; all other aspects of their lives were forgotten. —S.H.

Sharon L. Hame, second year student
Chicago Medical School

Odor

Daniel J. Brauner, M.D.
Geriatrics and General Internal Medicine
UIC College of Medicine

Firstborn

Come into this world
kicking and screaming
Mouth wide
Small life
Large eyes
shut tight
(Careful, don't drop it!)
Richman, poorman
beggarman, thief of my heart
Just formed
Unshaped
Curled up
in a pretty bow of potential
Hold it
Protect it
Watch it, help it
grow straight, grow strong,
grow true.
It's a little me
and you
and all we might have been,
if only ...
Careful, don't drop it.

John LoVetere, second year student
University of Illinois College of Pharmacy

Death of a Loved One

Mary C. Ayesse, graduate student
University of Illinois
School of Public Health

Socrates' Last Moments

Socrates, the philosopher and teacher of ancient Greece, experienced death by his own choosing. His death at the hands of the Greek government was a quiet end in the poison hemlock that passed his lips. How unique modern man stands whose end is one of resistance to the final breath. Here, the physician watches as he must, each last moment of the dying man, the man without choice.   —K.S.

Ken Serio, first year student
UIC College of Medicine

Going Home

Frank Papatheofanis, first year student
UIC College of Medicine

Letting Go

Frank Papatheofanis, first year student
UIC College of Medicine

Pediatric Nursing

dedicated to the kids of 9 West
Children's Hospital St. Louis, Mo.

Sheryl L. Wiegand, senior student
Southern Illinois University—Edwardsville
College of Nursing

A Child Died Today

dedicated to David Guffey

Sheryl L. Wiegand, senior student
Southern Illinois University—Edwardsville
College of Nursing
third place prize winner

Physician, Enlighten Yourself!
On the Joys of Literature

[EDITOR'S NOTE: This essay, which contains fairly detailed analyses of Romeo and Juliet and King Lear, has had to be heavily excerpted to fit our budget limitations.]

This essay is concerned with the unique contributions of literature to the learning of the physician—specifically to the learning about people, their inner life, and their interactions with their surround. Another mission of this essay is to imbue the reader with the sense of pleasure to be dervied from the study of literature, to infuse him with a singular sensory- intellectual experience. The joy of receiving the gifts that the great authors give—their insights into the nature of man, their felicitous and beauteous descriptions—all these and more are of special significance for the physician who devotes a great deal of his life to the understanding of his patients and their environment. Present day students, and physicians recently educated in modern technological medicine, cannot easily imagine what the practice of medicine was like throughout most of history. Until recently, the physician had to rely primarily or exclusively upon his skills as a listener or historian of the patient's life and symptoms in order to understand his illness.
Moreover, prior to the development of powerful technical tools for diagnosis and treatment, one of the physician's principal curative agents was himself. Plato recognized this when he wrote of the physicidn's need to exhibit "charms" (fair words) towards his patient. Plato wrote in "Charmides" of the method of involvement of physician with his patient. Plato wrote that medications and procedures are of little value if the physician does not utilize the rendering of "charms"—defined as "fair words"—to the patient. The experience hoped for in the patient with the usage of fair words is that of sophrosyne, the phenomenon of temperance or, as we would say, cohesion or equilibrium in the self.—

And so we stand in debt to the great authors who, through their skill in revealing their understanding of the human and the human encounter, enhance our lives.
We turn now to the contributions of the great authors to understand human life from the birth to death.

I. The Inner Life of the Child.

There perhaps exists no psychological portrayal of the infant's inner life to equal the opening of Joyce's Portrait of the Artist as a Young Man:

Not only do these lines represent memories of childhood, they reflect an idea of the way a child thinks and experiences things. They have the capacity to evoke an analogous mode of thought in the reader, enabling him perhaps to recapture forgotten memories of his own. That is, it has the capacity to evoke a vicarious introspection in the reader, the core process in empathy.
When Proust describes the small boy's longing for his mother's tenderness, there is an immediacy of feeling that no clinical or theoretical exposition of the mother—child dyad could match:

II. The Adolescent: Love and Death in the Second Decade of Life.

We next turn to a view of the adolescent through the study of Shakespeare's Romeo and Juliet. The reader is taken into the world of the adolescent and the problems which so often complicate their lives.
This play is remarkable as a compendium of the adolescent's experience of his self with his surround, especially remarkable since, in the sixteenth century of Shakespeare, adolescence had not yet been invented—all youngsters went directly to work, to apprenticeships, etc. Shakespeare described in an unforgettable manner the features of adolescence so comprehensively that one can hardly conceive of any student of adolescence not studying and quoting this drama. Here he made clear that adolescents fall in love in a unique manner—they "dive" at one another. The implication is that the eruption that takes place in adolescence reflects the unbridled appetites of those who were deprived of merging for so long. To Romeo, Juliet is the sun, a saint, an angel . . . . Nothing and no one can cause him to be deflected from his love of her:

. . . A ubiquitous aspect of adolescent love that is highlighted in the tragedy is conflict over autonomy. The young lovers, while pursuing their wishes for autonomy in one way (they plan marriage), in another way reveal their fear of autonomy by maintaining their liaison in secrecy. From the viewpoint of the self, what is at stake here is the dissolution of the self/ selfobject ties of childhood with one's parents, and thus a relationship is entered into with reluctance and trepidation. In modern times, a variant of the Romeo-Juliet secret liaison continues in the living-together arrangements of adolescents and young adults on college campuses and throughout our society. These arrangements are commonly kept secret from the respective families, but not from peers, even though they may continue for long periods of time. From this perspective, the need for secrecy is due to the fear of confronting the self/selfobject ties between the adolescent or young adult and their families. Still another modern commonplace variant of the Romeo-Juliet secret liaison is the reluctance of some couples to marry, with an anxiety outbreak when marriage is finally agreed to even though the relationship is of several years' duration . . . .
The psychological milieu in which Romeo and Juliet's love unfolded was one in which neither of the sets of parents could recognize and respond to their children's messages. Perhaps to emphasize this parent-adolescent gap, Shakespeare has a frustrated Lord Montague at the outset of the play entreat Benvolio to ferret out and ameliorate his son's distress. Further, on several occasions,.the Capulets cannot appreciate Juliet's manifest distress. Thus Shakespeare's Romeo and Juliet highlights a familiar occurrence in the lives of adolescents and their elders—the phenomenon of self-absorbed parents unable to respond to their children's strivings for greater selfhood.

III. On the Self in Old Age.

Perhaps King Lear offers more learning for the student of man than any piece of literature. Shakespeare's account of the aging Celtic King Lear and his three daughters deals in essence with the tragic consequences of empathic failures.
In this play, held by many to be the greatest of all Shakespearean tragedies, we immediately become caught up in the emotional turmoil of the father-king whose needs for self-support as he enters his declining years are neither recognized nor gratified. As will be remembered, Lear is in need of narcissistic supplies from his daughters on the eve of his retirement, which the two eldest do with enthusiasm. Cordelia his youngest refuses:

Lear explodes, ultimately banishing her from the kingdom.
The story unfolds as a tragedy of abandonment of the aging monarch. He is emotionally abandonned by his wicked older daughters; Cordelia goes to France.
. . . At this moment in Lear's life, his self-cohesiveness demanded mirroring responses from his surround. This was what Cordelia could not grasp empathically; she had become a major source of esteem for father, his selfobject. He proclaims his despair thus:

In this one stark vignette, the dramatist has illuminated a central problem of the self during a transitional state, the ability of the milieu to empathize with the self-need for sustenance, that is, to perform the functions of a selfobject making contact with a self in need of confirming or calming responses . . . . Lear's rage and impulsive banishment of his once-favorite daughter. to the astonishment of his court. revealed that the monarch now experienced his youngest daughter as a selfobject. His rage was therefore a narcissistic rage, evoked by the failure of his daughter who could not function as a mirroring selfobject.
This reluctance on Cordelials part to be her father's selfobject as he enters into the final state of his life is a familiar phenomenon in those families where the care of the aged parent becomes the responsibility of the children. The transformations required in empathizing with the selves of the aging require that the caretaker be capable of setting aside the rewards of the former self/selfobject unit and enter into the required functioning of being the selfobject to one's former selfobject—the new ward—ordinarily one's parent . . .
Ultimately there is reunion between Lear and his beloved Cordelia, but it is short-lived . . . . When Cordelia reenters Britain, she finds her father in a tattered state and begins her mission of mercy. Shakespeare makes it clear that the ministrations of Cordelia provide an Aesculapian cure; her calming, soothing presence and her admiring-confirming actions reestablish Lear's cohesive self . . .

IV. Discussion.

It must be clear by now that the great author is able to enlighten us in a remarkable manner with his views of the central dilemmas of man—intrapsychic conflicts, interpersonal conflicts, developmental fixations, culture—from birth to old age. And while teaching, to provide us, through his craft, the joy of the emotional gratifications that are evoked through witnessing and sharing in the artistry and sometimes wizardry. In fact there is nothing that can match the view of man that can be gained from imbibing of the great literature.
What is being revealed to us by the great authors? The teaching of man that is impactful in literature resides in the manner of a literary presentation: the authors illuminate for us the inner mental life ordinarily through recounting the experiences of his subjects (characters). Of a sudden, the audience can undergo a vicarious introspection, a transient identification with the characters in the literary work, and in this fashion an insight into the material is gained that is at once instructive and exciting . . . . The teaching process utilized here—ordinarily not with their [the writers'] design—are several and perhaps all akin to the learning that is a unique feature of the relationship formed in psychotherapy. The processes are empathy, confrontation and interpretation, the alliance phenomenon, transference and defense transference, et al.
In any teaching-learning relationship, including the one formed between the author and his audience, an essential element is that the learner and teacher can ally with each other sufficient to appreciate each others' strivings and needs. The alliance is based on a mutuality of empathy—the learner and teacher attempt to see the world from the side of the other. The learner is to appreciate the manner in which the teacher-author sees his world; the teacher is to empathize with the learner's manner of "seeing" sufficient to make him communicate his messages clearly or sufficient to ensure cognitive and empathic comprehension.
At times the author, again ordinarily without awareness, utilizes confrontation and interpretation, two major instruments is psychotherapy. Confrontation refers to the method of rounding up material in an interview so that the patient and therapist in alliance can study the sector of data. 'Let us, you and I, try to understand this piece of anger, infatuation, sadness, etc.' Interpretation refers to a technique in which the therapist attempts to evoke material from the repressed unconscious by offering a hypothesis alluding to the memory or affect that is currently held in repression. If successful, the patient will ventilate the affect, or remember the repressed complex. The author accomplishes similar goals when he reveals manifestations of unconscious material in his work, i.e., the repression barrier lifts and unconscious wishes, memories emerge. When Kafka wrote of the transformation of the man Gregor Samsa, after inviting us to look with him, he revealed to us the unconscious wish of the man to become a cockroach, no longer subject to the social and psychological rigors of life. At the moment when Dorothy in Ihe Wizard of Oz enters the fairy-tale world of the Munchkins, her unconscious wishes to master her universe become realized and she is the goddess among dwarfs.
A potent interference to appreciation of literature is the reader's transference reactions, which can at times block the reader's recognition of the self-state of a character which the author is attempting to portray. The literary characters may take the form of any of the transferences seen in clinical psychoanalysis between the self or the patient and what he has invested in the self of the analyst. For instance, one can see the self of the reader caught up in a transitory relationship with the character experienced as an authority figure from the past. in those to whom, as a manifestation of their unique literary transference, Lear is experienced as a tyrant harassing his fragile and muted daughter, the empathy required to be at one with his narcissistic injury will not be operational. On the other hand, one may experience Lear as an idealized figure, blending oneself to Lear's inability to empathize with his youngest daughter's limitations . . . .
The study of literature, of course, in the study of man, albeit the poet's ingenious version of man. Therefore it requires that, to decode and receive the psychological messages from the poet, we make use of the uniquely human tool for understanding the inner life of man—empathy. But literature is more than a study of man. it is, for those who can perceive the message, a selfobject, alternately infusing and uplifting or calming and soothing, and akin to the functions of the parental mentors of the past, giving us insights into our world and at times standards by which we can guide ourselves. It is to our empathic successes that we should now turn so as to bestow on these attainments their appropriate value.
An empathic success through which, as Freud said, "we are enabled to take up any attitude at all towards another mental life' always represents an achievement to be valued. It ushers us into the joys of understanding our fellow man and especially the joys of appreciating our poets and dramatists. Freud perhaps was speaking to this experience when he said of the artist: 'he makes it possible for other people once more to derive consolation and alleviation from their own sources of pleasure in their unconscious which have become inaccessible to them; he earns their gratitude and admiration and he has thus achieved through his phantasy what originally had achieved only in his phantasy—honour, power and the love of women." Thus the message of this essay-. literature lifts, literature teaches—take it in and be enhanced.

Hyman Muslin, M.D.
Jonathan Lewis, M.D.
Department of Psychiatry
UIC College of Medicine

ACKNOWLEDGEMENTS

The characteristic feature of all human cultures remains the imagination of individual members. Professional training requires a student and practitioner to focus hard on gaining a fundamental background in a variety of basic and applied studies. Fortunately, the practice of the health professions still requires fertile imagination and many other intangible qualities. Tenacity for work and enthusiasm may lead one later to great success in the health professions. However, most in our culture would argue the significance of such attainment if one's humanity and individuality are lost in the process. As in the three previous volumes, this edition of Body Electric extends facets of human expression that link the experience of education to artistic and literary creativity.

With this edition, the reach of Body Electric has grown from medical centers in the Chicago area to schools throughout Illinois. This achievement would not have been possible without the enormous contribution of Suzanne Poirier, PhD, to whom we are all indebted. Hyman Muslin, MD, of the Department of Psychiatry, kindly served as the final judge for the writing contest. Mrs. Bernice Coleman has been our patient, helpful typist.

Frank Papatheofanis

CONTRIBUTORS

As the size and scope of Body Electric has continued to grow, it has become necessary for the journal to broaden its base of support. The Humanistic Studies Program in the Center for Educational Development continues to be the primary financial sponsor of the journal, but in the past year we have established the means for academic units and individuals to show their support of the arts in the health sciences. Donations may be made as either a Friend (under $50) or a Fellow ($50 or more). This year we are happy to acknowledge the following contributors to Body Electric:

FELLOWS

College of Associated Health Professions
College of Pharmacy
CIU Campus Programs/University Hour (in-kind support of special programming)

Anyone wishing to contribute to next year's edition of Body Electric may do so by contacting Suzanne Poirier (312-996-7954) or Curtisteen Steward (996-7356), the Center for Educational Development.
Editor: FRANK PAPATHEOFANIS
College of Medicine '91
Advisor: SUZANNE POIRIER, Ph.D.
Assistant Professor of
Literature and Health Care
Design: BILL MAYER
Office of Publications Services