Last week I faced the task of telling brand-new parents that their 2-lb premature son needed emergency surgery. The conversation was all the more difficult because, surgery or no surgery, odds were he would die. They agreed to the procedure with one request: that we allow his grandparents and uncles the chance to meet him first. They didn’t want their son to die alone.
Ordinarily, I could facilitate such a reasonable request. Even in normal times, the hospital isolates patients from home, family, and community, so this seemed like a small sliver of grace. Yet even this was now precluded; in response to the ongoing pandemic, our hospital has instituted a necessarily stringent visitor policy.
The most inflexible policies are reserved for the COVID-19 unit, which only allows one parent, clothed in gown, gloves, mask, and goggles, to stay per sick child. This parent cannot leave the hospital room until the child is discharged. Knowing they too will likely get infected, parents choose to enter in so their child does not suffer alone.
The isolation we have experienced during the current pandemic has refocused our attention on the tendency of modern medicine to isolate individual patients. There lies a strict barrier, for example, between my operating room and the world outside. Only a select few are permitted to enter. And patients are often left alone in our ICUs, lulled by the rumbling of machines while in a semiconscious state. Pandemic-era policies have simply intensified the isolation that has already established itself as routine in medicine: we isolate the sick to make them well.
To be sure, in our current moment, the isolation and physical distancing so many endure are an acute necessity. But these severe measures should impassion us to lessen the isolation of those we care for once the pandemic is behind us. As we look forward, can we reimagine communal health, the practice of medicine, and the more subtle ways our systems and procedures might change?
Before the current pandemic, poet-farmer and cultural critic Wendell Berry reflected on the isolating effects of medicine in the wake of his brother’s massive heart attack. John, Berry’s brother, required emergency surgery and lengthy intensive care, which necessarily removed him from his daily life and community. During his hospitalization, Berry recalls, “the world of specialization, machinery, and abstract procedure” seemed incompatible with the world John came from—the world of love—embodied in the family, friends, and neighbors who gathered at his bedside. This community attempted to preserve John’s connection to the outside world and more importantly, to his humanity. Despite medicine’s seemingly necessary focus on the individual patient, Berry claims that community is “the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.”1
Our current scenario and the isolation it requires contains haunting echoes of Oedipus’ Thebes when it was ravaged by plague. In the opening scene of the classic Greek tragedy Oedipus Rex, the contagion’s effects are evident as the streets lie empty, children are ripped from their parents, and citizens from their polis. A priest laments:
A blight is on the fruitful plants of the earth,
a blight is on the cattle in the fields,
a blight is on our women that no children
are born to them; a god that carries fire,
a deadly pestilence, is on our town,
strikes us and spares not, and the house of Cadmus
is emptied of its people while black Death
grows rich in groaning and in lamentation.”2
Eugene-Ernest Hillemacher (1818-1887), Oedipus and Antigone Exiled From Thebes, circa 1843, French. Oil on canvas.
Musée des Beaux-Arts, Orleans, France. Bridgeman Images.
As the play continues, we learn that the pestilence is divine retribution for the murder of the late King Laius and that only by finding and banishing the one guilty of his murder will Thebes be saved from calamity. So the city turns to its new king Oedipus, a wise leader beloved by all who was crowned after his wit and intelligence earlier saved Thebes from the deadly Sphinx by solving her riddle.
It is to Oedipus’ (and our) shock and horror that he discovers he killed his father. Apollo’s oracle had prophesied Laius’ murder at Oedipus’ birth. Attempting to defy the prophecy, Laius leaves Oedipus to die on a hillside. The child is rescued and raised in Corinth and, learning of the prophecy when he comes of age, flees. During this flight Oedipus meets Laius at a crossroad and is forced off the path. Enraged, he kills the old man not knowing him to be both his father and king. Oedipus also unknowingly takes his mother Jocasta as his wife—a reward for freeing Thebes from the Sphinx. The climax of the tragedy is Oedipus’ recognition of these transgressions, and that his greatest strength—his proverbial sight, his wit and wisdom—are the source of plague on the entire city of Thebes. So humbled, he pierces his eyes that he might not ever deceive himself or harm others again and leaves the city in order to redeem it, sightless and never to return.
The story in Oedipus Rex sheds light on our current reality, accentuating some of the moral problems of modern medicine beyond the question of ventilator rationing.
What the polis finally relies on for its salvation—Oedipus himself, seemingly the greatest of its mortal hopes—is found to be the cause of its own demise. Likewise, medicine, at the same time that it brings much healing, becomes the means of patients’ isolation and intensifies the antimembership of our procedures, inadvertently in normal times, by design during this pandemic.
The plague of Thebes also speaks to the communal nature of suffering. Despite the modern fixation on “individualized medicine,” the current pandemic reveals radical individualism as a facade. We are social animals. A physician in New York recently told me, “The worst part about COVID-19 is that patients die alone, without their families by their sides.” Experts recognize that the isolation experienced by mandated physical distancing is having serious mental health consequences.3
As a genre, tragedy aims to teach citizens how to bear and respond to suffering, how and when it is proper to feel pity and fear. The original Athenian audience watching the play would have recognized that if this could happen to Oedipus, “whom all men call the Great,” the same could happen to them.2 Tragedy instructs us to accept the limits of our existence. The coronavirus is a reminder of our vulnerability and our finitude. Oedipus, despite his wit and intelligence, could not save his family or city from suffering and death. Similarly, medicine, despite its remarkable technological advances, ultimately cannot save us from the same.
Yet even in suffering there is hope. Although Oedipus leaves Thebes, he does not leave alone. Neither does he suffer alone. In Sophocles’ late play Oedipus at Colonus, he is attended by his daughters. No easy task, Antigone and Ismene suffer alongside the old blind man. Because he has not been completely isolated, his suffering can be shared and informed by love. A messenger recounts the deathbed encounter between Oedipus and his daughters:
Then the earth groaned with thunder from the god below;
and as they heard the sound, the girls shuddered
and dropped to their father’s knee, and began wailing,
beating their breasts and weeping, as if heartbroken.
And hearing them cry out so bitterly
he put his arms around them, and said to them:
“Children, this day your father is gone from you.
All that was mine is gone. You shall no longer
bear the burden of taking care of me—
I know it was hard, my children. And yet one word
frees us of all the weight and pain of life:
In my job, I feel defeated by death almost daily amidst the seemingly endless buzz of machines and procedures. Yet, as Berry reminds us, “the world of love includes death, suffers it, and triumphs over it…the world of love continues, and of this grief is the proof.”1 Perhaps one way to prevent medicine from becoming the enemy of its own kindred, as Oedipus inadvertently was to Thebes, is to ensure that love, which wills the good of the other, is present—even in a pandemic, even when supplies are short. Medicine is at its finest when it restores individual patients to the world of love. Seen from this perspective, the work of medicine itself can be an act of love.
And so I bring my patient back from the operating room to his expectant parents, grandparents, and uncles, back from the world of isolation, machines, and abstraction, into the world of love.
Corresponding Author: Ryan M. Antiel, MD, MSME, Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, One Children’s Place, St Louis, MO 63110 (email@example.com).
Published Online: May 21, 2020. doi:10.1001/jama.2020.8594
Conflict of Interest Disclosures: None reported.
W. Another Turn of the Crank: Essays. Counterpoint; 1995.
Sophocles. Oedipus the King. In: Grene
GW, trans, eds. Sophocles I. 3rd ed. University of Chicago Press; 1991:73-142.
Sophocles. Oedipus at Colonus. In: Grene
GW, trans, eds. Sophocles I. 3rd ed. University of Chicago Press; 1991:145-224.