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Editorials |
1 From the Department of Radiology, Indiana University School of Medicine, 702 Barnhill Dr, RI 1053, Indianapolis, IN 46202-5200 (R.B.G.); and University of Nevada School of Medicine, Reno, Nev (M.C.R.). Received August 11, 2005; final version accepted August 19. Address correspondence to R.B.G. (e-mail: rbgunder{at}iupui.edu).
Roentgen's 1895 discovery of the x-ray and the ability to peer inside the living human body without cutting it open stimulated the thoughts of not only physicians and radiologists but also other great minds in our history. If we in radiology wish to develop a thorough understanding of our field and its place in our larger culture, it is important that we attend to the insights of these poets, philosophers, dramatists, and other artists. This article explores a poem about radiology written by a man with a deep understanding of the chest radiograph: the Welsh poet and physician Dannie Abse. The poem is entitled, simply, "X-ray" (1):
Some prowl sea-beds, some hurtle to a starAnd mother, some obsessed turn over every stone
Or open graves to let that starlight in.
There are men who would open anything.
Harvey, the circulation of the blood,
And Freud, the circulation of our dreams,
Preied honourably and honoured are
Like all explorers. Men who'd open men.
And those others, mother, with diseases
Like great streets named after them: Addison,
Parkinson, Hodgkin—physicians who'd arrive
Fast and first on any sour deathbed scene.
I am their slowcoach colleague—half afraid,
Incurious. As a boy it was so: you know how
My small hand never teased to pieces
An alarm clock or flensed a perished mouse.
And this larger hand's the same. It stretches now
Out from a white sleeve to hold up, mother,
Your X-ray to the glowing screen. My eyes look
but don't want to, I still don't want to know.
Numerous physicians have led double lives as noted thinkers and writers (2). The western intellectual canon includes a number of physicians recognized for their epochal contributions to medical theory—men such as Hippocrates, Galen, and Harvey. The contributions of other medical men lay principally in letters. These individuals include such notable thinkers as Aristotle, Rabelais, Thomas Browne, John Locke, John Keats, Sigmund Freud, and William James. Among the most famous and accomplished physician-writers of the 20th century were Arthur Conan Doyle, William Carlos Williams, and Richard Selzer.
Of course, medicine and poetry do not always achieve a happy marriage. It is reputed that Oliver Goldsmith's skills as a physician were so limited that a friend advised him, "whenever you undertake to [prescribe], let it be only [for] your enemies" (3). Similarly, John Keats excelled in his surgical training but found himself continually distracted by more artistic contemplations, and he halted his medical education at age 21 after deciding "poetry was the only thing worth living for" (4). Others, however, such as William Carlos Williams, were able to draw deep insights into the human condition through a lifelong practice of medicine (5).
Daniel (Dannie) Abse was born in Cardiff, Wales on September 23, 1923. His parents were Jewish, and his father operated a cinema. Educated at the Catholic St Illtyd's College initially and then at Cardiff University, he graduated in medicine from King's College in 1943 and then completed his medical training at Westminster Hospital in London. He also worked part-time as a radiologist in a London chest clinic (6).
Abse is the author of more than 15 books and a recipient of the Foyle Award and Borestone Mountain Poetry Award. He also received an honorary fellowship from the University of Wales College of Medicine (7). As a member of two races, Welsh and Jewish, Abse challenges us to examine our beliefs and loyalties and how they affect others (8). One of his best-known books, White Coat, Purple Coat, describes his dual career—the white coat referring to his life as a physician and the purple coat, to his life as a poet (9,10).
The title, "X-ray," is itself ambiguous. In fact, ambiguity is a theme that runs throughout. In colloquial usage, the term x-ray applies to radiologic images captured on film. More precisely, x-rays are a form of invisible, highly penetrating electromagnetic radiation with a much shorter wavelength (about 10–11 m) and a higher frequency (about 3 x 1019 Hz) than visible light. X-ray vision reveals some things, such as the bones, but obscures others, such as the skin and other structures normally visible to the eye.
The ambiguity of the x-ray was reflected in the public's initial reaction to Roentgen's announcement of his discovery of this new form of invisible light, which could render the hidden inner structures of the human body accessible to the eye. Alarm at the potential threat to privacy and decency led to the introduction of a bill in the New Jersey state legislature prohibiting the use of x-rays in opera glasses (11). Later, x-ray investigators marveled that the same invisible light that could enable the detection of cancers could also cure and cause them.
The poem "X-ray" begins by invoking images of exploration and explorers. The desire to know and perhaps conquer—or at least harness—the forces of nature has drawn men to investigate the far corners of our world, from the ocean depths to distant galaxies. Aristotle, perhaps the greatest mind in the history of western civilization, begins his philosophical masterwork "Metaphysics" with this statement: "All men by nature desire to know" (12). In so doing, he posits that the desire for knowledge is not only innate but also the distinctively human trait that distinguishes us from all other species.
Yet, the poet, Abse, suggests that the desire to know can be taken too far. Addressing his mother for the first of three times in this relatively short work, Abse in "X-ray" indicates that the desire for knowledge can capture us and become an obsession. With this desire carried to the extreme, we may find ourselves unable to bear leaving a single stone unturned. An insatiable quest for knowledge may draw us to forbidden places—even into graves, whose boundaries the grave robbers of old transgressed under the cover of darkness. We, too, may become "men who would open anything " (1).
Such was the fate of early modern anatomists, such as Vesalius, who had to rely on a steady stream of disinterred corpses or executed criminals to carry out his biological investigations. Many of the great figures in the history of medicine were prepared to venture not only where no man had gone before but also onto paths that the majority of people in their time believed that no one should tread. To demonstrate the circulation of blood, Harvey had little choice but to practice vivisection. Freud probed the world of the unconscious, from which, he believed, bubbles up the unspeakable id. Although these men's intentions were honorable, they were prepared to transgress time-honored boundaries of practice in pursuit of their understanding.
Some medical explorers were so successful that more than streets were named after them. Some are linked forever with human abnormalities: Addison with insufficiency of the adrenal glands, Parkinson with atrophy of the dopaminergic neurons of the basal ganglia, and Hodgkin with the unregulated proliferation of renegade lymphocytes. For these individuals, respect for the dead gave way to fascination with death and its causes. Abse suggests that they even developed an enthusiasm that was utterly necessary for elucidating the underlying mechanisms. To these men, even so private an event as the end of life was first and foremost an occasion for discovery—an occasion less for grief than for the advancement of medical science.
The poet followed another path. As a child, he was slow to pry. This stemmed partly from fear and partly from a lack of curiosity. His hand was not drawn to dissection. He did not need to know what made the clock tick or what organs once carried out the functions of a small animal. Perhaps in him, the sense of respect or sympathy for a fallen creature was simply too strong. Perhaps his appreciation for the integrity of the whole was simply too great to permit him to pull it apart. Perhaps in him, as in most of us, the fires of inquisitiveness simply burned too dimly.
Even as an adult he has the same reluctance to pry. Now his arm bears the sleeve of a white coat; he wears the uniform of a physician. He has joined the ranks of a priesthood in which inquiry into the forbidden is permitted. Why did he enter the medical profession? If it was not primarily curiosity that drew him to a career in medicine, perhaps it was a profound compassion for suffering and a desire to relieve it.
Now he crosses another boundary. Regarding his mother with the invisible light, holding up her radiograph to the light, he perceives something new. It is something that his eyes register, yet his mind and soul resist. Perhaps he senses the enormity of this transgression, peering into the body of his own mother like the sons of Noah regarding their father's nakedness. Or perhaps his eyes behold something they would prefer not to recognize—a harbinger of mortality, such as lung cancer.
Abse's poem offers two important insights into the radiologist and the physician: First, it reminds us that obsession is, at best, a mixed blessing. Perhaps something verging on obsession is a prerequisite for serious discovery. Yet there is also a danger in it—a danger that we carry things too far and fail to respect our natural limits. This was the moral of Mary Shelley's Frankenstein (13), a tale about an inquisitive man's quest to conquer death itself and the human monstrosity that this quest spawned. Every time we cross such a boundary we risk losing sight of the stars by which mankind has navigated for centuries, even millennia.
Second, Abse warns us against a scientific curiosity that could not only cross but also possibly obliterate boundaries. In enhancing our understanding we must, he reminds us, also guard against disregard for personhood, that is, blindness to the miraculousness—for some, perhaps even the sanctity—of life. Abse's poem "In the Theater" reinforces this interpretation. It relays the true account of a patient undergoing brain surgery while in a state of local anesthesia. The man cries out to a prodding preoccupied surgeon, "You sod! Leave my soul alone! Leave my soul alone!" (1).
As we use the x-ray or the scalpel to lay bare organs such as the liver, the heart, and the brain, we glimpse something integral to our humanity, and when we do, we realize that health, disease, life, and death are matters that beckon us to more than purely scientific or clinical reflection.
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