Friday, November 8, 2013

the oath of maimonides

(author's note:  this post isn't funny and isn't entirely about medicine...)

you may have heard or read about this event two days ago -- a young man, sasha fleischman, was badly burned while asleep on a city bus after a fellow student set his skirt on fire.  sasha identifies himself as agender, neither male nor female, and occasionally wears skirts.  when i read about this my gut reaction was of course, horror.  how could someone do such a thing?  and in such a public and aggressive way?  and why does a boy in a skirt invoke such anger and hatred?

at the same time that my heart was sinking, it was also lifted up by the beauty and hopefulness of sasha's self-love and self-acceptance. that he loves himself enough to know that this is who he is, and that he accepts himself enough to openly express himself through his dress is a joyful and inspiring thing to me. but, as this shows us, the bravery of self-actualization sometimes requires incredible vulnerability.

so what does this have to do with medicine? well, events like this, intimate acts of hatred between one human being and another, make me think of the oath of maimonides.  maimonides was a twelfth century physician, astronomer and jewish philosopher.  similar to the hippocratic oath, maimonides' oath was a call to the physicians of his time to 'do the right thing.'   the part of the oath that i love the most is this:

     'may i never see in the patient anything but a fellow creature in pain.'

in my mind, i have adopted it as 'before and above all else, see the human being in the person in front of you' and i think of this every day in my medical life, usually right before i enter the exam room. it sounds simple enough, but it is so easy in my job to center myself on the illness, the chief complaint, the test results, the computer screen, and the dozens of other tasks i must attend to with each encounter, that  i need to make a conscious effort sometimes to center myself on the patient.  when i say that oath to myself, then i can relate to my patients as persons, as individuals with real suffering, not simply as a list of medical problems or test results.  when you do this, you open your heart to your patients, and i believe you become a more compassionate physician.  i am far from perfect at this.  ask any of my patients! i have my harried days when i want to close myself off from my patients' pain or suffering, when i want to just check all the boxes and move on, but i do try to hold this tenant in my mind with each person i see. (i'm getting bogged down in this paragraph but i think you're getting what i'm trying to say...)

so getting back to sasha -- i believe there is something in the oath of maimonides for all of us. an opportunity to see the fellow creature in front of us as a suffering human being.  not as a boy in a skirt, but simply as a person to whom we are intimately connected by our shared humanity. that is what maimonides asked of his fellow physicians then, and what i hope for sasha and all of us now.

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