What's lost in the blender

By Marc Ringel, MD

       After finishing medical training in Chicago, I landed in Burlington, Vermont, where I lived for almost a year. Things didn't ultimately work out for me there, but some wonderful things did happen during my stay: I experienced a splendiferous New England leaf season, made the decision to move to Colorado, and had the opportunity to tramp about woods and meadows with an herbalist named Mary Carse.

      Mary's services were in great demand. This was the mid-seventies, near the beginning of the current wave of the self-care, alternative medicine movement. Everybody wanted to "botanize" (as she called it). Because I was a medical doctor and Mary saw winning over physicians as an essential strategy for spreading the gospel of herbalism, I was chosen to join the select few who got to trek with her. For several months a small group of us spent an afternoon a week together in the countryside.

      Mary was in her early sixties. A religious woman, her views of nature, medicine, healing, and God were intertwined. I remember a few little miscellaneous facts from those days I gamboled about with Mary, things like: wild carrots, caraway, Queen Anne's lace and poison hemlock are all of the same Umbelliferae family so, unless you're an expert, you shouldn't taste any part of a plant with those big white complex flowers; ginger and ginseng are closely related and have green lobulated leaves; stuff that has been of especially little use to me since I've lived on the arid prairie, a completely different ecosystem from the lush green Northeast. Today I have not a memory trace of Mary's lessons about what herb is good for which complaint. The time spent with her was not a waste, though, because my true lessons came from experiencing Mary's reverence for nature.

      She insisted that all her pupils carry a hand lens. My father gave me a jeweler's loupe that he'd used for years in his diamond business. I was honored to have it, pitted lenses and all.

      One day, while examining under the lens a tiny white, delicate flower, Mary asked, "Do you know how to tell the difference between something made by God and something made by man?"

      She answered her own question: "The closer you look at a natural object like this flower, the more perfect it appears. If you magnify a man-made object far enough, even the most highly polished piece of steel, you eventually get to a level where you see how flawed and irregular it appears." I've never forgotten that lesson. And I still carry the same jeweler's loupe (all the more dear for the misspelled inscription that says, "Irv Ringle") in my pack whenever I hike, just so I can admire God's work from closer up.

      Botanizing with Mary did not make an herbalist of me. Though I sometimes recommend herbs and other more natural (whatever "natural" really means) substances for my patients and even take them myself, I'm still pretty much a straight, plain-vanilla family doctor. But the embedded-in-nature context that Mary introduced to me continues to influence my thinking. In practice, as I zoom in on a sore finger joint, for example, I strive to remember that finger's organic connectedness to a whole being in the same way that Mary could see the connection between a little white flower and God.

      Science has accomplished much of its understanding of the world by breaking the attachments between levels of being, by blenderizing the flower, for example, as a first step toward separating and identifying its volatile fragrant compounds. Even at the submicroscopic, biochemical level, the structure of living things continues to be mind-blowingly elegant, God-made in Mary's terminology. But something is lost in the blender.

      That's what's been happening in medicine for the last half-century or so. Proliferating, fissioning, medical specialty societies have staked their claims to ever-smaller inventories of body parts, at the expense of larger perspectives that reveal the integrity of human life. Remember the story I told in my last column about the knee doctor's response to my query about how my overall musculoskeletal mechanics would be affected by knee surgery? He said, "If you have ankle pain post-operatively then we'll send you to an 'ankle man.'"

      Take a look at the huge income disparities between most subspecialists and their colleagues, family doctors, general internists and general pediatricians. Why, particularly in America, have we continuously inflated the value of what medical specialists know and do while devaluing the skills of generalists? Here's my theory.

      What specialists do, especially surgical ones, is nameable. You can assign a code to it. You can charge for it. Most every surgical procedure generates a specimen of tissue that yields, when examined microscopically, a specific diagnosis. It's all tangible. Patients and insurance companies know precisely what they're paying for, whether it's a cataract extraction, a heart transplant, or a colonoscopy.

      Any businessperson can tell you that it is much easier to buy and sell a commodity, whether it's pork bellies or Porsches, than it is to make a profit on understanding. Though the health care marketplace is less rational than most sectors of the economy, skewed as it is by large industrial and government purchasers, the basic capitalist principal still holds that things are worth what people are willing to pay for them. The institutions that dole out most of the money for Americans' healthcare are willing to pay a lot more for commodified bits and pieces of patients than they are for unglamorous, unnamable, big picture items, like a patient's understanding of the meaning of his illness and how the changes wrought by that illness may affect his whole family.

      There's this continuous battle between data and stories going on at the heart of modern medicine. Specialists tend to be better at data, generalists at stories. It's a necessary tension because to heal, we need to take into account and balance what's found on both sides of the equation: data and story, science and meaning, man and God, specialist and generalist, marketplace and countryside.

      As a culture, we struggle to understand which types of questions science is good at answering and which ones it isn't, sometimes inappropriately "blenderizing" when we should be stepping back and taking in the bigger picture. For at least a century the story-meaning-God-generalist-countryside approach to understanding has gotten short shrift. Lack of a larger, integrated, human vision of health and illness is one of the main reasons for the growing odds that the medical care you receive today will be less human, warm and whole, and even less sensible and practical than it ought to be.

      All of us could use the equivalent of a walk in the woods with Mary. I'll even loan you my lens. The optics and even the inscription are imperfect but it's full of meaning. And meaning is what we need now more than ever.