Having trained medical students, I’ve come to recognize a familiar pattern of behavior when young doctors hold a scalpel for the very first time. Most people — actually anyone who has experienced even a paper cut — are hesitant to slice through flesh. Aspiring surgeons are no different. Their first efforts are tentative and almost always memorable.
“Really, me?” I asked, the first time I was handed the knife. I cupped my hand as if to accept a communion wafer but was taken aback by the scalpel’s weight, a sure sign in my mind of the instrument’s gravitas. Like doctors-in-training before and after me, I wrapped my fingers around the handle in a kind of death grip and winced as the belly of the blade touched the patient’s body. And as much as I’d like not to admit it, my hand shook, so great was my fear of pushing too hard and slicing too deep.
In the end, my first attempt at a surgical incision left barely a line on the patient’s skin. The mark was so tentative and so puny that even my cat wouldn’t have deigned to claim the scratch as her own.
These days I have to try hard to remember the surge of adrenaline and the extent of my fear that very first time. After years of training, cutting began to feel second nature to me, the scalpel merely an extension of my fingers. So when a friend earlier this week told me that she could never imagine cutting into another person and wondered how young doctors learn to do so, I had to stop and think before I could respond to her.
“Habituation,” I finally said. “You get used it.”
That response, and the idea of becoming habituated, has been haunting me ever since. Is it possible for all of us to become habituated to the horrific?
Two weeks ago, the Justice Department declassified four memos regarding the interrogation techniques approved by the Bush Administration and used by the C.I.A. with senior level Al Qaeda members. The details of these documents made my skin crawl; there are cool descriptions of dousing detainees with water at 41 degrees, forced nudity, slamming detainees into walls and waterboarding.
But my mind kept wandering back to one thing: the seemingly ordinary professionals who were responsible. These were lawyers, psychologists, physicians, judges, and military and C.I.A. personnel, not just a rogue group of marginalized military grunts. In fact some of these individuals seemed hardly different from, well, me. A few were even the kind of hometown denizens I might admire.
Take, for example, Jay Bybee, former assistant attorney general and now a judge on the United States Court of Appeals. In addition to his busy job, Mr. Bybee is a father to four children and has managed to serve as both a cubmaster for the Boy Scouts and an assistant coach for youth baseball and basketball. I am lucky if I can pack lunch for my two kids and get to work on time.
The reason I keep thinking about my response to my friend’s question is that I know it is possible for even sensitive souls to become habituated to a range of grisly tasks. I am someone who has learned — become habituated — to performing a whole host of unusual and, depending on your point-of-view, potentially gruesome undertakings: poking sharp objects into other people, removing organs and extremities, and switching parts between the dead and the living. And as I implied to my friend, even cutting the flesh of another human being can become just another part of your day job.
What renders a surgeon’s work different and humane, however, is not just the individual doctor’s desire to do the right thing by his or her patients (though I seriously wonder if Jay Bybee thought he was doing the right thing by his fellow Americans when he listed the 10 acceptable interrogation techniques, waterboarding among them). It is the surgeon’s commitment to and steadfast compliance with his profession’s code of ethical conduct. It is a constant awareness of the extraordinary trust that patients and the public place in their physicians, a trust that entails transparency and accountability in the patient-doctor relationship.
As I see it, the problem now with these documents is not that our trust in those accountable has been shattered. It is that the rest of us are beginning to show signs of becoming habituated to such transgressions.
Americans have been aware of brutal interrogation techniques for several years now: the first pictures from Abu Ghraib were shown five years ago this week, and the declassified documents in fact hold little new information. And while our current president speaks of moving forward, and not looking back at this chapter of our history, can we afford to turn away?
In doing so, we accept how we have become habituated. We risk seeing the brutality not as an atrocity but as part of who we are. We become the surgeon who might have shook when first taking the knife in hand but who now dares to cut with eyes closed.
PAULINE W. CHEN, M.D.
Full article and photo: http://www.nytimes.com/2009/04/30/health/30chen.html?hpw