Vol. 33, No. 1 11

Literature and the Arts in Medical Education

Johanna Shapiro, PhD Feature Editor Editor’s Note: In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at University of California, Irvine, Department of Family Medicine, 101 City Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714-456- 7984. E-mail: [email protected].

The Good Doctor: The Literature and Medicine of Anton Chekhov (and Others)

Lawrence J. Schneiderman, MD

In the spring of 1985, I posted a anything to do with me. “I don’t not possible in this public univer- notice on the medical students’ bul- want a doctor who knows Chekhov, sity; our conference rooms are best letin board announcing a new elec- I want a doctor who knows how to described as Bus Terminal Lite. tive course, “The Good Doctor: The take out my appendix.” Fortunately, The 10 second-year students who Literature and Medicine of Anton I was able to locate two more agree- signed up that first year spent 2 Chekhov.” It was a presumptuous able colleagues from literature and hours each week with me for 10 announcement, since I had never theatre. weeks. Under the themes of health taught a literature course and had In place of my own lack of skills and illness, doctor and patient, so- never even participated in a book and experience, I hoped to draw on ciety and the human spirit, men and discussion group. Naturally, I fond memories of my English ma- women, love and fate, aging, and looked for experienced colleagues jor days, which go back (Bear with death and grieving, we discussed to help me out. me; this is painful.) almost half a short stories like “Ward Six,” “The My first contact was not encour- century. I wanted to recreate the Black Monk,” “The Peasants,” aging. A professor with expertise in contemplative, discursive seminar “Ionych,” “The Gully,” “A Case Chekhov bluntly refused to have spirit that rises out of great writers’ History,” “The Darling,” “Ariadne,” thoughts, capacious leather chairs, “The Kiss,” “Lady With Lap Dog,” aromatic wood-paneled walls, “Agafya,” “The Bishop,” and Fam Med 2000;32(10):11-3.) evening light filtering through the “Gusev.” We read Cherry Orchard mullioned windows of a Gothic and observed a rehearsal by gradu- tower—and a break for sherry at ate theatre students. For back- halftime—as a kind of lush, human- ground, we also read some of From the Department of Family and Preventive istic oasis within the moonscape of Chekhov’s letters and, to gain in- Medicine, University of California, San Diego. medical education. Alas, lush was sights into the methods that actors 12 January 2001 Family Medicine use to understand their characters, non-stupifying mineral waters. I ground information on Chekhov namely how skilled professionals even tolerated disgusting swill like and his life, medicine, and times. achieve empathy, we read selections Coke and Pepsi. All quite interesting but a bit paro- from Stanislavski’s My Life in Art In time, I concluded that although chial (although not completely use- and An Actor Prepares and Uta the intensive explorations into the less—each year I have at least one Hagen’s Respect for Acting. short stories, which we could barely student who has never heard of Thanks to Chekhov, I found get through in 2 hours, gave us deep Chekhov). Now, I open the first many occasions to relate our read- acquaintance with each work, they seminar by plunging right into the ings to experiences I had as a phy- involved more effort than was nec- material, having the students take sician. This seemed to pass the time. essary to make the discoveries the turns reading his short story, “Mis- I also pointed out how, by selecting students seemed to find most grati- ery.” Right away we hear each oth- a few of many possible details, vivid fying—namely, connecting the sto- ers’ voices, so there’s no anxiety Chekhov makes his descriptions ries with their futures as physicians. about speaking up, and, at the same and reveals his characters. This, I No one really wanted to become a time, we are given an exemplary said, is what we all must do as phy- Chekhov scholar. They were hop- entry into Chekhov’s style and sub- sicians: select details among the ing to become doctors. So, I re- ject matter. many we observe, and find the pat- duced the reading and shortened the As for the Chekhov play, I have tern in those that reveal the diagno- course to an hour and, as further gone back and forth between stu- sis, and make vivid the patient’s ill- accommodation to the students’ dent rehearsals of scenes from ness and the routes to treatment. needs, made it a brown-bag semi- Cherry Orchard to movie versions At first, all I hoped was that the nar over the lunch hour. of Uncle Vanya, including “Vanya seminars would be interesting. It I also decided to expand beyond on 42nd Street.” In the course of was not long, however, before I re- Chekhov. This was, in part, because my searches, I made an astonish- alized that what the students were I was getting my fill of the same ing discovery—or, rather, a going through was not only inter- author but also because I was aware nondiscovery. There is not a single esting but important. By the end of of so many other fascinating works commercially available movie or the course, I was convinced that it of fiction, as well as poetry. Now, video version of Cherry Orchard in was not only important but essen- our readings include “The Whistle” the entire entertainment world. This tial. Nowhere else in the medical by Eudora Welty, “The Use of is a shame (and an opportunity, I curriculum did they confront and Force” by William Carlos Williams, might add), since I regard Cherry discuss the wide array of human and some of his poetry, as well as Orchard, with its solipsistic aristo- concerns raised by Chekhov (and poems by Sylvia Plath and Ann crats yielding to the power of the by our patients)—the deep and Sexton. In particular, I like to com- woodchopper, a remarkably apt painful thoughts and feelings pare the tempestuous richness of metaphor for what is taking place aroused by illness and death, the ca- Anne Sexton’s Unknown Girl in the in medicine today. priciousness of fate, the unexpected Maternity Ward with the terse jot- The final exam, so to speak, is a dignity in suffering, the power of tings of Williams’ Spring and All— paper—namely, a short story the simple acts of kindness, and the the kind of reduction that takes students must write from any point haunting desires and ambitions we place between the patient’s story of view other than their own and discover in ourselves, sometimes at and the medical record. If you’re from any point of view other than the worst of times. really a good physician, I tell them, a medical one. In other words, this After a few years, I noticed the you will, in your abbreviated ver- is a test of empathy and creative tendency of the students to skip the sion, like Williams, somehow keep imagination. For the most part, the sherry as it was passed around—my the story alive. I also have added an students have produced remarkable hallowed ritual! Why? Gently and excerpt from Fiction and the Fig- stories, which are read aloud at the politely, they relieved me of my ro- ures of Life, by William H. Gass, end of the course. (One student mantic notions about student life. who shows how great writers pro- took up the challenge by writing Falling asleep over a novel late at vide a descriptive accuracy beyond from the point of view of a penguin night—which I must have done mere numbers. (For example, who in the San Diego Zoo.) Students tell many, many times during my En- needs a thermometer when Shake- me this test is more terrifying than glish major days—was not as ca- speare’s Hamlet says, “The air bites, any other. One year, six students lamitous as falling asleep over a shrewdly; it is very cold,” and found the assignment so daunting neurophysiology textbook on which Horatio replies, “It is a nipping and that they dropped the course. An- one would be tested early the next an eager air.”) other year, however, the students morning. So, the sherry was de- In the beginning, I devoted the were so caught up in the exercise clared history, and we switched to first seminar to providing back- that they banded together and Literature and the Arts in Medical Education Vol. 33, No. 1 13 founded a literary magazine, which not know whether this course suc- how to study such a question. But, still comes out once or twice a year. ceeds in turning students into bet- I continue teaching the course none- As for more formal outcome ter doctors or merely self-selects the theless, nourished by faith and plea- measures, I have none. I have no students who are going to be better sure. idea whether the students who take doctors anyway. As a physician the Chekhov course actually be- immersed in health care research Correspondence: Address correspondence to Dr Schneiderman, University of California, Depart- come better doctors than the non- that measures patient outcomes, I ment of Family and Preventive Medicine, 0622, takers. And, even if they do, I would am embarrasingly ignorant about LaJolla, CA 92093-0622. 858-534-4206. Fax: 858-534-7053. E-mail: [email protected].

Recommended Books

Chekhov’s short stories and plays in Penguin Classics paperbacks

The Collected Stories of Eudora Welty, New York, Harcourt Brace Jovanovich, 1982

Stanislavski on the Art of the Stage, New York, Faber & Faber, 1988

Respect for Acting, Uta Hagen, New York, IDG Books Worldwide, 1979

Fiction and the Figures of Life, William H. Gass, New York, Knopf, 1970

On Doctoring, paperback edition, Richard C. Reynolds, John Stone, eds, New York, Simon and Schuster, 1995

Friends, Romans, Countrymen, Teachers of Family Medicine . . . Lend Us Your Ears:

re you using literary and artistic materials as part of your curricula? Share your experiences and observations with A Family Medicine readers! To submit material for publication in the “Literature and the Arts in Medical Education” column, contact the column editor, Johanna Shapiro, PhD, at [email protected]. Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to Dr Shapiro, University of California, Irvine, Department of Family Medicine, 101 City Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714-456-7984.