Acknowledgments

ACKNOWLEDGMENTS HE CONSTRUCTION of this account of medical narrative has been enriched by my family and friends and colleagues. Those Twho know something of the history of attention to patients in American medicine and the investigation of the psychosocial issues that complicate their illnesses and their medical care will recognize the influ- ence of the University of Rochester. While I was still at Morehouse, David Satcher lent me The Clinical Approach to the Patient, an influential guide to the patient-physician encounter by Rochesterians William L. Morgan, Jr., and George L. Engel. Once there, I incurred debts that are numerous and great. Throughout the years of my research, my colleagues were un- failingly helpful, subjecting me to little more than a bracing modicum of skepticism about literature's place in understanding medicine. I owe my clinical education especially to Robert L. Berg, Lynn Bickley, Cecile A. Carson, Jules Cohen, Christopher Desch, William R. Drucker, David Goldblatt, William A. Greene, Robert J. Joynt, Rudolph J. Napodano, William L. Morgan, Jr., John Morton, Jr., W. Scott Richardson, John Romano, the late Ernest W. Saward, Olle Jane Sahler, Barbara L. Schuster, Seymour I. Schwartz, and T. Franklin Williams. Craig Hohm, then a third-year resident, was my Aeneas during the first year of clinical observation. Lewis White Beck and Jane Greenlaw were dear and unfail- ing sources of advice and criticism and encouragement. At other institutions Howard Brody, Eric J. Cassell, Rita Charon, Julia E. Connelly, Daniel M. Fox, William Frucht, Robert Kellogg, Loretta Kopelman, Joseph Margolis, John Stone, Carolyn Warner, and William Beatty Warner variously argued about ideas, read chapters, or took me on rounds. Anthropologists Joan Cassell, Ayala Gabriel, and Grace Gredys Harris provided essential guidance in the methods of eth- nographic research. In the faculty study group on social theory at Roch- ester I learned much that was useful; I am particularly grateful to William Scott Green, Donald Kelley, and Philip Wexler. I learned, too, from the ideas and observations of those who were then students and residents at Rochester and in the summer humanities seminars for medical students funded by the National Endowment for the Humanities at the Kennedy Institute, Georgetown University; chief among them were Holly Ander- son, Emily Finkelstein, Stephen Matchett, Barry Saunders, and Brian Zink. I am indebted to the Hastings Center, especially to Daniel Callahan, Thomas Murray, Arthur Caplan, and Marna Howarth, for the time I spent there as a visiting scholar near the beginning of this project. A two- XVI ACKNOWLEDGMENTS year grant from the Ethics and Values in Science and Technology pro- gram of the National Science Foundation (RH-8310291) funded my research, and a fellowship from the American Council of Learned Societies and a sabbatical from the University of Rochester in 1986-87 gave me a welcome year to write. Ellen Key Harris, Pelin Aylangan, Elizabeth Gajary, and Jennifer Powell helped with research, and Lucretia McClure, librarian of the Edward G. Miner Library, and Christopher Houlihan, its history of medicine librarian, lightened my work. In Chicago I have bene- fited from a community of scholars from several institutions, especially James F. Bresnahan, my colleague at Northwestern University Medical School, Christine Cassel, William Donnelly, Leon Kass, and Suzanne Poirier. Charles L. Bosk, Julia Connelly, Ellen Key Harris, J. Paul Hunter, Lisa Hunter, Steven H. Miles, Beth Montgomery, and Francis A. Neelon read many of the chapters in draft and made indispensable suggestions. I have learned from presenting some of its ideas informally to members of the Camellia Grill Literary and Debating Society and, beginning in 1983, at meetings of the Society for Health and Human Values and its Associa- tion for Faculty in the Medical Humanities. Long projects have a way of becoming indistinguishable from one's life, and I am grateful to all those who have shared mine. A version of Chapter Two originally appeared as "A Science of Indi- viduals: Medicine and Casuistry," Journal of Medicine and Philosophy 14 (1989), 193-212. © 1989 by Kluwer Academic Publishers. A version of Chapter Four originally appeared as "'There Was This One Guy . .': The Uses of Anecdotes in Medicine," Perspectives in Biol- ogy and Medicine 29 (1986), 619-30. © 1986 by The University of Chi- cago. Part of Chapter Six originally appeared as "An Noil: Syndrome Let- ters in the New England Journal of Medicine," Perspectives in Biology and Medicine 33 (1990), 237-51. © 1990 by The University of Chicago. A number of the ideas and phrases in Chapters One and Two first appeared in "The Physician as Textual Critic," The Connecticut Scholar: Occasional Papers of the Connecticut Humanities Council 8 (1986), 27- 37. © 1986 by the Connecticut Humanities Council..

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