At the Will of the Body, Part 2: (Becoming a Body)

Lisa Freitag says:

Dr. Lisa Freitag is a former pediatrician in Minneapolis, Minnesota. She wrote some guest posts for us in 2013, and we are delighted to have more of her insightful presence here. This is the second of three or four parts; the first is here. Watch for the others over the next month or so, between posts from Laurie and Debbie.

It was a fortunate coincidence that I found a copy of Arthur Frank’s 1991 book, At the Will of the Body, just a week or so before I fell and broke my arm at the shoulder and elbow. During the incoherent time that followed, I wasn’t able to read much, but I found Frank’s book surprisingly easy to read for an academic text. I had to reread it (several times, actually); its observations on what it means to be ill were close enough to my experience that much of it instantly resonated.

Frank has become, since writing At the Will of the Body, an acknowledged expert on the modern doctor-patient relationship and how it is failing both doctor and patient. This book has his very first observations on the subject, not yet fully developed, but all too clear to a reader of his later books and papers. I read the first chapter, ‘Becoming Ill,’ the night before going in for surgery. In it Frank describes the interaction between himself and his physician after he had a heart attack, He is surprised and dismayed at the clinical coolness with which his doctor relayed the diagnosis. The doctor speaks as though the body was nothing other than a thing, and its ills a mechanical breakdown which can be managed with no concern to the inhabitant of that body. Frank says, “Thus in disease talk my body, my ongoing experience of being alive, became the body, an object to be measured and thus objectified.”

This is perhaps not the wisest thing to read the night before surgery, particularly if one is already aware of, and resentful about, the distance which modern medicine has placed between itself and the people it purports to want to help. The next day I would have a first-hand experience of the objectifying process. Following the ways in which I lost my self to the practice of medicine at least gave me something to do while I was waiting. It was certainly better than giving way to the gnawing uncertainty and fear that comes before surgery.

The giving up of my self began, actually, in the parking lot. The hospital was under construction, and there were very strict signs conveying rules regarding who was allowed to drive where. When my husband dropped me off at the front door, an actual armed guard appeared, his duty clearly to make sure we were allowed to use the entrance. Only after assuring him that I was a patient were we allowed to stop there. Just to be allowed in the entrance, I had to change from person to patient.

Just inside that door, a brash woman demanded paperwork and answers to a bunch of questions that in other circumstances would have been grounds for invasion of privacy. She did not question her total right to answers, or her ability to keep them private, despite there being only a small padded partition between her and the coworker sharing the same desktop. At that stop, I gave up both privacy and identity. I was given a wristband proclaiming my new identity; Lisa,  open reduction of humerus and olecranon fractures, 01/05/56, no allergies.

I was a physician on staff at that hospital for almost ten years, yet the hallway down to the surgical waiting room was totally unfamiliar. Fifteen years ago, I used to walk these halls as though I owned the place, a fiction to which everyone else also ascribed. I was quite aware that as a lowly pediatrician, I did not own anything, but was still comfortable in belonging there. I saw no one I knew, and was relieved that no one who knew me had to see me in my new guise.

The surgical waiting room is like one of Dante’s levels of Hell. I am not entirely sure what I gave up there, but it was a loss worth grieving. Perhaps it was something like freedom. After turning over the evidence of my new identity to another woman at another desk, I was told to sit. And wait. My husband was with me, but neither of us knew how to act. Other family groups shared the room, but each group isolated ourselves in our own private knot of pain and worry. It seemed to be expected, and was surprisingly hard. We were all waiting to be admitted to the inner sanctum where, amid wonder and terror, we would be saved. Or cured. Or something. It was like waiting for Godot. The only appropriate response would have been to run away, but that was impossible. So we sat. Patiently. Patient. Waiting.

In a later chapter, that I had not read at the time, Frank talks about the body as territory, which medicine claims as its own by the combination of clinical distance and clinical expertise. Frank was given a new identity, as I was, as the cancer patient in a certain room. His doctors spoke to him about his disease in the passive voice, as though no actual person was involved. His body became the recipient of a treatment called chemotherapy. He says,

When a person becomes a patient, physicians take over her body, and their understanding of the body separates it from the rest of her life. . . Medicine cannot enter into the experience; it seeks only cure or management. It does offer relief to a body that is suffering, but in doing so it colonizes the body. This is the trade-off we make in seeking medical help.

He admits that, if the treatment works, as it did in his case, the colonization might be worth it.

By waiting in that room, I was allowing the colonization of my body. I had been identified. My elbow and shoulder had been mapped out for attention. Waiting was a form of consent, permission to be converted fully into a body.

In the next room, a small exam room, I lost my clothes. In a pretend effort to help me preserve something of myself, I was offered replacement clothes, an enormous blue thing with ties at the back and, amazingly, a pocket containing a small heater. That they had really no concern about my essential nakedness was demonstrated by leaving the door to the room open. My body sat in a huge recliner chair, in full view of everyone in the hall outside. No one passing by seemed to notice. I found that I really didn’t care much either.

The next room was a sort of surgical staging area. We bodies were lined up on gurneys, separated from each other by thin curtains. Here, I finally met a doctor. So did everyone else. At this point we were supposed to be sedated into incoherence. I was not, because I did not want narcotics. My punishment for this was a nerve block, a trivial procedure, at least for the anesthesiologist. Holding still for this, and not screaming, was like being complicit in my own torture. I do not recommend this route.

I was beginning to resent becoming a body, but then I had a pain-inspired revelation. Early in my training, I had seen operations similar to what was about to happen to me. I had two fractures, one in my elbow and one in my shoulder. A person I had met only once, an orthopedic surgeon, was about to cut ten-inch incisions over both joints in order to directly manipulate my bones into their proper position with his gloved hands. He was then going to keep the bits of bone where he put them by inserting metal strips held in place by screws. I had a vivid image of this, but could not apply it to myself. This is, after all, not something you do to a person. It can be done only to a body. And so, I submitted willingly to colonization. I became a body for them. And for me. It was much better that way. In the operating room, as the anesthesia hit my veins, I felt a surge of relief close to joy.

One week later, at my post-op appointment, I was still a body. The surgeon told me that most people want the metal removed from their elbow after it heals. I told him that it would take a massive amount of discomfort before I wanted anything like that operation to happen to me again. He seemed offended that I hadn’t appreciated the experience more. Maybe he was just disappointed that he would not get to cut me open again. Most surgeons are known to be massively disinterested in anything that doesn’t involve scalpels. He glanced at my two scars, assigned a nurse to remove the staples he’d put in a week ago, and left without a word.