Tag Archives: Arthur Frank

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.

At the Will of the Body: Part I (Pain)

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 first of three or four parts; watch for the others over the next month or so, between posts from Laurie and Debbie. 

It is not clear to me whether it is a side effect of having gone to medical school or an inborn personality trait, but I have always had a rather distant relationship with my body. This, I believe, is not completely uncommon. David Sedaris, in an essay called “A Shiner Like A Diamond” (in Me Talk Pretty One Day) says that he and his brother thought of their bodies as “mere vehicles . . . machines designed to transport our thoughts from one place to another.” (p. 133) His sisters, by contrast, were not allowed to ignore their bodies; they were expected to maintain and decorate them, presumably in order to attract a mate. It seems to me that this could be considered as merely a different form of distancing body and self. But, either way, I gave up early on the feminine decorating bit, and completely subscribed to the idea of the body as a convenient form of transportation.

I just expected my body to walking across a parking lot, straight into a negative 20-plus wind chill. There was a layer of ice at least an inch thick over everything, but it was way too cold to be slippery. All I wanted was to reach a restaurant where it would be warm. Then suddenly my feet swept sideways, and in an instinctive action that I had no time to consider, my entire body weight landed on my left elbow and shoulder. There was pain. No further description is adequate. I waited for it to subside, like it usually does after your mind takes back control, but it did not. With no other choice, really, I got to my feet and walked the rest of the way into Noodles and Company where I sat down at the nearest table. Collapsed actually might be a better word. My body would no longer obey my will.

I stole the title for this essay from a 1991 book by Arthur Frank, a “medical anthropologist” who is quite famous in ethics circles for his writing on the nature of illness and the doctor-patient relationship. He wrote At the Will of the Body after a heart attack at age 41 and a diagnosis of testicular cancer the following year. He is still alive and lecturing about this at ethics conferences, so there is no suspense involved. The book is not about learning to die, but about learning to live in a body that is not performing as expected.

Before the heart attack, Frank was a physically fit man, who was able to run marathons. He unfortunately doesn’t describe what it was like for him to live in this body, as if he never noticed it at all, except to keep it tuned and running like a good car. After the heart attack, he could not depend on his body to help him keep up his image as an athlete, but he was still functional. The cancer put an end to that also, for a while.

And the cancer was heralded by pain, which became the subject of one of the first chapters of the book.

He noticed, as I have, that it is impossible to describe pain. You can point to locations and play with pain scales, but nothing approaches a coherent description of the experience of being in pain. I have found that the more someone complains, the more exaggerated the words chosen to express pain, the less likely one is to be believed. Fewer words have almost exactly the same effect, since pain endured stoically becomes pain ignored by others. Frank believes this is a form of silencing. “Unable to express pain,” he says, “we come to believe there is nothing to say. Silenced, we become isolated in pain, and the isolation increases the pain.” (p. 30)

Pain, Frank thinks, takes over everything else, isolating us inside our bodies and setting us apart from others. The mythology of pain makes it into an external enemy which must be fought, but pain is not a thing separate from the self. Frank feels that his pain, which was a warning signal that something was wrong, made him more aware of his body. The pain was not an external enemy, but a fact of his embodied existence. He says, “Dealing with pain is not war with something outside the body; it is the body coming back to itself.” (p. 32) Pain comes from the body, and so facing pain is facing oneself.

This was not exactly my experience. There was a long, horrible time during which I still imagined things getting quickly back to normal. Since I could not move my arm, and even a tiny bit of movement of my shoulder caused impossible pain, I thought my shoulder might be dislocated. I had a vague idea that if it could be quickly relocated, I could still go on to have dinner and go home. But my body would not cooperate, absolutely refused to walk back to my car and drive me home. There was instead a stretcher, an ambulance, an IV, and narcotics, which I declined but was given anyway. When your body no longer obeys your will, I guess no one else has to either.

I did not have a dislocated shoulder. A series of x-rays, during which my language was quite atrocious, showed a very obvious separation of my elbow, and some mild shoulder displacement due to a displaced fracture. And so, instead of going home and doing whatever it was that I’d meant to do with the next few weeks, I became acquainted with pain.

Perhaps I came back to my self as a body, as Frank did, but that awareness did not seem at all desirable. There was certainly loneliness and isolation, with no way out. I was trapped in my body. Oddly, the elbow, which was the most serious fracture, did not hurt at all (then, anyway). But my shoulder was a weight both holding me down physically and keeping my mental focus internal. Nothing else existed.

I had to stay in the hospital that first night, because I couldn’t move, nailed to the bed by pain that became more intolerable at the slightest shift of position. I was sent home the next morning in a splint that felt like it weighed twenty pounds, to a new world that held very little other than pain. Then they had me come back a week later to have surgery on both joints, and the pain began all over again. After surgery, I needed two nights in the hospital before I could make my body do anything. My shoulder hurt too much.

Eventually Frank was able to do something that he called “seeing through” his pain. He was able to accept the pain and the fragility of his own body, by appreciating that there was still beauty in the world. He found this a transcendent experience, and wrote a five-line “haiku” about it.

I had no transcendent experiences involving pain. It did indeed isolate me in my body and then pin my body to the earth. I did not appreciate any extra awareness that this might have provided. No bad haiku for me.

The pain that Frank was able to “see through” was very different from mine, of course, and ultimately of vastly more importance and consequence for his life. He was, at the point he wrote about it, having pain mostly at night, and was often awake and wandering his house alone. He did not yet know that cancer was causing the pain, and part of his experience was the anxiety of uncertainty. What he saw, through this pain, was a beauty in living that he hadn’t understood until grounded in his own body by the possibility of illness. The pain became more tolerable because of its inability to prevent this joy. I think what he learned was that, while the pain was HIS whole world, the pain was not THE whole world.

For me, the pain was instantly identifiable and expected to improve with healing and, indeed, it did. I’m a bit disappointed that I was unable to see anything “through” it at any point. It feels like some sort of moral failure. Perhaps as a woman I already know vulnerability in a way that Frank could not. Perhaps with the pain slowly improving, I got used to it, and became able to ignore it rather than needing to “see through” it. Perhaps I’ve already learned to see the beauty in the world in other ways.

More likely, I’m just not as nice a person as Frank, unable to find beauty in adversity and instead resenting it very much. In a later chapter, Frank watches from his window as people run past the hospital where he is receiving chemotherapy. He takes joy in the unrestrained movement of their bodies. I’m afraid that I watch people with two functional arms and feel mostly an extreme jealousy.

At this point, my worst pain is pain I cause myself by doing the recommended physical therapy, something I understand I must do if I am going to regain full use of my left arm. My body will once again transport me from place to place, but it is having trouble carrying things.

The shoulder hurts, though not at much, but the elbow won’t bend past ninety degrees. This is astonishingly inconvenient. I spend hours a day doing exercises, during which there is no question that it is not “the” shoulder and elbow, but “my” shoulder and elbow that are hurting. I am exerting my will over my body by causing myself pain.

I fear I want my body to obey me again, and as soon as possible, so I can get on with ignoring it as usual.