Tuesday, September 8, 2015

Metaphors in medicine, and a night hike in the desert by blogger of the month Jessie Seiler



We know that the heart is one of the simplest medical metaphors we encounter. It rushes in excitement, it skips beats in anticipation, and it nestles beneath our right hand as we make pledges and promises. So the metaphor’s pretty good, really. But your heart pumps blood, not feelings. It’s lumpy, but not in the way you used to draw it as a child. It stops and starts, but those events aren’t romantic in real life.

I haven’t always been a fan of metaphors. They feel like a way of smoothing over the details that don’t match your personal view of whatever you’re describing. They’re tiny lies, lazy shorthand, and so easily nothing more than clichés.

And isn’t it weird that so many metaphors are attached to our bodies? After all, we’ve all got a body. Why aren’t they easier to describe to each other?

But metaphors are useful, and I wasn’t surprised when we encountered some other medical metaphors during our first full week of classes. Our first immunology class was full of them, and they were pretty helpful. Everything has a character. The helper T cells are sneaky and manipulative, not killing infected cells themselves, but rather directing the actions of others. B and T cells have long memories, remembering old wounds and infections and fighting them off more robustly each time they sense them crossing our borders. And in autoimmune disorders, the whole finely tuned immune mechanism turns upon the body it is otherwise perfectly suited to love and protect.

My discomfort with metaphors aside, I like describing the world, thinking about it, and sharing it with other people. Which means that metaphors are a part of my life.

Speaking of which, we went on a night hike on the Thursday evening following our first full week of classes. About 45 minutes south of Beer Sheva is the small desert town of Sde Boker, famous for being the retirement spot of choice for David Ben-Gurion. Even to an outsider who knows little about Israel, the community is obviously built around a powerful idea: the metaphor of life in the desert. 

Ben-Gurion saw the appeal of the metaphor himself:
“The desert provides us with the best opportunity to begin again. This is a vital element of our renaissance in Israel. For it is in mastering nature that man learns to control himself. It is in this sense, more practical than mystic, that I define our Redemption on this land.”
More practical than mystic in its conception, maybe. But you get a healthy dose of the mystic, too, standing at the edge of the canyon’s cliffs as the moon rises, listening to the wind shearing through the river valley below.

We waited until full darkness to take advantage of the almost-full moon, bringing our headlamps with us to shine light on only the most precarious stretches of the path. We stopped once to visit a water reservoir that our guide claimed was over 2,400 years old, and again to gaze at an unremarkable bush. Young men would pluck a supple branch of this bush, tie it in a knotted circle, and leave it for their beloved to find. If she enjoyed his attentions, she would return it to him with the bow untied; if not, she’d leave it where she found it.  Metaphors, again.

The rock walls of the canyon were warm after the long, hot day, but the air was chill and refreshing. Our guide told us about the flash floods here, though you can tell just by looking around that the water comes through hard and fast. Nothing here is in a straight line: curves and dips and valleys are everywhere. We walked on and on, speaking sometimes and sometimes in silence, on a path lit by the moon and our trust in our guide.

After a couple of hours, we stopped once more to scramble up a rocky hill off the path for a higher view. I decided to stay on the main path, since my feet were being gross and sweaty, which made my Tevas a little slippery on steep inclines like this one. My classmates ditched their bags next to me, and I stretched out on the sand to sip water and wait.

As they climbed away, I thought about the body and its metaphors.

How happy I am, to have legs that swing out and land steadily, bringing me to new places by strange routes: skin that shields me and warms up pink in the sun, a barrier with a perfect combination of protection and permissiveness: arms that embrace and lift and reach, always up and out: a brain with a will to learn and to seek adventure, to descend these moonlit canyon walls and scale them again.
How happy I am, to have a heart that beats calmly as I hear my classmates shuffle up the rocks, that relaxes and slows into the fresh silence as my back might relax into a good stretch, and that springs high with happiness to hear my friends returning just a few minutes later. It pumps blood, and it pumps feelings. The metaphor is true.


How happy I am, to have metaphors for the feeling of having a body, the experience of health, and the path of medical education. 

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