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Arts in Medicine

The European Doctors Orchestra and the Irish Medical Choir

24 Feb, 17 | by cquigley

Professor Des O’Neill

One of the pleasures of medicine is the frequent sense of a shared vision of how enmeshed it is with the humanities. As a group, doctors tend to have a high level of cultural engagement: for example, our own studies show that over 50% of medical students play, or have played an instrument http://mh.bmj.com/content/42/2/109.long.  Yet we rarely celebrate our cultural participation in a collegial manner, and perhaps it is time that we more openly acknowledged this shared portal to the bigger picture in life and medicine.

These elements came to life vividly at a remarkable workshop in Belfast in early February for the nascent Irish Medical Choir. It arose because the very talented European Doctors Orchestra https://www.europeandoctorsorchestra.com/ has decided to scale new heights with a concert in Belfast in November featuring Mahler’s mighty 2nd symphony, the Resurrection Symphony https://www.europeandoctorsorchestra.com/next-concerts/.

As the work has an extensive choral finale (as well as the chill-inducing Urlicht in the fourth movement http://onlinelibrary.wiley.com/doi/10.1196/annals.1360.041/abstract ), a bright idea was to recruit a chorus drawn from medical practitioners and students across the island of Ireland.

The take-up has been fantastic, with a waiting list of highly qualified sopranos and altos, albeit some space yet for tenors, a constant for choral societies around the world! The introductory workshop was an intense pleasure at many levels, with virtually all specialties represented, and ranging from medical students to those retired for many years, a very intergenerational project.

Having expected a direct exposure to the Mahler, we were initially surprised by the list of works provided by the expert and engaging choir master, Brian MacKay http://www.zezerearts.com/brian-mackay-artistic-director. In the event it was a brilliantly constructed voyage around Mahler, proving as ever that the elliptical beats the direct approach every time.

Our choral journey allowed us to engage with historical and contemporary contexts for Mahler’s music, preparing the soil for future rehearsals. The first work was an eighteenth century hymn by Graun based on a Klopstock poem on the resurrection. It is this piece, played at the funeral of the celebrated conductor Han von Bülow, which inspired Mahler to use the poem in the symphony and it was both simple and affecting.

A perspective of late-romantic German choral music was provided by Josef Rheinberger’s Abendlied, a truly beautiful piece which was a fantastic discovery for most of us (and do watch out for his (and Reger’s) brilliant re-working of the Goldberg Variations for piano four-hands http://www.tal-groethuysen.de/cds/bach-goldberg-variations.html!).

We then immersed ourselves in another avenue of spiritual music, the potent and deep Rejoice, O Virgin, from Rachmaninov’s Vespers. It was a visceral shock to be a part of this extraordinary music, a further intensification of the feelings arising from my recent exploration of choral singing http://blogs.bmj.com/bmj/2017/01/03/desmond-oneill-singing-in-the-new-year/.

Friendships and connections were forged over lunch, and I was in awe at the wide range of pursuits and achievements of those present, and sense of shared pleasure and purpose.  After some business arrangements for upcoming rehearsals, we then sight read twice through the first movement of Brahms German Requiem, further extending our aesthetic, communal, pleasurable and spiritual journey.

For a group dealing with illness and death throughout our working lives, there is something extraordinary reassuring and quietly energizing about this participation in music probing mortality, resurrection and a deep sense of consolation. All of these composers had more extensive personal exposure to death than we do http://blogs.bmj.com/bmj/2011/05/24/des-oneill-death-and-transfiguration/ and their music provides an extra layer of opportunities to see the bigger picture, echoing and providing a more positive spin to Milan Kundera’s dictum that all we can do in the face of that ineluctable defeat called life is to try to understand it.

The coda to the meeting was a clear desire to continue an Irish Medical Choir after the Mahler, a testament to the organizers, our choir master, and those positive elements in medical life which make it such an interesting and satisfying career. If you are a Mahler fan, do consider joining us in the Ulster Hall on Sunday, the 26th of November: all proceeds will go to music and health charities.

 

Des O’Neill is a professor of geriatric medicine and co-chair of the Medical and Health Humanities Initiative at Trinity College Dublin https://www.tcd.ie/trinitylongroomhub/medical-humanities/

Reflections on Art, Voicelessness, and the Patient Experience

14 Feb, 17 | by cquigley

 

Emma Barnard MA (RCA)

‘Silence is not Golden’

 

‘For those who live neither with religious consolations about death nor with a sense of death (or of anything else) as natural, death is the obscene mystery, the ultimate, affront, the thing that cannot be controlled. It can only be denied’.

Susan Sontag

 

One time, a healthcare professional completely removed the artwork (that I’d made with patients) from the Patients As People exhibition stating that it depicted death. This puzzled me. I couldn’t work out where the offence had come from; the closest reference to death was a thought bubble of the words “RIP” that a patient had drawn over their portrait. That particular patient’s condition was actually relatively minor and not serious; surely the thought bubble merely reflected something we all think about when we are sitting in a hospital waiting room? Where better to contemplate one’s own mortality? GP Dr Jonathon Tomlinson says, ‘Doctors are tortured by the idea that death represents a failure of medicine and this is worsened by a punitive shame and blame culture and highlighted by mortality league tables.’ Medicine has a great deal to offer, and prolonging life is not the only item on the agenda. To paraphrase William Osler, ‘What’s important is not simply what is the matter with the patient but what matters to the patient’.

How do you respond though when someone asks you if they’re going to die?

As artist in residence within an ENT (Head and Neck) clinical department, I have been collaborating with surgeons to explore the patient experience through art. Part of the work I do involves discussing with patients their experiences immediately after the medical consultation, where they reveal what lies behind the mask that they present to the doctor. Very often, patients are at that point trying to come to terms with their diagnoses. On one occasion, when speaking to a patient who had received a diagnosis of laryngeal cancer, to my amazement they seemed unconcerned that treatment might involve removal of their larynx; their major concern was that ‘didn’t want to die’.

As someone whose work as an artist is dependent on being able to communicate both verbally and visually, I am particularly intrigued by a person’s loss of voice and how that might alter his or her life. People not only have to come to terms with having their larynx removed, using a feeding tube and learning to swallow, but they also become voiceless in the conventional sense, having to relearn how to communicate. As laryngeal cancer survivor Kay Baker states, ‘I felt as if my personality had been taken away from me because I could not express myself anymore’.

It is not the words spoken by the voice that are of importance, but what it tells us of the speaker. Its tone comes to be more important than what it tells. “Speak, in order that I may see you,” said Socrates. (1)

(Reik, 1956, p.136)

The voice is one of the most important means by which we communicate. In the words of Alice Lagaay, an academic philosopher from Bremen University:

 ‘A voice is both individual and communal: On the one hand, every human voice is unique, no two voices are ever quite the same. In this sense every voice is the signature of an individual’. (2)

 

 

Portrait photographs (which contain their drawings) of people who attend the Talking Heads group held at St Josephs’ Hospice which supports people who have had experience with laryngeal cancer.

 

The building was warm, friendly and welcoming. But in fairly familiar community-type surroundings, the sounds that I heard were not. I had been invited to present my work on patient experience to the group ‘Talking Heads,’ a support group for people who have dealt with laryngeal cancer; more often than not they are without a regular ‘voice’. Denise Redmond, having worked as a Macmillan nurse for some time facilitating the support group for laryngectomy patients, reflected: ‘If you removed the gearbox in a car then the car would have no useful function and be scrapped. Patients with laryngectomies really humble me in their ability to overcome not only a cancer diagnosis but to survive and live beyond their cancer treatment with a significant impact of treatment.  There is always a trade off with cancer treatment especially when the aim is to cure somebody. Removing the organ that lets the patient communicate, speak, sing, breathe and eat and drink which are normal basic functions to sustain life is debilitating holistically. It is a life-changing event’. 

‘That’s great, it looks lovely and clear now’, said the surgeon. Physically, everything looked good and how much easier it would be if illness was just about an individual’s physicality. That’s not the case, of course, the mental scars remain, exacerbated by lack of understanding from family, friends, and others, too often scared of the change in you as you speak in a way that they do not understand. Denise: ‘There are many misconceptions about “neck breathers” and they can be very isolated. I know doctors and nurses who are afraid to look after patients that have laryngectomies as they perceive the laryngectomy as difficult and complex when the patients themselves are masters of their own care’. 

Mike Papesch FRACS, an ENT Head and Neck consultant surgeon explains his viewpoint: ‘From a surgical point of view, it is very clinical…with the end goal being survival and with recognised significant social, psychological and personal impact. It is impact that may be underestimated by the patient, but it is not underestimated by the medical team looking after them. And indeed, the doctor understands the difficult choices that patients have in undergoing these treatments. Perhaps it is that the patient, in reality, has no choice as to the treatment and its impact, if they do not wish to die of the disease. The reality they face truly is this harsh. And the patient will never fully understand what it means to have head and neck surgery, until after the process. This process can take place over several months. People do make some recovery, but never return to their pre illness performance status. I would not wish this surgery on anyone, but if they needed it, I would embrace it, advise it, and undertake it willingly, knowing full well it was done as a lifesaving, albeit life changing, intervention’.

Illness isn’t something you wave goodbye to in the consultation room after your appointment or in the theatre after a surgical operation. It follows you home, it is with you while you sleep and haunts you in your waking moments. In the words of Susan Sontag ‘Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick’. Days, weeks, years, and it is still there, refusing to let go. Unlike other cancers, which to a certain degree, are invisible, this one remains in full view for all to see and because there seems to be so little knowledge on the after effects, responding to someone who has had this disease can be uncomfortable for the onlooker.

 

Of the legacy that is laryngeal cancer, two years on Kay Baker writes:

No airway

No smell

Not much taste

Eating and drinking very slow

Have to be very careful in the bath – cannot get water down my stoma

Never go swimming (would drown)

More difficult to breathe especially in very hot, cold and windy weather

My life is so different now and there have been times when I have had bad thoughts – why this cancer, why me? Not wanting to live.

 

What I don’t like is people thinking there is not a PROBLEM.

No escape – there is a constant reminder every minute of the day – as soon as I wake up, unlike other cancers.

There is no hiding place.

Silence is not GOLDEN as the song goes!

 

‘Silence remains inescapably a form of speech’. Susan Sontag

 

References

1 Reik, T. (1946) The Ritual: Psychoanalytic Studies, Bryan, D. (trans). New York: International University Press.

2 Lagaay A 2008 Between Sound and Silence: Voice in the History of Psychoanalysis Freie Universität BerlinVolume 1 (1), ISSN 1756-8226

Quotes from: http://research.ncl.ac.uk/e-pisteme/issues/issue01/contents/e-pisteme%20Vol.%201(1)%20-%20Alice%20Lagaay%20(Full%20Text).pdf

Emma Barnard MA (RCA)

Bio

Emma Barnard is a visual artist, specialising in lens-based media and sound installations. Her work deals with social commentary, seeking to highlight contemporary issues and encourage debate surrounding them. The experience Emma has gained through several years of working with consultant surgeons and their patients from various disciplines, including ENT and Psychodermatology, is now influencing the field of medical education. Her “Patient as Paper” project (co-founded with Mr Mike Papesch FRACS, ENT consultant surgeon) artwork is currently being exhibited widely in galleries, universities and hospitals in England and internationally. It has been presented at several conferences within the medical and medical humanities fields, and most recently at University College London, Medical School and in a series of presentations at Surrey University for the Department of Health Sciences. At King’s Medical School in London Emma has led a highly successful pilot project to introduce art into medical education, undertaken in conjunction with a critical care consultant and a fourth-year medical student. An exhibition of this work is planned for later this year.

@PatientAsPaper

Exhibitions:

‘Patients As People’ (work created alongside patients) – currently installed within the Department of Health Sciences, Surrey University, Guildford

More information:

https://www.facebook.com/PatientAsPaper/?ref=aymt_homepage_panel

‘A Stitch in Time’ series of works to be shown at The Lawson Practice, London at the invitation of GP Jonathon Tomlinson during February/March.

Artist page – BerlinBlue Art: http://www.berlinblueart.com/emma-barnard

 

 

Physicians and Magicians: A Magical Education in Life, Death, Power, Potions and Defence Against the Dark Arts by Fiona Dogan and Mark Harper

20 Jan, 15 | by BMJ

Abstract

The worlds of magic and medicine both involve the sudden initiation of an intimate relationship between two complete strangers – the magician and their subject, or the doctor and their patient. Magic requires the subject to have some degree of trust in the magician, to accept that props and setting may be required to aid the illusion, and to witness such a high degree of skill that belief in the magician’s ability is sustained once the trick is complete. In the medical setting trust and confidentiality, the use of medical equipment, and the expertise and competence of the doctor are but a few essential components of a successful interaction. This is not to imply that the art of medicine is a trick, but rather a complex set of circumstances that can be engineered to promote the best possible outcome for both the doctor and the patient – or the magician and their audience.

The concepts of magic in the Harry Potter series can be used as examples to study issues that medicine raises in our own society. By focusing particularly on The Order of the Phoenix, The Half-Blood Prince and The Deathly Hallows, it is possible to compare the learning processes for both young magicians and medical students that are considered necessary to prepare them for life in their profession. Within the books there are interesting issues regarding perspectives of professional knowledge and power, with diverse examples of socio-economic status informing the treatment of certain groups by others. The psychology of the misuse of power by those in positions of authority and professionals acting under duress provide a measure of insight into the actions of doctors under a totalitarian regime. Finally the ethics of using science and magic are debated throughout the series, and provide valuable material for discussion of moral issues that can be translated directly to medicine.

Physicians and Magicians: A Magical Education for Physicians in Life, Death, Power, Potions and Defence Against the Dark Arts 

Education

There is a clear comparison between magic and medicine in the structure of training which can be classified into three, occasionally overlapping, areas which broadly equate to the classic educational paradigm of knowledge, skills and attitudes.

Right from the very beginning (we are excluding Owl Post although that may be equated to the acceptance letter) the similarities are striking. The young, aspirant magician’s trip to Diagon Alley, to buy a pile of books they don’t understand and a wand they don’t know how to use, equates to the medical student’s first visit to the University bookshop and purchase of stethoscope and other medical equipment. A cat, rat or owl would make a more interesting and interactive companion than a skeleton – if somewhat less relevant to medical studies. Here we see the first inklings of a professional attitude, in that both sets of students begin to take on the accoutrements that distinguish them from the non-medical or Muggle population.

There are also many similarities in the education process. Hogwarts requires seven years compulsory teaching, with the witches and wizards “coming of age” the year before they qualify. This provides a greater degree of freedom for them to practice their magic and hone their skills in the Muggle world, unprotected by the castle’s enchantments and restrictions on underage magic. Similarly doctors in the UK qualify after five years but have a further two years as junior doctors, gaining more responsibility during their sixth and seventh years.

Furthermore, both educations consist of a combination knowledge acquisition through book learning and skills through an apprenticeship. There is also a degree of crossover in the subjects studied: Potions and pharmacology, Arithmancy and chemistry, and Muggle Studies and communication skills.

There are even parallels in the same work hard, play hard ethic. Hours are long, learning goes on late into the night and copious quantities of beer are consumed – though there may be some suspicion that Butterbeer is not as potent as real ale.

Right from the beginning, both sets of students are externally regulated by either the General Medical Council (GMC) or the Ministry of Magic (MoM). As well as overseeing competencies these bodies define and regulate the appropriate attitudes through the ‘fitness to practice’ committee and, as Harry discovers more than once in the series, the Improper Use of Magic Department. Furthermore they effectively create a closed-shop which cannot be breached by the non-professional. (1,2)

However, whereas the GMC and the medical profession seem to be striving towards an ever more open and inclusive approach to the delivery of medicine, it could be argued that the MoM is rigidly sticking to a more archaic, paternalistic model. Muggles do not possess magic, and are generally not permitted to even know that wizards and witches exist. If mistakes are made and members of the Muggle population do become unintentionally aware of magic, it is acceptable to have memory charms performed on them without their knowledge or consent. This is demonstrated throughout the books, from the murders committed by Peter Pettigrew on the night of Voldemort’s destruction to the treatment of the Roberts’ family at the Quidditch World Cup in the Goblet of Fire. In The Deathly Hallows Hermione decides that the best course of action for her parents is to modify their memories, in order to make them forget they have a daughter and feel a sudden desire to leave the country. As she possesses the knowledge and skill to perform such a spell, she does this herself without consulting her parents or any of her fellow magicians. (3–5)

Much as one might, at times, wish to remove a patient’s memory of an interaction -ethics aside – conventional (i.e. non-magical) medicine still only has the power to induce prospective amnesia, and even then on an imperfect basis. (6) Additionally, research has shown that better outcomes are associated with patients understanding their illness and being involved in decisions about their treatment so maybe a shift towards a more informative and holistic partnership between patients, doctors, magicians and Muggles can only be a good thing. (7,8)

 

Power in life…

It’s not only actions that have consequences but attitudes too, particularly when it comes to wielding the kind of power possessed by physicians and magicians. The “use-or-not” of power is both a central theme of the Harry Potter books and an important consideration in terms of the doctor as magician.

The magical world is hidden from Muggles, as Hagrid explains to Harry at the very beginning of The Philosophers Stone, because people would want magical solutions to all their problems if they knew it was available. (9) His point is reinforced in The Half-Blood Prince during a conversation between the Muggle Prime Minister, the ex-Minister for Magic Cornelius Fudge and his replacement Rufus Scrimgeour:

‘The Prime Minister gazed hopelessly at the pair of them for a moment, then the words he had fought to suppress all evening burst from him at last.
“But for heaven’s sake — you’re wizards! You can do magic! Surely you can sort out — well — anything!”
Scrimgeour turned slowly on the spot and exchanged an incredulous look with Fudge, who really did manage a smile this time as he said kindly, “The trouble is, the other side can do magic too, Prime Minister.”’ (10)

This is useful in exploring the expectations some people – and some doctors – have about the power of medicine. In the past the physician was more like the magician, albeit one who used sleight of hand rather than real magic, creating power through obfuscation in a veneer of classicised language and instruments, such as the stethoscope, that put space between them and the patient. Interestingly, as their real powers have grown, the façade has come down to a large extent and patients can have much greater knowledge of their conditions and of the ‘spells’ possessed by the doctor.

Nonetheless, expectations have simultaneously risen and it often seems that patients think doctors should be able to do magic. Maybe it would help to show them how “the other side” also has “magic”; whether it is the ability of the virus to mutate to escape drugs and detection, or the cancer to hide in the patient’s own cells (DNA even) to evade chemotherapeutic spells and radiation wands, only to re-emerge like Voldemort from his Horcruxes. There is still no “Magic Bullet” to specifically target every disease process. (11–14)

The exchange above also illustrates how the patient can be affected by the amount of power they feel they have over their condition. As he feels he is losing control of the situation, the Muggle Prime Minister cannot contain himself any longer, and his words are redolent of patients and their relatives in the face of a poor prognosis. (15)

The Dursleys are Harry’s Muggle family from his mother’s side. Despite being among the few Muggles who know about magic, they choose to ignore it for as long as is possible because they see magicians as troublemakers and a source of embarrassment. They pretend that Harry is mentally unstable rather than admit to him being a wizard. It is only in The Order Of The Phoenix when…

“The arrival of Dementors in Little Whinging seemed to have breached the great, invisible wall that divided the relentlessly non-magical world of Privet Drive and the world beyond.”

…they see the possible impact of magic on their own lives, and they begin to ask for Harry’s advice and guidance.

There are patients who have an analogous distrust of doctors, to the extent that they will leave conditions far longer than they should in order to avoid confronting the medical world. The Dursleys represent this group and demonstrate how people can have deep-seated and rationalised (though not necessarily rational) views. The Dursleys are, therefore, useful characters to consider when dealing with patients can be very afraid of a condition that they do not fully understand. (2)

 

… and power over death

The biggest ethical dilemma raised in Harry Potter books relates to the death of Albus Dumbledore in The Half-Blood Prince. After putting on a cursed ring by mistake Dumbledore asks Severus Snape for help. Snape uses a potion to trap the curse in Dumbledore’s right arm temporarily, although they both know he will still be dead within the year. Dumbledore then asks Snape to kill him when the time comes, as this will prevent him suffering for longer than necessary whilst also solidifying Snape’s position with Lord Voldemort in his double agent role.

This situation is analogous to palliative treatment and physician-assisted death. As Snape delivers the final blow himself rather than provide the means for Dumbledore to take his own life, and Dumbledore is conscious up until the Avada Kedavra killing curse hits him, it would most likely fall under the category of voluntary active euthanasia. (5,10)

The first issue this series of events raises is that of the ethical dilemma that surrounds the boundary between a duty of care and actively shortening a patient’s life. Snape finally agrees to undertake this task ‘for the greater good’- to protect his double agent identity and therefore help assure the safety of the students at Hogwarts.

In medicine the death of a terminally ill person in order to benefit the life of another is one of the core issues when discussing the legalisation of euthanasia. Setting aside the moral issues, benefit may be derived from both the individual, in terms of reduced suffering, and the collective, through the reduced drain of limited resources. However, this must be set against the need to protect elderly and vulnerable people, and provide optimum medical care. (16)

The second issue this event raises is the emotional effect on the doctor or magician who delivers the final, fatal blow. We see Snape hesitate before killing Dumbledore and, even though at this stage he is portrayed as Voldemort’s henchman, we can feel his reluctance. This is despite the fact that he is acting on a well thought-out and considered advance directive. As Dumbledore explains in The Deathly Hallows:

“I ask this one, great favour of you, Severus, because death is coming for me… I confess I should prefer it to be a quick, painless exit to the protracted and messy affair it will be…”

Nonetheless, Snape fears for the consequences to himself:

‘“That boy’s soul is not yet so damaged,” said Dumbledore. “I would not have it ripped apart on my account.”

“And my soul, Dumbledore? Mine?”

“You alone know whether it will harm your soul to help an old man avoid pain and humiliation,” said Dumbledore.’ (5)

This illustrates a common argument against euthanasia, regarding the psychological burden that could be felt by the enabling physician. This has been a subject of specialist research for many years, involving doctors who work in clinics such as Dignitas in Switzerland and those who are required to administer lethal injections to criminals in the United States. (17)

Part of the problem is that Snape is, necessarily, acting alone. It would be much easier if he had advice, support and objectivity from others. It therefore underlines the need in medicine for a multidisciplinary approach to these situations. (18)

The description of the last moments before Snape kills Dumbledore bring up two further issues. The first is the effect on the peripheral characters: in the medical context, the relatives; in this context, Harry, who is shocked and frightened by the unfolding events.

‘“Severus…”

The sound frightened Harry beyond anything he had experienced all evening. For the first time, Dumbledore was pleading.’

It is not until The Deathly Hallows that it becomes apparent Snape was acting on Dumbledore’s wishes. At this point it seems that the old wizard is begging for his life to be spared.

‘…Snape gazed for a moment at Dumbledore, and there was revulsion and hatred etched in the harsh lines of his face.

“Severus… please…”

Snape raised his wand and pointed it directly at Dumbledore.

“Avada Kedavra!”’

But furthermore, it is impossible to tell whether Dumbledore had actually changed his mind at the last minute and was, as it seemed to Harry, pleading for his life. And this is something that needs to be considered with medical euthanasia, particularly in patients with degenerative diseases that may compromise their ability to communicate or comprehend over time. These decisions are often made a long way in advance, and it can sometimes prove very difficult to be sure that their wishes have not changed. (10,19)

 

Defence against the Dark Arts

The steady implementation of the totalitarian state in the second half of the Harry Potter series closely mirrors the rise of Nazism in Germany prior to the Second World War. The persecution of the Jews and the Muggle-borns, Neville Chamberlain’s appeasement policy and Cornelius Fudge’s feverish denial, and the use of propaganda by Voldemort and the Death Eaters are but a few similarities. The actions performed by different magicians under this regime is an interesting study in psychological terms, and provides some insight into the behaviour of professionals such as doctors during wartime and under duress. (20)

Under the rule of Hitler it was deemed necessary for doctors to experiment on classes of people who were considered ‘lesser beings,’ in order to further knowledge and discoveries in the field of medicine. This began with the psychological dehumanisation of the Jews and other ‘undesirables’ through smear campaigns, blaming them for the defeat of Germany in 1918 and the subsequent economic depression. Through the use of careful and steady propaganda it seemed like an almost natural progression for the Jews to eventually be segregated and placed on a registry system. Some doctors chose to accept the idea of the “Jewish plague” and took pride in providing what they believed to be a valuable service to Germany and scientific advancement, whilst other doctors performed their duties under duress to avoid being killed themselves. It became commonplace for those within the medical profession to control, torture and kill Jews, homosexuals, the disabled and many others as part of their day’s work, and to record the results of the various experiments performed. (21)

In Harry’s world there are certain witches and wizards who can be used to represent the actions of different medical professionals under the oppressive regime in Nazi Germany. Firstly interesting parallels can be drawn between Hitler’s “Angel of Death” Dr. Josef Mengele, and the Head of the Muggle-Born Registration Committee Dolores Umbridge. Mengele had a background in genetics and twin studies in particular, and revelled in the fact that Hitler’s regime allowed him to further his studies through experimentation in a way that would not have been possible previously. Similarly Umbridge is vociferous regarding the offensive nature of half-breeds and later Muggle-borns, and seems unperturbed who is in charge as long as she is able to increase her power and her freedom to use it. It later comes to light that she abused her position or power as early as the beginning of The Order of the Phoenix, when she illegally sent Dementors after Harry to try and silence him regarding Lord Voldemort’s return. She was initially appointed by the Ministry as the Defence Against the Dark Arts teacher at Hogwarts in order to keep a closer eye on Harry and Dumbledore, but rapidly progressed up the ranks due to her dedication and ruthless personality. Whilst not in league with Voldemort himself, she certainly upheld his ideals and, similar to Mengele in Germany, seemed to delight in using the political situation to her advantage to achieve her aims. (2,21)

Alecto and Amycus Carrow represent the Nazi doctors who truly believed in their leader’s vision and would do everything in their power to assist in its’ realisation. They differ slightly from the type of doctor portrayed by Umbridge, as they believed in Voldemort’s particular ideals rather than his general approach. The Carrows excelled under Voldemort’s rule during the Second Wizarding War, and revelled at the chance to freely use the previously illegal Unforgiveable Curses: Imperio (control), Cruciatus (torture) and Avada Kedavra (death) – the same methods used on the “undesirables” by the Nazis during the Second World War. Harry is depicted on posters and referred to by the Ministry as ‘Undesirable No.1’.

Professor Snape’s true loyalties are in question up until his dying moments at the end of The Deathly Hallows, where it is revealed that he had indeed been trying to protect Harry all along. Working as a double agent for Dumbledore, he made the difficult decision to continue to work for Voldemort in the hope that he could exert some control over the Carrows’ punishments inflicted upon the students they were in charge of. This has previously been the case with doctors who speak out after working under duress, in an attempt to limit suffering as much as they can in a difficult situation. (5)

The character of Voldemort himself raises important issues regarding the psychology of a dictator. Voldemort used great acts of evil to split his soul into 7 pieces (Horcruxes) to attempt to gain immortality and power. The concept of ‘doubling’ describes how a person is able to commit acts previously abhorrent to them, as they simply ‘switch off’ their other side. This has been offered as an explanation why people, such as Nazi doctors, were able to torture and kill ‘undesirables’ on a regular basis. (10,21)

Conclusion

Throughout the Harry Potter books there are many comparisons that can be drawn between the magical and the medical world. The similarities and differences that have been highlighted give us an original way of looking into important issues concerning the medical profession, and the magician-Muggle relationship raises interesting points regarding the doctor-patient interaction. Ultimately it leaves one wondering whether we as physicians try too hard to be magicians? Or is it that patients actually want us to be magicians? As always, the reality probably lies somewhere between the two extremes.

 

References

  1. General Medical Council L. Tomorrow’s doctors: Recommendations on undergraduate medical education. 2009.
  2. Rowling J. Harry Potter and the Order of the Phoenix. 1st ed. Bloomsbury; 2003.
  3. Rowling J. Harry Potter and the Prisoner of Azkaban. 1st ed. Bloomsbury; 1999.
  4. Rowling J. Harry Potter and the Goblet of Fire. 1st ed. Bloomsbury; 2000.
  5. Rowling J. Harry Potter and the Deathly Hallows. 1st ed. Bloomsbury; 2007.
  6. Twersky RS, Hartung J, Berger BJ, McClain J, Beaton C. Midazolam enhances anterograde but not retrograde amnesia in pediatric patients. Anesthesiology. 1993 Jan;78(1):51–5.
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Author contact details:

1. Fiona N Dogan, 5th year BM BS student, Brighton and Sussex Medical School

f.dogan1@uni.bsms.ac.uk

2. Dr C Mark Harper BSc MBBS FRCA, Consultant Anaesthetist, Brighton and Sussex University Hospitals
mark.harper@doctors.org.uk

Artist Mark Gilbert and his Portraits of Care: Medical Humanities’ Editors Choice

28 Jul, 10 | by Deborah Kirklin

Anyone lucky enough to have come across or been engaged with Mark Gilbert’s work in the Changing Faces exhibition will be pleased to hear that more of his work is now publicly available.

http://mh.bmj.com/content/suppl/2010/06/23/36.1.5.DC1/MH_Appendix_003780.pdf

One of Mark’s paintings, Jarad, featured on the cover of the June issue of Medical Humanities and I would urge you to go on-line and to take time to look this extraordinary portrait. If you do, then I suspect that the experience  will be profound, and, depending perhaps on your perspective and your experiences, even a little disturbing. For some of you this will be the first time you have born witness to someone else’s experience of illness, and you may be struck by the introspective quality of Jarad’s portrait. Others will already know more than they wish to about being ill or of caring for someone who is ill. more…

Believing Without Seeing

11 Jan, 10 | by Ayesha Ahmad

Esref Armagan was born blind in Ankara, Turkey. He has now become a famous artist due to his sheer talent and also due to certain significant and unusual reasons. His art displays the colour, vividness, light, dark, imagination and perspective that we are used to considering as the gifts of sight. Esref is changing the meaning of what it is to see the world.

Whilst taking part in a documentary with the University of Toronto, he exclaimed: “why would I want to see when I can see so much more with my hands?” These words fall upon us at a time where medicine is advancing through producing images of our body that otherwise we are blind to, such as fMRI, X-Rays, CT scans. We are looking into how we can perceive the human body in its finest detail. Our direction of what it means to achieve the fullest understanding of the internal physical world of the body is engaged with finding what is hidden. more…

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