The Sociobiology of Humanism
The Sociobiology of Humanism: John Lantos, MD
John Lantos, MD Professor of Pediatrics
Section Chief, General Pediatrics
The following essay is an edited version of the talk delivered by Dr. John Lantos at the first annual Gold Humanism Honor Society Induction Ceremony.
In March of 1982, the interns at Children's Hospital National Medical Center demanded a meeting with our chief residents. February had been a brutal month. Every night would bring eight or ten new admissions. We interns were running hard just to stay in place, treating and triaging like crazy. Our care was all crisis intervention. We were not sensitive or humanistic, we were technical, pragmatic, and ruthlessly competent. In March, as things finally slowed down a bit, we met with our chief residents. It started as one of those basic gripe sessions. Too much work, too little sleep, complaints about medical records and incompetent agency nurses.
Then Ellie began to talk. She described how, one night in February, one of her teenage patients had died. The girl had bone cancer. Her leg had been amputated but, in spite of that, the cancer had returned and metastasized to her liver and brain. We were providing palliative care. We'd all gotten to know her over the course of the year but Ellie had cared for her the most and gotten the closest to her and her family.
When the end came, it was peaceful, but also very sad. No matter how much a death is anticipated, it is always, for loved ones, shockingly painful. Ellie cried. The family cried. The nurses cried. The hospital room became transformed momentarily into something different, a surprisingly spiritual place. As deaths go, this was a pretty good one. The grief that came with the inevitable end was a healing sort of pain.
Then, Ellie said, her beeper went off. It was the Emergency Room. She had two asthmatics to admit. Her beeper went off again. It was one of the nurses on the toddler unit. A patient's IV line had fallen out. Could she come and restart it? Her beeper went off again. As she sat by the deathbed, she felt a deep moral obligation to stay connected. She felt her own emotional need to grieve a little. At the same time, all the routine stuff for an intern's night on call was piling up. The two sets of demands seemed incommensurable, absurd, and ultimately enraging.
As she told this story to the hushed group of interns and chief residents, she began to cry. But she kept talking, tears rolling down her cheeks, her voice getting huskier, determined to say what she had to say. And one by one, we all began to cry with her.
She was not asking for much, Ellie said. She could do eight months in a row of caring for sick and dying children. She could do it without sleeping every third night. She could cover the cancer patients and the preemies and the motor vehicle accidents and the child abuse cases. She thought she was pretty tough. But she also thought that, when one of her patients died, she should be allowed a little time, just an hour or two, she suggested, without getting paged, to sit with the family and grieve and to let herself feel something.
Our chief residents said they would see what could be done. But, as it turned out, not much could be done. No matter how the system is designed, it is hard to stay connected—either to others or to ourselves. There are always other things to do.
Evolutionary biologists have been long puzzled by cases of apparent altruism in certain animal societies-vampire bats who regurgitate blood and donate it to other members of their group, birds who help other birds raise their young, vervet monkeys who give alarm calls to warn fellow monkeys of the presence of predators, even though doing so increases their personal chance of being attacked. Scientists develop complex mathematical models to explain the survival advantages of such behaviors. Underneath the elegant math is a straightforward idea: it may benefit an animal to behave altruistically towards another. If you do unto others as you hope others will do unto you, someday they just might. Each act of altruism is a sort of prayer, and many of the prayers are answered.
Maybe the world of medicine requires dramatized humanism. The ugly and horrible things that make up the stuff of daily life in hospitals are enough to harden the humanism out of anyone. But they are also the stuff out of which any genuine humanism must be fashioned. When medical technology fails and we face our own vulnerabilities, then the truths of art, of sociobiology, of religion and of medicine come together. We fall back on what we started with-the enactment of a prayer that is built into our most magnificent theatre, the faith that is encoded into our DNA-that if we care for others, then someone, someday, will care for us. In the end, it is what we have to believe.
