In the first chapter of Moby Dick, “Loomings,” Ishmael gives his reasoning for going on a sailing journey. He is anxious, irritable, and needs to find an escape from his current life, symbolized by the land, so he plans on going to sea as a sailor. In my previous post, I likened his narrative in the first chapter, redolent of the famous Shakespearean monologues, to an exchange between a patient and a physician. I noted that understanding Ishmael’s narrative is analogous to understanding a patient’s story. In chapter two, “The Carpet-Bag,” Ishmael prepares for his sailing journey and leaves Manhattan island, but he faces a problem:
Quitting the good city of old Manhatto, I duly arrived in New Bedford. It was a Saturday night in December. Much was I disappointed upon learning that the little packet for Nantucket had already sailed, and that no way of reaching that place would offer, till the following Monday (Ch. II)
Ishmael realizes he must look for a hotel to spend the cold December weekend. He surveys the area and finds several hotels: The Sword-Fish, The Crossed Harpoons, and The Trap. Finally, he stumbles upon one that seems reasonable, at least by its name:
Moving on, I at last came to a dim sort of light not far from the docks, and heard a forlorn creaking in the air; and looking up, saw a swinging sign over the door with a white painting upon it, faintly representing tall straight jet of misty spray, and these words underneath- “The Spouter Inn:- Peter Coffin.”Coffin?- Spouter?- Rather ominous in that particular connexion, thought I. But it is a common name in Nantucket, they say, and I suppose this Peter here is an emigrant from there (Ch. II).
Here, Ishmael’s response to something seemingly as simple as the name of a hotel illustrates an important point—that the perception of language shapes how one feels about what one’s exposed to in life. This is a vital issue in science and medicine, one that deserves more attention in medical education. A few weeks ago, Dr. Mary Simmerling of Cornell University gave a lecture to first year medical students about the ethical, social, and economic issues surrounding kidney transplantation, and in her lecture, she talked about “how much language matters.”
As someone trained in philosophy, I’m very attuned to how the choices we make about words have a huge impact… And I think it’s so true when talking to patients. When I was in graduate school, we called what we now call ‘deceased donors,’ ’cadaveric donors’. So, who wants an organ from a cadaver, and who wants an organ from a deceased donor? Right? So, every word counts. And, it’s really important that we are careful in how we talk about things and describe them because it makes a big difference in how people think about things and how receptive they are, and how willing they are to do things. For example, ‘harvesting’ versus ‘recovering’ an organ—all these things that you might not think really make a difference… The way we talk about things has a huge impact on how the public thinks about them, how we think about things, and most importantly, about how the patients that you care for are going to understand and think about what you’re saying to them.
I’ll take Dr. Simmerling’s point one step further with a personal example. I recently participated in a small group discussion about taking a complete patient history, and the question came up of whether or not to ask about religious identification as part of the social history. I noted that asking about this issue is relevant but can be difficult to bring up in conversation. But there are ways to ease into this conversation. For example, asking patients what support groups they turn to in times of trouble is a better way to start this topic than asking directly about what religion they identify with. How can physicians be more conscientious about how they present information and ask questions? There are two ways, and the first is simply keeping this issue in mind while speaking to patients, students, or colleagues. The second way is to read more, and particularly imaginative literature and poetry, because such works are written in ways that require readers to be attuned to how language is used. Moby Dick gives readers a poem and play clothed in what appears to be a novel, but it really is an enormous prose-poem, and the dialogue between characters very much resembles interactions in Shakespeare’s plays. Reading Moby Dick is great practice for physicians and very much deserves to be alongside Bates’ Guide in a student’s carpet-bag.
Moby Dick by Mal Jones