Public health and the muse

At first glance, it might seem odd that a public health journal would initiate a section about arts and humanities. Public health, after all, deals with populations; it eschews the individual except as it forms one of a group. The creative arts, however, deal almost exclusively with individuals. Literature, in particular, always has a protagonist, and the protagonist is never ‘alcoholics with pancreatitis,’ ‘female prisoners receiving hepatitis B vaccination,’ ‘South Asians with cardiovascular risk factors,’ ‘UK asylum seekers with infectious disease,’ or ‘teenaged asthmatic smokers.’ A protagonist is an individual. Madame Bovary, Huckleberry Finn, Jay Gatsby, Pip, Hamlet, Odysseus, Harry Potter, Holden Caulfield, Captain Ahab, Anna Karenina, Sherlock Holmes and Jean Valjean are individuals, not populations. What happens to each is entirely unique. There is nothing in their characters that is ‘applicable’ to larger populations; they define individualism. Our pleasure in reading these novels is the exhilaration of being swept up in the singular journeys of these remarkable individuals. As an academic internist, I teach medical students and junior doctors in both the inpatient and outpatient settings. I have often been disappointed in how easily the house staff lose the trees for the forest. Too often, they take a ‘population’ approach to their patients, though not exactly in the public health sense, more in a category approach: Chest pain patient1⁄4 telemetry, serial enzymes, echo, stress. Pneumonia patient1⁄4 X-ray, IV ceftriaxone plus azithro. Altered mental status patient1⁄4 CT, LP, pan-culture, broad-spectrum antibiotics. A few years ago I began to supplement rounds with readings from classic literature or our own Bellevue Literary Review. I always chose stories, essays, or poems that specifically highlighted the individual. I wanted to use literature’s greatest strength—the uniqueness of the protagonist—to remind junior doctors that because each patient’s chest pain occurs in a different life that each chest-pain story is, by definition, exceptional. Up until the invitation to write this essay, however, I had never thought to look at literature from a public health perspective. Like most internists, my gaze is locked only on the one patient in front of me, and then the next one, and then the next one. There is rarely time to pick up one’s head and consider the wider medical perspective. And like most writers, my gaze is locked only on the one story in front of me. Therefore, I was forced to pause and think about how I might pull together literature and public health. After reading some of the current literature of public health, one aspect resonated most strongly to me as a practicing clinician—the understanding of the social context of disease. Social context is a broad palette. In the second paragraph of this essay, I listed some of the most memorable protagonists in literature. Each is highly individual and unique. But each inhabits a complex, carefully wrought environment. Most are defined by, or defined against, their respective social contexts. Perhaps this is one way in which the humanities can be applicable to public health. Since title of this section of the journal was to be ‘Chekhov’s Corner,’ I felt duty-bound to revisit the master. I pushed aside my medical journals and dusted off my volume of Chekhov stories. Reading them again was like returning to the motley but familiar assemblage of eccentrics and ordinary folks living in a muted corner of my history. Indeed, this New York Public Library edition was entitled ‘Motley Tales and a Play.’ (As a writer, I am deadly envious of anyone who manages to get a blurb from Tolstoy on the back cover of his book.) I read through the stories, skeptical that I would find anything that would relate to public health. Each story is about a very particular individual and the very particular circumstances into which he or she is plopped by a dexterous literary creator. The story of the sexton’s wife who is mesmerized by the face of the mail carrier lost in a