Paying Attention to Beauty (Gilead)
Authors: Stephen Hibbs, Simon Hallam
Journal: HemaSphere (2021)

Foreword This is the second of a short series of perspective articles by Dr Stephen Hibbs, in which he explores literary fiction to reflect on the wider impacts of our lives and work as hematologists. Specifically, this short essay is a timely reminder to search for glimpses of beauty and wonder to sustain us through difficult times. Simon HallamWhere you turn your eyes the world can shine like transfiguration. You don’t have to bring a thing to it except a little willingness to see. Only, who could have the courage to see it? —Reverend John Ames, Gilead1 Our work as hematologists is a privilege and yet is sometimes almost unbearably sad or disturbing. I have found that to be able to continue in this work requires glimpses of beauty and restoration of my sense of wonder at the world and at people. Gilead is a profoundly beautiful book that depicts a main character who has cultivated a powerful and sustaining sense of wonder in his outlook on the world. While the book rarely directly mentions health or the medical profession, this generous and curious view of the world and of people has helped to sustain me in my medical vocation. Gilead is a celebrated book, winning the Pulitzer Prize in 2005. Barack Obama loved the book so much that he interviewed the author, Marilynne Robinson, for the New York Review of Books in 2015. Robinson spoke of how she set out to write the book with the simple image of an old man writing at a desk while a young child plays on the floor nearby. This old man became the Reverend John Ames, an aging third-generation church minister in the small town of Gilead, Iowa. Ames has unexpectedly remarried and had a son late in life, after losing his first wife and child in his youth. The book is written in first-person perspective in the form of an extended letter from Ames to his son, with poignant awareness that he will not live to see him grow to adulthood. Ames writes with unusual attentiveness towards the natural world. At one point, he tells of watching a young couple walking down the road where the young man spontaneously jumps up to hit a wet branch, scattering shimmering water droplets into the light. Ames cannot get this picture out of his mind: “it is easy to believe in such moments that water was made primarily for blessing, and only secondarily for growing vegetables or doing the wash. I wish I had paid more attention to it… This is an interesting planet. It deserves all the attention you can give it.” Elsewhere, he writes of watching his son play with a friend in a garden sprinkler, “you two are dancing around in your iridescent little downpour, whooping and stomping as sane people ought to do when they encounter a thing as miraculous as water.” This regard for the beauty of the world is equaled by the sense of dignity and awe with which he views other people. On performing baptisms of children, he feels “the sensation is of really knowing a creature, I mean really feeling its mysterious life and your own mysterious life at the same time.” After years of living as a widower, Ames is still amazed at meeting and marrying Lila, a woman who has lived a profoundly different life to him. He has ministered to the same congregation for many years, and now feels convicted by the newcomer’s sincerity, “As though she might say ‘I came here from whatever unspeakable distance and from whatever unimaginable otherness just to oblige your prayers. Now say something with a little meaning in it’.” I have often wondered if some patients “from whatever unimaginable otherness” might ask this of me and my colleagues. At one point in the book, Ames is amazed at the sudden falling of acorns from a line of oak trees. He reflects on this capacity to be surprised by the commonplace: “I thought, It is all still new to me. I have lived my life on the prairie and a line of oak trees can still astonish me. I feel sometimes as if I were a child who opens its eyes on the world once and sees amazing things it will never know any names for and then has to close its eyes again.” It is this very sense of wonder at ordinary things that made morphology come alive for me. I recall the joy of being in a district general hospital meeting where a brilliant morphologist exclaimed their happiness at seeing a vivid example of a relatively common bone marrow feature. I cannot remember his exact words, but the spirit of it was “I have looked down the microscope for years and a dwarf megakaryocyte can still astonish me.” In contrast, there is a loss of wonder and a hardening that can happen in us that means we no longer experience the sadness of things that are sad, nor the gladness of things that are good. Everything is narrowed to a flat and cynical tone—an emotional “regression to the mean.” To avoid being disappointed or wounded, we tell ourselves that sad things are not really that sad (a shrugged “shit happens”) and that seemingly good things will turn bad in time. John Ames resists this. He has maintained a childlike sense of wonder at the world that provides sustenance to himself and others. Yes, at some level, he is naive, as am I, and as are we all in some respects—but he has resisted the deconstructing impulse that would unmake every true emotion inside of us. I remember feeling depersonalized, stressed, and tempted to be cynical during my first hematology rotation as a registrar on a busy day unit. I expressed that my hope at the start of this job was to get through it while avoiding being hardened by the experience. Arriving home on the evening of my final day, I spoke about a patient with cardiac amyloidosis who could no longer sit up without fainting due to the severity of his postural hypotension. That day, we had spoken of his stopping futile chemotherapy and of how his two brothers would care for him in his final days. As I spoke of the dignity of the patient and his brothers, I suddenly found myself weeping. My friend observed this as the very thing I had hoped not to lose at the start of the job. Whether it will survive the length of my career is not clear, but Ames exemplifies someone at the end of their vocational journey who has become softer rather than harder. The late Irish poet-philosopher John O’Donohue spoke of how every person needs to keep something truly beautiful in their mind if they are to be sustained in places of great bleakness. I picture myself and colleagues weighed down by professional and personal sadness, which goes mostly unspoken, and these words ring true. Good literature can defamiliarize and challenge, but it also has the capacity to give us truly beautiful glimpses of the world that can sustain us in the difficult work that we do. Gilead has been a sustaining glimpse of beauty and wonder for me. Disclosures The authors have no conflicts of interest to disclose.