“Now and again you get proven the sunshine
Within the strangest of locations in case you have a look at it proper.”
That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has adopted generations like a benediction disguised as a track lyric. Launched in 1974 on the Grateful Useless album From the Mars Lodge, it has turn into one thing greater than poetry. It’s a philosophy of consideration, a reminder that which means doesn’t at all times announce itself with ceremony. Typically it arrives quietly, sideways, disguised as coincidence or contradiction.
Medication, significantly now, is determined for that reminder.
These are pessimistic occasions. The day by day headlines learn like a working differential prognosis of despair: warfare, antisemitism, Islamophobia, political violence, ecological anxiousness, institutional distrust, and a well being care system that always feels as brittle as it’s overburdened. Physicians and different clinicians take in this darkness each professionally and personally. We see it in our sufferers’ eyes, within the examination room silences, within the ethical residue we feature dwelling after one more no-win day.
And but, every now and then, we’re proven the sunshine.
The Hanukkah story could be seen, at its core, as a medical story. A small, weak group confronting overwhelming odds. A refusal to simply accept extinction as inevitable. A cussed insistence that mild, nonetheless restricted, nonetheless issues. One candle on the primary evening, not eight. No grand miracle on the outset. Simply sufficient to start.
This yr, that symbolism collided painfully with the trendy world. A lethal antisemitic assault at a Hanukkah celebration on Bondi Seashore in Australia despatched shockwaves throughout Jewish communities worldwide. In communities throughout this nation, rabbis and organizers responded not by retreating, however by rising safety and lighting menorahs anyway (publicly, defiantly, intentionally). As one rabbi put it, “Darkness doesn’t win by power, it loses when mild seems.”
That sentence must be carved above the doorway to each hospital.
What struck many observers most, nonetheless, was an added layer of irony that felt nearly scripted by Robert Hunter himself: The hero who tackled one of many Bondi Seashore shooters and saved numerous Jewish lives was Muslim. In a world more and more hooked on inflexible identification narratives, the sunshine appeared in a spot many had been conditioned to not look.
That is what Scarlet Begonias is basically about. Not naïve optimism. Not denial of hazard. However the self-discipline of notion.
Within the track, the narrator doesn’t search enlightenment. He’s strolling by Grosvenor Sq., mildly uncomfortable from the “nip to the air,” not anticipating revelation. The encounter that modifications him is fleeting and ambiguous: “I needed to study the onerous option to let her move by,” he tells us. And but the irony, not often famous, is that in life she didn’t move by in any respect. The girl with the scarlet begonias grew to become Robert Hunter’s spouse, Maureen, a reminder embedded within the line that comes simply earlier than the well-known one: “It seldom seems the way in which it does within the track.” The knowledge arrives anyway, not as a result of it was pursued or predicted, however as a result of it was acknowledged, after the very fact, and solely by it proper.
Medication works the identical method. We’re educated to go looking relentlessly (for diagnoses, for causes, for solutions). However mild will not be at all times discovered by pursuit. Typically it arrives by presence. By way of noticing. By way of being prepared to revise the story we expect we’re in.
Does the sunshine come to us? Do we have to seek for it? Or is it merely serendipity?
The reply is: Sure.
There are moments after we should actively search mild (advocating for sufferers, resisting dehumanizing programs, talking when silence can be simpler). There are different moments when looking too onerous blinds us to what’s already there: a quiet act of braveness by a trainee, a affected person’s sudden grace, a colleague’s ethical readability in a gathering the place everybody else shrugs.
After which there are moments of pure serendipity, when goodness seems uninvited, inconveniently contradicting our assumptions.
The Muslim man who saved Jewish strangers on an Australian seaside didn’t get up planning to turn into an emblem. The rabbis who lit menorahs after a bloodbath didn’t erase the darkness. They merely refused to let it dictate the ending.
This issues deeply for drugs.
Well being care has turn into obsessive about outcomes whereas neglecting which means. We measure burnout, but ethical damage deepens. We speak about resilience as if it had been a person trait slightly than a communal obligation. We overlook that mild is cumulative. One candle doesn’t finish the evening, however it modifications the room.
For clinicians, recognizing mild requires unlearning some habits. We’re educated to identify pathology, to anticipate worst-case situations, to organize for issues. These expertise save lives. However they’ll additionally slim our visual view. When every part is framed as danger, we miss marvel. When each story is diminished to an issue listing, we miss the individual.
The seasonal convergence of Hanukkah and Christmas affords a corrective. Each traditions insist that mild doesn’t eradicate struggling; it coexists with it. A manger will not be a glorified birthplace; it’s a feeding trough. A menorah burns below occupation, in a land not but free. Neither story guarantees ease. However each promise hope.
The deepest types of hope don’t eradicate hardship; they refuse abandonment. That’s as true on the bedside as it’s in historical tales of sunshine. That could be probably the most radical lesson drugs can reclaim proper now.
Optimism in drugs doesn’t imply pretending programs aren’t damaged or that the world isn’t on hearth. It means believing that focus nonetheless issues. That care nonetheless counts. That moral motion will not be rendered out of date by scale or cynicism.
Now and again, we’re proven the sunshine (in an ICU hallway, in a refugee clinic, in a parking zone menorah lighting guarded by police, or within the arms of somebody we had been taught to concern).
If we have a look at it proper.
And if we don’t look away.
In pessimistic occasions, that could be probably the most scientific talent of all.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Affiliation for Doctor Management, and an adjunct professor of psychiatry on the Lewis Katz Faculty of Medication at Temple College in Philadelphia. He’s the writer of a number of books on narrative drugs and the fictional collection Actual Medication, Unreal Tales. His newest e-book, a novel, is Commonplace of Care: Medical Judgment on Trial.
