Monday, April 04, 2005

Motorcycle Diaries: Che Guevara as Doctor

Finally got to watch Motorcycle Diaries over the weekend, which is the depiction of Che Guevara's journey from Argentina to the northern-most tip of South America in Venezuala on a motorcycle, some months before he is about to finish med school. The film is a really moving depiction of Che's development of what ended up to be a Marxist thought, but was during the period of his travels empathy toward the natives and the poor. The Dude got teary eyed...

...and is addressing it here because Che was a doctor (and an asthmatic) and treated lepers as a part of his residency. Some scenes in the movie made me think back to a series of posts that Dr. Bernstein wrote on Sympathy v. Empathy, and how Che’s beliefs shaped his approach to medical treatment. Making use of Dr. Bernstein’s post provides a good kick-off/foundation to this rant:

Harry Wilmer (Wilmer HA. The doctor-patient relationship and issues of pity, sympathy and empathy. Br J Med Psychol 1968 Sep;41(3):243-8.):* Pity describes a relationship which separates physician and patient. Pity is often condescending and may entail feelings of contempt and rejection.* Sympathy is when the physician experiences feelings as if he or she were the sufferer. Sympathy is thus shared suffering.* Empathy is the feeling relationship in which the physician understands the patient's plight as if the physician were the patient. The physician identifies with the patient and at the same time maintains a distance. Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.

Based on the above, Che had an inherent understanding of empathy (which is one of the likely reasons he was such an effective orator and leader) that enabled him to understand the human condition of his patients. This is perhaps best demonstrated by the scene in which upon entering the leper colony for the first time, and being instructed to wear gloves when dealing w/ the lepers as the nuns persisted in that unnecessary measure (leprosy is not transmittable when under treatment), Che rejects that order and shakes hands w/ his patients. He reaches out to them recognizing the dignity they deserve as human beings, not as mere patients. The movie drips with metaphorical scenes like the one above. For example, in another scene, Che swims across the river separating the health care workers from the lepers, in the midst of the night, to celebrate his birthday with his patients as well.

It is, however, acts like that which make the Dude wonder whether Che crossed the line into sympathy and biased his professional judgment. I’m not sure, did he cross the line, did the patients receive the best care possible without being at the center of unnecessarily prolonged or conversely, abbreviated care? From the movie and his diary, it appears that he did not, that he was able to keep his role in perspective by maintaining a personal distance…but in the end it was the frustration of recognizing that distance and questioning its validity that led him to question the values of his environment and become a political leader. And by that, he did become sympathetic.

What has begun stirring in my mind is whether it is that very presence that propelled him to action; i.e., that by being only empathetic he would not have been able to do the great things he did. The passion/fire people spoke of that was so evident in him and others like him was because of sympathy, not empathy.

Clearly, there have been those great men and women in the past in the field of medicine and philosophy (and, yes, others; - ) that have pulled their fields along kicking and screaming to new heights who expressed that removed empathy, but sympathy doth a moving tale make and need not necessarily be a bad. Maybe it’s a Greek-drama thing, our attention’s and affections are attracted to the hero/heroin driven by sympathetic fire, destined to do great things, but knowing well that they’re not going to stick around forever…these people follow their passions without sacrifice and expire too soon because of that.
Ignac Semmelweis and a herd of other great individuals led lives driven by sympathy and bettered the welfare of man, but at their own cost. I recall reading a chapter on Dr. Semmelweis which showed the effects sympathy had on his health. The chapter showed a picture of the doctor at age thirty looking as one should, and then in his mid-thirties looking closer to a man in his fifties. It is perhaps because of such cost that we are advised to be empathetic toward our fellow man (read as patient). Not solely due to the fact that sympathy will likely bias one’s professional judgment, as it need not, but because of the great detriment it has upon the person…

*The Dude would like to note, in case anyone is wondering, that he is not a Communist, nor a Capitalist. He’s just Bioethics Dude.


Blogger Orac said...

Unfortunately, later in his life, when he turned into a totalitarian, Che's sympathy apparently didn't extend to Castro's political prisoners who fell into his clutches, nor did it extend to other enemies of the state, whom he ruthlessly killed and persecuted. The question then becomes: What happened to him, to turn him from caring doctor into Castro's ruthless enforcer, who once said: "Hatred as an element of struggle; unbending hatred for the enemy, which pushes a human being beyond his natural limitations, making him into an effective, violent, selective, and cold-blooded killing machine. This is what our soldiers must become …"?

April 06, 2005 8:25 AM  
Blogger Bioethics Dude said...

Thanks Orac for the comment. That part of his life is one of the reasons why the Dude is not in favor of just doesn't work when actualized (the Dude is from a former Commie country, and his parents and their parents know...summers in Siberia are not fun, so the Dude heard from several uncles, and neither are winters). Perhaps the sympathy of Che took hold and ran boundless, wreaking the dictates of his medico-ethics foundations....-BD

April 06, 2005 11:19 AM  
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Blogger dylan said...

You have to remember that this was just a movie... It was a completely biased depiction of a man who everyone wants to think was like a God. For example, Robert Redford *forgot* to use excerpts from Che's diaries such as "My Nostrils dilate at the acrid odor of blood and gunpowder...i will stain my rifle red with the blood of any enemy." He was a downright evil man and those who disagree have not studied both sides of the argument. They also probably think Castro is a good guy. I am cuban and know the atrocities first hand.

April 11, 2008 1:09 AM  

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