Friday, September 28, 2018

Sentiment and, and vs. Morality: In Praise of the Triage Nurse


            If you have to have your dissertation topic “anticipated,” it’s nice if it’s done by a really classic old essay; maybe not so nice if it’s anticipated rather casually as a kind of side-chapter in a book in, mostly, another field. In any event, my original topic for a dissertation in English was on “The Fool in King Lear,” which is more or less the title of a chapter in a classic work on Fools generally, by the major scholar, Enid Welsfordin 1935.

            Still, the Fool in Lear remained the heart of my dissertation, and the upshot of my reading of Lear was that it’s a rigorously, almost militantly logical play coming to the sentimental conclusion that human morality and ethics rest in compassion, in suffering — if necessary — with other people, in learning to see the world “feelingly.” 

            So I argued in 1970-71, so I still believe about King Lear and about the real world. If God is dead or never existed or doesn’t get involved much in human affairs; or if God is a hard-ass Christian God who’ll damn you to eternal Hell for getting your theology wrong — and definitely if you're a heathen like all the people in the play — or a Calvinist God who’ll save or damn you as He damn well pleases. Or if “As flies to wanton boys, are we to the gods.They kill us for their sport”. If Nature is not a compassionate Mother Goddess but indifferent, or favoring as fittest the strongest and most cruel; if social ranks and law and rules and customs, if respect for old age and condemnation of cruelty are just human conventions and unreliable — If the world is pretty much as a naturalistic, materialistic, thoroughly modern vision sees it; then pity exists if people feel it; morality, too, exists only if its restraints are felt.

            That’s not very respectable philosophy — it’s “Intuitionism” or something equally disreputable — but that sort of stress on feeling (with) is one logical reaction if you want to drop a moral God and maintain a modern but moral approach to life. It’s a position, though, that nowadays, must be balanced.

            The first Age of Sentiment in the West was roughly 18thcentury, between the Enlightenment and the Romantics; we live in a second one. «Trust your feelings, Luke» does not actually occur in the STAR WARS saga, at least not that I can find on line, but it’s a good statement of the “ethos” of the movies, and of our era.

            I’m suspicious of the idea, starting with me and some of my feelings but going on to more general and ultimately appalling possibilities: “The devout,” Eric Hoffer asserted in 1951, “are always urged to seek the absolute truth with their hearts and not their minds. […]Rudolph Hess, when swearing in the entire Nazi party in 1934, exhorted his hearers: ‘Do not seek Adolph Hitler with your brains; all of you will find him with the strength of your hearts’” (The True Believer §57). And closer to home and far less sensationally, Barry Goldwater campaigned in 1964 on the slogan "In your heart, you know he's right" — and Goldwater scared me enough that I worked on the local campaign for Lyndon Johnson, a man I didn’t really trust. 
 (Take away his crudeness, and you can get a tragic figure out of LBJ: serial mass murder can go with a tragedy — Macbeth — but not, the folklore has it, humiliating high-ranking underlings by making them confer with him while he took a shit, or showing his penis and asking if Ho Chi Minh had a dick like that.)

            Now an emergency-room nurse once told me to fill out a form when I was in there for what turned out to be bilateral corneal abrasion — the top layer of cells ripped off of my corneas by my contact lenses — and couldn’t open my eyes without severe pain (the cops had given me a lift to the hospital); so I know this can go too far. Still, my most-excellent introduction to an ethical imperative to suppress feelings was when I regularly stopped by the emergency room at Michael Reese Hospital in Chicago.

            In college, I was a summer worker at Reese in the Microbiology Department, and being low-person in seniority I got the job of walking a route in the hospital first thing in the morning and collecting blood-agar plates from various other departments, including my first stop, the ER.

            There had to be some exceptions, but there was remarkable consistency: Every Monday, there’d be a trail of blood leading to the ER, and most days there was a cop car in front. And I’d walk in, and wait while the receptionist-nurse talked to a couple of parents trying to suppress hysteria and getting “Father’s Name / Mother’s Name / Address …” and with barely looking up and not missing a beat motioning with her head at the keys hung behind her. I’d get the keys and unlock the small refrigerator where they kept the narcotics and the petri dishes, and I’d pick up whatever needed to be picked up and drop off new plates as needed.

            And I’d go out, and replace the keys, with the receptionist still not missing any beats, watching me to be sure I replaced the keys and hadn't stolen any narcotics, and nodding at me her thanks. 

            She did that every day, and the folklore was that ER nurses got terminally bored with just about every other job at the hospital. Anyway, I got to watch the receptionist carefully and every day got glimpses of the work of the rest of the staff and later in life learned more.

            In I and Thou, Martin Buber celebrates the “encounter” and the I-You relationship; but our usual interaction with the world and our fellow beings is I-It. And part of my take-away from the book is that it is the potential for an I-Thou relationship that is crucial and not to get too hung up if most of my interactions with people are just, well, interactions, transactional. Later this got clarified when my relationship with bank clerks got usually replaced by my relationship with ATMs. Earlier, and relevant here, was coming to understand that for the ER personnel especially, but many medical people, the I-Thou potential was indeed crucial, but more immediately important was the ability to tamp down feeling and deal with injured people, often people in great distress, dispassionately: I-It. 

            This is very clear with the Triage nurse and what we can call “Triage situations” — which you should do your best to avoid and to try to prevent. However, in a Triage situation, there’s an ethical imperative to perform Triage: roughly, to establish priorities of treatment by dividing the incoming wounded, injured or whatever into those likely to die no matter what care they receive; those likely to live even if not treated or barely treated; and “Those for whom immediate care might make a positive difference in outcome” (to lift a phrase from the linked Wikipedia article). If resources are limited, this is definitely not “Women and children first” or any other sentimental association: a strong man who might live with treatment gets preference over a child whose injuries could break your heart, but are going to be soon fatal. If you’ve got morphine or something more modern, you shoot the kid up and move on.

            A “Triage situation” burned into my memory just reading a report years ago concerned a UNESCO or similar group responding to a famine and having to deal with a starving village. The relief workers were doing “Women and children first” until the young men of the village confronted them and told them to give the food to them and to young women: they’d make more babies later. Some self-preservation was involved here for the relief workers (many of the young men were armed), but they decided to give the food to the strongest of the young and to the strongest of the skilled elders and village leaders. In that desperate situation, the best they could do was to save the village as a functioning social unit, and the young children could indeed be replaced. 

            As I said, Lesson One: Try to prevent “Triage situations.” When in one, however, the ethical duty is to choose the least evil and maybe least downright horrific choice, while recognizing that choosing the lesser of two or least of several evils is still evil — and that failure to choose or refusal to choose is also a choice.

            And in such extreme contexts, «Trust your feelings, Luke» or «Following your heart» could lead to terrible, immoral choices.

            Sometimes also in less extreme situations. 

            I’m confident if you’ve gotten this far in the blog, you’re way ahead of me on this: The ideal, maybe of course, is someone like the character Cordelia in Shakespeare’s King Lear, who is compassionate and strong and rational for as long as reason can work. 

            On the way to such an ideal, though, we need to first keep in mind that King Lear is a play, make-believe, and relevant for my point here reconsider the soft spot in the American heart and head for the person of correct feelings.

            So look, when a great politician like Bill Clinton says, “I feel your pain,” tell him, thanks for the effort, but if you felt all of our pain it would destroy you, and that now that he’s considered our pain enough to throw out a properly sensitive comment what does he intend to do for us? 

            Or consider this thought experiment on sensitivity and feelings’ variation: attitudes. Politician Boll Weevil tells you that he don’t (sic) much like Colored folk, but his family owned a number and he and the rest of White America have inherited wealth stolen from slaves. “Guilt ain’t inherited,” he says, “but the loot is; and we who are recipients of stolen goods have to discuss how we’re going to make restitution.” He doesn’t much like African-Americans, but he wants to discuss what would be the most rational and ethical way to do the honorable thing and pay reparations. Politician Tear Duct — and as a male writer I’ll make both my stereotypes male — politician Tear Duct just loves members of the African Diaspora, and loves and likes and respects them/you so much he won’t insult you with re-establishing condescending, dependent, subordinate, subaltern relationships … and no way is he going to discuss reparations.

            Most of us have problems dealing with snobs who dislike us, but if Boll Weevil’s sense of family and national — hell, even racial — honor gets him to start negotiating reparations, support him and vote for him even if he’s not feeling your pain and has no intention of having a beer with you, ever. 

            Boll Weevil is not trusting his feelings, and if you dislike him, feel that, treasure your dislike, and deal with him if, when, and as long as it’s to your advantage to do so.

            Ursula K. Le Guin has a political saying on a planet nicknamed Winter that would translate into our terms as “You don’t have to be lovers to haul a sled together.” And sometimes you — I, we — can form effective coalitions with people you dislike and who may really dislike you. 

            So have feelings, Luke, and consider them and be capable of caring relationships. Be compassionate and sensitive. But get into the habit of critical thinking and hard-headed, sometimes hard-hearted ethics. That paradoxical injunction by the Prophet Micah (6.8) — that ethical parallel to the paradox of “Liberty! Equality! Fraternity!”: it’s like that. “Do justly, love mercy, and walk humbly”: combine logic with compassion and have the humility to understand that you’re dealing with contradictions much of the time, and there’s really no right answer here.

            But in our time, another age of passion, let’s stress that reason and logic. 

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