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

WORKING

            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 Welsford, in 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 18^thcentury, 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. 

A Teaching Issue: "Blind" Grading

Here's one statement of a policy of mine when I was teaching. 

"'BLIND' GRADING: There are limits on the practice, but I grade written work 'blind,' not looking at the name of the author until after I've assigned a grade." 

When I refereed for journals I also tried to ignore authorship when a name slipped through — the essays were supposed to be "anonymized" — or when I could guess. And when I read scripts I usually tried not to look up names at all or not until late in the judgment part of the process.

I started teaching at the University of Illinois (Urbana) about 1966/67, during US warfare in Vietnam, when a male student's flunking out of school could make him immediately subject to military conscription and, possibly, "Sent to Vietnam to kill or be killed or wounded or maimed — and my blood is on your hands!", as we also-draftable Teaching Assistants used to bitterly joke about student grade appeals.

With that issue in the background, to grade blind was one of the first decisions I made about teaching when I started out, and I decided that working a bit against biases, likes, or dislikes in assigning a grade was more important than any advantages from getting to know students a bit better as human beings, tracking their development in the course — etc. 

I am not now nor I ever been an orthodox "New Critic" — looking at words on a page and considering nothing but the words on the page — but I consciously opted to deal, when grading, with a text as text, leaving out as much as possible the human author.

I did have some "I-Thou" moments with students and made some friends (and at least two open enemies plus one weirdo who gave me [?] a scathing evaluation on Rate My Professor for a course I never taught). 

This far, anyway, I opted out of the "Teach the whole child" movement — "College Is For Grownups" for one thing — and went over to an "I-It" relationship more than I needed to. 

Martin Buber says that impersonal I-It relationships are usual and normal and okay so long as there's the potential for "I-Thou": "I" dealing with "you" as a real Mensch on both sides, directly, human and humanely. If the Other in an encounter can be replaced by an ATM or a beverage-delivery device, it's probably not a situation for I-Thou. I sometimes thought that for a number of my students I could be replaced by a grading machine, and I sometimes felt — near the end of a pile of essays — that I *was* something of a grading machine and most of my students mechanisms churning out essays.

And I was definitely long enough in the Ed Biz and just long enough in the script-reading biz not to privilege scholars and scriptwriters all that much over their (usually) precursor-forms of college students. 

ANY COMMENTS OUT THERE ON INTENTIONAL DEPERSONALIZATION between teachers and students (and perhaps also superiors and inferiors in work-place and other hierarchies)? 

"I and Thou" / "I and You" / "I and It" (10 Oct. 2013)

CAUTION 1: I'm going to steal from and then seriously over-simplify Martin Buber here, so if you're sophisticated, and strict, about philosophy or theology, you might want to stop reading right now or risk getting really pissed off.

CAUTION 2, and here I'll get into something I know about — There's a good chance even sophisticated English-speakers, for example many of my readers, have exactly the wrong understanding of the English word "thou."


            Most readers encounter "thee's" and "thou's" in old translations of the Bible or reading Shakespeare, and most, I suspect understand "thou" as a formal word: The way we wretched, finite, mortal sinners address God. That's wrong. "Thou" is the English cognate of the Germanic "du" and is like Spanish "tu" plus similar words in the Romance languages: it's the informal second person, used for addressing one's social inferiors, assuming one has social inferiors, or for addressing children or friends. "Thou" is for people and other beings with whom one can be informal, truly friendly.

            I'll modernize "thou" to "you-my-friend, or quite possible friend" and note that one of the nicer things about old Biblical translations is "Thou" for God: God not as Creator and Lord and King but as, at least potentially, friend or lover — or one's opponent in a wrestling match (Genesis 32.22-32).

            Jacob wrestling with the angel is a primitive dumb-ass story taken literally; as an image out of a healthy relationship with the divine, it's pretty profound.

            Anyway, an I-thou relationship is a personal one, as with a friend, including a friend with whom one wrestles or makes love: a relationship that's face-to-face, hand to hand: human-to-human, person-al.
            As I interpreted Buber for literary-critical purposes — it's a long story and irrelevant here — my "take-away" from Buber is that human relationship with God, the great and Eternal Thou, allows significant relationship with humans and other creatures, with the Others in our lived worlds. Whether through God or "immanent Being" or something totally mundane, there is always and necessarily a potential for human relationship with other humans, and that potential is of central importance.

            It's just a potential however, and that, too, is important.

            Look, last estimate I heard was that we humans can "maintain stable social relationships" with maybe 150 other people. Back when I was in a fraternity, our estimate was that a guy could associate fairly closely with maybe fifty other guys; so I think "Dunbar's number" of 150 is about right for a maximum. Obviously the great majority of us live and deal with far more than fifty to 150 other people, so the great majority of those relationships will not be "I-thou."

            Most will be I-it relationships — dealing with Others instrumentally, as if they were things — and that's okay.

            Here's a thought experiment. You go to a bank and deal with a clerk. You are polite to her — quite likely a "her" — and she back to you. Still, next time you go to the bank you may decide to use an ATM: an Automated Teller Machine, which we often redundantly, but usefully here, call "an ATM machine." In the colloquial sense of the word, the essence of your relationship with the teller was I-it: a machine clould replace her. Indeed, if she said to you, "Good morning! And how are you today?" And you said "Fine." And she said, "No, really: you look miserable. How are you?" and waited for a serious answer — if she switched to I-thou communication, it would be indecorous, improper, rather impolite.

            Similarly, back when I taught college, I saw my students as human beings, and at least on occasion I think they saw me that way as well. Still, they were to me primarily generators of papers to grade, and — given the limits of what they wanted to talk to me about — I think I appeared to them mostly as a generator of grades, eventually course credit, and, intermittently, of information that might prove useful, at least useful for getting a desired grade and course credit.  

            If one of my students walked into my office and said, "Hey, how are you?" and I didn't feel fine and gave an honest and detailed answer — I suspect I'd have gotten into trouble. Our relationship wasn't really "I-thou" and an "I-thou" answer wouldn't have been, as they say (often euphemistically), inappropriate.
            But sitting face-to-face in the office, our relationship wasn't exactly I-it. It was, or I think should have been, I-you: a relationship that might develop into friendship, in other contexts, and which might allow, in emergencies, intimate conversation, but was now more formal. It was an interaction not totally instrumental —our just using one another like things — but not quite personal either.

            I'll try to clarify that with three stories and a quotation, and then repeat my point. (Hey, I taught for a long time; trust me: repetition can get annoying, but it's useful.)

            Two of the stories are background, and all can be told quickly.

            On my first day of teaching at Miami University, Oxford, OH (my first job out of grad school), I had my students write writing samples, and for the rest of the week I had tutorials with them, and I graded and discussed with them what they had written. On my second day of teaching, the first day of the tutorials, the second student talked about the essay for a little bit and then started crying, telling me "This is about me!" and he told me how he'd knocked up his girlfriend … and wanted to know, in a sense, "What are you going to do about that?!"

            Uh, huh. Welcome to the Ed Biz, Rich; and welcome to a bit more I-thou than I was ready for, though I gave what advice I could. (And if in my writing I return to the subject of condoms fairly frequently, it's not only because I worked a summer in a public health lab and know the dangers of STDs.)

            On another occasion, I had become friendly with a former student — repeat: former student — and offered him a lift, and he asked if he could talk to me, and we talked, human to human, and his crying there in my car was not an imposition. He asked for advice, and I gave it, and he fairly quickly followed it: I advised him to get out of a relationship where he could not help a woman in great pain but was only hurting himself. Or, more exactly, allowing the woman and her friends to hurt him, repeatedly, systematically.

            And if I sometimes point out that survivors of horrors can move on to do damage themselves, it isn't only because I absorbed that lesson from Sidney Lumet's The Pawnbroker (1964), Art Spiegelman's Maus (1991), and, preeminently, Kurt Vonnegut's Slaughterhouse-Five (1969). The woman hurting my former student and (now) apparently former friend survived a plane crash that killed her family. The main point of the story for this essay is that my conversation with the former student was an I-thou interaction that was decorous, appropriate. If you think my advice cruel, a secondary point is that a moment of truly human communication is just truly human communication: if you've dealt seriously with any humans, you know we often fuck up, sometimes in the form of giving bad advice. This advice I'll stand by, however; and if you're a woman reader who dislikes such insensitive advice, please imagine yourself with a woman friend in an abusive relationship with a guy who has suffered and/or is suffering horribly; now consider the question, Can she really help him, or is she mostly just getting hurt herself? I-thou, person-to-person, truly intimate human relationships — sometimes suck; and one should run, not walk, away from some of them.

            The last story leads to the quotation and back to my point.

            For a long time I was "Student Mediator" for the good-sized English Department at Miami U. Most of the time, I just shuffled paper in this job and helped students through a fairly complicated complaint process; every now and then, though, I actually mediated. In the relevant case, the student, teacher, and I got together, and I couldn't quite figure out at first what the issue was; and then it became clear, and I said something like, "Oh, you two dislike each other."

            Neither was comfortable with my observation. The teacher was far, far too professional to react emotionally to a student; and the student was much, much, much too good a good Catholic boy to dislike an authority figure.

            Right.

            I told them, "You don't have to like one another. You just have to get along for a few hours a week for the next ______ [whatever] weeks." And I explained to them one form of what I'm calling here an I-you relationship, with a "you" being "a 'somebody' but not somebody I like" — but in a neutral sense of not liking.

            And here I'll throw in the quotation.

            In Shakespeare's Julius Caesar, the highly-flawed protagonist, Brutus — yeah, he's the protagonist; like, are you going to pay money to see a play called Marcus Junius Brutus the Younger? — Brutus asks his messenger Lucilius how Lucilius had been received by Cassius, a main co-conspirator in the assassination of Caesar, and Brutus's current ally in the following civil war. Lucilius says he was treated "With courtesy and with respect enough" but without the little touches of easy-going friendship he was used to when dealing with Cassius. Ever the analyzing intellectual, if not good at it, Brutus tells Lucilius that Lucilius has described "A hot friend cooling" — i.e., a close friend growing more distant (and that's all; Brutus was a puritanical republican Roman, not an aristocrat from the Empire who'd hump most anything mammalian and breathing). "When love begins to sicken and decay," Brutus continues, "It useth an enforced ceremony" (4.2).

            If Brutus's attitude here is a good indication, and it is, cool correctness wasn't much appreciated in Shakespeare's time, and Shakespeare makes plausible that even ancient, aristocratic, republican Romans would feel the same way. We Americans, strongly into friendliness, have a problem with not liking someone — which is a big problem since there is no reason you should feel one way or another about the vast majority of human beings; there are very few you will actually like, actually know and like as individuals.

            I'm suggesting that a little "enforced ceremony" can be a damn good thing: cool correctness to people we actively dislike but must deal with, a warmer courtesy to those whom we might potentially like and where we can move beyond an I-it relationship to something a bit more personal and humane: I-you.

            As a practical matter, I'd eliminate the friendliness gestures of asking people, "And how are you this morning?" when we don't give a rat's ass and would barely hear an answer like, say, "Depressed, but not quite suicidal" (a great line I heard from the son of a friend). A generalized wish of "Good morning" is fine for now, although it'd be nice to go to something like aloha, or shalom or as-salam alaykum or "Peace, you-all" or "Hi; I'm _______" and state your name. As a practical matter I'd have us admit that the potential for intimate I-thou relationships is crucial — but that it's just a potential. We can have honest I-it relationships with people — coolly correct with enemies or those we just don't take to — and behave more warmly neutral to most.


            I-it, I-you, and, at least on occasion I-and-thou. "Love one another" when you can; rest of the time, let's try be polite and mildly cordial — and let it go at that.