Classical Quotes for Critical Care

Suriyakanthi Amarasekara had recently been invited as the Chief Guest to make a presentation to the Clinical Society of Sri Jayawardenepura Hospital. What follows is a gist of her talk. 

When I received the gracious invitation to be the chief guest at the Scientific Sessions of the Clinical Society, I had to choose a topic of my address. After much thought I decided that rather than talk to you on a ponderous scientific theme, I would share with you some of my collection of quotes concerning life and critical care. I may add that from my early teens I got into the habit of jotting down anything that touched my heart so what is presented to you in the next few minutes is picked from a collection that has taken me almost a half century to compile.

All of us present here are engaged in working. So I would like to start with a quote by Khaleel Gibran from his masterpiece “The Prophet”

“A plough man said speak to us of work.

And he answered saying

You work that you may keep pace with the earth and the soul of the earth

For to be idle is to become a stranger unto the seasons,

And to step out of life’s procession that marches in majesty and proud submission towards the infinite

When you work you are a flute through whose heart the whispering of the hours turn to music.

Which of you would be a reed dumb and silent, when all else sings together in unison ?

You have been told that life is darkness.

And in your weariness you echo what was said by the lonely.

And I say that life is indeed darkness save when there is an urge,

And all urge is blind save when there is knowledge,

And all knowledge is vain save when there is work,

And all work is empty save when there is love.

And when you work with love, you bind yourself to yourself,

And to one another and to God

I firmly believe that no one working in critical care of for that matter caring for the sick in any location can be truly successful and happy unless he has a special care and concern for the welfare of his patients. We need to treat or patients with compassion and we need to work with love.

I think that St Paul’s epistle to the Corinthians captures the type of love we should have when he wrote:

“though I speak with the tongues of men and angels, and have not love, I am becoming as a resounding gong, or a clanging cymbal.

And though I bestow all my goods to feed the poor, and though I give my body to be burned, and have no love I am nothing.

Love is patient, love is kind.

Love does not envy and does not boast

Love is not proud, it is not rude it is not self seeking

Love is not easily angered, it keeps no records wrong

Love does not delight in evil but rejoices with the truth

Love always protects, always trusts, always hopes and always preserves

Love never fails”

I remember being told many years ago, to replace the word love with “I” .

So to paraphrase

I am patient,  I am kind.

I do not envy and do not boast

I am not proud, I am not rude I am not self seeking

I am not easily angered, I keep no records wrong

I do not delight in evil but rejoice with the truth

This shows us how far short we fall from the expected ideal

Every patient is important, and every encounter with that patient and his family is important. Things that we may sometimes consider trivial, and therefore overlook, may have tremendous significance, especially in view of the complexity of multiple medical problems that we are faced with.

As John Donne said,

“No man is an island entire of itself,

Every man is a piece of the continent, a part of the main…..

Any man’s death diminishes me because I am involved with mankind

and therefore never send to know for whom the bell tolls,

it tolls for thee”.

Very few people work harder than ICU personnel, but not infrequently, it does not really seem to change things. All our skill, wisdom and efforts may seem to be of no avail, not only with patient care, but also academically.

“I returned and saw under the sun

That the race is not to the swift

Nor the battle to the strong

Neither yet bread to the wise

Nor yet riches to men of understanding

Nor yet favour to men of skill

But time and chance happens to them all”

Ecclesiastics 9 : 11 – 12

Sometimes we feel so let down and disappointed by the circumstances we are faced with, that we wish we could transform the situation and remake the world

“Ah love could you and I with fate conspire

To grasp this story scheme of things entire

Would we not shatter it to bits and then

Remold it nearer the Hearts Desire”.

The Rubaiyat of Omar Khayyam Stanza 99

Often our efforts seem futile and there seems to be nothing we can do about what is happening around us

“the moving finger writes and having writ

Moves on: not all your piety or wit

Shall lure it back to cancel half a line

Nor all your tears wash out a word of it”

The Rubaiyat of Omar Khayyam Stanza 71

But we should not be discouraged. In life, in medicine there are few “quick fix” situations. But eventually the impact of our efforts begin to show.

‘The smallest effort is not lost

Each wavelet on the ocean tossed

Aids in the ebb tide or the flow

Each raindrop makes some flower glow

Each struggle lessens human woe’      Charles Mac Kay

For an ICU or that matter any Unit or Ward to function optimally, everyone on the team has to do his job well no matter how menial or small the task is.

“We can’t all be captains, we’ve got to be crew

There’s something for all of us here

There’s big work to do, and there’s lesser to do,

And the task you must do is near

If you can’t be a pine on the top of a hill

Be a scrub in the valley – but be

Be the neat little scrub by the side of the rill

Be a bush if you can’ t be a tree

If you can’t be a highway then just be a trail

If you can’t be the sun be a star

It isn’t by the size that you win or fail

Be the best of whatever you are!”

Douglas Malloch

We must also recognize that we can never stop trying to learn. Acquiring medical knowledge is like rowing up stream against a strong current. You have to work very hard to make any headway at all, but if you slacken your efforts you are rapidly swept down stream. I recall that I never felt confident about my medical knowledge as I did when I was a 3^rd year Medical Student

“A little learning is a dangerous thing

Drink deep, or taste not the Pierian spring

There shallow draughts intoxicated the brain

And drinking largely sobers us again”

And

Be not the first by whom the new are tried

Nor yet the last to lay old aside

An essay on Criticism Alexander Pope

A sense of humour is something that we need to cultivate if we are to keep our sanity in this stressful world of ours.

If you see the funny side, you’ll stroll along the sunny side

While other folks are walking in the shade

Things will never harass you, embitter or embarrass you

A sense of humour is the finest aid

To wisdom and philosophy, in trouble and adversity

It brings you smiling through the stress and strife

So cultivate the power to see, the little touch of comedy

Behind the trials and tragedies of life

We often do not appreciate the role played by the nurses in the care of critically ill patients. The 3^rd stanza of William Wordsworth’s poem “She was a phantom of delight” captures the description of a perfect ICU nurse

“Endurance, foresight, strength and skill

A perfect woman, nobly planned

To warm to comfort and command

And yet a spirit still and bright

With something of angelic light”

And again

Oh woman in our hour of ease,

Uncertain, coy and hard to please

Uncertain as the shade

By the quivering aspen made

But when pain and anguish wring the brow,

A ministering angel thou”

I recall an incident when I was about 14 years old, I was running a very high temperature and having a blistering headache. My mother gently placed a cloth soaked in iced Eu de cologne on my forehead. It felt so soothing that I caught her hand and quote the above poem to her. My mother’s response was to pop a thermometer in my mouth – she thought I was delirious!

Eventually no matter how hard we work we need to go to a very special place we call home. At home at the end of the day we may finally be able to relax with some peace and quiet

Longfellow captures a sense of that relaxation that might come at the end of the day in his poem The day is done

“The day is done and the darkness

Falls from the wings of night

As a feather is wafted downward

From an eagle in his flight

And the night shall be filled with music

And the cares that infest the day

Shall fold their tents like Arabs

And as silently steal away”

As we are just  a little over 2 weeks away from the dawn of the New Year, some of you may be thinking of making new year resolutions. So I thought I would share with you a poem I wrote for the SLMA Newsletter in January 2006:

FOR THIS NEW YEAR

This I would like to be, braver and bolder, just a bit wiser, because I am older

Just a bit kinder to those I may meet, just a bit braver taking defeat

This for the New Year, my wish and my plea,

May this New Year make a good doctor of me

This I would like to be, just a bit finer, more of a smiler and less of a whiner

Just a bit quicker to stretch out my hand, helping another, who’s struggling to stand

This is my wish for the New Year to be

May this New Year make a good doctor of me

This I would like to be, just a bit truer, less of a wisher and more of the doer

Caring, compassionate, more willing to give, living and helping me patients to live

This for the New Year, my wish and my plea,

May this New Year make a good doctor of me

Finally I would like to end with the words of Henry Wadsworth Longfellow from A Psalm of Life

“Lives of great men all remind us

We can make our lives sublime

And departing leave behind us

Footprints on the sands of time

Footprint that perhaps another

Sailing o’er life’s solemn main

A forlorn and a shipwrecked brother

Seeing, shall take heart again

Let us then be up and doing

With a heart for any fate

Still achieving, still pursuing

Learn to labour and to wait”

Ladies and Gentleman I thank you for your attention.