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The Staff of Asclepius: A New Perspective on the Symbol of Medicine

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Note: this was originally published in the Wisconsin Medical Journal in 2008, which I authored as a medical student. Multiple other articles discuss the differences between the staff of Asclepius and the Caduceus, but that is not the purpose of this article. 

The staff of Asclepius (Aesculapius in Latin) has been associated with medicine since ancient times. Asclepius, a son of Apollo, was a practitioner of medicine and is 1 of 4 specific gods and goddesses to whom is sworn the original Hippocratic Oath. The other element of this symbol, the serpent, was seen by the Greeks as a symbol of healing and renewal due to the continual shedding of skin, and was often worshipped to protect one’s health. While the staff is not often associated with other conventions, the serpent also serves as a symbol in the Judeo-Christian tradition and the meaning is worth looking into as it relates to the health care profession.

Sacred writings shared by both Judaism and Christianity represent serpents not only as healers and saviors, but also as destroyers. The idea of the serpent as a destroyer originated in the Book of Genesis in the Old Testament, as the devil takes the form of the serpent to beguile the first humans, Adam and Eve, into partaking of the forbidden fruit, thereby ending their stay in the idyllic Garden of Eden. The duality of the serpent, however, is possibly best represented by an account in the Book of Numbers, also from the Old Testament. As many Israelites were dying from a plague of “fiery” poisonous serpents, their leader, the prophet Moses, prayed for help. He was instructed by the Lord to fashion a bronze serpent on a staff, for all of Israel to see. Once an Israelite had been bitten by a serpent, they would be made whole merely by looking upon this bronze serpent. Though some neglected the easy charge, many were saved. The serpent has since been associated as a symbol of the expected Messiah, who it was believed would come to save Israel from spiritual and temporal destruction.

The application of this duality to medicine is unfortunately altogether too real. The majority of doctors, if not all, have seen, either as patient or health care professional, both the “destroyer” and “savior” in medicine. The destroyer often shows itself in a negative health care professional who damages hope in the patient. Sad experience shows us that this characteristic is present in all health care professionals at least some of the time. Often, physicians may not even realize that they are being cold to a patient because they are accustomed to the esteemed position they have held for years. It can be easy to forget what it is like to be a patient, to not know or understand what is wrong with your body, to not know where current or potential problems will lead you in the future, to fear that your simple symptoms hide something more serious than the more likely and lesser diagnosis, to worry about payment for services or prescriptions rendered. The prestige and regard of the profession should not lead to high-minded behavior by its professionals, but this is often the origin of the presence of the destroyer. Unfortunately, the long, difficult years of training distance us from our patients, not just in medical proficiency, but also sometimes in emotion and understanding. In order to be the savior we are trained to be, we do not necessarily need to build up hope in the patient, but simply to build up the patient by showing genuine compassion and concern. Not only is showing this empathy for the patient’s condition the right thing to do, but it can in fact improve their health. It is often said that medicine is an art in addition to a science. The mastering of the proper interaction with patients in order to provide the best care possible is the art of which is spoken, and should be further emphasized by everyone in the profession.

An example from my own life seems to perfectly underscore this duality of the medical serpent and its effect on the well-being of patients. As a 16-year old young man, my mother was diagnosed with breast cancer. The diagnosis of cancer, no matter how positive the prognosis, carries with it severe anxiety and fear for any patient, and these feelings were no different for my mother or our family. My mother came into contact with many physicians who were at least partially involved in her care. And some of these physicians were inconsiderate and unfeeling toward her condition. It is certainly understandable from the physician’s perspective to experience this apathy when very similar conditions are seen every day, in numerous patients. However, this is no excuse. In attitudes and behavior, the destroyer aspect of the serpent was on display. The physicians’ negativity was infectious, causing my mother to become more fearful, more anxious, and lose some hope for a normal life, even though the cancer was identified early and she was expected to respond well to treatment. Fortunately, my mother also experienced the other aspect of the serpent, the physicians who were saviors to her hope, outlook, and understanding of her diagnosis, and all that went with it. When these physicians took the time to talk with her and to understand what she was experiencing, the light was back in her eyes and she was able to find the inner strength to deal with her illness. One surgeon in particular showed genuine excitement and support as he ran up numerous flights of stairs in the hospital with a broad smile to report to her that the cancer had not spread to her lymph nodes. Her cancer has been in remission now for many years, and she has been able to serve as a savior to others going through the experience as a volunteer at the cancer clinic where she was treated. Looking at the situation from her perspective, and the positive and negative effect that a physician can have, I decided to become a physician myself. I hope to act as a savior for my patients, in body and spirit, instead of the destroyer.

The symbol of medicine, the staff of Asclepius, is one that has represented healing and renewal for millennia. However, as evident in the Judeo-Christian tradition, it often represents a destroyer in addition to a savior. This is evident every day in medicine, as the physician can act as either emotional and psychological destroyer or savior for their patients. As we become more aware of how the little things—a look, tone of voice, and certainly our actions—can affect our patients, we will come to represent the intended meaning of the serpent, healing and renewal, in body and spirit, and the destroyer will remain a symbol from civilizations past.

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Bridging the Patient-Physician Gap

A few months ago I wrote about the difference between the way patients and physicians approach medical issues. To summarize, physicians are taught to think as a scientist, looking at population-based studies of multiple individuals and applying it to the patient in front of them. The typical individual thinks about things the opposite way, from anecdotal stories that we then apply to ourselves and the broader population. This way of thinking is based in basic human nature, and it is how we innately perceive the world. Not only is this difference in thinking important to understand as physicians and patients interact with one another, it may provide the key to bridging the gap between patient and physicians.

Though the patient-physician relationship is ideally based on trust, many interactions these days are based in suspicion between the two. There is a ubiquitous fear among physicians of malpractice suits, causing not only defensive medicine, but affecting the interactions with patients; we’re simply scared of many patients some of the time. This will sometimes lead to the ordering of whatever the patient may want, though much of it is not medically warranted. This not only increases costs, but also decreases the quality of care provided and often leads to dangerous and unneeded procedures, all in the name of patient satisfaction and lawsuit avoidance. Many payment systems are putting increased emphasis on this patient satisfaction, which while it is an important component of patient care, also has the unintended consequence of driving further uneasiness between physicians and patients; physicians are essentially being asked to go against established medical guidelines.

Physicians and patients don’t seem to recognize this difference in thinking as a basis for discrepancies in thought. When a mole that looked pretty normal on your neighbor ended up being melanoma, it’s natural for us to think that our moles, therefore, could represent serious disease. Physicians will oftentimes mock patients behind their backs for this reasoning, though this is nothing more than how our human minds have evolved to perceive our world. A physician looking at this benign appearing mole will likely recommend monitoring, but if the patient is persistent in their desire for removal, they will search around until they find a doctor who will do it. That typically means that us as physicians will lose a patient and fear negative comments online, or a lawsuit at the worst. Patients may interpret the physicians “lack of concern” as evidence of the medical system “not listening” to them, or not taking their concerns seriously. Based on the very low odds of the mole being malignant, it would be difficult for a physician to justify to themselves, the patient, and even sometimes to payers, the reasoning for biopsy/removal.

What physicians perceive as “inappropriate” requests from patients is almost always based in the misunderstanding of these disparate paradigms; what patients often perceive as negligence or lack of concern is almost always based in this same misperception . The solution is communication, which takes time. Patients and physicians don’t have much time. And yet this can save time later on and is very important to the trusting relationship that should pervade our medical experiences. So push your physician for an explanation of their thinking. Push your patients to explain why they have their particular concerns. Understanding that physicians think from the population down and that patients think from the individual up may actually be the biggest patient satisfaction, quality, and tort reform improvements we can have. This would nearly eliminate the fear that currently pervades many encounters today.

 

 

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Baseball and Civil Rights

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Last week on Wednesday April 15th was Jackie Robinson day, celebrating the 68th anniversary of the first modern day African-American to play in Major League Baseball (MLB) (there had been a small number of others prior to the current MLB professional system). Like most of us baseball fans, I love seeing all players wearing #42 in his honor, this being the only number retired by MLB as a whole but allowed to be worn on this one day a year. Jimmy Rollins, shortstop for the Los Angeles Dodgers, recently wrote about what a thrill it would be to wear that number while playing for Jackie’s Dodgers, an experience he has for the first time this year (log in likely needed for article).

Jackie Robinson has been my hero since I was in elementary school, either the 4th or 5th grade. I read Stealing Home: The Story of Jackie Robinson, a Scholastic Biography by Barry Denenberg aimed at kids my age. I don’t remember how I came upon it, though being a big baseball fan it wouldn’t have been hard for me to pick it up seeing it at the library or book store. The first thing that really caught my imagination was that thought of stealing home, such a lost art of the game in the early ‘90s (and on through today), having seen that iconic picture of him hook sliding into home against Johnny Pramesa in 1952, his hat flying off and his teammate watching on, filling me with immense excitement.

But as for so many of us, Jackie’s story has inspired me immeasurably. Having to be yelled at, taunted, sworn at, thrown at, spat at, ridiculed, hated, spiked, received multiple death threats to him and his family while being completely alone in this endeavor and not being able to give into his natural instincts of fighting back or responding brings me to tears whenever I think about it. I love him for his courage, for working towards something that was bigger than him (or baseball), for being willing to go through all of that. He was truly amazing.

These experiences were shared by many more than just Jackie, both in baseball and outside. But generations of African-American struggle were personified and epitomized in him. He obviously prepared and foreshadowed the remaining civil rights movement in this country, providing more liberty and opportunity for the descendants of those who were physically enslaved by allowing other courageous men and women to free themselves and all minorities from societal enslavement. It all could have blown up if he had behaved differently.

The thing that really sold this was that Jackie could play; if he couldn’t, none of the other stuff would have mattered. He has also been credited with starting a revolution in how the game is played. Those from the Negro Leagues who came to MLB after him furthered this free-styling, risk-taking, hard-running, slap-and-dash method of play, what would commonly be referred to today as small-ball. Buck O’Neill, the late great spokesman and advocate for greater knowledge about and appreciation for the Negro Leagues, describes it as something close to jazz. Many, myself included, would call this a much funner way to play and watch baseball. “There was a lot wrong with the world, but we weren’t sad, man. We had the time of our lives,” said Buck O’Neill about those days.

I have also had much more interest in the Negro Leagues in recent months. Part of it is because of my love for Jackie, part of it is because I travel to Kansas City a few times a year and get to visit the Negro Leagues Museum, part of it is because if you’ve ever listened to Buck O’Neill how can you NOT love the Negro Leagues! It’s characters, it’s history, it’s BASEBALL is full of wonder and excitement. Its “separate but equal” place in baseball history should not be forgotten nor neglected. “We overcame, see. That’s the lesson of the Negro Leagues,” said Buck O’Neill on another occasion.

Both Jackie and the Negro Leagues led to not only more African-American players, but also many Latino players, who have left their own indelible mark on baseball. Roberto Clemente, who had the 60th anniversary of his first game played on April 17th and a huge pioneer in his own right for the racism he faced and overcame, chose number 21 because he hoped he could be “half the man” that Jackie Robinson (#42) was. Robinson Cano, by far the best 2nd baseman in MLB today, was named after Jackie because that is who his father’s hero was. Many other Latino ballplayers now participate in what we greedily refer to as “our” national pastime, and do so with many similar challenges, though to a far lesser extent, than what Jackie experienced.

But the best way that civil rights and baseball intersect is an experience Joe Posnanski had with Buck O’Neill while writing a book about Buck near the end of his life. Buck had just spoken at a press conference in Washington, D.C. to request national designation to the Negro Leagues Baseball Museum in Kansas City. Buck needed to take a break in a backroom after speaking. Here is an excerpt from The Soul of Baseball (one of my favorite books, and definitely one of the best baseball books ever written):

“’Hold on for a second, hold on,’ Buck said, and he pointed at a television nearby. ‘You know something funny? Look at that television. You know, if the Willie Mays catch was on right now—the one from the World Series—everyone would stop and watch it.’

“Everybody around stopped and listened to Buck. He was talking about the catch Mays made at the Polo Grounds in the 1954 World Series, the one where he turned his back and raced toward the wall on a long ball hit by Vic Wertz. Mays ran full speed to a spot and somehow caught the ball over his head without even looking back. His hat flew off. And then, in one motion, Mays whirled and threw the ball back to the infield. Jack Brickhouse, the announcer, screamed that it must have looked like an optical illusion to a lot of people. More than fifty years later, most people would say it was the greatest catch ever made.

“’How many times have we all seen that catch?’ Buck asked. ‘And yet, if Willie Mays was up there on the television, this whole place would come to a stop.’

“’If Willie was up there, people would stop making laws. They would stop running. They would stop arguing about little things. Or big things. No Democrat or Republican, no black and white, no North or South. Everyone would just stop, watch the TV, watch Willie Mays make that catch. That’s baseball, man.’”

That’s what baseball means to civil rights. Jackie sliding into home against Yogi Berra—the wonder of baseball and nothing else—still represents that to me.