I have admired this surgeon and physician as one who exemplified the honorable traits of a true healer: one who try to heals not only physically but spiritually. This is the true mark of care giving as I described in my book The Healers.
In his theory of transcendental humanism, the Eighteenth-Century German philosopher, Emmanuel Kant (1724-1804), believed that the human subject is at once, together with all of creation, a part of nature, subject to its laws, but on the other hand, an autonomous, rational being who, through his elaborate cognition and curiosity, is one who transcends nature, incompletely bound to its laws and, in fact, on occasion the author of those laws. In many respects, then, humans have agency independent of any divine influence. One must respect that autonomy – both physical and spiritual – in the search for truth and knowledge.
A fascination, then, with human autonomy began to replace the metaphysical ideology of medieval medicine
The end objective of humanism is the controllable, engineered welfare of human beings instead of unassailable and, sometimes, seemingly whimsical supernatural directives. The individual person then is all important, their needs, their wants, and their interactions with society as a whole – irrespective of divine influence.
In fact, humanism appealed to the healing arts. No longer might abstractions be necessary to explain the complex physiology and pathology of human nature. Scientists had begun to lean heavily towards technology and seemed more occupied with the machinery than the mystical.
And there was no better demonstration of man’s ability to heal than the sudden, dramatic reversal of fortunes many surgical procedures could produce. Such technical finesse delivered a cult of pragmatism.
At the turn of the Twentieth century, surgeon William Halsted of Baltimore led the charge in his devotion to research and his own dexterity. His rugged, matter-of-fact experimentalist character assumed the mantle of healer in a more profound manner than any other physician. For him, the handiwork of the surgeon must be perfected before all else. Everything paled to the dexterity of the operator.
And his philosophy abounded. His trainees were of like mind, that surgery was a skill akin to celibacy in all else. Total devotion to the profession and to the patient.
Yet, despite their often-perceived callousness, surgeons, more than any other practitioner, fostered an unavoidable and unique intimacy with their patients. They touched and explored and massaged the most precarious and cherished of bodily anatomy: brain, heart, liver, gut – those organs the ancients considered the core of humanness, the essence of life. Art historian Suzanne Biernoff had written “The history of surgery . . . is partly a history of touch: technologically extended and transformed by the invention and refinement of surgical instruments.
But the perception of surgery was that of the brutal art. Only occasionally would one hear a more sensitive message, as that put forth by Halsted trainee Harvey Cushing.
“Three fifths of the practice of medicine depends on common sense, a knowledge of people and of human reactions . . . [medicine] is an art and can never approach being a science.”
So, in the midst of this exponential growth of technology and pragmatism, surgery needed a more humanist side. It needed a William Osler.
Edward Delos Churchill (1895-1972) rose to the occasion.
The mild-mannered Edward Churchill grew up in Chenoa, Illinois. His grandparents had settled there in 1805, probably some of the earliest settlers to do so. They were typical of the westward movement, first homesteading in Connecticut and Maine in the 1640s before moving to Illinois. The family business was in grain, haltingly successful but so much toil that Churchill’s parents encouraged their offspring to move elsewhere. That the youngest son, Edward, did by entering the small Methodist college of Northwestern University in Evanston, Illinois. Majoring in biology, Churchill spent an extra year at Northwestern earning his Master’s degree before entering Harvard Medical School in 1917. Because of his academic brilliance, Churchill was accepted as a house officer on the West Surgical Service of the Massachusetts General Hospital his senior year in medical school, a notably prestigious appointment. He would spend two years as House Officer (“House Pupil” was the local term used) and two years as House Surgeon (or “Resident Surgeon”).
Churchill was not an imposing figure. His manner was far from that. He exuded gentlemanly reserve and thoughtfulness, but not intimidation. A man of medium build, trim, more endomorph than mesomorph, Churchill was orderly in his appearance but not fastidious – one who did not necessarily stand out in group photographs. He featured a kindly face more fatherly than scholar, more inclined to smile than frown, more listener than talker. Polite at first encounter, Churchill seemed almost shy as he engaged. He would lower his head just slightly when conversing as if to catch every syllable spoken, like a shortstop anticipating a sacrifice grounder. Yet, he seemed to read people between their utterances as if words were mere interference to distract from inner ruminations. By dodging them like so many darts, he could figure the true measure of a man. Churchill was not content to accept the apparent, rather he was more inclined to gently crack the surface and peer inside. It seemed intuitive to him that fearful solitude was inherent in any person, and often was the true driver of curious and disparate behavior.
He was a fan of Rudyard Kipling, who was an unabashed admirer of surgeons. In a eulogy for his beloved colleague, Richard Harwood Sweet, in 1962, Churchill quoted Kipling on the life of surgeons. Kipling had said, “And, meanwhile, their days were filled, as yours are filled, with the piteous procession of men and women begging them, as men and women beg of you daily, for leave to be allowed to live a little longer, upon whatever terms.” That would not take dexterity. That would take sensitivity, empathy, and passion. For Churchill, healing was not just a matter of the reunion of damaged tissue and restoration of integrity. Healing encompassed a deeper commitment to massaging bruised emotions, bestowing hope, and taking a measure of suffering onto themselves by words or touch that might momentarily lighten the burden of illness for their patients.
At a deeper level, Churchill’s humanism touched on the supernatural. He was of the belief that medicine and religion were inexorably entwined. However, science had produced a rift in this alliance. This division of responsibility “left the soul and the nurture of man’s spiritual life to religion and defined the mind and the body as the province of medicine,” he said. Yet, Churchill knew – as many physicians did – that “effective therapy is as often as not based on and dependent on the interpersonal relations of doctor and patient.” It is the doctor who must tend to the spiritual as well as the corporal. There can rarely be a clean distinction. Churchill’s mannerisms put patients at ease, so adept was he in recognizing the worried anxieties of the seriously ill. Friend and fellow surgeon Michael De Bakey wrote him in 1951 about a personal referral, “I am certainly grateful to you for your considerable attention to Mrs. T-. I realized that she presented a tough psychological problem . . . and I was confident that you were best able to cope with it.” To communicate with human beings under the powerful emotional stress of illness “is no easy matter and not infrequently requires the heart as well as the head”, Churchill had said.
As a man of faith, he felt that “[t]he image of the healer was ever a constituent of man’s religious matrix. Small wonder that man is now seeking out the physician for symptoms that arise in frustrations, loneliness, and uncertainty.”
In Churchill’s day, learning surgery was more of an apprentice model than true education. Referring to his time in training, “[t]hey [the attending surgeons] had been conditioned as apprentices to the standards of the generation that preceded them,” It took, then, an extremely bright and motivated individual to thrive in that environment – basically, to self-teach and glean what he could from a preoccupied attending staff. Churchill was a standout. His quiet, calm composure and self-effacing personality charmed quickly. In fact, he was so well thought of that, when there was talk of him leaving for the University of Pennsylvania, Dean Linn Edsall of Harvard Medical School offered Churchill the Mosely Traveling Fellowship as an enticement to stay in Boston and join the Harvard faculty. Churchill accepted and eagerly prepared for his year abroad (1926-1927). He called It his Wanderjahr, a “wandering-year” and later wrote about it. It was a whirlwind tour through the big academic centers of London, Berlin, Prague, Munich, Zurich, and Heidelberg. Besides, there had been a quick resurgence of German surgical ingenuity following World War I, and they were eager to demonstrate it.
While diligent clinicians and impeccable operators, Churchill felt the Germans treated their subjects merely as clinical material. Few words of comfort emanated from the mouths of professors. Their speech was clipped, technical, their subject catatonic in silent terror.
Not more than a year after his return from Europe the 35-year-old surgeon was named the John Homans (IV) Professor of Surgery and Chief of Surgery at the Massachusetts General Hospital, a remarkable achievement for one so young and relatively inexperienced.
His philosophy seemed in tune with that of the distinguished line of Homans physicians of Boston. John Homans III, the honoree of that professorship had said almost a century before:
“Unless [the physician’s] mind be cultivated and imbued with the spirit of religion, he cannot resist the tendencies of his profession to make his heart callous and insensible.”
A devotee to reformation of surgical training so that all chosen candidates received full instruction in the skills and art of surgery, Churchill made the humorous analogy that “[h]alf a surgical training is about as useful as half a billiard ball”
Even deeper than the mechanistic training of surgical skills, Churchill, the humanist, knew there were aspects of practice that were distinctly unscientific and pertained to the sensitive, compassionate side of surgical dealings. The human constitution was no mere machine. The underlying spirit – however it might be thought of – permeated all aspects of vitality. Whether one supposed it was of divine origin or a mere result of hopelessly complex neural networks, intellect and emotions in some inexplicable way gave impetus to life and were inseparable from the blood-red organs that sustained them. What impacted the body, impacted the spirit.
“How much greater the satisfaction of him who practices scientific medicine, tinctured with a love for the suffering humanity placed in his care”, he wrote in 1949.[2] To address this complexity, Churchill’s idea of the surgeon was a blending of both technical wizardry and empathetic support. Surgeons could not be emotionally illiterate. He urged a blend of scholarship and spirituality. He often quoted the legendary chemist and historian, George Sarton (1884-1956) who contended that
Many men of science, even among the most distinguished ones – the very ones who are called the greatest authorities on this or that – are so uncultured, so ignorant outside of their specialty, so lopsided, that their claims of leadership are preposterous.[3]
Churchill aspired to nothing of the sort. So different from the callous cutters of a century ago he preached a different philosophy, one of charitable proficiency. Charity, the “compelling force of Humanism”, he orated, “is the most precious possession of Medicine”. In fact, to those so enraptured with the rigidity of German science, he admonished, “[m]edicine is too close to the needs of humanity, and is too loyal a friend of mankind in times of fear and trouble, to cast aside abruptly its heritage of Christian ethics for what has been called the ‘moral irresponsibility’ of Science”.
The transformation of postgraduate surgical training would be Edward Churchill’s most enduring legacy. Indeed, he was the consummate surgeon: grounded in the sciences but aware of the unique privilege to shape not only the human body but the human soul – both in his students and his patients. It was imperative, he believed, that each generation pass on those indispensable building blocks upon which the profession ascends. Before the American Surgical Association in 1947, he echoed the Oath of Hippocrates when he said: “I will impart this Art by precept, by lecture, and by every mode of teaching”. As he pointed out in his new design for surgical training, the art was more than a career of manual dexterity.
He had written, “[Surgery] transcends Technology in the desire and responsibility to find safe application of these techniques to the needs of humanity”, he wrote. His “Content of Surgery” encompassed not only “hand work” but humanism, science, and empiricism. He had said, “The surgeon worthy of the name combines in liberal measure the love of humanity, science, and craft.”[4]
Yes, now the surgeon now must be more than a mere scientist. They now had the capability to radically alter life’s quality and quantity. With such an impact on the physical, Churchill realized, surgeons had the power to manipulate the spiritual as well. Surgeons must bridge the gap between the dispassion of science and the virtue of medicine. It was his guiding principle that doctors “must tend to the spiritual as well as the corporal.” He knew full well that “illness is an emotional event that demands value-judgment, and that in the face of suffering and death, logic and rational thinking are quite regularly tossed out of the window.”[5]
With retirement, Churchill spent his time at the family farm in Vermont, tending his trees and blending into the local community, much as he had tended his patients and trainees. It was consistent with his perceived role as caretaker of the world within his grasp. On an August afternoon in 1972 he went for his customary walk through the hills of his farm. In a fashion entirely consistent with his modest and humble character, Edward Churchill collapsed somewhere in that countryside, alone and without fanfare. When he did not return, his wife searched and found him some time later.
A contemporary across town in Boston, Francis Daniel Moore, wrote in his tribute to Churchill in 1973: “We can also imagine his own enjoyment on those last walks in the hills turning over in his mind the happy times . . . [that] saw him change the face of surgery throughout the world.”[6]
Churchill was a man for the ages. A student of history, he interpreted his contributions as one of many in a line of healers extending from ancient Greece and before into an unfolding future. While insisting on a scientific foundation to medicine, he felt an irresistible bond with antiquity and with humanity. His guiding principle of charity was never far from his lips. As he spoke before the American Surgical Association in 1947, never forget the compelling drive of medicine to relieve suffering, to heal within and without, to use science not as an end in itself but as a tool to accomplish those most holy of endeavors – the complete healing of human beings.
References
[1] Allison, H.E. “Kant’s Transcendental Humanism” The Monist 55 (1971): 182-207
[2] Campbell, Eldridge: 1946-1957 corres, 1946-1957. Edward Delos Churchill papers, H MS c62, Box: 3, Folder: 1. Center for the History of Medicine (Francis A. Countway Library of Medicine, Boston MA)
[3] Sarton, The History of Science, 126
[4] Corres and r.m. re speeches, addresses, lectures, 1938, 1938. Edward Delos Churchill papers, H MS c62, Box: 59, Folder: 18. Center for the History of Medicine (Francis A. Countway Library of Medicine, Boston MA)
[5] Edward D. Churchill, The Surgeon and the University: Centennial Lecture in Surgery, Queen’s University, Kingston, Ont., 15 Oct 1954, 15 Oct 1954. Edward Delos Churchill papers, H MS c62, Box: 60, Folder: 46-48. Center for the History of Medicine (Francis A. Countway Library of Medicine, Boston MA)
[6] Moore, Francis D. “Edward Delos Churchill 1895-1972” Ann Surg 177 (1973): 507-508, quote 508