Doing his best in the space between life and death
Guy Micco encourages future physicians to contemplate their own mortality
| 08 December 2004
(Peg Skorpinski photo)
A clinical professor in the UC Berkeley– UCSF Joint Medical Program (JMP), Micco carries “a small flag” for the place of the humanities in medicine — and for attention to the universal human experience of suffering and death — wherever he treads. That is to say, into many settings on and off campus: he teaches JMP students (who take basic science and electives at Berkeley and get clinical practice at UCSF) and heads the School of Public Health’s Center on Aging and its Center for Medicine, the Humanities, and Law (CMHL). Until several years ago, he also maintained a thriving private practice in internal medicine and chaired the ethics committee at Alta Bates Medical Center.
‘The good doctor’
Micco says it was Albert Camus’ novel The Plague (which he read as an undergraduate at Loyola University) that first instilled in him the idealistic and “not very well- formed” desire to “fight off the absurdity of suffering in the world” by becoming a doctor. His interest in death per se dates back even further, to the late 1950s, when his grandfather died and the adults in his life “protected” him from full knowledge of what was going on. “I was seven or eight,” Micco recalls. “I thought people were laughing, but they were crying. I was kept out. It piqued my curiosity and wonder.”
He brings that early sensibility to his notion of “the good doctor” and thus to his sense of what future physicians need to learn in medical school. Day in and day out, doctors deal with suffering and death — “trying to alleviate suffering and to stave off premature death.” In light of that reality, Micco says, medical students need to learn biomedical skills like anatomy and diagnosis, but should also be encouraged to think deeply about their relationship to their own mortality. Self-knowledge of that sort, and the capacity to empathize with others’ suffering, can have “a profound impact, potentially, on how we care for people at the end of life, people who may be suffering immensely,” he believes.
Ironically for Micco, his own education as a UCSF med student in the early 1970s, like much of Western medical training, encouraged none of that. “You couldn’t find the word ‘death’ in the index of any medical textbook,” he recalls; the experience of suffering was never broached. “We talked about hearts and coronary arteries and their clogging, and of cancer, but unless you took some strange elective from a peripheral member of the faculty, you wouldn’t have known that suffering and death were medicine’s ultimate concerns.”
A ‘generous mindset’
Now it’s Micco who offers the “strange electives” — among them “The Course on Death”; humanities and medicine courses on aging and old age; a multidisciplinary course on suffering and its depiction (co-taught with post-doc art historian Beth Dungan); and an ongoing class, “Narrative in Medicine,” in which students discuss their personal writings as a way of self-understanding and perhaps of developing their capacity, as future doctors, to “hear fully the story that unfolds” between a sick person, family, physicians, and staff.
“As a teacher he has a charismatic quality that makes medical students want to be humane the way he’s humane, and want to understand patients the way he understands patients,” says history professor Tom Laqueur, CMHL co-director and a longtime friend of Micco’s. “He doesn’t have a particularly adept teaching technique, and God knows he can’t administer, but he draws people out in a way that’s really quite special.”
A former patient of Micco, Laqueur tells the story of the renowned ethicist Bernard Williams, who often went head to head with Micco, during the years he taught at Berkeley, over philosophical questions. “I can’t bear Micco and all his nonsense!” Williams was known to say of Micco’s belief in the capacity of the arts and humanities to “humanize.” But then Williams got sick, and none of the doctors at Oxford University, where he was then teaching, could diagnose his ailment. He asked to be seen by Micco — “who figured it out in 30 minutes,” Laqueur says. “He’s a brilliant diagnostician.”
Many who have had dealings with Micco speak of his generosity. Dungan refers to his being generous with his time, but also praises his “open mind” — saying that Micco is more inclined to “hear and learn from others” than to agree, disagree, or categorize. “He absolutely empowers and enables so many students to pursue their own direction. I’m a beneficiary of that in spades,” she says. “He enables students to pursue a more complicated path… and ultimately to contribute so much more. He’s a visionary in that way.”
After Art Practice Professor Katherine Sherwood had a cerebral hemorrhage in 1997, Micco reached out to her with suggestions on how she could interface professionally with various campus programs, including JMP, his own classes, and even the Life and Death Potluck Group. “Guy was instrumental in my recovery, in terms of my life in the university, she says. “It turns out he offered a blueprint for my future. He’s a terrific catalyst — getting together, for the sake of medicine, practitioners of diverse arts and scholarship that penetrate it.”
As he lay dying
There’s nothing like a personal encounter with “the great elephant of death,” as Micco calls it, to make one realize how “easy” it is to suddenly be a dying person. Three years ago, he came face to face with the elephant when he was diagnosed with a rare and often deadly cancer, acute myelogenous leukemia. “It’s in the realm of what I would call ‘big’ diseases. There was a good chance I would die from it, and I almost did,” he recalls.
(Cathy Cockrell photo)
“I would go so far as to say that people’s prayers and good wishes, putting out that kind of — I hate to say the word ‘energy,’” he winces — “had something, maybe everything, to do with my recovery.”
“When Guy got sick, it was like a saint being sick,” Laqueur recalls. “People queued at the door to see him; there were websites on his progress.”
Against the odds, Micco survived his leukemia and rebounded. Since that time, he has given up his medical practice and his work on the ethics committee in order to participate in several new initiatives: a palliative-care service for terminally ill patients at Alta Bates, a humanities concentration for medical students at UCSF, and a Berkeley program designed to expose JMP and other students to the “rigor and pleasure” of geriatrics through a longitudinal experience at local facilities for the elderly.
For these and all the rest of Micco’s activities, Laqueur views him as an “unsung hero of campus” — a faculty member whose contributions don’t lie in the realm of publication, scholarship, or administrative acumen, but who nonetheless has made an “enormous impact on students and the ethical environment. In another age he would have been a religious leader or one of these doctors who would have had a cultish following.”
In this age, however, in Micco’s more modest estimation, he’s one man doing his bit in the interval between birth and death. “Every so often, when medicine gets too biomedical, too heavy into the technological,” he says, “someone calls for a corrective: ‘we need to turn back to the human element, the doctor-patient relationship.’ That’s happening now around the country, and the humanities play a key role…. I feel I’m a small part of that movement.”
To learn more about the Center for Medicine, Humanities, and Law, e-mail Guy Micco at email@example.com.