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Medical Humanities

The Spectacle of Suffering

Benjamin W. Frush, MD, MBA
Published June 7, 2020

“Anything else we can do for you today Justin?” the pediatric intern asked as she placed her stethoscope back in her white coat pocket.  Justin was a thirteen-year-old with sickle cell disease in the midst of an intense pain crisis for which our pediatrics team was treating him, and to this point not very successfully.  As the patient remained in his characteristic brooding silence to which we were now accustomed, I glanced up and was surprised to find his dark, sunken eyes fixed on me, eyes accentuating an ashen face of despair and anger.  In the midst of this stolid silence, Justin’s countenance bespoke a clear and incisive question: “What are you doing here? What right have you to witness my pain?”  

It was a good question and one I had asked myself frequently after my third year of medical school began.  To the best of my knowledge, I was simply there for my educational development.  My ticket to the audience of Justin’s suffering consisted of my MCAT score and undergraduate extracurriculars, and then an ability to pass preclinical medical school exams.  Important prerequisites to be sure, but none of which taught me how to be an idle witness to the plight of a suffering child brought into such stark relief at this instant.  After what felt like an eternity, the team mercifully moved toward the door, and I scurried after them, determined to escape the searing discomfort of Justin’s wordless question. 


“Can pain be a spectacle?” The philosopher-historian Michel Foucault famously posed this question in his account of the advent and development of the contemporary medical system entitled The Birth of the Clinic.  If we take the time to listen, Foucault’s question reverberates more than fifty years later for the contemporary medical student, whose education often consists of observing the suffering of others.  For the student, the term “spectacle” is especially apt, as we frequently merely witness, instead of offer treatments or recourse for improvement.  

In my experience as a student, this uncomfortable voyeurism is felt especially keenly when dealing with the pediatric population.  Adult patients possess the faculties and confidence to voice their displeasure with unwanted team members in the room, and will make their wishes known clearly; to some degree they are able to dictate the audience of their suffering.  However, pediatric patients frequently display a deference or shyness which precludes this opportunity, broadening the spectacle of their pain.

Additionally, the rawness of this suffering is both more overt and more difficult to deny in pediatric patients.  In pediatrics, gone is the comfortable (if not problematic) rationalizing recourse of convincing ourselves as practitioners that the suffering adult patient “did this to himself.” Sick children do not afford us this dubious luxury, as it is much harder to pin any so-called “personal responsibility” on this vulnerable population.

While medical students are keenly aware of this “spectator to suffering” role in dealing with children, we are not the only ones.  I suspect this same “spectator” phenomenon creeps into the minds of residents and attending pediatricians when dealing with their patients.  Even if those writing orders or performing procedures are more active in care, quite frequently they encounter children for whom these tireless efforts prove futile.  Indeed, it’s likely that the fecklessness and futility that medical students feel in observing suffering children is amplified in those who work furiously to relieve such suffering to no avail.  

How we are to proceed with care when unable to offer intervention (as a medical student) or our interventions prove ineffective (as a doctor) seems to me to be one of the central questions facing medical trainees today.  In a medical culture which trains us to construe patients as lists of problems, the only evident response seems to be some form of efficient management; this is an example of our proclivity to name constraining our possible solutions. Problems, after all, are meant to be solved, not endured, as the existential state of suffering all too often seems to entail.  

Perhaps then, rather than viewing ourselves as problem-solvers, as interventionists, identities which fail us when the suffering we encounter does not avail itself of ready solutions, we might consider one role that would afford a more fitting response: that of friend. 

When we encounter a suffering friend, we are moved to comfort, not to merely observe.  Such a response does not claim to solve problems, for a good friend recognizes that her commitment to being with supersedes any interventionist approach of doing to.  A good friend serves as a witness rather than mere spectator;  she offers a coming-alongside rather than a staunch distance-keeping.

We in medicine today are warned constantly of the importance of boundaries for patients we serve, and to be sure these must be maintained to protect patients’ dignity in the midst of moments of immense vulnerability.  But the friendship I am referring to has to do more with a way of seeing than one’s actions.  It refers to the ability to recognize the central parts of our humanity that we share with those whom we care for, rejoicing when we see those parts flourish and mourning when we see those parts threatened.  This way of seeing also involves being seen, namely allowing ourselves to be visibly moved by those for whom we care without shame or fear.  This engenders an unmistakable trust that patients place in the residents and attending physicians I have seen cultivate and exhibit this habit. 

I wish that I had taken the time or opportunity to cultivate such a friendship with Justin, but I fear I was more intent to observe than to witness.  My pediatrics rotation ended shortly thereafter and I did not see him again after that moment; or if I did I do not recall.  But I am eternally grateful for what he taught me that day, that we must learn to be friends even when we cannot be fixers; to offer care even when we cannot cure.

Editor's Commentary

Benjamin W. Frush, MD, MA 

Vanderbilt University Medical Center, Nashville, TN

Monroe Carrell Junior Children’s Hospital at Vanderbilt, Nashville, TN