House in the House!
Tuesday, December 1, 2009 at 06:23PM | 6 Comments (heheh... heh... okay, well, if you saw the last post, you'd get it, oh, and then if you followed me on twitter, you'd know that I'm kinda weird about House... anyway...)
Last night's show... wait, um, possible spoiler alert, if you have some sort of space-age device that allows you to watch the show long after it airs, and maybe you haven't yet....
So, last night's show focused much more on House's doormat-y best friend, Wilson, whose compassion and dedication to his patients nearly cost him his liver.
Literally.
It brought up a lot of interesting dilemmas concerning ethics and boundaries and compassion and guilt and the role of the doctor/healer/therapist.
On the one hand, Wilson (head of the oncology department, and while we rarely see him in professional action, we know that he has a sensitive nature, but a very hard time saying no to people) has a gift for his ability to listen, and in one highlighted case, he saved a patient from certain death, all because he noticed what this patient didn't say. (This patient, normally effusive about his grandkids, didn't mention them during a follow-up exam, indicating depression to Wilson, which caused him to reexamine said patient and found cancer in his lungs, which was immediately removed.. just so you can dig how attentive Wilson is.)
On the other hand, another patient whose cancer was in remission for some years and was now forever bonded in gratitude and friendship to Wilson, and through a series of unfortunate events, found himself at risk of losing his liver and dying within 24 hours. Given that Wilson was heading his case, this 'friend' demanded, in the presence of his ex-wife and daughter, that Wilson give him a part of his liver.
It was only right, after all.
But I'm a doctor, Wilson said.
Well, then, I'm firing you as my doctor, he said. Now you're just my friend.
But you're a doctor, the hospital administrator said. And, I didn't make you head of oncology because of your availability of body parts. (ooo, good one!)
You're a doctor. And you're a doormat, offered House, in his usual helpful way. And besides, if you die, I'll be alone.
Leaving Wilson to feel responsible for yet one more broken human, while he struggled alone with guilt, and the duties of love and friendship, and doctor-ness, and "The Right Thing To Do", while he went ahead with handing over a piece of his liver anyway, thereby saving the guy, who went on to make insensitive decisions with his redeemed life that disappointed Wilson in the end, but that's a WHOLE 'NUTHER story about generosity and expectations....
So yeah. Where is that line?
Boundaries are necessary. Dammit Lists are life-saving. Clearly-defined roles and appropriate behavior as doctors and therapists and parents and employers and passers-by cultivate a much-needed sense of security in our society as we go about our business of living and trusting.
But we're all human. Ultimately equal and fragile and mortal in the grand scheme of things.
Granted, I doubt any of my clients or friends would have the audacity to ask me to hand over an organ, like this guy did, sparing me this particular moral dilemma.
But what if someone needed my liver - really, only a piece of it - or another vital item in my possession which they would die without - could I possibly weigh the value of my life over their own, and still be able to sleep at night?
And as a doctor, if I took a vow of "do no harm", and was committed to doing everything in my power to preserve life, and, well, technically this would be in my power, wouldn't I be bound to do this?
Again, I ask, where is that line?
Was Wilson really a doormat? Or a saint?
And what of the myriad non-internal-organ sacrifices I choose or not choose to make in my practice - those concerning fees, and time spent on days off, and listening ears, and small favors?
I suppose, ultimately, it's up to us as individuals and what we can or cannot live with. What drains us, what energizes us, what allows us to feel that we were of service without feeling depleted or deprived ourselves.
Whether it's guilt that informs our decisions, or service.
I think for Wilson, it was a bit of both. Being compassionate by nature, he felt good about the choice he made. But having had past experiences of loss in which he believed he 'could/should have done something', and an expectation of saving more than just his ballsy patient's life, we can assume that he had some hope of redemption with this act.
To take a stab at answering my own question, about the elusive line, perhaps it depends a lot on our own inner store of resources, and about which well we're drawing from when we give of ourselves to help others.
Or maybe it should, rather than a static definition of appropriate boundaries.
What do you think?
Reader Comments (6)
I would think that the 'Do no harm' rule applies first and foremost to yourself. You can't take proper care of someone else without first taking care of yourself.
Also, what kind of bastard guilt trips someone into handing over their liver?
I was thinking about this .. and it reminded me of an email newsletter from Norma Gentile that I got a while ago and saved because I thought I should contemplate it as part of considering a reiki practice. It was about the idea of service vs helping - and how things we do in the act of service should renew us and things we do in the act of helping might deplete us. Essentially, that helping (or fixing) is trying to change something that they (or we) perceive as broken, while service recognizes that life is a mystery and is aligned with the greater good.
Anyway, it sort of digresses from your post a bit, but I would agree with your end point. I want to draw my elusive line where I am renewed, not depleted. (Not that that doesn't mean that sometimes you cross over, I imagine, but I think if you regularly deplete your own store, there is not much to offer others.)
I probably would have offered up my liver. And then been slightly resentful, I expect, if I felt my liver wasn't being put to good purposes.
I was doing something else while watching this episode (probably grading papers) so I didn't focus on it. This is a fascinating question. The whole episode had multiple moments of motives/consequences: House is always willing to bully patients, family and staff into doing what he wants, but we often condone it because he turns out to be right and saves a life. Wilson suspended his better medical judgment and one of the consequences was that he destroyed his friend's liver. His friend bullied him into the donation. The whole situation was fraught with mixed motives. Was giving up part of his liver and putting his life at risk Wilson's way of atoning for the harm he had done by not taking House's colder advice of not doubling the chemo dose?
We tend to think of House as the needy character in denail, but Wilson is just as flawed.
Elizabeth, that distinction between service and helping is a really useful way of thinking about it.
It's so funny that you posted this, because I was having some of the same thoughts while watching that episode.
It's that Sovereignty thing again. And I don't really know the answer to where the line is, but I think you're on to something that it might vary from person to person, depending on what resources are available.
"I suppose, ultimately, it's up to us as individuals and what we can or cannot live with. What drains us, what energizes us, what allows us to feel that we were of service without feeling depleted or deprived ourselves."
That sounds like a pretty good answer to me.
I just wish it were easier to know where our own line is, without having to cross it a bunch of times before we learn, you know?
@Chloe: LOL. Seriously. Which is why I think House kept referring to Wilson's friend as a 'self-important' jerk. Point proven.
@Elizabeth: I don't think it digresses at all. I ask the question because I see therapists around me taking a variety of stances. Some never share anything personal about themselves; another I know picks up a client and drives him to tai chi class, if that's the only way he'll get there.
It comes up in my practice. It certainly comes up writing a blog... how open to be, how personal, ie: 'authentic'. And I keep making the mistake of looking to others for answers rather than what is right for me and my clients.
@Joanna: There were plenty of layers and questions, indeed. And yes, Wilson is certainly flawed. I also think that House would not be above asking Wilson to donate a liver, or at least considering it, as he knows Wilson well enough that he wouldn't be refused. There was Wilson's second-guessing.. there's also his guilt over Kutner's suicide, his understandable feeling of responsibility for everything and everyone, which tends to get a lot of us in trouble and muddy those waters of "service" and "help".
@Victoria: Yeah, live and hopefully learn, right? And the means by which we finally 'get it'...sometimes a major thunk on the head. Or life crisis. And so, as I was saying on twitter, perhaps Mark Silver's practice of Remembrance would be a very useful tool to determine that line before we step over it?
Thank you all for playing along! Next week, perhaps I'll address the impending shift to the Dark Side that Wilson now seems to be taking.
Love this whole exchange....