I scowled at my backpack from the comfort of my bed as the thought of my reading assignment popped into my mind. After working until 2 a.m. the evening before, I was not in the mood to read, especially a book as dense and borderline indecipherable as this one. After fighting this feeling for about an hour and watching various videos on YouTube, I finally lifted myself out of bed and recovered my copy of Moby Dick from my backpack before sitting down at my desk. I sighed deeply as I opened the book to the first of six chapters I needed to finish before class tomorrow.
During my sophomore year of college, I took a literature course centered on Herman Melville and Moby Dick. The course encompassed a number of essays and short stories from luminaries like Ralph Waldo Emerson and William Faulkner, which contextualized the ideas presented in Melville’s magnum opus. At first, I was not engaged in reading Moby Dick; it is rhapsodic, often disorienting and remarkably dissimilar to how popular media represents Ahab and his epic tale of revenge. However, when I stopped straining to interpret every passage’s minutiae in an effort to control my reading experience, I started to actually enjoy this wild ride of a book.
The element of Melville’s writing that captivates me the most is his purposeful use of physical characterization. The more Melville describes the physical attributes of a character, the more ingrained in the physical world of Moby Dick the character becomes. Vice versa, the less detail he provides about a character’s appearance, the more incorporeal he becomes, which makes the character feel disconnected yet somehow still involved in the narrative world. Nowadays, elements of people’s physical appearances are often associated with the work they do. As a society, we often ascribe specific physical characteristics to certain groups of people based on the roles that they play, such as white coats to scientists and physicians. The underlying problem with this practice is that life is about far more than just work, and the more our lives are connected to these symbols of our work, the more we become defined solely by the work we do.
Now that I am a little older and deep into my medical education, I realize how well Moby Dick elucidates the values of resilience, interconnectedness and self-renewal in medicine. In fact, there is one “character” that epitomizes the lessons we as health care providers can learn from Melville’s work: Ishmael.
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The thesis of my final paper was that, in a traditional sense, Ishmael does not exist in Moby Dick because he is not physically characterized like more concrete characters, such as Queequeg and Ahab. Instead, Ishmael serves primarily as an integral narrative mechanism, driving the story with his various speculations, digressions and inquisitive observations. Ishmael’s crucial insights into situations unbeknownst to other characters enable him to serve more effectively as a narrative voice than as a stable character. In this way, Ishmael appears to delocalize his physical being so that he can be deeply introspective and purely aware of the world on an extra-mundane level.
Throughout the novel, physical appearance plays an essential role in symbolization and adumbration. For example, Ahab’s “lividly whitish” scar from his previous encounter with the White Whale raises questions about his past and the crew’s impending fate. The thorough description of Ahab’s physical characteristics makes his role on the Pequod more defined and, thus, makes his connection to the physical environment more concrete. Ishmael, by contrast, lacks any physical description and is a self-described “simple sailor,” which implies that he could represent anybody — an everyman — aboard the ship. In his essay titled “Self-Reliance,” Emerson remarks, “…the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.” This idea embodies the soul of Ishmael: the ambiguity of his appearance and role on the ship suggests that he could be anybody or, possibly, nobody in particular.
In the “Epilogue” chapter of Moby Dick, which follows the crew’s calamitous encounter with the White Whale, there is another salient example of Ishmael’s obscure characterization: “It was the devious-cruising Rachel, that in her retracing search after her missing children, only found another orphan.” As “her” crew members were searching for the “missing children” — fellow crew members — who were lost at sea, another ship called the “Rachel” comes across Ishmael, who is clinging onto a coffin afloat in the open waters. The brief chapter is told from Ishmael’s perspective and describes Ishmael as an “orphan” whom the Rachel found. The imagery of a nameless, faceless orphan seems to imply that this survivor could be any crew member. Perhaps, Ishmael’s lack of a concrete identity served as a safeguard against the devastation because it separated him from the injurious energy of what had transpired.
Now, what can health care professionals and trainees learn from Ishmael’s peculiar role in Moby Dick? As I described in an article on stress and its downstream consequences, we face a crisis in which systems-level factors are degrading the foundation of health care. The energy we have to pursue our major goals in health care delivery is finite, which means that focusing our energy on meaningful duties is imperative. Like Ishmael, we must find a way to exist where we actively engage in patient care without succumbing to the extraneous demands of our work. Fortunately, various health care delivery models have demonstrated promise in focusing our individual energies on meaningful goals, including multidisciplinary team-based care and emphasizing provider-led quality improvement initiatives.
The tenets of transcendentalism heavily influence Ishmael and the entire story of Moby Dick. They help to explain how Ishmael “transcended” the conventions of traditional storytelling and became the “transparent eye-ball” that Emerson, Melville’s contemporary, described in his essay “Nature.” These tenets comprise several major themes: “God” permeating everything including human instinct, the value of intuition over empirical truth, connecting with nature to “transcend” and the value of individualism and self-reliance over groupism. Our modern individualistic culture has fewer prescribed social roles and emphasizes empirical truth and finding power in relationships with others. Transcendentalism thus contends with our current understanding of what makes us flourish, and this divergence in philosophy makes it difficult to apply transcendentalism directly to our lives. However, through the lens of transcendentalism, medical professionals and trainees can emulate Ishmael and minimize their vulnerabilities to harm without distancing themselves from living.
Rather than retreating inward to protect ourselves from the intimidating task of improving our patients’ health, I propose that we do the opposite: engage in interprofessional teams. By participating in a team in which each member shares the same mission and objectives and upholds a culture of mutual respect and synergy, we can “delocalize” our own beings, exercise interdepence and become a collective entity that is substantially greater than the sum of its individual parts. The logic of this approach is not to become an everyman or “simple sailor” without an individual identity; rather, it is to bring an identity — skills, interests, strengths — to the table in order to create a group identity that, much like Ishmael, exists on a level that “transcends” the forces of the daily work environment.
Moby Dick, Ishmael and transcendentalism provide a framework for how we can lead professional lives that are sustainable and fulfilling. This framework gives us insight into how we can shield ourselves from the inevitably draining parts of our work and prevent our own encounters with the “White Whale.” The answer we find in Moby Dick and the principles its story was built on is that the only way out of the stress we experience as health care providers is not necessarily through; in fact, Ishmael shows us that one of the most effective ways out is by going above. While our strategies for “transcending” will be different from those that Ishamel employed, the endgame is the same, and both health care providers and patients will be the beneficiaries.
As medical students, we sometimes lose sight of our purpose for going into medicine and feel that we are exerting ourselves excessively with little feedback from our environment. It is important that we remember that, while we are living through the experiences that come with our training, our future patients are also living through their own experiences. The focus of this column is to examine topics in positive psychology, lifestyle medicine, public health and other areas and reflect on how these topics relate to medical students, physicians and patients alike.
Columnist, Medical Student Editor and Former Managing Editor (2017-2018)
OU-TU School of Community Medicine
Ashten Duncan is a third-year medical student at the OU-TU School of Community Medicine located in Tulsa, Oklahoma. A 2018-2019 Albert Schweitzer Fellow, he recently received his Master of Public Health (MPH) with an interdisciplinary focus from the University of Oklahoma Hudson College of Public Health. Ashten attended the University of Oklahoma for his undergraduate program, completing a Bachelor of Science (BS) in Microbiology and minors in Chemistry and French. An aspiring family physician, Ashten is currently on a National Health Service Corps scholarship. His research interests include hope theory, burnout in medical education, and positive psychology in vulnerable populations. Ashten is passionate about creative writing and what it represents. He has written pieces that have been published on KevinMD.com and in-Training.org and in Blood and Thunder and The Practical Playbook. Ashten is currently serving as Associate Author for the upcoming edition of First Aid for the USMLE Step 1.
The Lived Experience
As medical students, we sometimes lose sight of our purpose for going into medicine and feel that we are exerting ourselves excessively with little feedback from our environment. It is important that we remember that, while we are living through the experiences that come with our training, our future patients are also living through their own experiences. The focus of this column is to examine topics in positive psychology, lifestyle medicine, public health and other areas and reflect on how these topics relate to medical students, physicians and patients alike.