“No man is an island entirely of itself”
JamesB. Young, M.D.Houston Methodist Hospital, Houston, Texas
Pick up any edition of Earnest Hemingway’s masterpiece For Whom the Bell Tolls, first copyrighted in 1940, and you will see on a front piece the John Donne work from which his title came:
No man is an iland, intire of it selfe; everyman
Is a peece of the Continent, a part of the maine; if a
Clod bee washed away by the Sea, Europe is the lesse,
as well as if a Promontorie were, as well as if a Mannor
of thy friends or of thine owne were; any mans death
diminishes me, because I am involved in Mankinde; And
therefore never send to know for whom the bell tolls;
It tolls for thee.
The “poem” is, more accurately, several lines from a prose work titled Devotions Upon Emergent Occasions and severall steps in my Sickness written in 1624 for Prince Charles, the son of King James the First. Donne was the Dean of St. Paul’s and had been very ill with “spotted fever.” Fearing death as he heard church bells tolling on the occasion of others’ deaths, Donne penned his meditations. Hemingway used the “for whom the bell tolls” line to entitle, and set the stage, for a major philosophical work that has become one of his most famous. The story line, as noted on the jacket of the used 1993 Book-of-the-Month club edition I bought some years ago as a re-read, was about “…love, death, honor, and betrayal.” And so it was. But recently I used the short poetic lines in a different manner. Yes, the poem is deeply steeped in our mortality and that of the patients we care for, but there is a much less sobering message here as well. The words serve to provoke us into contemplating our daily lives as healthcare providers, as part of that experience.
The wide audience of healthcare providers has morphed from a gladiatorial mano-a-mano sport into a complex intertwining of teams-of-teams. Certainly there have always been teams of one sort or another. But no longer is the patriarchal, dominating, hubristic pyramid that once was the practice of medicine the best model. And so it is that no man is an island unto itself. Everyone is a piece of the healthcare continent and a part of the “main.” There is a new model of healthcare provision that requires embracing teams. And that is why I remember Houston Methodist (AKA “THE Methodist Hospital”) as so accomplished—it has always taken a team approach. Yes, we should ponder “for whom the bell tolls.” But let us also appreciate that “no man is an island entirely of itself.”
James B. Young, M.D.
Chief Academic Officer, Cleveland Clinic
Professor of Medicine & Vice-Dean for Cleveland Clinic Academic Affairs
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Section Editor, Poet’s Pen, Methodist DeBakey Cardiovascular Journal