Academic Medicine:
doi: 10.1097/01.ACM.0000399608.43481.ad
Medicine and the Arts

Commentary

Kendall, Fran MD

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Author Information

Dr. Kendall is president and founder, Virtual Medical Practice, LLC, Atlanta, Georgia; e-mail: drfkendall@gmail.com.

In the flash of a moment, at the age of 34, Elisabeth Tova Bailey was transformed from a vibrant, active healthy person into a bedridden patient racked by a mysterious relapsing illness, later discovered to be a mitochondrial myopathy that sapped her energy and confined her to an unfamiliar room 50 miles from home. A reminder that illness can happen to anyone.

In her quest to survive a dark and lonely time of illness and isolation, she befriends a wild snail which takes up residence on her nightstand and which provides just the quiet, uncomplicated companionship she needs. As she ventures into the seemingly simplistic world of the common gastropod, she finds a complex creature whose existence gives her insight into her own challenging and changed life. Though the book tells the entertaining, charming, and often surprising natural history of her snail companion, the deeper context is the story of surviving isolation.

The profound isolation that accompanies chronic debilitating illness, even when in the company of hopeful family and friends, is palpable throughout her story. The loss of purpose, of meaning, and even of her “humanness” is clear as she recounts her drastically altered existence. It is into this world that the tiny gastropod arrives, a gift from a friend who found it while exploring the nearby woods. The snail is given a home in a moss- and fern-filled terrarium at her bedside and it soon becomes Bailey's lifeline and muse.

Through months of quiet contemplation, Bailey discovers intimate details of the snail's daily existence—its dietary preferences, sleeping habits, foraging and locomotive abilities, and courtship and mating behaviors. She explores the similarities and differences between gastropod and Homo sapiens anatomy, physiology, and neurology, gaining insights into her own human experience.

Slowly, over countless weeks and months, the author regains some strength, returning home to reclaim a shadow of her previous life. It is during this transition that she releases her small companion back into the wild. In a moment of reflection she writes to one of her doctors:

I could never have guessed what would get me through this past year—a woodland snail and its offspring; I honestly don't think I would have made it otherwise. Watching another creature go about its life ... somehow gave me, the watcher, purpose too. If life mattered to the snail, and the snail mattered to me, it meant something in my life mattered, so I kept on.

The simple act of observing her gastropod friend allowed her to surmount the seemingly impossible obstacle of living with a devastating illness, moment by moment and day by day.

As Bailey moves through the seasons, she continues to draw on her memories of the snail. “The snail and I had been fellow captives,” she says,

but now we had both returned to our natural habitats. As I tried to make my life livable within a few rooms of my house, I wondered how the snail was coping in its native woods. Though I was home, I was still not free from the boundaries of illness. I thought of the terrarium's limited space, and how the snail had seemed content as it ate, explored and fulfilled a life cycle. This gave me hope that perhaps I, too, could still fulfill dreams, even if they were changed dreams.

One winter night she chronicles in her journal a reminder to herself that life is still worthwhile: “A last look at the stars and then to sleep. Lots to do at whatever pace I can go. I must remember the snail. Always remember the snail.”

The beautiful, poignant journey undertaken by the author as she comes to terms with her illness serves to remind those of us who care for such patients on a daily basis of the true hardships they endure, many of which are unseen or undetected by MRIs or blood tests. Isolation, loneliness, and an overwhelming sense of loss are frequently hidden beneath the cloak of illness and buried by pills and procedures, but often much more deadly and destructive.

Letting go of hopes and dreams, of preconceived notions of our lives and others' and accepting circumstances we can't change is among the most difficult and challenging journeys we navigate as humans. We struggle to remain whole and empowered without succumbing to the loss, isolation, and bitterness that can so easily enfold us, cloud our thoughts, and further diminish our life force long before our last breath.

Despite her circumstances, Bailey considers the role of pathogens in both illness and speciation with acuity and humor: “Pathogens ... helped shape all species, and it was because of a pathogen that I found myself nose-to-tentacle-with a snail.”

The Sound of a Wild Snail Eating is lively with the voices of notable poets as well as medical professionals and scientists from Sir William Osler and Florence Nightingale to Charles Darwin, E.O. Wilson, and many others. Bailey's seamless melding of natural history, literature, and the illness experience creates a unique and intriguing medical humanities narrative that will engage both medical faculty and their students in discussions of compassion, palliative care, and the meaning of life.

Bailey's work is a quiet, but powerful testament to our need to understand and acknowledge the hidden demons that threaten our patients more than we care to know. As they journey through illnesses, our patients are unsung heroes and mentors who allow us to glimpse the deepest challenges of human existence.

© 2011 Association of American Medical Colleges

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