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The Art of Medicine

Lessons learned from the brute beast

Maurer, Brian T. PA-C

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Journal of the American Academy of PAs: June 2015 - Volume 28 - Issue 6 - p 70
doi: 10.1097/01.JAA.0000465233.59384.26
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Send us, bright one, light one, Horhorn, quickening and wombfruit. Hoopsa, boyaboy, hoopsa! ... Before born babe bliss had. Within womb won he worship. Whatever in that one case done commodiously done was.—James Joyce, Ulysses

James Joyce patterned his best known novel after Homer's Odyssey. Individual chapters in Ulysses correspond to episodes in the Homeric epic.

In the chapter corresponding to the Odyssey's “Oxen of the Sun” episode, Joyce uses careful word choice and syntax to model the evolution of the English language as well as the intrauterine development of the human fetus. It is not an easy section for any reader to slog through. Indeed, some literary critics have dismissed the episode completely on the grounds that it appears to be gibberish. A number of close readings are needed to discern just what Joyce is attempting to do.

Before he chose a career in writing, Joyce was a medical student. He kept a model of the human fetus in the womb on his desk while he crafted the “Oxen of the Sun” episode. We can surmise that the theme of gestational development was constantly before his eyes and in his thoughts as he wrote.

Little overt action takes place in this chapter. The protagonists, Leopold Bloom and Stephen Dedalus, brush shoulders at the lying-in hospital in Dublin, where Mr. Bloom has come to inquire as to the progress of the birth of a friend's child. There is considerable coarse banter among the medical students, led chiefly by Buck Mulligan, who offers up a soliloquy on sex. But the underlying theme runs much deeper.

These thoughts dart through my mind as I stand leaning against the counter in exam room #6, speaking with an 11-year-old boy. He came in with his father for a physical examination required for sixth-grade entry. The boy knows he needs two shots today, and he's a bit nervous at the prospect. I do my best to put him at ease. In the course of our dialogue, I've learned that he lives on a working farm.

“How interesting!” I say. “So what do you do to help out?”

“Right now he's training a team of oxen,” his father says.

“Really? Tell me about them. What do you train them to do?”

“Well, we use teams of oxen to pull sleds of heavy stuff,” the boy says. “So they have to learn to follow commands. Right now, I'm teaching them Gee, which means turn to the right. Haw means turn to the left, Get-up means go forward, Whoa means stop, and Back means back up.”

“Wow, that's pretty neat,” I say. “How long does it take them to learn those commands?”

“The trick is to start while they're relatively young,” the father explains. “If you can get them to learn early on, it sticks with them for the rest of their lives.”

“Ah,” I say, “sort of like teaching kids.”

The father nods his head.

My thoughts run back to the beginning of my career in pediatrics. What intrigued me most was human development, particularly language development. It's amazing how rapidly most children progress from the coos and babbles of infancy through holophrastic speech to verbal narration by age 4. This relatively short span of complex language acquisition holds us humans in good stead through the subsequent decades of our lives.

Most likely this farm boy will never read Joyce, will never wrestle with the complex language development in the “Oxen of the Sun” chapter. But with the verbal skills he has acquired, he is off to a good start, learning the art of teaching brute beasts to do what they were destined to do—to bear their burden of work in the world.

I too have been working, using my verbal skills to put this boy at ease in preparation for his shots. This too is part of the art of medicine. It is something learned over time through the fits and starts of professional development; yet once learned, it becomes incorporated into the clinician's being, an integral part of how he or she relates to patients professionally.

This evening I will revisit a couple of my mentors. I will peruse the drawings and electron micrographs in the “Morphogenesis” chapter of my battered copy of Smith's Recognizable Patterns of Human Malformation to review intrauterine human development. Taken together, these pictures posit a visual display of Joyce's verbal renditions.

And then I will sit at my desk, open a different dog-eared epic tome and struggle once again with the language of a master craftsman, recalling the commands for the Oxen of the Sun: Gee, Haw, Get-up, Back, and Whoa!

Copyright © 2015 American Academy of Physician Assistants