Dr. Lewis Thomas (1913-1993) is one of the most influential physician-writers of his time, yet very few of today’s physicians remember him. Thomas was a prolific essayist, often carving out time late at night to write about science so that even non-scientists could understand the highly complex concepts. From 1971 to 1980, Dr. Thomas was invited by the editors of the New England Journal of Medicine to contribute a monthly essay (over 50 in total), under the category, “Notes of a Biology-Watcher.”
Dr. Thomas was also an accomplished clinician, researcher, and administrator. He served as Dean of the medical schools at both Yale and New York University. He also served as President of Memorial Sloan-Kettering. He published his first collection of essays, the Lives of a Cell, Notes of a Biology Watcher [1] in 1974 which won two National Book Awards, in two separate categories, “Arts and Letters” and the “Sciences.” His second book, The Medusa and the Snail, More Notes of a Biology Watcher [2], was also awarded a National Book Award. He went on to compile six published collections of his essays which also included a few poems.
The topics of his essays span biology and medicine to music and etymology. This includes such disparate titles as “The Hazards of Science,” “Organelles as Organisms,” “On Committees,” and “On Artificial Intelligence.” One essay best exemplifies his skill at capturing the very essence of an observed moment in time through the eyes of a learned scientist. “The Tucson Zoo” starts:
Science gets most of its information by the process of reductionism, exploring the details, then the details of the details, until all the smallest bits of the structure, or the smallest parts of the mechanism, are laid out for counting and scrutiny. Only when this is done can the investigation be extended to encompass the whole organism or the entire system. So we say.
Sometimes it seems that we take a loss, working this way. Much of today's public anxiety about science is the apprehension that we may forever be overlooking the whole by an endless, obsessive preoccupation with the parts. I had a brief, personal experience of this misgiving one afternoon in Tucson, where I had time on my hands and visited the zoo, just outside the city. The designers there have cut a deep pathway between two small artificial ponds, walled by clear glass, so when you stand in the center of the path you can look into the depths of each pool, and at the same time you can regard the surface. In one pool, on the right side of the path, is a family of otters; on the other side, a family of beavers. Within just a few feet from your face, on either side, beavers and otters are at play, underwater and on the surface, swimming toward your face and then away, more filled with life than any creatures I have ever seen before, in all my days. Except for the glass, you could reach across and touch them.
I was transfixed. As I now recall it, there was only one sensation in my head: pure elation mixed with amazement at such perfection. Swept off my feet, I floated from one side to the other, swiveling my brain, staring astounded at the beavers, then at the otters. I could hear shouts across my corpus callosum, from one hemisphere to the other. I remember thinking, with what was left in charge of my consciousness, that I wanted no part of the science of beavers and otters; I wanted never to know how they performed their marvels; I wished for no news about the physiology of their breathing, the coordination of their muscles, their vision, their endocrine systems, their digestive tracts. I hoped never to have to think of them as collections of cells. All I asked for was the full hairy complexity, then in front of my eyes, of whole, intact beavers and otters in motion [3].
Thomas encapsulates his struggle as a scientist and as an observer of nature to fully reconcile what he is seeing with his own eyes. He juxtaposes his marveling at the sheer beauty of the movement and play of these beavers and otters as they frolicked in the water with his knowledge of how they are actually doing this, understanding the interplay of neurotransmitters, glucose metabolism, and muscle physiology.
Thomas’ essays are full of take-home messages from the scientific world that translate to normal everyday life. Some of them would seem obvious after a medical education. In "To Err is Human," Thomas writes:
Mistakes are at the very base of human thought, embedded there, feeding the structure like root nodules. If we were not provided with the knack for being wrong, we could never get anything useful done. We think our way along by choosing between right and wrong alternatives, and the wrong choices have to be made as often as the right ones [4].
Some of the topics he wrote about in the 1970s and 80s are even topics that we see in today’s medical literature or as headlines in the lay press, including his perspectives on human cloning and artificial intelligence. As an astute observer, Thomas in an 1980s essay makes the observation that “today, the doctor can perform a great many of the most essential tasks from his office or in another building without ever seeing the patient.” This is certainly more true than even Thomas could imagine with the advent of TeleICU or other virtual care modalities. But he goes on to provide a cautionary tale:
The close-up, reassuring, warm touch of the physician, the comfort and concern, the long, leisurely discussions in which everything including the dog can be worked into the conversation, are disappearing from the practice of medicine, and this may turn out to be too great a loss for the doctor as well as for the patient. This uniquely subtle, personal relationship has roots that go back into the beginnings of medicine’s history and needs preserving. To do it right has never been easy; it takes the best of doctors, the best of friends. Once lost, even for as a short a time as one generation, it may be too difficult a task to bring it back again [5].
As thirty-plus years have passed since Thomas’ passing, we cannot let his writings fall into a forgotten history of medicine. I strongly encourage you to consider reading some or all of Thomas’ essays, which are available in his books and online under “Notes of a Biology-Watcher.” Not only does he provide a model for integrating narrative medicine into a medical career, his writings offer an invaluable perspective into today’s complex scientific concepts and medical dilemmas.
Neil M. Paige, MD, MSHS, neil.paige@va.gov
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
References
- Thomas L. The Lives of a Cell: Notes of a Biology Watcher. New York: The Viking Press. 1974.
- Thomas L. The Medusa and the Snail. More Notes of a Biology Watcher. New York: The Viking Press. 1979.
- Thomas L. The Tucson Zoo. N Engl J Med. 1977 Apr 14;296(15):863-4. doi: 10.1056/NEJM197704142961510. PMID: 846498.
- Thomas L. Notes of a Biology-Watcher. To err is human. N Engl J Med. 1976 Jan 8;294(2):99-100. doi: 10.1056/NEJM197601082940207. PMID: 1244506.
- Thomas L. “Leech, Leech, et Cetera.” The Youngest Science: Notes of a Medicine Watcher. New York: Viking Penguin, 1983.