Interdependence

You can learn a lot from your younger self. Especially when that self said or did something that, even if relatively unremarkable at the time, seems presciently potent years later.

The result of excessive hubris and self-focus, many of my life’s insights or actions would benefit from a healthy dose of amnesia. A fair share are in need of actual forgiveness. One particular contribution to the human enterprise, however, an essay filed away in a stack of old journals, re-presented itself to me today as a possible framework for refinding my footing in the modern era: a declaration of interdependence.

It was January,  2000. I had been publishing some essays in the Western Journal Medicine. Tired of the growing commercial influence in medicine, and no doubt bolstered by the turning of the millennial page, I fashioned a statement patterned on the U.S. Declaration of Independence, written 224 years earlier. Surprisingly, the editors of the journal published it.

“We hold the truths to be self-evident, that all people are born to an interdependent whole; that illness embodies isolation from the whole; that ill people are entitled to kindness, compassion, and blameless charity in their pursuit to re-experience the whole. That to help ill people return to the whole, hospitals and health care systems are instituted among communities, deriving their sacred authority from the confidence of the sick; that whenever any hospital or health care system recklessly segregates the sick, it is the obligation of healers to change or abandon it, and to organize new centers and systems of healing that remain faithful to the basic precepts of compassionate caring and interdependence.” 

In deference to the 1776 document, my 2000 declaration mirrored the basic structure of, and the use of certain language in, Jefferson’s masterpiece. There the similarity ended. The writing was by no means comparable. Neither was the risk to the writer, the reality of the circumstance, nor the readership and its response. My document was published, not discussed or copied, and never heard of again. And yet, in rediscovering it this morning, I don’t find it woefully lacking, in either perspective or passion. Sure, it might benefit from some editing and updating. But the basic clarion call for collaboration and compassion in healing feels as applicable today as it felt to my younger self in the year 2000. In fact, it humbles my modern self to sense the urgency in my voice from the 20th century and recognize that the flame for change, while still alive, may flicker less passionately inside me today than it did eighteen years ago.

“And, for the support of this declaration, with a resolute reverence for the presence of divine mystery in our lives, we pledge to those who are sick, and to each other, our hearts, our histories, and our sincere humility.”

Our sincere humility. Would that I could say that our healing professions stand in proud possession of such a trait. I am no paragon of it. Nor am I uniquely qualified to judge its existence in others. We all can feel though when it is lacking, can’t we? We can sense when something is missing. We can suss out insincerity and arrogance in care delivery without the need of scientifically tested algorithms or statically validated scoring systems.

Our 21st century health care system is not one known for sincerity and humility. Neither, sadly, is the society in which that so-called “system of care” exists. Ours is a culture of survival. We are market-based, merit-focused, and success-minded. Media bombard us with reminders of the power of personal triumph, accountability, and advantage. Our public leaders fill the airwaves with the bombast of individual advancement. We have designed silos of service-oriented but partnership-impoverished solutions that leave many of us – both those offering and those receiving care – wary of motive, means, and methods. We are losing confidence in our social institutions.

Have we become too independent?

When Jefferson and the architects of America’s freedom articulated their independence demands on the 18th century world stage, they did so with the intent of political separation from a distant and oppressive government. Did they intend that future generations would take the idea of separation to the extremes where we currently find it?

I doubt it. But that doesn’t matter. What matters is what we find today and what we decide to do about those findings. I wasn’t thinking too much about our freedom’s ancestors when I wrote “a declaration of interdependence”. I admired their courage, their integrity, and the precision of their language. I aspired only to emulate those qualities in a then contemporary version of a call-to-action of a different kind. I re-share my younger self’s 2000 declaration now, not because it is worthy of wider readership than it previously received, but rather because it reminds me that some of our best offerings don’t take years to mature. And they can’t be helpful if they lie hidden from view.

We can rely on ourselves. But we must depend on each other.