Lessons on Aging from King Lear
For those of us who have been involved in medicine for decades, the growing revitalization of interest in the arts and humanities within medicine is very welcome. I have long bemoaned the single-minded focus on the sciences—an increasing number of medical school applicants have spent their pre-medical years majoring in one of the sciences and only a handful are minoring in something almost “artsy,” but often more on the cusp, such as psychology. In truth, I, along with the others in my clinic or seminar group, would be surprised if one of the medical trainees would admit to being an English major. Sometimes I would jokingly quip, “If I were king, everyone’s first degree would be in literature. Alas, for now, I just have to do my best to promote the idea of reading outside of medicine not just for information, but for the enjoyment and understanding of the human condition.”
Importance of Literature
The importance of literature, in all its iterations, came back to me this past summer as I watched a production of King Lear at the Stratford Shakespeare Festival in Stratford, Ontario, Canada. Although I had previously seen this play on the very same stage, this opportunity to see it in high-definition was quite a treat.
Shakespeare’s King Lear remains one of my all-time favorite plays. I was first introduced to the play as an undergraduate at Brooklyn College, desperately in need of an English course to balance my other coursework. In what could be called the “good old days,” the requisites for medical school at the time required only the basic introduction into biology, chemistry, and physics—allowing premed students to pursue a wide range of courses in the humanities, including philosophy, history, classics, and English literature.
To this day, I often maintain that it was these philosophy and literature courses that set the stage for my future career. While medicine is at my core, the strong influence of philosophy led me toward the pursuit of medical ethics, extra education, and a degree, and literature remains part of my ongoing existence, enjoyment, and a source for my teaching.
Shakespearean Influence
Led by a professor who had previously been a Shakespearian actor, with a deep sonorous voice and perfect timing as he read the text, all 250 students in that undergraduate Shakespeare class were equally mesmerized. I even signed up for a 10-week extracurricular program, and it was in that evening class, where we parsed and explored from every possible angle and discussed salient passages, that I fell in love with King Lear.
As the story unfolded, I followed tragic family dynamics, sibling rivalries, parenteral umbrage, age-related personalities, decision-making altercations, and the ultimate tragedy of family dissonance. The 2 parallel and mutually supporting stories—that of Lear and his daughters and that of Gloucester and his two sons—intertwine with great upheavals and tragic losses for both families. The idea of ultimate loss—in Lear’s case, of the parent king, the youngest daughter, and multiple other characters—in the name of greed, love, lust, power, and pity was simultaneously replicated as Gloucester loses his legitimate son (Edgar) because of his trust in the basest of lies told to him by his illegitimate son (Edmund). The result is a theatrical performance of phenomenal power and poignancy.
Beyond the linguistic beauty for which Shakespeare is well-known, here are some important and relevant life lessons.
•Actions are louder than words. That Cordelia, King Lear’s youngest and most precious daughter, would not adequately declare her love for him, even after her sisters showered their (albeit, shallow) expressions of filial love and devotion, reflects a basic conundrum in human relationships—actions should speak louder than words. Lear, despite his age, experience, and wisdom, falls prey to a well-recognized human failing—striking out against those whose actions reflect true, deep, and consistent in favor of appearances and honey-tongued expressions that ultimately proved to be hollow.
Similarly, Gloucester’s willingness to heed Edmund’s tales of Edgar’s betrayal ultimately results in his brutal blinding. And, from tragedy, Gloucester reconnects with Edgar.
• Actions have consequences. Of the many memorable lines that show deep insights into aging and humanity are the following words by Lear, “I am a very foolish fond old man, fourscore and upward, not an hour more nor less; and, to deal plainly, I fear I am not in my perfect mind.” Lear describes himself as a poor, weak, and despised old man and says, “You see me here, you gods, a poor old man, As full of grief as age; wretched in both!” as he begins to realize what his actions have wrought.
As the play progresses, there are the intricate relationships, power-grabbing actions, and the deceitfulness of Lear’s 2 older daughters—all of which contribute to the tragic deaths of Cordelia and a broken-hearted Lear.
• Always remain your patient’s advocate. For any one of us in the healthcare system, we must always be aware of power relationships that exist on both the micro and macro levels. There are times that we are called upon to speak on behalf of our vulnerable patients. One of the most memorable passages in Lear has less to do with aging and family relationships than with justice. For observers of law and society, this passage rings as true now as when it was penned, “Plate sin with gold, And the strong lance of justice hurtless breaks; Arm it in rags, a pigmy’s straw doth pierce it.”
• There is a place for emotion in decision-making. For all of us caring for aged, frail and dementia-afflicted individuals, we must try remember to understand the importance of love and care in healthcare decision-making. In this play, the role of filial love—even in the midst of estrangement—reminds us that none of us are paragons of virtue.
I am not king and therefore, cannot require literature to be part of all pre-medical programs, but I can do my best to encourage the love of books, stories, and plays as a way of preparing young physicians for their role in bringing out the stories of their patients. In your patient’s stories are the keys to the people they are and the illnesses they have—information that is needed for us to provide the best of humane medical care. n
Michael Gordon, MD, MSc, is a geriatrician working at Baycrest Health Science System. He is medical program director of the palliative care program, co-head of the clinical ethics program, and a professor of medicine at the University of Toronto in Canada.