Jackson Martin
Lubbock, Texas, United States

Ursula K. Le Guin describes a paradoxical and provocative utopian city in her short story, The Ones Who Walk Away from Omelas. The story reads as a parable, differing from an analogy or metaphor in that it intends to provoke varying conclusions from the audience. Le Guin does not explain the correct interpretation of her story, but rather allows the reader to sit, ruminate, and decide.

Le Guin’s seemingly perfect city brims with delicious food and drink, loving families, elegant flute performances, and most of all, abundant happiness. Widespread peace reigns, with no governing agency or monarchy, while orgies abound, and gorgeous priests and priestesses make love with whomever so desires. Citizens may partake in a euphoria-inducing but mysteriously non-habit-forming drug called “drooz,” although the perfection of the beautiful city almost precludes the people from feeling the need to partake. She touts happiness for all the inhabitants of the city. Well, nearly all.

The joy of the city is contingent upon the misery and suffering of one individual. This is a child around ten years old imprisoned in a windowless basement with floors of dirt. It once knew sunlight and had a mother, but she has now even forgotten her mother’s voice. She used to cry out promising to be good, but with minimal human interaction, she no longer recalls how to speak. She squats in her own excrement like an abused animal, groping around the dim room and quivering in fear from the monstrous shadow cast by the supercilious mop in the corner.

Medical professionals encounter patients who suffer as much as this pitiable individual. At times we are powerless to the injustices dealt to our patients, whether from family members, their illness, or the medical system itself. The predicament of such patients is hardly singular. Even the least tenured caregivers can describe many encounters with patients enduring unremitting anguish, devoid of both agency and autonomy—voiceless and invisible.

The realities of medicine are not sympathetic to idealists, inundated as it is with suffering people. It seems many physicians—some of whom were once idealists—devolve to reductionists and compartmentalists, severing human suffering from the pathology afflicting the patient. I vividly remember a physician who, with a sardonic smirk, revealed how he had perfected his physical exam to appear compassionate to the patient, which is of course not true compassion but only a formula for a passable bedside manner. Yet I am sympathetic to him, as he has likely witnessed endless pain in his patients and ultimately responded with emotional abdication. Le Guin proposes an interesting change in the inhabitants who choose to remain in Omelas despite firsthand knowledge of the tormented child. She writes, “Theirs is no vapid, irresponsible happiness. They know that they, like the child, are not free. They know compassion. It is the existence of the child, and their knowledge of its existence, that makes possible the nobility of their architecture, the poignancy of their music, the profundity of the science.” Caregivers, like their patients, are not free from the suffering they witness. Many choose abdication. However, some choose instead baptism—an immersion into human suffering—and resurface more compassionate, kind, and humanistic.

I want to avoid insensitivity to healthcare providers experiencing burnout and compassion fatigue. The late dean of my medical school, an avid humanist himself, once told me a story about a friend, an infectious disease specialist who practiced during the AIDS epidemic and eventually became overwhelmed with the pain and deaths of his patients and decided to withdraw from medicine for a season. He spent his time away earning a Master of Fine Arts, and he returned to medicine a few years later. Since then, he has produced many acclaimed novels and continues to practice medicine, emphasizing humanism and compassion for patients. Ostensibly, he navigated the double bind all medical professionals eventually find themselves in. Do we leave our patients, or do we remain with them while experiencing emotional bankruptcy? He did not permanently leave, but instead stepped away, returning more intent and emboldened to lovingly care for his patients.

Upon my first read of Le Guin’s story, I thought the ones who walked away were the heroes and heroines. But a closer reading reflects the nuances we face in medicine. A curious transformation occurs within the citizens of Omelas who stay. Le Guin writes, “Their happiness, the beauty of their city, the tenderness of their friendships, the health of their children, the wisdom of their scholars, the skill of their makers, the abundance of their harvest and the kindly weathers of their skies, depend wholly on this child’s abominable misery.” Similarly, our existence as healthcare workers is inextricably tied to human suffering. I would argue we also should not try to escape it, for the calling of medicine establishes a unique responsibility caregivers exhibit for patients. We cannot walk away from the misery of the people we encounter, unlike the ones who walk away in Le Guin’s story. Instead, we remain, keenly aware of the suffering of our patients, upon whom the very existence of our profession relies, nurturing our compassion and tender kindness, even when it would be much simpler to walk away from the Omelas of our patients’ experience. Anatole Broyard, an essayist describing his own experience with terminal illness, wrote, “[Physicians] have little to lose and everything to gain by letting the sick man into his heart.” I think we should let the sick person in. I think we should stay in Omelas.

References

1. Le Guin, Ursula K. “The Ones Who Walk Away from Omelas.” In The Wind’s Twelve Quarters. New York: Harper & Row, 1975: 224-31.
2. Broyard, Anatole. “The Patient Examines the Doctor.” In Intoxicated By My Illness. New York: Ballantine Books, 1992: 34-58.