Where Branches Touch

Today I won’t pretend to understand
the ways we care for one another.
Today I will simply stand
in these thick woods and love
how the branches of one tree
reach into the branches of another.     

Richard Jones

My husband and I spent some hours this past week making our way through the thickets of the healthcare system. This adventure included several phone calls that began with an automated assurance that our call was very important and continued with a few bars of music relentlessly repeated as we waited for those to whom it was very important to pick up.

It included a brief conversation with an ER doctor who said the emergency we’d come in for wasn’t what they’d generally consider an emergency, though it certainly seemed to me to resemble one. Still, in our quest for pharmacological guidance we had helpful conversations with humans who somehow managed, in drab offices by noisy hallways, to maintain humanity and humor and knew how to offer help. 

In the course of our efforts to get appropriate care the lines quoted above from a poem by Richard Jones came to mind. The “ways we care for one another” have grown complicated. We have normalized the strange notion of “managed care” and learned to seek institutional answers to questions we trim to fit questionnaires.

Ivan Illich’s critique of institutionalized health care, Medical Nemesis, still pertinent fifty years later, begins bluntly, “The medical establishment has become a major threat to health.” In the controversial and often curmudgeonly argument that follows he speaks of “the myth of benefit through an increase in the specialization of labor . . . and the myth that increasing dependence of people on the right of access to impersonal institutions is better than trust in one another.” 

Of course, lives are saved in those “impersonal institutions,” most often by means of increasingly high-tech interventions and pharmaceuticals produced by giant companies with powerful lobbies. His point, however, which might be made even more urgently now, was that we need to take stock of the tradeoffs: what have we forfeited in normalizing a healthcare system to which not all have equal access, and within which services are siloed to the extent that specialists involved in the same case may not actually talk with each other; in which computer algorithms have begun to displace touch and in-person observation as ways of gathering clinical information; in which overbooked caregiver and patient barely know one another and rarely know one another’s stories?

It was Illich, I believe, who mused that as soon as an ambulance turns its siren on in a small village, those who might once have hastened to take some responsibility for each other turn back to their own business, assuming their neighbor will be taken care of. We have to work to keep our sense of mutual responsibility alive and our massive institutions and systems human and humane–all of them–not just clinics and hospitals, but educational institutions, and even churches. A good image to keep in mind to that end is the one Jones offers in his poem: “how the branches of one tree reach into the branches of another.” 

In Braiding Sweetgrass Robin Wall Kimmerer, botanist and member of the Potawatomi Tribe, has offered timely, profound reflections on how the nonhuman world teaches us — the trees that reach out not only branches but roots through which they can feed each other; the fungal networks that quietly share life-sustaining information; the pollinators who are agents of fecundity and the animals who honor their interdependencies better than most of us. They are interactive, these non-human species, in fluid, adaptable ways, and fierce in the ways they care for their young, and for each other. Elephants stay and stand with the dying. Bees alert each other to sources of pollen. Lions, wolves, and wild dogs cooperate in hunting and share the kill. Stories appear from time to time of one animal caring for an orphaned infant of another species. 

Historically, humans have had to attend to each other’s health and well-being in grittier, bloodier, more intimate ways than are usually required of us now, often in ways that were largely ineffectual by modern standards, but that were also, as McLuhan put it, “high touch” rather than “high tech.” We don’t necessarily have to accept one or the other; high-tech medicine dominated by the pharmaceutical industry doesn’t have to displace simple caring and “trust in one another.” At an institutional level, though, we have re-learning to do.

Recognizing that need, twenty major medical schools include faculties, programs, or courses in medical humanities, sometimes called “narrative medicine.” In them the importance of story and of metaphor, poetry, imagery, and spirituality in clinical encounters and in the process of healing are explored. Listening for the words a patient uses to describe her suffering can provide valuable, usable information and, just as importantly, make medicine more relational. 

The slide toward impersonality is culture-wide, and the work of maintaining eye-to-eye, hand-to-hand, heart-to-heart contact incumbent on all of us who live and move in institutions all week, including church on Sundays. In that work the small things are the big things in disguise: I’m delighted, for instance, when a real person in the church office answers the phone. And when a person I don’t know well bothers to follow up on a recent prayer request. Or when someone is willing to ask for help I happen to be in a position to provide — a ride, an errand, help with a college essay, an hour of respite care for an adult who can’t be left alone.

“The ways we care for one another” are various and vocational: we offer what we have and let others do the same. Human kindness flows in many tributaries, leaving its blessings in both lush and desert places. Inside large, impersonal institutions, driven by bottom lines and quantitative measures and fixed notions of productivity those small exchanges that “bless the space between us,” the moments when branches touch, become little acts of subversive love.

Underneath the protocols and algorithms and “best practices” and standard procedures, unstated on agendas and policy statements and annual reports, those moments when we become like bees or elephants or migrating birds are precious as breath. They remind us we are members of one body whose parts are fed by one great beating heart.

Header photo by Ambareesh Sridhar on Pexels
Ambulance photo by camilo jimenez on Unsplash