I and Thou and Cancer

Craig R. Hildreth, MD

“The basic word I–You can be spoken only with one’s whole being. The concentration and fusion into a whole being can never be accomplished by me, can never be accomplished without me. I require a You to become; becoming I, I say You. All actual life is encounter.”

- Martin Buber, Ich und Du 

To all those who have an appointment with an oncologist in the near future, whether it is for the first time or the umpteenth, I have a question: when you leave the office, will you feel more connected to your doctor? By that I mean will you enjoy the comfort of knowing that he or she truly cares what happens to you? Would you have no hesitation in calling them for help or encouragement, confident that your doctor wants nothing more than to be by your side in your time of need?

The relationship between oncologists and their patients is labor-intensive and arouses great emotions. The specter of death is always in the shadows; as it waits patiently, it makes conversations poignant. Oncologists should be skilled in soothing the fears of their patients without appearing trite or patronizing. One method I have found success with is from the seminal work of an Austrian philosopher-published in 1923.

Martin Buber (1878–1965) worked for years on his magnum opus Ich und Du, translated as I and Thou, in which he proffered his thesis on how to reach the pinnacle of spiritual human existence. I believe this short essay is relevant to the study of patient care and can be an inspiration to oncologists. It is abstruse, though, enough to the point that I apologize to those familiar with Buber as I try to share his enlightenment.

When oncologists perform such tasks as reviewing records, interpreting x-rays, and planning treatments this relationship between doctor and world is designated by the term Ich–Es (I–It), “the world of experience,” as Buber calls it. This interface is cemented in time and space and objectifies all that the “I” encounters. The establishment of Ich–Es illuminates the differences between “us and them,” keeping a distance between the two. Ich–Es can be measured; it is close-ended; it is concerned with things, not others. As Buber put it:

“I perceive something. I feel something. I imagine something. I want something. I sense something. I think something. The life of a human being does not consist merely of all this and its like. All this and its like is the basis of the realm of It. But the realm of You has another basis.”

The realm of You is where we form a noble and thoughtful harmony between ourselves and another human. When oncologists interact with their patients in the world of Ich–Es they do not grant the other person the same respect as they bestow upon themselves. By considering the patient as a patient, ignoring the fact that both of us are whole beings in the world of the present, we sacrifice the chance to form an affinity with this person, a salutary relation that Buber names Ich–Du:

“When I confront a human being as my You and speak the basic word I–You to him, then he is no thing among things nor does he consist of things.

“He is no longer He or She, limited by other Hes and Shes, a dot in the world grid of space and time, nor a condition that can be experienced and described, a loose bundle of named qualities. Neighborless and seamless, he is You and fills the firmament.

“As long as the firmament of the You is spread over me, the tempests of causality cower at my heels, and the whirl of doom congeals.”

If I were lecturing medical students I would say, “Do not place your patients in categories. Do not assign them a label. Look at them and appreciate them as unique, just as you appreciate yourself. Enjoy their conversation and get to know them. When you value the life of another and make an effort to help, ‘I and Thou’ become fused into a singular relation that elevates us to the highest planes of happiness and meaning.”

Oncologists who truly believe that a patient’s life is no less than their own, who are ready to give themselves to the relation with sincere appreciation of the other’s life, who regard the bond between two people as the indispensable measure of service-they are headed toward the sublime and ultimate satisfaction. As Buber states: “The It is the chrysalis; the You the butterfly.”