On the Normal and the Pathological
by MICHEL FOUCAULT Everyone knows that in France there are few logicians but many historians of science; and that in the 'philosophical establishment' - whether teaching or research oriented - they have occupied a considerable position. But do we know precisely the importance that, in the course of these past fifteen or twenty years, up to the very frontiers of the establishment, a 'work' like that of Georges Canguilhem can have had for those very people who were separ ated from, or challenged, the establishment? Yes, I know, there have been noisier theatres: psychoanalysis, Marxism, linguistics, ethnology. But let us not forget this fact which depends, as you will, on the sociology of French intellectual environments, the functioning of our university institutions or our system of cultural values: in all the political or scientific discussions of these strange sixty years past, the role of the 'philosophers' - I simply mean those who had received their university training in philosophy department- has been important: perhaps too important for the liking of certain people. And, directly or indirectly, all or almost all these philosophers have had to 'come to terms with' the teaching and books of Georges Canguilhem. From this, a paradox: this man, whose work is austere, intentionally and carefully limited to a particular domain in the history of science, which in any case does not pass for a spectacular discipline, has somehow found him self present in discussions where he himself took care never to figure.
Josie s Story
Sorrel King was a 32-year-old mother of four when her eighteen-month-old daughter, Josie, was horribly burned by water from a faulty water heater in the family’s new Baltimore home. She was taken to Johns Hopkins—renowned as one of the best hospitals in the world—and Sorrel stayed in the hospital with Josie day-in and day-out until she had almost completely recovered. Just before her discharge, however, Sorrel noticed something was wrong—Josie was looking pale, she appeared severely dehydrated, and her eyes were rolling back in her head. Sorrel pleaded with the doctors and nurses (many of whom she had become close to) that something was wrong, and they agreed to stop administering Josie methadone, the narcotic they were using to wean her off morphine. Josie had begun noticeably improving when a new nurse approached her with a syringe of methadone. When Sorrel tried to stop her from administering the drug, the nurse said that the orders had been changed again. Sorrel, against her better judgment, decided that Hopkins must know best, and stepped back. Almost as soon as the drug had been injected into Josie’s system, she went into cardiac arrest. The doctors raced to save her, but by the time they stabilized her, Josie was brain dead, her organs shutting down one by one. She passed away shortly thereafter, her family having made the choice to take her off life support. In the days and months that followed, Sorrel went through the tumultuous processes of grieving. For a while, she thought she would not survive; suicide and alcohol both seemed like viable escape possibilities, and Sorrel toyed with both. But ultimately it was her rage that kept her alive—rage at the doctors, at Hopkins, and at the medical institution that had allowed this to happen. She wanted the doctors to feel the same pain she had caused them. She wanted to destroy Hopkins “brick by brick.” Dizzy with grief, she came close to ending her marriage, but slowly pulled herself and her life back together, for the sake of her family, and for the memory of Josie. It was around this time that Sorrel learned a staggering fact—though indeed an error, Josie’s death wasn’t a fluke in the statistical sense of the word. About 98,000 American patients die a year as the result of medical error, making it the fourth most prevalent cause of death in the US. Armed with this fact, the money from her settlement with Hopkins, and a vague awareness that Josie’s death could have been prevented, Sorrel began to penetrate the healthcare industry. An appearance on Good Morning America and a long article in the Baltimore Sun raised the public profiles of her and her mission, while speaking requests began to pour in from hospitals and healthcare groups across the world. For the most part, medical errors had simply not been talked about; most doctors involved in them were paralyzed by remorse and fear of lawsuits, while the patients were dead or badly injured and their families crippled by grief. Sorrel was helping to pull back the curtain on an all-too-common killer, and the world of healthcare knew it. Despite some initial resistance, most in the industry came to welcome her message, and to look to her for answers. With the help of other patient safety advocates—many of them doctors, and some of them the very Hopkins officials who had defended the hospital after Josie’s death—Sorrel and The Josie King Foundation began to develop and implement in hospitals basic programs that emphasize communication, respect of the patient, and attentiveness to their concerns. Rapid Response Teams, for instance, can be called from the beside by patients or their families who feel they are experiencing a serious change in their condition that is not getting sufficient attention from hospital floor staff. A team made up of doctors, nurses and a patient relations coordinator responds quickly to evaluate the patient and develop a plan for care. This is just one example of a program that came out of Sorrel’s efforts, and it’s in place in hospitals across the country, and has saved countless lives. Sorrel’s account of her unlikely path from grieving parent to nationally renowned advocate is interwoven with descriptions of her and her family’s slow but steady road to recovery, and ends with a deeply affecting description of a ski trip they took recently. The sun is shining, her children are healthy, and they are all profoundly happy—a condition that Sorrel has learned to appreciate all the more for Josie. The book ends with a resource guide for patients, their families, and healthcare providers; it includes information about how to best manage a hospital stay and how to handle a medical error if one does occur. Two prominent characters from the story, Hopkins’ lawyer Rick Kidwell and Paul Bekman, the personal injury attorney who handled the case for the King family, have come together to contribute advice in a Q & A section, and Sorrel also provides lists of general advice, useful online resources, and essential books on the subject.