Excerpt
Power Healing
IN RESTAURO
With its cold, marble floors, gray walls, and cavernous ceiling, the room reminded me of a ward in the old Bellevue Hospital, where I’d spent my medical internship. The patients here, blighted and broken, lay silently in rows, tended with a reverence I had never seen in any hospital. Most were very old, four hundred to seven hundred years old, medieval altarpieces and Renaissance paintings sent from museums and churches to this hospital for sick works of art, Laboratori di Restauro, on the grounds of a fortress near the center of Florence. Botticelli’s Coronation of the Virgin, ready for discharge after ten years of painstaking restoration, stood leaning against a wall. Forty years it had spent on its back in the damp and musty basement of the Uffizi Gallery, its vibrant colors hidden by a brown scum of dust and mold, smelling like aged cheese and peeling so badly from a prior restoration that the picture would have fallen in flakes had it remained upright. Nearby, a Raphael Madonna awaited her return to the Palazzo Pitti. In a far room stood a ceiling-high crucifix, painted by Giotto in 1296, recently admitted from the Church of Santa Maria Novella. I had looked for it in the church’s sacristy the week before and found only its photograph and the familiar sign, IN RESTAURO (In Restoration), which confounds art lovers throughout Italy. Today I was able to climb the scaffolding and inspect Giotto’s masterpiece face to face. To stand in the mysterious place where restauro actually happens filled me with such excitement that I found it hard to concentrate on the purpose of my visit.
The enemies of paintings are also the enemies of people: physical injury, bacteria, fungi, and air pollution, which hastens the ravages of time and of light. Successful art restoration requires detailed scientific support, the reason why Restauro seems more like a hospital than a studio. Before 1500, most paintings were made with a mixture of egg yolk, vinegar, and plant and mineral pigments applied over several layers of aged gypsum and parchment-glue to pieces of wood stuck together with cheese and limestone. Left undisturbed and protected from light, these are the most permanent paintings that humankind has yet invented. Their colors don’t darken with age, as do those of oil paintings, but shine out brightly when the grime of centuries is removed. They were rarely left undisturbed, however. Varnishing, overpainting, cosmetic trimming, and botched restoration have joined forces with microbial parasites to damage them all. Even Mona Lisa, an oil painting whose colors have dimmed from their initial liveliness to a murky gloom, had a swatch of her panel sliced off in the seventeenth century to accommodate a new frame, distorting Leonardo’s complex perspective.
The technicians of Restauro use X ray, ultrasound, and infrared thermography to define the layers of a painting, detect revisions, and discover the artist’s original charcoal sketch. Minute fragments of paint and priming are removed for microscopic and chemical analysis and microbial culture. Under high magnification, the color of paint fractures into its component primary pigments. Blue azurite and red cinnabar are revealed from purple, the richness of color directly related to the coarseness of granules in the paint. The chemistry of restoration must distinguish mineral pigments from plant dyes and the curious lake pigments formed from lac, dead insects mummified in the sap of living trees. Chemical assay can reveal the artist’s original intent. Blue salts of copper, limestone, and ammonia lose ammonia to turn green with age. Precise analysis suggests the proper treatments. Old varnishes, if their composition is known, can now be safely removed with tailor-made enzymes rather than with corrosive solvents. White lead, darkened by the sulfur in air pollution, can be blanched by hydrogen peroxide, with no harm to other pigments. Mold growth can be removed mechanically; no chemical methods have been found that are both effective and safe. It was the mold problem that first led me to Restauro on a wintry morning in 1990, to consult with the laboratory’s microbiologists, Iseta Tosini and Maria Rizzi, who were searching for a safe way to remove mold. I went there to help them by drawing upon my experience with natural antibiotics. I left enriched by a vision of their work that raised my hopes for my own profession.
Art restoration owes so much to medical technology that restoration directors often compare their work to medical care. Laboratori di Restauro is like a multispecialty group practice: each “patient” has a primary physician coordinating a team of specialists in surgery, infectious disease, and environmental health, drawing on the support of radiologists and clinical chemists. In Restauro, however, unlike in medicine, the primary physician is always the senior member of the team, because she alone has the training to treat the whole patient. Attention to the patient as a whole is so distinctly missing in contemporary medical care that physicians and patients have much to learn from Restauro.
While Florentine restorers rely heavily on scientific techniques to gather information about the state of their patients, they acknowledge science as a servant that helps them uncover the unique attributes of each work as it has changed over time. Their primary guide to its application is an unfaltering awareness of the individuality of each piece. Guido Botticelli, senior restorer of frescoes for Restauro, expressed his view succinctly: “… every chapel is different, with different problems which require different solutions. Every fresco is different, even if they happen to be in the same chapel.”
Understanding individuality is a perplexing task for science. Scientists study individual events to discover general principles, which can then be applied to other events. The validity of their conclusions is established by replicating their findings under controlled conditions. Medical scientists are, therefore, most comfortable when analyzing the similarities and differences between groups of patients. Artists, on the other hand, use general principles, like the rules of perspective, to create unique works that derive their value from being irreplicable. In the art of medicine, every patient is approached as an individual, biologically and psychologically unique. General principles—sometimes validated by the methods of science—are applied to each case, solely for the purpose of better understanding the unique characteristics of each patient. Sadly, in most medical practice today, the bond between art and science has been severed. The art of medicine lies dying of malnutrition, recognized only in the “bedside manner” of a good physician or the dexterity of a skillful surgeon. The science of medicine has lost its human face, deformed by the massive technology it has spawned. I have spent most of my life searching for an antidote, a person-centered medicine, in which the power of science is harnessed to the plow of art, so that medical care becomes restauro for sick people.
When I entered medical school in 1964, I knew the profession was ailing, but I thought its sickness resulted mainly from greed. I believed that doctors moved into narrow specialties and ordered excessive numbers of tests and procedures solely for monetary reasons. It took me years to see that doctors were doing this because they were following a fundamentally flawed blueprint. In this blueprint, sickness is understood as mechanical breakdown and the patient is a broken machine. Each type of breakdown is considered distinct, so distinct that it can be given its own disease-name and its own disease-code and can be fully described and understood as an independent entity, with no relation to the person who is sick or the environment in which the sickness occurs. “What disease does this patient have?” is the primary clinical question. Its answer dictates the treatment to be prescribed—treatment for the disease, not the patient.
Like all my contemporaries, I received my clinical training in hospitals, observing patients who were acutely, often critically, ill. We were taught from the catechism of modern biological science, which preaches that the best way to understand anything is to break it down into its component parts and to study each part intensively. The ideology that promotes this approach to solving problems is called reductionism. Within its conceptual framework, specialization is a pathway to deeper understanding. The narrower the vision, the deeper it penetrates. The power of the specialist reinforces the grasp of reductionist thinking, because specialists tend to ask only questions that can be answered by the tools they possess.
My patients taught me the limits of medical reductionism. Their problems could never be fully explained by their “diseases.” There was always something strange or quirky that separated each person’s illness from the textbook case. Sometimes, there was little correlation between the patient’s pain or distress and the pathology that could be measured. Often, the response to treatment was unpredictable, each patient behaving like the subject of a unique experiment. The care of patients taught me that disease-entities are merely abstractions, the shadows cast by each individual’s struggle to maintain health in a hostile world.
I learned from patients that medicine’s greatest challenges are not posed by the questions that most clinical research attempts to answer. They are posed by the frustrations of general physicians who are responsible for the primary care of patients. Researchers and specialists have the luxury of confining their activities to those aspects of patient care that fit into the theory of diseases. They can ignore concerns that lie outside the domain of the specific disease or pass them on to another specialist.
At a time when the best and the brightest of students were in record numbers deserting primary patient care for specialty training, I sought to invigorate primary care by elevating its status within the hierarchy of medical education, and spent several years pursuing this goal within the State University of New York. I finally concluded that a generation would pass before the training of primary physicians was likely to be a central goal of medical education and that engaging in the struggle would teach me a great deal about academic politics but little about the needs of patients.
Two decades ago, I left a full-time academic career to establish a general practice in a small town in Connecticut. As I describe in Chapter Two, there I developed a habit that taught me more about patients than did eight years of schooling and residency training and five years of teaching. I began phoning patients that I hadn’t seen for several months to inquire about how they were feeling and what they were doing to take care of themselves. I was constantly impressed by the huge extent of individual differences in response to the same kind of treatment. I also realized that most of the accepted therapies for chronic ailments did little to improve the quality of a patient’s life or health.
