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6 min read

The whole love song of the garden

Listening to a garden and its gardener, high in the Andes, has Anthony Baker recalling an old song.

Anthony is a theology professor at Seminary of the Southwest in Austin, Texas.

A Garden in the heart of the Andes
Image generated by Dan Kim using Midjourney

Saint Augustine taught that whenever we witness a true relationship of harmony forming in the world around us, we hear a new version of the oldest song there is: the music of the Triune God. In the mountains just east of Medellín, Colombia, I met a man whose ear was attuned to this music.  

Fincas of the silleteros 

I was there with my wife, visiting her many aunts and uncles and cousins who had remained in the homeland when her own parents immigrated to the United States. One Saturday when they were off work and out of school, the family said they wanted to show us the fincas de los silleteros, or country estates of the chair-bearers. That sounded confusing enough to pique my curiosity.  

On the winding road out of the city, Stephanie's cousin gave me a brief history of the fincas. The indigenous and mestizo peoples of the region have for countless generations farmed this rich mountain soil, specializing in flowers that, once the Spanish arrived, the farmers would sell at markets in the growing colonial city of Medellín.  

Through the centuries of Spanish imperial presence, a strange and unique tradition developed. The poor inhabitants of the region, mostly but not only the Indigenous peoples, would tie chairs to their backs and carry elderly, wealthy, sick, or pregnant Spaniards through the Andes passes and into the villages and city. A sure-footed peasant could offer a smoother trip than a mule or a cart. The famous linguist and world-traveler Alexander von Humbolt was among the first Europeans to document this practice. 

Moonlighting as silleteros, the local farmers of the region decided their backpack chairs could serve also as baskets when it was time to carry their flowers down to the markets. Properly stacked and carefully transported, they could walk the five or so hours to the market without losing many petals and so have plenty of flowers to sell. They would return to their fincas with chairs full of rice and beans and corn meal and other market goods.  

Listening to the garden 

The history of the region is even more complex than all of that, involving the closing of flower markets, a dramatic protest by the silleteros, and the beginning of Feria de las Flores, Medellín's largest annual festival. 

As we followed Don Fidel, the reigning patriarch of one family of silleteros, I got the feeling that all that richly layered history served as backstory to his primary occupation: caring for his beloved flowers. The festival was tradition, and the tourists like me paid the bills, but Don Fidel's first love was clearly his garden. 

Our guide led us on a meditative walk through the plots, apparently oblivious to the rain that was pelting us with increasing strength by the minute. As we walked, he pointed out to us the various species he nurtured. Geraniums, calla lilies, roses, hydrangeas, and many that I didn’t know the English names for: pascua (or "lovers’ flower"), astromerias (“lily of the Incas”), button de oro, claveles, campanitas, clavellinas

Walking the hillside that his grandparents once farmed, Don Fidel was deeply familiar with the soil, the slopes and waterways, the rhythm of sunlight and shade. He knew where to look on the mountain horizon for rain clouds that might make it to his acreage.  

Because of the way he'd grouped his flowers, he knew that the predatory bugs would be near their prey, and the system would find a balance. 

He even told us some secrets of his garden. He had both personal and ancestral memory of the various species, and knew to group certain communities of flowers together to keep them healthy. He told us that the word "pest" is just a consumerist term for a living thing that threatens economies. In gardens and farms, we tend to eliminate them with chemicals. Don Fidel told us that all those pests lived in his garden as well, but because of the way he'd grouped his flowers, he knew that the predatory bugs would be near their prey, and the system would find a balance. For extreme cases he showed us the simple mixture he made from the flowers themselves that he used to "fog" the garden, much like the pre-Columbian peoples did with toxic tobacco leaves. 

Don Fidel was listening deeply to the music of his garden.  He heard the refrain of the insects and flowers about what it was they most desired. And it wasn't chemical spray. 

The music of sunflowers and bees 

This circular living economy enabled a remarkable new birth within the garden. Toward the end of the tour, when the rain had driven most of the family back onto the wraparound porch of the house, Don Fidel was proud to show my wife and me what he’d learned about his sunflowers.  

The sunflower (girasol: "sun-facer") is a big draw for the shops in the city. Everyone wants the classic, grand, bright yellow flower. The particular variety grown in that region is sterile, modified by many generations of laboratory hybridization.  But the gardener one day noticed something curious about the sterile male flowers he planted. A big group of them bloomed darker, nearly violet, and smaller, with multiple flowers on each stem. Why was this happening? It didn't seem to be disease, so he didn't worry. He just listened for a new melody. 

Soon he found the culprit: honey bees, flourishing in the garden thanks to Don Fidel’s aversion to chemical pesticide. The proximity of the lab-altered flowers to a cousin-species meant that bees could travel naturally from one sort to the next. The cousin was fertile, with both carpel and stamen. When the bees landed on the genetically modified girasoles, they brought the other pollen along with them. Remarkably, this landing changed the genetic makeup of the sunflowers and rendered them fertile once again. It undid generations of artificial selection to bring forth new life and new beauty.   

The music of the triune God 

When Saint Augustine contemplated the Trinity, he said that God is something like a lover and a beloved who find one another. Like a sunflower and its once estranged sexual partner, watching one another across a swath of shorter garden flowers.  

It's a flawed image in many ways, as Augustine himself admits. God does not "begin" as two independent beings, like the two flowers do. We might say that the triune God's image is reflected in the whole love song of the garden, the harmonious melody the organisms make together.  

At the heart of Augustine’s analogy is the observation that two can only become one if a third, a gift, passes back and forth between them. In theology, we call this third character the Holy Spirit. In Don Fidel’s garden, it’s the bees. They land on the faces of the one and the other, transferring the gift of being and life in the pollen clinging to their feet.  

  

Notice also how the three—the sunflower, its distant cousin, and the bee—are also one. The bee owes all that she is to the flowers: her habits, her communicative dance, the hairs on her feet. She is not just a bee looking to gather nectar from separate organisms called flowers. She is a living extension of the flower, the flower’s winged desire for life and fertility.  

The same holds for the flowers: they become what their apian lover asks them to be, in surprising ways that not even the bee, let alone Don Fidel, could have guessed. 

In other words: the love song of two is always a song of three. The lover, the beloved, and the gift of love itself that passes between them and forms a new celebration of their bond.  

This, Augustine says, is the song that God sings from all eternity. And it's the song, remixed a thousand ways, that creatures of earth come to sing.  

Because he kept listening, Don Fidel heard a melody few of us would have noticed. A less curious gardener would have uprooted the “flawed” blooms and replanted the flowers that the shops down the mountain were asking for. As the rain soaked my clothes, I said a prayer of gratitude for his patient curiosity, and for the love that binds the world together. A love whose proper name, according to the theologians, is God. 

 

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Care
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5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.
Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;  

 “Fine thank you sir.”  

 He then went on to ask what she had done with her younger child who came with her.  

Looking more astonished she said:   

“I left him with my aunt who lives in Edinburgh.   

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.  

Turning to the students he explained  

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens  and the skin rash on her hands is typical of workers in the  Linoleum factory.   

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.  

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket.  We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.  

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.     

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.  

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.  

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.  

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.  

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.  

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:  

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?   

He replies:  

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.   

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.   

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process. 

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.   

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford,  said:  

“It is more important to know about the patient who has the disease than the disease that has the patient”.  

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too.