Reviews Personal view

A magical education

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.1399 (Published 08 June 2006) Cite this as: BMJ 2006;332:1399
  1. Daniel K Sokol (daniel.sokol{at}talk21.com), PhD candidate
  1. medical ethics unit, department of primary health care and general practice, Imperial College London, and hospital magician, Charing Cross Hospital

    One afternoon a week, when tired of thinking about medical ethics, I put on my volunteer's badge, pick up my cards and coins, and head over to the nearby hospital. In large, black letters, the badge reads “MAGICIAN.”

    For a few hours, I meander through the wards, performing tricks for the “guests” and their relatives. At the bedside, a large silk scarf vanishes and reappears before their eyes, three coins jump invisibly from one hand to the next, a £5 note changes into £20, two cards change places in a blink of an eye, a signed card disappears from the deck, only to reappear in my wallet, and so on.

    In my first week as a hospital magician, I nearly vomited twice. In one oncology ward, the stench of urine and faeces was such that I could barely finish my first trick. I held my breath, rushed to the end, and briskly walked out, gasping for air. Looking back, I should have told the nurse about the situation. No human being should endure such odours.

    All amateur and professional magicians should devote one day a year to visiting a hospital ward

    The second time was in the rheumatology ward, when I performed for a young man whose badly broken leg was perforated by metal rods at several places. Standing at the end of the bed, I could see that the area surrounding each entry point looked like the inside of a red and rotting fruit. I gagged at the sight, but somehow kept my composure.

    When patients are doubly incontinent, when their bones are shattered, when their flesh is riddled with cancer or their heads covered in a constellation of sutures following neurosurgery, I wonder why some should care about magic. The main weapon of the close-up magician is not sleight of hand, as is commonly believed, but misdirection: diverting the spectator's attention away from secret operations. As a hospital magician, misdirection adopts another meaning. For a handful of minutes, it diverts patients' attention away from their experience of illness, their impending tests or surgery, the tubes and the drips, and the gloomy surroundings. In return, they divert mine away from the trivialities and pettifoggery of academic life. When I perform, publications in high impact factor journals are the last thing on my mind. And when I open my wallet to reveal a card, and sense a momentary astonishment, I no longer care that the wallet is otherwise thin.

    My role as a hospital magician has opened my eyes to many aspects of health care and ethics (both medical and personal). I shall mention only two.

    The first relates to hospital life in general. There is, in British hospitals, an epidemic of boredom. Unless in agony or in the throes of death, hospitals are terribly dull places for patients. The dreary silence of the wards often screams out for excitement and activity. The books, magazines, and crosswords will not do, and neither will the toing and froing of various staff members. Although the dreariness is undoubtedly effective in encouraging patients to go home, the mood on the wards sometimes borders on the suicidal. I often wonder whether better entertainment would result in fewer patient complaints. And if immunological states are indeed linked to mental states (as suggested by the “placebo effect”), lifting patients' spirits may even improve their recovery. “Send in the clowns,” as the song goes, and splash the walls with coloured paint. As with military service in France, all amateur and professional magicians (and other suitable entertainers) should devote one day a year to visiting a hospital ward. They would learn much from the experience.

    The second deals with what I consider an important lacuna in the education of many academic medical ethicists. For most ethicists, hospitals are mysterious places. Large and impersonal, festering with invisible bugs and transient bodies, echoing with inhospitable sounds of pain, relief, anger, and other primeval human emotions, the hospital is viewed as a melting pot of moral issues to be addressed—from a distance. This unfamiliarity is cause for regret, as it perpetuates the chasm between theory and practice and contributes to the tension between ethicists and healthcare professionals. The latter often complain that ethicists are too theoretical and out of touch, while the former grumble at the lack of philosophical rigour in doctors' reasoning. At present, in the United Kingdom, only illness or injury will allow an ethicist to experience a hospital ward. Brief hospital internships to expose them to the realities of clinical practice would do much to remedy these problems. Welcoming ethicists into the nitty gritty of medicine would result in more empirically informed advice and greater collaboration between academics and practitioners on real life issues.

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