1. Simone, Joseph V. MD

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After many of my lectures, especially to those who are still in medical training or in early or mid-career, I mention the integrity and sanctity of work. I am passionate about this issue, which is why I wrote this column about 10 years ago.

Joseph V. Simone, MD... - Click to enlarge in new windowJoseph V. Simone, MD. Joseph V. Simone, MD, has had leadership roles at many institutions and organizations, and has served on the NCI's Board of Scientific Advisors. His

In a short play, titled The Stonemason, author Cormac McCarthy has encapsulated the irreplaceable gist of a profession practiced correctly and with honor. This applies to every profession, whether medical or the "dirty hands" type. I think the lesson it teaches is even more relevant today in our ever-changing medical environment and is especially appropriate for a medical and nursing audience; we deal with lives and the stonemason deals in buildings.


The play is set in Louisville, Kentucky, in the 1970s and is narrated by Ben Telfair, a stonemason whose father, Big Ben, and his grandfather, Papaw, are also stonemasons (papaw is a common name for a grandfather in the South.) It is a masterfully written story of a family faced with the acute problem of Ben's wayward nephew, Soldier, who is in trouble with the law.


The play has a number of important layers, but the soul of the work, and the reason I read it over and over, is Papaw, the 100-year-old stonemason. His passion intimately weaves the sanctity of work and craftsmanship into a single fabric with spiritual wisdom about what really matters in life. He reminds me of the craftsmen who built medieval cathedrals with pride of craftsmanship and with an acute sense of the nobility and sanctity of their work.


Ben recognizes the knowledge and wisdom Papaw offers and he avidly tries to soak it up before Papaw is gone. When he realizes what a remarkable and unique resource his grandfather is, he says, "Oh I could hardly believe my good fortune. I swore then I would cleave to that old man like a bride." Neither Big Ben nor Soldier places a high value on Papaw's views of stonemasonry and his exacting standards.


During the course of the play, Papaw relates through Ben's narration what he knows and how he feels about stonemasonry, and not coincidentally, about life. He also is speaking to us about how one loves and respects his work: the truth of it, the wholeness of it, the essence of it. For Papaw, how he approaches his work is inextricably linked to how he views the world, how he treats others, and how this is all intertwined with his basic faith.


Here are excerpts from the play. While Ben and Papaw are working on a farmhouse, Ben the narrator speaks about stonemasonry:


"For true masonry is not held together by cement but by gravity. By the stuff of creation itself. The keystone that locks the arch is pressed in place by the thumb of God. When the weather is good we gather the stone ourselves out of the fields. What he likes best is what I like. To take the stone out of the ground and dress it and put it in place. We split the stone out along their seams. The chisels clink. The black earth smells good. He [Papaw] talks about stone in a different way from my father [Big Ben]: always as a thing of consequence. As if the mason were a custodian of sorts. He speaks of sap in the stone. And fire. Of course he's right. You can smell it in the broken rock. He always watched my eyes to see if I understood. Or if I cared. I cared very much. I do now. According to the gospel of the true mason God has laid the stones in the earth for men to use and he has laid them in their bedding planes to show the mason how his work must go. A wall is made the same way the world is made."


There are physicians who have the same respect, almost reverence, for their patients and how to put them back together. Perhaps for them it is because the mystery of their lives is held together "by the stuff of creation itself" and deserves-no, demands-professional and personal respect.


Ben continues, describing the essence of the work. "So. It's not the mortar that holds the work together. What holds the stone trues the wall as well and I've seen him check his fourfoot wooden level with a plumb bob and then break the level over the wall and call for a new one. Not in anger, but only to safeguard the true. To safeguard it everywhere...I see him standing there over his plumb bob, which never lies and never lies and the plumb bob is pointing motionless to the unimaginable center of the earth four thousand miles beneath his feet. Pointing to a blackness unknown and unknowable both in truth and in principle where God and matter are locked in a collaboration that is silent nowhere in the universe and it is this that guides him as he places one stone over two and two over one as did his fathers before him and his sons to follow and let the rain carve them if it can."

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Ben then talks about seeing samples of Papaw's work, some of it 80 years old, while driving in the region. " a thousand structures I've never seen a misplaced stone... . The beauty of those structures would appear to be just a sort of a by-product, something fortuitous, but of course it is not. The aim of the mason was to make the wall stand up and that was his purpose in its entirety. The beauty of the stonework is simply a reflection of the purity of the mason's intention."


Papaw and Ben feel a passionate responsibility to their profession and for its integrity. They believe what they do matters not only for the quality of the wall they build, which can be seen by all, but also for what cannot be seen, what almost no one will know or understand or value. They do things right out of respect for their profession, their craft and, most of all, out of respect for themselves. The characters who disdain such values, Big Ben and Soldier, are chronically unhappy and unfulfilled and find it hard to love unconditionally. They make excuses for their unhappiness, their impatience and the short cuts taken in their work and in their lives. For them, too, their jaded and cynical views of work are of one piece with their views of life.


The message is clear: Integrity in one's work and a passion for doing the right thing and doing things right are an inseparable part of what we love and value, of what brings happiness. Medicine is the same. Doing the work that we love is a privilege and a blessing; doing it with the same integrity and passion for truth as Papaw is the way we respect our patients, our profession, and ourselves.


I recommend that you read The Stonemason, because I cannot do it full justice.