November 2018 – A Medical Education

From Administrative Science Quarterly, May 29, 2014:

In this longitudinal study, we build a theory of a culture of companionate love—feelings of affection, compassion, caring, and tenderness for others—at work, examining the culture’s influence on outcomes for employees and the clients they serve in a long-term care setting. Using measures derived from outside observers, employees, family members, and cultural artifacts, we find that an emotional culture of companionate love at work positively relates to employees’ satisfaction and teamwork and negatively relates to their absenteeism and emotional exhaustion. Employees’ trait positive affectivity (trait PA)—one’s tendency to have a pleasant emotional engagement with one’s environment—moderates the influence of the culture of companionate love, amplifying its positive influence for employees higher in trait PA. We also find a positive association between a culture of companionate love and clients’ outcomes, specifically, better patient mood, quality of life, satisfaction, and fewer trips to the emergency room. The study finds some association between a culture of love and families’ satisfaction with the long-term care facility. We discuss the implications of a culture of companionate love for both cognitive and emotional theories of organizational culture. We also consider the relevance of a culture of companionate love in other industries and explore its managerial implications for the healthcare industry and beyond.

A review I wrote for the Guardian 13 years ago of an oddly titled book by the son of the “84th most dangerous red in the world.” As I wrote, it is not entirely a memoir of the 1956 polio epidemic, nor is it an thorough history of the outbreak, but nevertheless it is an interesting read.

The Broken Boy
by Patrick Cockburn
320pp, Cape, £15.99

Writing about the house in which he grew up in Youghal, East Cork, Patrick Cockburn says it “owed its vigorous personality to our lack of money, which ensured that it never saw the hand of a contractor and was reconstructed piecemeal by my mother”. Cockburn’s engaging and witty book itself has a vigorous personality. It is far from the straightforward memoir of his experience of the 1956 polio epidemic in Cork suggested by the title and cover.
While being taken to see child casualties after the American bombing of Baghdad in 1998, Cockburn – a foreign correspondent – began to wonder about his own childhood experience of polio, and the epidemic about which he knew so little. Hardly any written accounts existed. In 1999, he began to interview those who remembered the outbreak, but the Chechen war and the world situation after September 11 combined to prevent him from continuing his research for some years.

This perhaps contributes to the somewhat disjointed feel of the book. Six of its 14 chapters deal with the 1956 epidemic. It begins with a six-year-old Cockburn waking with a headache and sore throat. The local doctor is called and the sensation of the stethoscope on his skin is one of the few clear memories Cockburn retains from the time. Three months earlier, in July, the epidemic had arrived in Cork city.

Cockburn was taken by ambulance to St Finbarr’s hospital in Cork city. Although terrified and uncomprehending, his memories of St Finbarr’s are sunnier than those of Gurranebraher, where children were transferred after the acute phase of the illness. Cockburn’s father, the radical journalist Claud Cockburn, wrote that children in Gurranebraher “seemed to be largely in the hands of maids – young country girls with no special training at all”. One reason for this was that female nurses, like any woman working in the public service at the time, had to resign on marriage – a glimpse of a very different Ireland from today’s.

Although Cockburn quotes doctors and physiotherapists critical of the handling of the outbreak, he himself seems curiously detached. The Salk vaccine had been field tested the year before, but was still unavailable and not entirely trusted by doctors. Quarantine was pointless, given that the majority of carriers of polio are asymptomatic. Some agitated for sporting events to be cancelled and for a form of temporary apartheid to be implemented against Corkonians – but though some politicians indulged in similar rhetoric, such sanctions were avoided.

Paradoxically, the victims of the Cork epidemic largely came from the more prosperous areas. This was because, in places where hygiene was poor, exposure to the virus was near-universal, and infants would be protected by maternal antibodies, so tended to have mild or asymptomatic forms of the illness. Improved water supply and sewage systems led to the loss of this immunity. Indeed, Cockburn argues, the outbreak could be seen as an early marker of Ireland’s later prosperity.

Cockburn writes well about his Anglo-Irish childhood, the tangled lives of his mother’s forebears and what Olivia Manning called “the usual Anglo-Irish sense of belonging nowhere”. His father Claud, described by Senator Joseph McCarthy as “the 84th most dangerous red in the world”, is a benign, rather impish spirit hovering over the book. As well as the affectionate personal memories of his father, Cockburn describes the absurdly detailed file kept on his father by British intelligence. For 20 years, with dutiful pedantry, agents followed him around recording who he met, where he went and what he did there.

The title The Broken Boy is slightly mystifying, as Cockburn doesn’t seem to have thought much about his polio experience until 1998. He does refer to “emotional scar tissue from polio” that he was aware of from an early age, but the nature of this emotional scarring isn’t at all clear. Though he spent a lot of time in school reading by himself, he writes “I was not solitary and made friends easily.” In fact, this is an oddly uplifting book. It is refreshing to read a disease memoir that is far more focused on the lives of those around the author than on trying to whip up sympathy or outrage.