Doctors, with limited time, need to deal with things you can see, touch, feel rather than states of mind. The abscess, the perforation, the fever, the suppuration, the bacteria, the thing you can X-ray, chart, pursue. To stenches their senses appear numb; of vomit, sweat, blood, feces, death, halitosis, they are no more aware than they are of the flowers on the bedside tables.
Yet for the patient, stripped of the roles and outer garments that give him his dignity, his body, and whatever respect it's allowed, is all he has left. He doesn't see the tumor in his head or the infection in his liver, but he does know if he soils the bed or if his odor is offending other patients. Andrew's state of selective awareness- in which obtuseness combined with acute sensitivity- made this particular horror a mortification. Freud points to the beginning of civilization, of cultural consciousness, as the moment when the infant, hitherto happy with his own fecal smells, realizes they are offensive to others. Andrew was crossing this painful threshold over and over again.
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