Wednesday, November 18, 2009

ON LOOSENING UP

A few years ago, a dermatologist spoke at a medical education lunch at our local hospital. Given his specialty, his talk was a series of color slides depicting skin lesions. Some photos, of course, challenged the audience’s appetite, but that comes with the territory.

He showed a slide and said, “This is the typical kind of lesion you get with Type A skin.” With the next slide, he said, “This one, though, is more characteristic of Type B skin.”

And on and on, Type A and Type B. Finally, one physician said, “Excuse me, but I’ve never heard of Type A and Type B skin. Where is this in the medical literature?”

The dermatologist seemed shocked. He said, “It’s not in the literature. It’s my fantasy.”

Several physicians, outraged, pounded the table and stormed out. The presenter called after them, “What’s the matter? Don’t you fantasize?”

I guess not. They wanted facts, by God. Call me deviant, but I was delighted by the presentation.

Where would science be without fantasy? Every disciplined investigation begins as a fantasy. We have no idea what to look at until we say, “I wonder…” Albert Einstein, arguably the archetypical scientist, hardly ever entered a laboratory. His deepest revelations came to him while he was lying on his back in his sailboat on a Swiss lake, daydreaming. He wrote, “The most beautiful experience we can have is the mysterious. It is the fundamental emotion which stands at the cradle of true art and true science.”

I admit it: I fantasize continually, often about healthcare.

For example, is illness always an unmitigated misfortune, or, by temporarily evicting us from our regular habits, does it offer us the opportunity to alter our lives?

For example, is pathophysiology (what goes “wrong” in the body) sometimes a form of body language—our deeper selves expressing an encoded message?

For example, does pain exist not just to torture us, but also to get our attention?

For example, when is it okay to die?

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