Tuesday, December 15, 2009

TWO ROADS DIVERGED IN A WOOD…



I embarked on the doctor path when I was nine years old. I was miserable for a week with a throat infection. In those days, doctors made house calls. Ours sat at my bedside that evening, took my temperature, peered down my throat. I had no way of knowing he was searching for enlarged lymph nodes when he palpated my neck; with my kid’s mind, I assumed doctors made people well by touching them. I don’t remember the penicillin injection I’m sure he gave me, but I clearly recall that when he touched me, my pain vanished. Magic! I had to learn this.

Medical schools wisely ask applicants about their motivations. The ones who answer, “I want to make heap big bucks” or, “I enjoy wielding power over naked people” don’t often make the short list. Nor do the ones who muse, “I want to learn magic.” Even as naïve as I was, I gave the preferred answer, also sincere, which was that I loved science and wanted to help people.

Orienting us on our first day, the dean listed the classes we’d take: anatomy, physiology, pharmacology, cytology, biochemistry, public health. Something wobbled inside me. Nothing but science? When do I learn how to touch people to make them feel better? Do they teach magic in the second year, maybe? Or on the wards? Before I was foolish enough to raise my hand, my guardian angel had me whisper my question to the student beside me.

“Magic?” He screwed up his face. “Did you say ‘magic?’”

Ooooo. “Well, er, maybe not, um, magic, but you know, like, well, ah, the doctor-patient relationship, and being with patients, and…”

Today that student is a successful psychiatrist who showed therapeutic promise that morning by telling me, “Hey, look, buddy: there’s no magic. It’s pure science. Get used to it.”

I got used to it. Along with my classmates, I absorbed the standard avalanche of information. Afterward, practicing in a variety of settings, from the National Institutes of Health to county hospital emergency departments, my silent question continued to pester me: where’s the magic?

Come now, I told myself, here you are, a grownup, a medical doctor, a trained scientist, longing for magic. Did I mean to dispense talismans and cast off curses? It was so difficult even to phrase a reasonable question that it crossed my mind that I was I losing it.

Providence intervened in the form of a film, “Diner” (I highly recommend it; rottentomatoes.com scores it 96%), about a pack of callow male adolescents in Baltimore. Two of them have lascivious designs on a wealthy young woman. She finds them repulsive and has twelve times their brains. She arranges for the guys to be stranded in a bleak, remote pasture late one moonless night.

Grimacing, one turns to the other and asks, “Didja ever think maybe there’s stuff going on that we don’t know about?”

Well, didja? I began asking questions: might there be more to medical practice than what I was trained to notice? Is there, say, some connection between the way people lead their lives and how they get sick? If there is, why don’t we examine their lives along with their lungs? Do people experience sickness uniformly or uniquely? How much can the sick contribute to their own healing? Can the placebo effect be initiated voluntarily? Is there actually a way to touch people so they heal? What do we mean by “healing,” anyway? When is it okay to die? All in all, what exactly is healthcare's mission—to diagnose and treat disease, or to treat the person, in addition? And what does “treat the person” mean?

You can't keep asking such questions without ultimately finding yourself in that bleak, remote pasture late one moonless night. But at least I could dimly see the “Two roads," as Robert Frost put it, that "...diverged in a wood…”

I left standard medicine in order exclusively to facilitate cancer support groups. There are no miracle cures here, nor raising of the dead. In fact, very little changes in the material world. What changes dramatically is people’s attitudes and, subsequently, their experience. It reminds me of when my doctor touched my nine-year-old aching throat. My fever and lymph nodes remained just as abnormal, but I’d felt better. Magic.

1 comment:

  1. So good to hear your words. In the past 7 months I have had 3 surgeries (mastectomy, port installation, and breast reconstruction)and chemotherapy. What means most to me are the kind touches and words from the medical staff, and a hug a got from my plastic surgeon. I find that the medical staff do want to "hug" but I have to make the opening for that to happen, and I will continue to do so.

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