Today was my last day of Cardiology. I did nothing, as usual, but I got to listen in on a very interesting discussion. The woman in question did her PhD thesis on the role of women in the ?Mexican Revolution? between 1812-1818 (History people, please correct me) and talked about the fighters, the poisoned-tortilla-sellers, and the over 100 women who played a documented role in the combat. Her partner has a masters in something equally interesting. It started with them reading Margaret Truman's novels for fun and led to me listening as they and Dr. O talked about how they wished they could write, but didn't have the creative gift - the ability, as Dr. O said, to think outside the box.
It was a window into another world, O Best Beloved. They've tried keeping daily writing journals and found them to be dry, pedantic, and fact-oriented. They keep journals when they go on trips; the journals consist of "Drove down I-79 today. Stayed at SnuggleBear Motel." I am willing to put forth the theory, O Best Beloved, that neither the doctor nor either of these eclectic and fascinating women has stopped after the rain to stare at a leaf fallen onto the sidewalk, and the wet-dry pattern when it is disturbed. I wonder if it has even occurred to them that such an inspection is possible. To me, it is necessary almost, and I have been late by several minutes at times when I was stopped by the sun on a spider's web in the early morning.
My mother is a woman who does not consider herself a writer, but she writes. I am proud of her for that. I am even more proud because when she does write she avoids the needless pedanticism (is pedanticism a word? It sounds lovely) of recounting unimportant details and she tells a story. When my mother writes, although she does not consider herself a writer, she has the capability to shut up and tell the story. This capability is adjucated by the fact that creativity and verbal skills run in my family for many generations, and that certainly doesn't hurt, but what really makes my mother's writing worth reading is her narrative, her soul as it reflects itself onto paper.
My travel journals are punctuated with sketches (I am not very good, O Best Beloved, but if anyone is interested I will perhaps scan one or two in) of things, word-pictures of the people I see, pressed leaves and flowers, tickets and postcards; pages are dated occasionally but more often I forget to do even that. The facts of the journey I remember; some pedantic bit of my mind dutifully records them, discarding bits at whim. The feelings, though, are what I must be able to recapture later, and that is what I write down.
We could all do with fewer facts and more feelings sometimes, O Best Beloved. Perhaps I am being cynical, as I sit at my computer with a book of questions beside me, being quizzed on my ability to recall and synthesize those facts. I will depend on them, when I am a doctor, when this metamorphosis from naïvete to competence is complete. I will need those facts. But there is another part of being a doctor, and another part of being a human being.
I don't recall which day it was, now, when my preceptor closed his chart and looked at me very solemnly after I had just closed my lips around the last syllable of a question that began "Don't the studies show..." It was a doctor whose full attention I rarely got, and I was pinned down at that moment by the gaze.
"You can do studies and write programs that pretend to diagnose and treat a patient without ever having a human touch them," he said to me. "We have a computer program in this office that looks at the diagnoses a patient has and recommends medications." He drew up the chart for a patient we'd seen that day and adjusted the medications for; I stared at a screen full of red bars across prescriptions, making suggestions, giving warnings. At the top there was a list of things that the computer thought the patient should be on. I looked them up, while he went to see to another person. When he came back, he sat down again.
"I don't understand," I said. "Why is the computer trying to give drug X? It won't help in his situation, and it's likely to give him more problems."
Because, he said. studies show that in his condition, drug X statistically benefits the majority of patients. And the computer doesn't know him. He grew solemn once more, this man who was too busy for poetry, who answered my questions quickly, brusquely, who scoffed at the outdated information in a year-old review book and quoted clinical trials at me to back up his words; he took his time responding. "That is the art of medicine, Nicole," he said quietly. "That is why doctors will never be replaced by computers. We have the ability to look at a patient and see the person behind the list of problems, to put things together and figure out what's best for each person, not just what to do for each diagnosis. There is a science to medicine, and that science can be done by any lab, anyone who wants to study it; but there is an art as well, and that's what you're here to learn."
I could lose myself forever in the infinite beauty of a raindrop crawling from cloud to ground, take the time to savour the flow of sap from branch to leaf, appreciate the infinite echoes of a single heartbeat. And perhaps, sometimes, I will continue to be a little bit late.