Only Human

redcurrant61115

photo by Nate Gibson

                                                                                                                               above photo by Nate Gibson

pastureoctober1

 

They work with herbs
and penicillin.
They work with gentleness
and the scalpel.
They dig out the cancer,
close an incision
and say a prayer
to the poverty of the skin.
They are not Gods
though they would like to be;
they are only human
trying to fix up a human.
Many humans die.
They die like the tender,
palpitating berries
in November.
But all along the doctors remember:
First do no harm.
They would kiss if it would heal.
It would not heal.

If the doctors cure
then the sun sees it.
If the doctors kill
then the earth hides it.
The doctors should fear arrogance
more than cardiac arrest.
If they are too proud,
and some are,
then they leave home on horseback
but God returns them on foot.
~Anne Sexton “Doctors”

 

Decades ago, essayist, journalist and storyteller E.B. White advised, “Be obscure clearly.”

As a physician, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  There is much that is still unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem.  Sometimes the solution is very muddy, hardly pristine and clear.

Let’s face the lack of facts of the plethora of shifting, changing facts.  Our conceit about our clinical work is ready to unseat us and plunk us in the dust even on the best of days when everything goes well.  We hope our patients communicate their concerns clearly and comprehensively, reflecting accurately what is happening with their health.  In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study.   Our footing, advertised by our training as so solid and reliable,  is quicksand much of the time even though our patients trust we are giving them advice based on a foundation of truth learned over years of education and experience.   Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Over thirty years of doctoring in the midst of the mystery of medicine — learning, unlearning, listening, discerning, explaining, guessing, hoping,  along with constant silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients.  What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for.  Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm.  The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records.  The pitfall of not knowing what work up was previously done will be a thing of the past.  The risk and cost of redundant procedures can be avoided.  The patient shares responsibility for maintenance of their medical records and assists the diagnostic process by providing online symptom and outcomes documentation.   The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops,  reflecting a relationship able to transcend the unknowns.

So we can be obscure clearly.   Lives depend on it.
And maybe we can stay on the horse and out of the dirt a little while longer.

elderberry2

pyracantusnov

6 thoughts on “Only Human

  1. Doctoring is a lot like firefighting, from oath to retirement and often beyond. You’re on-duty 24-7-365 and the calls never stop coming. No two are exactly alike and you never stop thinking about the bad ones. Experience matters, though the only certainty is uncertainty: the source of the problem may appear to be in one particular location when actually it’s somewhere else. You work hard until you eliminate the threat, you’re exhausted, or worse. Failure is not an option, yet it is commonplace. Success, when it occurs, is almost always “qualified.” When you go in, you’re not going in alone. Come out standing up and you come out a believer, if only for the moment. Until the bell rings again. And so on. Makes one wonder why anyone would want these jobs!

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  2. What a wonderful description of the reality of a fireman’s profession, one that often entails service
    above and beyond the call of duty — a vital human part of our society that
    we tend to take for granted – and fail to appreciate and to say ‘thank you,’

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  3. Thank you, Alice. ABCD it often seems, though in my experience there were no true heroes. We were decidedly ordinary, but in the worst situations I can recall, some managed to ramp it up to “extraordinary” and get the job done. We took turns in the cape and cowl, you see. Here’s another job description I love for its brevity: “put the wet stuff on the red stuff.” Sanding the runners on my Flexible Flyer this afternoon. They say we’ll get more snow this winter.

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  4. Rob, that reminded me of a doctor rule of thumb on skin diseases: if it is dry, wet it, if it is wet, dry it, if it is red, put on the white cream, if it is black, cut it out.

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  5. Cookie (Edward G. Byrnes, not the Muppet) says, “Ginchy, Emily!” And I hope you’ll turn on the Barnstorming snowfall this year. We missed it last winter!

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