Be proud of returning to the fire, doctors

This is my column in the October Emergency Medicine News.  ‘No matter how hot it gets, doctors, be proud of returning to the fire.’

(Who knew that blacksmithing and medicine had so much in common?)

http://journals.lww.com/em-news/Fulltext/2013/10000/Second_Opinion__No_Matter_How_Hot_It_Gets,_Be.6.aspx

 

When I want to clear away the chaos and confusion of medicine, I walk down the worn path in our back-yard (followed by children, dogs, cats and deer). At the end of the path is the shop, which the kids and I helped a friend to build for us. We helped set the foundations and nailed the floor; we raised walls and put in roof trusses.

The shop sits in an area that was once a garden, but a soil-poor garden that yielded more blackberries, brambles and hornets’ nests than corn or beans.  The best crop of the garden was a treasure trove of arrow-heads and Native-American pottery; what still lies there I can’t imagine, but it is evident to me that someone, some people, camped or lived in what is now my yard a very, very long time ago.  They would be surprised to see my shop.

Under the extended roof at the back of the shop is our smithy.  Years ago, my son Seth asked if he could learn to blacksmith.  He may have been born in the wrong century.  He plays the bag-pipes and banjo and black-smiths.  (And is addicted to science.)  But to condense the narrative, we have.  Well, I should say we’ve learned a bit thanks to our gracious teacher George, the man who cannot seem to feel the heat of the hottest fire.  We don’t really even rise to the level of his apprentices,  but we can build and tend a coal-fire, we can handle a hammer and anvil, we can forge-weld iron, twist iron and curve iron; we can quench the iron and we can do most of it without being burned (very often) by the lemon-yellow and orange colored metal.

When I want to let my mind rest from medicine, I walk down that path and look at the old tools and the old anvil and vise.  I look first for wasps and rattlesnakes, of course. But then I just take it in.  The old colors, the bits of rust, the ordered disorder of a work-place; gravel on the ground, coal in the corner.  It isn’t professional and it isn’t perfect.  But it’s beautiful.

Rarely has a hobby captured my mind like this one.  And seldom has any activity enabled me to slip the bonds of medicine so readily.  From the moment I start the walk, I drift into a different place and time.  And when I start the fire, when the coal burns, the green sulfur clouds the air and blows around me, as I turn the crank of the blower that feeds air to the fire, well from that moment I am meditating.

It can be a hot day or a cold day, but cold days are best; cold days when standing by the fire is a comfort; cold days when it’s so hot there that a t-shirt is enough.  It can be a sunny day or a rainy day.  Rainy days fill our bucket with water from the sky with which to quench hot metal from the earth.  It is mystical.

And taking that metal, cutting it, heating it until it is over 2000 degrees, then shaping it from a mundane round or square stick into a wall-hook, a decorative leaf or even into a new tool, well that’s pure joy.

It’s unlike the emergency room.  It is single-minded.  The interruptions are virtually non-existent; and if they exist, they are laughter and jokes between my sons and me; or gentle arguments about how best to accomplish the task at hand.  Or the warning shout, ‘Hot Iron!’ which reminds us to watch lest we be burnt.

There are mistakes, but they are of small consequence.  Burnt metal can be cut off and thrown on the ground.  Crooked metal can be hammered straight.  An item made poorly can remain as a reminder of what not to do next time.

It’s so unlike the emergency room, where mistakes can be life-ending.  Where danger lies at every turn and if we shouted every danger we would shout for 8 hours.  And yet. There’s the heat and smoke.  There’s the risk of injury.  And there’s the shaping of something.  The transformation of something.  Hammer and hot iron and anvil and water; tongs and vise.  The change from what was to what is.  The rescue of an old piece of scrap, a lawn-mower blade, a piece of re-bar and the gift of watching those things have new life.  And the ring of that anvil, made around 1850, that says ‘I’m alive!  I’m alive!  I’m still here and needed!’

They seem connected to me, those two divergent places.  Writers see everything in metaphor and simile. Maybe the heat is metaphor for the pressure and stress of our work in emergency medicine.  Or maybe hammer striking heated metal on anvil is a metaphor for the way we want to shape a new reality; from sickness to health, from injury to healing.  We are blacksmiths of the human body; or red-smiths, maybe, for the blood we see spilled.

I know that as I grow older, I see another metaphor here.  I see my patients like those unshaped bits of iron; of uncertain value and utility, dirty and sometimes abandoned. But I know that in them lies potential; beauty and goodness beneath years of rust and disuse and neglect.  Like the way I put the grinder against my 150+ year-old anvil and when I stopped, it’s rough surface shined like a new platinum ring.

Most of our hobbies, our ‘avocations’ give us insight into our medical work.  Perhaps we choose them for that reason.  Or maybe just for the escape; for the Zen moments of ‘no-mind’ that allow healing and rejuvenation as we work at a thing without feeling as if it is work.

All I know is this.  Medicine seems to be getting more difficult all the time.  And the house of medicine is leaning on our specialty more heavily than ever before.  But whatever your hobbies, let me assure you that we have walked through the smoke and fire, all of us. We have all been ourselves shaped by the fire, hammer and anvil of suffering and struggle.  We have also shaped new realities for the people we have treated and saved.  And most of us keep coming back because we feel a comfort in the artistry that medicine has become; a deep, abiding pride in our craft.

So I say this, friends:  be strong. Do not be afraid of the struggles to come.  Embrace them with joy. Find the peace that comes from artistry well-practiced; for remember, medicine is art.  And however hot it gets, however choked you are by smoke and ash, however tired your limbs, be proud of the skill and strength that brings you back to the fire each day.

Only a few could do it.  And you are numbered among them.

If you’re looking for me, I’ll be down the path, hammer in hand.

 

 

 

 

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