Here’s my column in this month’s Emergency Medicine News. Please remember to submit to grand rounds; our theme ‘Profit in Health-care!’ Send links or essays to email@example.com.
Happy New Year!
Consider what you love
I love the skin of babies, because it is soft, and because it bears none of the scars that time, sickness, injury and heart-ache will leave. It is a canvas waiting to be filled with kisses, touches and embraces But I love the skin of the elderly because it is textured with time and stories, like imprints on a vinyl record. Wrinkles simply represent long life, stored in the many hills and valleys of a body that has seen much, and endured much. Touching the skin of our patients is such a rare delight.
I love, in an odd way, the sound of patients crying. Not because I want anyone to suffer. I love crying because I have cried. Falling tears and heaving sobs are signs that we are all equally vulnerable. They mean that we have in common our frustration with this life, and our desire for help, healing or simply comfort. Sometimes, when a patient is crying, I want to hold them close. I’m not there yet, but maybe I will be one day.
The sound of breath, smooth and clear or sonorous and rattling, is fascinating to me. I think I love knowing the difference between good breaths and bad. It is magnificent to have listened to that sound thousands upon thousands of times. They say that with every breath, we inhale a molecule of air that Julius Caesar exhaled on the Ides of March. By now, I can almost hear him say ‘Et tu, Brute?’ It is a gift, an amazing gift, to have heard life move in and out so many times.
Equally fantastic is the sound of the heart. I am fascinated every time that I hear its amazing twisting movement and contraction, its mysterious expulsion and reception of blood that occurs over and over again until one day, with similar mystery, it ceases. The heart is special because as I listen, I may put my hand on the wrist or neck of the patient, and feel the pulsations travel down the highway of arteries, feel it beat against my nerve endings and travel back up all the long distance to brain where I sense it. And across infinity to my mind, where I perceive it. The heart gets inside my head, you might say, and its beating can thrill as much as its cessation terrifies.
I am enamored of examining the abdomen, wherein lie so many organs, so many blood vessels, babies in the process of becoming, tumors in the process of destroying. To examine the abdomen is to shake a Christmas package, wondering what might be inside. I love the feel of appendicitis, though I am sorry for those who endure it. There is such joy in seeing the wisdom of our teachers made manifest in our hands, and confirmed in the truth of our suspicions when the diagnosis is made.
The smooth symmetry of intact limbs is artistic, but equally wonderful is the way I can know, frequently without any test, that a limb is broken. The many shades of blue and gray that surround fractures are testament to the underlying dysfunction. There is an awful artistry to the jagged, disordered, fractal geometry of broken bones.
Wounds of all sorts are oddly amazing, and I have touched so many that I almost enjoy the reproducible warmth of blood, and its smell, as it pours across my gloved hand and I admire its lovely scarlet shades, my delight nearly vampiric. Holes and slashes from weapons are unfortunate portals into the mysteries of the living, and sometimes the dead, human body. I hate to see such suffering; but I am a voyeur of the flesh, having spent so many years hovering over it and touching it.
And death, death! The lessons it has taught me over the years! It is sudden and slow, painful and painless. It is tragedy and loss, hope and opportunity. And it is a thing unlike any other. I have seen life depart in young and old alike. I know, through death, that there is something indescribably holy that enlivens us all before that moment and that leaves with breath and heartbeat. I sense, in that fact, indescribable hope.
We humans are such pieces of wonder. Every year that I have the privilege of practicing medicine, I realize that what I’m actually practicing is far more. Medicine is the word for the study of the soul and flesh that dwell together in humans, and by which we physicians seek (in our limited ways) to put it right while it walks the earth; and before it is lain to rest in the earth.
Spend a day, now and then, in amazement. Love the broken, touch the sick, caress the dying, shake hands with the scandalous and wicked, embrace the mad. Learn the feel of their heartbeats and the sound of their breaths, the color of their eyes and the textures of their hair. Each of them is a wonder no less than the stars.
Learn to see your career that way, and you’ll be able to keep going from body to body, wonder to wonder, without misery. Let this be the year you fall back in love with your career by falling back in love with humanity, with the amazing structure and function of each human, and with the eternal worth of each and every life entrusted to your hands.