Becoming medical archeologists

(my EM News column for February).

I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)

My kids and I walk the red-clay paths and look down for bits of stone protruding up, especially after a good, soaking rain. Elijah, my youngest boy, was the first to find one. ‘Is that an arrowhead, Papa?’ ‘Yep, good eye son!’ He had found what was probably the point of an atlatl (a kind of mix between arrow and spear).

We look for rocks that seem shaped by human hands. That’s the ticket; look for something that seems to suggest a purpose or a history. Things with no shape, no marks from being worked, are probably not worth our time.

Medicine is like that. We learn to look for patterns, for shapes, for things that suggest meaning, and that give us a way to help, to understand, to predict. From the way a patient breathes to the shape of their deformed extremity, we learn to find the pathology beneath the normality; and sometimes vice-versa.

But it isn’t only true of things physical. Sometimes, it’s true of things emotional, things psychological; things of the heart. Behaviors and lifestyles often have deep sources, not easily uncovered. Soaking rains don’t wash away the years that cover their origins. Why does this man continually use cocaine? Why does that woman become pregnant by different men, over and over? Why is this beautiful child cutting her wrists with a razor? What pain is she hiding?

Of course, we could apply the same kind of insight to our colleagues. Why does this surgeon always treat me with anger and disdain? Why does that resident consistently fail to do her job? Why is this nurse perpetually downcast, why does that one make me smile? And why is this specialist always happy?

As medical archeologists, we can use our skills to find answers. But we have to look closely at ‘what lies beneath.’ We have to do it purposefully, carefully, gently. And we have to be willing to accept that the answers may not be pleasant.

I recently saw a woman in withdrawal from years of morphine abuse.  Year after year she had injected it, but a few days prior to her visit, she decided to stop abruptly.  I was impressed by her resolve, though she felt quite miserable.

While she shook and sweated, I saw the assorted track marks and scabs that are the artifacts of an addict’s skin.   But I saw something beneath; the faint lines and swirls of a burn up and down one arm.  I touched her; I felt the texture of the lines and ridges that develop from burns and grafts.  If she were another species, they would have been fascinating.  The epidermis of a sentient alien.  But she was not. She was one of us; Homo sapiens.  The swirls just represented past pain.

‘Is this how you started using?’  I asked.

‘Yeah, that and a bad car wreck,’ she said between tremors.

In the feel of her once-burnt skin lay the heiroglyphic explanation for much of her life’s misery. Of course, it’s true of so many. Beneath razor wounds there may lie years of rejection. Beneath hostile drunks may lie sick children or unhappy marriages. Behind indifferent physicians may lie frustrated engineers or artists. A catatonic, depressed man may be concealing a childhood of sexual abuse.

Likewise, beneath smiling physicians, gentle nurses and kind patients may lie years of experience, surmounted struggles, loving families, personal suffering or deep faith. A calm exterior may be the fruit of unimaginable past pain, smoothed like that arrow-head by constant, intentional pressure and meaning.

We would do well to excavate a bit; to find the wounds behind the wounds that cover our patients, our co-workers, even our loved-ones. We would do well to look up and down at all of those we encounter, trying to find the shapes of things, the history, the origins of pain. And even the origins of joy. There are worlds of understanding carved in human lives, and untold artifacts lying about for us to discover. And no profession is better training for this than ours; a lifetime of looking down in the mud of human troubles, trying to find something useful and beautiful.

My kids asked me, not long ago, ‘what would you rather find, Atlantis, El Dorado, Avalon or Beowulf’s tomb?’ I think I picked Avalon; we could use a little more King Arthur these days.

But I’m sure that when I go to work tonight, if I try, I’ll find something almost as interesting. The trick is wanting to look.

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