The Real Work of Medicine

In college, I remember being conflicted about becoming a doctor. Competitive, pre-medical students made me anxious—they seemed to know exactly what they wanted to do and where they wanted to go in life. Furthermore, I was not particularly fascinated by the sciences. They seemed irrelevant to my idea of doctoring. And even worse, they required long hours of memorization and endless time spent in the laboratory. I had to work hard for a B or C. I was more interested in literature, psychology, and philosophy. I wanted to learn how to live a “good life” in the midst of evil and suffering. I remember skipping organic chemistry lectures to attend philosophy seminars…and I have my poor “Orgo” grades to prove it.

When I was rejected from medical school, I heard the impeded stream sing—it was a song of disappointment. General questions about the meaning of life suddenly became real and personal: Did I want to become a doctor? Was I motivated to do the hard work required to get into medical school? 

The Real Work 

It may be that when we no longer know what to do we have come to our real work,
and that when we no longer know which way to go
we have come to our real journey.
The mind that is not baffled is not employed.
The impeded stream is the one that sings.¹ 

Wendell Berry, 1983

Time to Buckle Down

Long story short: I did the work. It took a while, but I began to understand how I could be a doctor and integrate the humanities into my work. I learned what a person thinks, feels, and believes is an important part of doctoring, and that the philosophy of Camus and the wisdom of Dostoyevsky are relevant to the practice of medicine. And science mattered too! Vulnerable patients count on doctors for answers not only to their physical problems, but also to their emotional, social, and existential ones.

Poet Wendall Berry, author of “The Real Work,” would probably say my journey to get into medical school was the real work of my early adult life. And he would be right. Once I committed myself to becoming a doctor and understood the relevance of a humanities education to the practice of medicine, the science courses in college and medical school, the long hours working as an internal medicine resident, and all the rest did not feel like work. My mind was, and still is, pleasantly employed by baffling patients and their problems. 

It is also pleasantly employed by baffling poems.  

Finding the Balance

I’m not the first to suggest that reading poems is similar to reading patients. Precise language and communication are paramount for both: What is the patient trying to say? What is the poet trying to say? Am I able to read between the lines of the patient or the poem? Can I tolerate the ambiguity in the room of the patient or poem? Am I sufficiently present and detached to figure out what is going on? 

Too much empathy clouds judgment. Too much detachment and analysis emotionally isolate the patient or reader. As the patient’s story unfolds—or as the poem’s story unfolds—meaning evolves. Details emerge. After more questioning, or re-reading, I learn more about the patient or poem. And although lives usually do not depend on an accurate reading of a poem, I believe an inspiring poem can turn a person’s life around.  

Impeded Streams

Berry’s poem particularly resonates with me because I know what it feels like to be lost—the poet’s words and metaphors took me right back to the uncertainty I experienced in college. I’ve literally and figuratively experienced an impeded stream. I suspect other readers can relate to the metaphor. 

Although there are similarities between reading patients and reading poems, there are important differences. Doctors make decisions. They take quick action, depending on how they read a patient. A patient’s life may depend on an accurate reading. Poetry lacks medicine’s urgency. It can be read at one’s leisure—in the comfort of a library instead of a crowded emergency room. A reader can reflect on a poem for a few minutes, hours, or days, or come back to it years later. Reflection may prompt action, but usually it occurs over a longer period of time—maybe even a lifetime. 

Today, I look back on my life and recall the impeded streams (there have been more than one!) that I’ve experienced. I think about the frustrations, disappointments, setbacks, and losses. I remember the pain of not being able to get through or around them—until I took stock of my life, and made changes. And now the song of the impeded stream I encountered in college sounds so different to me. It’s now a song I enjoy listening to, knowing it brought me to the place I presently am: A physician writing a commentary on a remarkable poem, a poem that may inspire physicians to integrate poetry into their own professional lives.

The changes occurring in medicine today are enormous, mostly driven by the perceived need to control the high costs of medicine. Physicians are frantically trying to adapt to impeded streams—multiple versions of electronic health records, new technologies, patient-centered medical homes, accountable care organizations, team-based care, new payment models, and ICD-10, among other challenges. Many physicians do not know what to do, or which way to go, because it’s not clear that these changes will protect what most doctors value the most: the patient–physician relationship. I believe it is up to physicians to make sure that relationship survives the present transformation. 

I believe that is the real work of medicine today. 

“The impeded stream is the one that sings.” ■

Reference:

1. Berry W. The Real Work. In: Standing by Words. 1983. Accessed from The Writer’s Almanac with Garrison Keillor, August 4, 2012.