It never fails. I get caught up in the intensity of academic preparation that is the medical school experience, and then we have a patient presentation and I am stopped in my tracks- and given a lot to think about. This time round we heard the story of siblings with the same condition, Cystic Fibrosis, one of whom is still alive and the other who died at 18. The reason one lived and the other died did not have anything to do with differing severity of illness. It came down to one thing: hope. The brother (who died) was essentially told by counselor not to plan for life beyond 18. He was also fired from his job for "coughing too much." As his sister relayed, it broke his spirit. The sister on the other hand, was defiant in the face of the counselor's statement, and was determined to live and she did, now living well beyond the life expectancy for this condition. Of course, this raises the question of how much a patient's sense of hope affects the course of their illness; and if, as I suspect, it is a huge factor, how can I, as the doctor, provide that hope, without conveying false optimism? I think it may take a combination of humility (all the scientific knowledge known may still not tell us what we need to know) and careful attention to language, and the deeply connotative nature of the words we may say. In acting, we would closely study the emotional meaning of words. The sequence, we learned, was that words provoke an image and that image provokes an emotion. What image am I provoking for my patients with my words?
When we probed the patient for further thoughts on what impressed her about her interactions with her doctors, she brought up a point I had never considered. She said that it bothered her to be undressed before the doctor's arrival, as she was sometimes requested to be. What bothered her about being in the hospital gown was that it depersonalized her. She felt that the doctor should see how she ARRIVED at the visit. She recognized, astutely, that her personal appearance was revealing about her emotional and physical state and it was meaningful to her to have the doctor acknowledge that. In hearing this, I could not help but think about discussions I have had with costume designers about what I want a character to suggest with their physical appearance--from color to style to cut to make-up, accessories. When teaching an introductory theatre class, we would often talk about how much we assimilate from someone's appearance within seconds of meeting them. In the name of efficiency, is the medical structure depriving the doctor of a vital diagnostic resource?
Alright, so after all these deep thoughts, I thought it was time to get out of Ann Arbor for a little while and joined some friends for Soul Food at Beans and Cornbread in Detroit on Saturday night. We had a great conversation, full of much needed laughs, but it was also a great exchange of ideas. At one point, one of my friends, a third year student, described the third year of medicine as a performance. She focused in on one moment in particular, when the third year presents a patient to the attending physician. She spoke in terms of how one commands the space, vocally and physically. Another dimension was the arrangement of bodies in the room. Who stood next to whom, at what level? I mentioned that she could easily have been describing a play rehearsal. As a director I would prepare for rehearsals, by considering spatial relationships of characters in the play, in order to convey differing levels of power, intimacy and focus. To hear that these very same dynamics were at play in interactions on the wards blew my mind. I cannot wait to explore this directly in two years time when I expect my entries will be more frequent. But for now, it was gratifying to learn that my theatre training continues to illuminate my understanding of medicine . . . hope, personal costume, and cornbread . . . good week.
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