.Twice in the last 24hrs I've been reminded very poignantly that teaching in medicine is a rebellious act. And the closest analogue I can find to this experience is that of the artist in the world. Teresita Fernandez's words ring true to me: "Being an artist is not just about what happens when you're in the studio. The way you live, the people you choose to love and the way you love them, the way you vote, the words that come out of your mouth...will also become the raw material for the art you make." In my mind, I substitute artist with doctor. That being a doctor is "not just about what happens when you're at work, it is in the way you live, the people you choose to love and the way you love them"....the community you create and find yourself a part of, the values you bring to the practice of your art, will all come to create your doctor self. Your doctor identity. This healing self will be as unique and individual, and interpretive of your life and experiences, as any work of art.
I didn't always see it this way of course. None of us do. We enter medical school, which for me started just before my 18th birthday, with some vague sense of doing good, and no real concrete idea of the life that awaits us. I thought that much like any other job, there would be a body of knowledge that I would be expected to master, prove myself worthy of and then be let loose to practice the skills I had learned. No more difficult than that. Only recently have I come to describe it as a process much like the transformation of Bruce Banner into the Incredible Hulk. The transformation of self, the shedding of an original identity for a newer one is rapid. Within two years you go from a young person with an unremarkable relationship to other human beings, to suddenly being in a position of great privilege with regards to the privacy and well being of these human beings. People will reveal their secrets to you, look at you with searching eyes as you formulate and interpret, translating their own body to them as easily as if you were reading an intimate missive to an unlettered client. Which is to mean, not easily at all.
It wasn't until I stumbled upon narrative medicine, and the idea of attending to and allowing in the stories of our patients, that I was able to grasp what Teresita Fernandez was referring to. The notion that we are changed by the stories of our patients is central to creating that physician identity. The alternative to the internal change, where we perform our jobs without letting in the experiences and meaning that our patients bring to us as offerings, is to negate the very essence of the practice. The alleviation of suffering, a central ethical consideration at the very core of medicine (for we must justify tearing people open so we can alleviate their suffering), is intricately linked to our ability to sense and find and excavate out this meaning. Because unless we do, medicine can quickly turn into torture, tragedy and injustice. And letting it in means, invariably, to be touched and burned and changed by it.
And so to be a doctor in this world, is by necessity a perpetual act of rebellion. To allow the world in constantly is to be aware of injustice and inequity in all the small, insidious ways it can manifest everyday. And so my two doctor friends, a man and a woman, both individuals I would trust with my life, good people with inner compasses pointed straight north, find themselves in a place where their campaigns for good have been or are under severe attack, and are on the verge of collapsing. Excellent doctors, wonderful human beings, warm and generous and caring, smart and ambitious, they are a microcosmic view into how rebellion is part of the fabric of being a good doctor. And like most rebels, they are deeply affected by these set backs, even as they are carried by the courage of their convictions.
And to them I can offer my therapeutic self. My own formulation of doctor self, renewed by my teaching efforts, my own journey-in-evolution the only constant available to me. And I believe now that these two things are connected. That forward motion and the constantly evolving self, with a greater understanding of life, our times and our world, is in effect a response to the work of doctoring, even as it becomes a panacea for the work of doctoring.