Blog | Thursday, March 22, 2012


I have the room to myself. I really like the breakfast bar and the high-backed leather benches my wife found at Value City. We set up the Mac down here where we can see kiddo using it and where I can easily fill a glass of water or get some pretzels.

I wrote a post yesterday that took something out of me, like removing a splinter. I can't write directly about my patients so I put together scenes, impressions, words collected over the years into sketches that help me make sense of what I see every day.

The hard work, the work I'm always learning is the quotidian, the tedious. Following paper from one place to the next, learning the technocratic side of medicine has been hard, but my teachers excellent. As good as my pathology professor was, my partners are month by month helping me learn the minutiae and the big picture of the behind-the-scenes work.

But it's still the exam room that I love, that I find easy, natural. I don't know what the hell a doctor is. Am I a scientist? A shaman? I know that life is terribly contingent. These contingencies are the gaps in the blinds, letting in a cloying darkness.

My wife asked my why cancer patients look like cancer patients. I gave some sort of lame answer about cancer cachexia, temporal wasting, but it's really the gaps in the blinds. A young person you recognized in decades of photos suddenly looks very different, and that difference says "sick." The patient may not see it, the family may not see it as they take pictures they hope show hope and happiness, but I can see it. It's a glimpse of what is to be (or not to be, right?)

I refuse to believe it's all narcissism, that we see only ourselves in our sick friends, or that we see our opposite. We may identify, and we also know that it cannot be us--ever. We're protected from these contingencies. But there is something more empathic, a more real connection. In the exam room the Kleenex box isn't just for the patients. We try to build a Chinese wall, but when you tell someone you've known for ten years that you're unlikely to share an eleventh, you can see the wall for what it really is--old, crumbling, fallen in places. The feelings seep through, and so does the sense of your own precariousness.

Whether the metaphor is a blind or a wall, it's imperfect and porous. Clinical terms can lend a distance, a sharpness. The sharpness can cause us to pull back suddenly as the pain of the wound reaches the brain. But it can draw us into the story, sometimes deeply. You may start to fantasize about making a house call or insinuating yourself even more into the bruising scrum.

There are no really good comparisons to be made. No metaphor captures the conflict, the emotions that are real, and distant, and intrusive.

I'm not a shaman. I'm not a scientist. I'm a human being immersed in the life of other human beings, bringing knowledge to their sometimes-disrupted lives, sometimes phoning it in, sometimes delivering a eulogy for the living.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.