I learned to see the world through words. Words I picked over all day at school then curled up with long after I was supposed to be asleep. I reflect through writing, turn to all 1124 pages of my worn The Lord of the Rings in every difficult time, and dream best with my head pillowed on a book.
Yet I never realized how fully these words and stories shape my experience of the world until I entered medical school, a space where the world is not often viewed through the lens of stories. In college, I took pre-med classes as a means to end: becoming a doctor. However, as a creative writing concentration English major, I really flourished in my writing courses. I immersed myself in the minds of book characters and authors, learning to understand myself and the people around me through fictional beings. My English courses were the land of “no right answers,” where every discussion centers on a “why” question. Why would a character take a certain action? Why would an author describe the character this way? Stories and poetry create worlds of ambiguities and shifting perspectives, inspiring and challenging each other. To appreciate these nuanced worlds, one must pay attention to details: their building blocks of words and punctuation.
Like English, medical education requires attention to minute details. Take the stark white on black of X-rays or the gradients of darkness in ultrasound. First, we learn which parts of the body will show up as bright or opaque, what it would mean for a line to be sharp or blurry. Then using this information, we build an image of the body. Suddenly, a shadow in the ultrasound field, one I may not even have seen a second ago, is called a gallbladder. There is often strange dissociation between how these body parts are viewed in medical school versus the “outside” world. On the outside, blood gushes forth red and panic-inducing. But in my life right now, blood exists as the shades of pink and blue polka dots on pathology images. Those tiny cells, smeared onto glass and fluorochrome-stained, now huge on the projection screen. This language consists of shape and color: which cell is pinker, denser or has nuclei off-center? We use these details to name what we see, normal process or disease.
This progression from learning to read these images to understanding them seems linear, yet, for me, it’s fraught with difficulty. While reading stories, I easily build myself mental bridges from the mechanics of language to its grander purposes. I savor words and turns of phrase for pleasure. I expand my view of the world by being in someone else’s head. I travel, crossing continents or scoping out imaginary societies. I dissect stories, interpreting those building blocks of style, word choice, even spelling — but all this leads towards understanding, towards absorbing the words and applying them to the world I live in. Whether my sense of justice, honor, spirituality or love, each has been filtered through the words of countless authors. I miss this in medicine. I learn to read CT scans and X-rays and turn their myriad shades into coherent diagnoses. Yet as I do so, it remains hard for me to build to their grander purposes.
After all, learning to navigate these multivariate languages of medicine is a feat in itself, one our medical education revolves around. One day, we may be studying the (literal) Latin of anatomy terms. Another, we may start listening for the sound of an irregular heartbeat. With all the effort learning each of these skills requires, interpreting them becomes an end in itself. This cloudy gray shadow is a pleural effusion on X-ray. That bright spot is a tumor on MRI. But why are we learning these things? If I am looking for a larger meaning, then I am seeking the reason behind these diagnoses. Where is the patient in our medicine?
Stories draw me closer to people: author, narrator, character or — in happy times — someone else reading the same work. Yet, in medicine, we learn many of our skills in a vacuum. Eventually we may read an X-ray to help treat a patient, but right now it does not apply to anyone needing treatment. The pathology slide we examine has no connection with the full constellation of a person’s existence, and perhaps it never will. After all, we are not expected to interpret every kind of test once we graduate medical school. We are destined to sub-divide and specialize. Pathologists will immerse themselves in their slides, radiologists in their scans, and so forth. So, what does learning all these methods teach us?
I hope to learn from these medical methods again what reading taught me without my knowing it: there exist countless ways to understand people. A poetic stanza, a phrase of prose, a word in a foreign language or one made up — each exposes humanity differently. As doctors, we are meant to treat our patients, to heal their bodies. To do this and understand someone else’s body, we examine it with our tools. X-rays, ultrasounds, MRIs, physical exams, blood tests or pathology slides — none is an end in itself. Each is a different lens placed over the body to show us something not otherwise apparent. I hope we recognize these lenses as such: mechanisms refracting a portion of a patient’s reality for us to see. None can reflect a patient or her body in totality. Instead, each becomes another way we could learn about ourselves or those who surround us, another story we can read.