Yours is the name I carry on / You were the first I mourned when gone
Mr. T did not smile at me. No, I didn’t think it was because he was mean or anything; in fact, he was polite and had quite a calming voice. But honestly, it was hard to read someone’s facial expression behind a mask — at least during the first few months of the COVID-19 outbreak.
“I’m sorry that you have to see me this way,” said Ms. A as we exited the examining room.
Twenty minutes earlier, Ms. A had been laughing and cracking jokes while my attending physician and I obtained her medical history and life updates. Ms. A came in for a pre-op evaluation and concerns of high blood pressure readings at home. The room was cold, but I felt like we were three friends having coffee and catching up, so there was a familiar warmth.
The power and beauty of writing rest in a process of active narrative formation. The act of expression helps us make sense of what happened, integrate this into our sense of self, and clarify our values that will influence our next steps. Conveniently, our expression serves as a record of both identity and narrative formation, giving us a glimpse of ourselves more intimately than we typically take time for.
Instead, I was worried that medicine would consume me only to regurgitate me as a mere collection of cells and systems – just like those I would be expected to regurgitate on the test. I was worried that the demands of knowing it all would make me believe that I could know it all, that there is nothing in the spaces between what we know. I was worried that bathing in science would make me stop believing in art.
For better or worse, I have always partaken in escapism in one form or another. “Escapism,” defined as the practice of avoiding a difficult reality by immersing oneself in distraction or entertainment, is a concept that rose in popularity in the 1930s as a natural reaction to the Great Depression of the previous decade. Although I did not know it at the time, I have been practicing escapism since 2000 BC (before COVID). As the eldest daughter of immigrants who were new to the continent and busy building a life from scratch, I would get lost in stories from a very young age. I had little in the way of friends and even less of an interest in being popular, so naturally I was drawn to books to fill that emotional void; novels were the way to my heart — fantasy and fiction, oh my!
My medical school career was complicated by more than just complex cardiac physiology or biochemical pathways. Little did I know that at the end of my second year I would go from knocking on a patient’s door during a clinical session, to sitting in an exam room myself.
The heart monitor beeped incessantly, and the pulse oximeter kept dropping to the 80s. I ran to get a nurse. He walked calmly into the room, straightened the patient’s finger and left without a word. The oxygen went back up to 98.
I no longer feel alone the way that I did the first few weeks of dissections, because now I recognize that my peers were sectioned off at their tables also worried that they were losing their sensitivity, that they weren’t good enough to belong, and they didn’t know how to cut into a person. I wish that I had known what my classmates were thinking and feeling during the anatomy course.
To understand the issue surrounding assessments, we must understand that it has become increasingly challenging to train physicians suited to face contemporary changes. To future physicians who have access to a repository of ever-expanding information on their smartphones, being tested on ‘high-yield’ minutia serves little purpose. Being able to think critically (and perhaps even imaginatively) in order to make sense of that information for patient care is what counts. And thus, no matter how standardized an examination is, lack of contextual reference renders it futile.
Why would someone choose to donate their body to medical education? We have a dishonorable history in medicine of illicitly sourcing cadavers for dissection: robbing corpses from graves, murdering people for their bodies and salvaging the unclaimed dead from city hospitals and morgues. Today, we call the bodies we learn from “donors” instead of “cadavers” to honor their autonomy and personhood, their choice to be in the room.
As physicians, we must work to lift patients up when they are struggling, rather than shaming them into well-being. As Dr. Donald Berwick once noted, it is not always patients’ diagnoses, but their helplessness that kills them. Indeed, the helplessness we instill through our focus on individualism and molecular pathology in the clinical setting will ensure that this epidemic kills millions prematurely and costs billions of dollars. If obesity is a disease caused by society — its inequities, trauma, and expectations — then the solution for obesity should address more than just the patient sitting in front of us.