First of all, we believe in the magic of doctors and medicine. The purpose of a talisman is to give us control over the things we are afraid of. Doctors and patients are accomplices in staging a kind of drama in which we pretend that doctors have the power to keep us well.
— Alice Trillin, “Of Dragons & Garden Peas: A Cancer Patient Talks to Doctors,” New England Journal of Medicine, 1981.
I’ve been thinking a lot about doctors. Two weekends ago, I led my final day-long writing workshop for students, faculty and alumni of the Stanford Medical School. It’s something I’ve been doing for nearly twelve years, thanks to meeting Audrey Shafer, MD, who is a driving force behind the medical school’s “Medicine and the Muse.” I admit it was not only a joyful day of writing together, but an emotional one—saying good-bye to Audrey and the many individuals who’ve written with me at one time or another. It was also a rare opportunity to move to the other side of the medical experience, from leading writing workshops for men and women living with cancer to those either treating patients, teaching or studying medicine. In both cases, the writing has been powerful, deeply moving and honest, reminding me over and over of the power of story, of fostering compassion, listening and respect for one another’s stories. I returned home full of gratitude for the honor to lead these workshops.
But that’s not all. This past week, I had cataract surgery on my right eye, a relatively quick and straightforward procedure, but one that raised my anxiety nonetheless. Yet I was lucky to have a surgeon recommended as one of the best. And “best” went far beyond his technical skills. My anxieties were assuaged by his warmth and compassion, willingness to listen but also to calm the nervousness I felt. I was reminded again that the “magic” in medicine and the doctors who treat us, is more than their technical expertise.
I think of one gifted neurosurgeon who had a reputation of creating miracles. Indeed, he saved more than a few lives, including my own. As a teenager, I became mysteriously ill, and for a time, was diagnosed with mononucleosis, or mono, a glandular fever and infection caused by the Epstein–Barr virus (EBV). But it wasn’t mono that was making me ill. I began to have more disturbing symptoms over a period of weeks, and was shuttled from one physician to another before ending up in the office of a gifted young neurosurgeon practicing in an Oregon community about an hour’s drive from my family home. I was fitted into his appointment schedule the same day I’d been referred, admitted to hospital that evening and, two days later, I in surgery for osteomyelitis of the skull and an abscess against the membrane of the brain. I remember awakening the next morning, hearing my father’s whistle as he entered the room, his eyes glistening with tears. “I’m sure glad to see you, Kid,” he said.
Six months later, I returned to have a metal plate installed in my forehead by Dr. C. to replace the portion of skull that had been removed. An earnest and grateful teen, I wrote Dr. C. a heartfelt thank-you note following both surgeries and from time to time over the years, a letter. He always responded with a personal note of his own. He died just a few years ago, and the tributes and remembrances of him were extraordinary. Gifted in his medical practice, he was warm, compassionate and generous with all his patients. I doubt any one of us doubted he possessed magic, because he inspired trust and the will to live in his patients.
Perhaps some of you saw the film “50-50,” a 2011 comedy-drama about cancer and survival, inspired by the experience of screen writer, Will Reiser. In it,Adam, the main character, learns from his physician that the pain in his back is caused by a rare and possibly fatal spinal cancer. His diagnosis is delivered by the doctor in a manner both impersonal and brusque while he points to the illuminated image of Adam’s spine and tumor and reviews the specifics in a nearly incomprehensible salvo of facts and medical terminology. All the while Adam succumbs to shock and disbelief. Although the comedy exaggerates the impersonal interaction between a physician and patient, I’ve heard more than a few similar accounts between newly diagnosed cancer patients and their doctors.
The relationships we have with our doctors are complex, often profound. Implicitly or directly, we’re asked to entrust our very lives with them. We’re poked, prodded and examined by our doctors, as Molly Redmond describes in “The Cancer Patient Talks Back,” and it can sometimes have a de-humanizing effect:
I have suddenly crossed the boundary line
of the risky circle called cancer.
It has made me public property, like being largely pregnant.
People invade – an assault of connections… –
The medical cadre, too.
I am covered with fingerprints, with labels.
(In: The Cancer Poetry Project, Vol. 1, 2001)
Think about it: How often do you have the chance to examine the “medical cadre” with whom we entrust with our lives? How often do you stop to ask yourself, “What do I want in a doctor?”
Literary critic Anatole Broyard, did just that in his memoir, Intoxicated by My Illness and Other Writings of Life and Death (1993), as he reflected on his relationship with his doctor after receiving a diagnosis of metastasized prostate cancer:
The knowledge that you’re ill is one of the momentous experiences in life. You expect that you’re going to go on forever, that you’re immortal…When the doctor told me I was ill it was like an immense electric shock. I felt galvanized…and I was reduced to essence. I began to look around me with new eyes, and the first thing I looked at was my doctor.
I had no reason to believe that he was not good. He was in a good hospital…what turned me against him was what I saw as a lack of style or magic. I realized I wanted my doctor to have magic as well as medical ability. It was like having a “lucky” doctor.
Broyard went on to ask, “Now that I know I have cancer of the prostate, the lymph nodes and part of my skeleton,” “what do I want in a doctor?” He detailed several characteristics he would like in a physician, including a doctor who
- understands that beneath my surface cheerfulness, I feel…panic,
- was a close reader of illness and a good critic of medicine,
- would be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness
- can treat body and soul
- gropes for my spirit as well as my prostate
- knows that he is my patient too, and I have my diagnosis of him…
The characteristics Anatole Broyard defined as the wish list for his physician got me to thinking about doctors who’ve cared for me in times of serious illness. I realized I’ve been lucky having a gifted neuro-surgeon, cardiologist, eye surgeon and family physician—ones who have demonstrated the capacity and compassion to understand me as well as the diagnoses that forced me to put my life in their hands.
- Why not ask yourself the question Broyard asked? “What do I want in a doctor?” Think of the medical experiences you’ve had, what you know about yourself, and what matters most to you. List them.
- Examine your current doctor-patient relationship. What is your diagnosis of your doctor? What characteristics have been most important in establishing your trust?
- Which doctors made you feel “lucky,” as if they possessed that little bit of magic? Why?
Postscript: A Valentine for a Doctor
(As I thought about the prompt for this week and of the many doctors who’ve treated me over the years, I came up with a wacky idea. I have, as I’ve written before, mild to moderate heart failure and have been treated since 2008 by a local cardiologist I greatly respect. I have, as it turns out, an appointment with him on Valentine’s Day–a day defined by the preponderance of hearts and appreciative sentiments. Inspired by the obvious humor of seeing a heart specialist on February 14, I’ve written a humorous poem to be accompanied with a box of chocolates he can share in the cardiology department, my poem not defined by Cupid-esque mythology, but rather, gratitude for cardiology!)
Happy Valentine’s Day!