A Doctors Journal: Searching for the True Poetry of Life

The good news is that once you are a licensed professional healer in service to mankind, you will likely live relatively comfortable lives. At least you will unlikely suffer from the structural violence—eg, lack of food, water, shelter, and healthcare—which Paul Farmer, MD, PhD (Consultant, Guest Commentary, June 2014) is working to address. As highly educated, respected members of your community, you will spend your working days using your training to help others. What a fulfilling way to make a living! 

Remember The Positive

When things look dark, Sir William Osler said: “Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows, and their griefs.”¹

I add that it is even better to write it down. Healers are in a great position to begin keeping or maintaining a diary, journal, or blog in which memorable stories are saved. I urge you to write down some of these more memorable stories and look back on them often. Reading these stories years later, as your wisdom increases and your beliefs evolve, will sustain you.

The American poet and general practitioner William Carlos Williams (1883-1963) “worked harder at being a writer than he did at being a physician,” wrote his biographer, Linda Wagner-Martin.² Williams felt that being a practitioner of medicine helped him become a better writer. I admit to being inspired by William’s Doctor Stories,³ a wonderful collection of tales that illustrates what 1 practitioner can create by simply putting his or her own stories down on paper. Do not worry if you are not the same caliber of writer as Williams. That’s not the point. The important take-away here is that each one of us has at least 1 story that could be published if crafted properly. 

To get started, I recommend Robert B. Taylor’s Medical Writing⁴ on this subject. 

I hope reading these entries will encourage you to begin your own collection of writings. As memorable events occur, you will discover that they grow dim over time and are eventually forgotten. Surely, looking back on what you considered to be significant experiences throughout the years will bring you back—not only to those events themselves, but to that time and place, and to the life events surrounding you at that moment. These memories are true treasures. They perk you up after depressing or difficult days. They ground you when you feel overwhelmed. They remind you why you became a healer, and hopefully inspire you to continue your extraordinary work.

My Journal

Although many situations in medicine are often difficult, some of the most poetic moments we encounter in practice are incredibly positive, uplifting, or just plain funny. What follows are a few entries from a journal I started years ago, when I first began private practice.

Gregory is an adorable 3-year-old boy whose mother brought him in to see me for a number of complaints. He’s been suffering from a cough along with some nasal discharge, a bellyache, and some assorted bodily pains, among many other issues. As his mother listed concern after concern, I directed the interview to the preschooler himself. 

I asked Gregory, “What bothers you the most?” His eyes opened wide as he immediately thought of his answer. “Fire…and snakes in the mud!” he chirped. 

His mother explained that, in fact, he had experienced a nightmare with those exact images last night, and to that extent she felt this response was accurate.

Children definitely describe symptoms differently than adults. Stephanie is a 7-year-old girl who was experiencing some GI distress. She described this innocently as, “It feels like a feather in my throat…like birds taking a bath in my stomach.”

I met a 6-year-old boy sitting on the examining table looking annoyed. He had a different chief complaint than what was described in the nurse’s note. I asked the boy what bothered him the most, other than the reported cough. He looked once towards his parents, who were sitting to his left, and said, “When I am trying to talk, and people—like these 2 here—interrupt me.” When I asked him if anything else bothered him, he said, “Yeah, when I am trying to watch TV and people stand in front of it.”

A smartly dressed, well-spoken gentleman saw me at the office with the chief complaint of a sore throat. From the start of the visit, it was clear that he wanted to provide me a very specific and detailed description of his condition. During the course of the interview, he pointed to the normal “punching bag structure” found dangling from posterior aspect of his soft palate (known medically as the uvula). He cited that what bothered him most was his “vulva.” 

I immediately asked him to repeat his answer, as I was not sure I heard him correctly. “I saw that my vulva was swollen,” he said. 

I now faced a dilemma: Should I correct him on the proper use of the word uvula? Should I ruin this humor for all doctors down the road who might otherwise hear his mistake? I won’t tell you my decision. 

Margaret is a proper 68-year-old lady from London, England. I have taken care of her for many years, and over this time we have enjoyed many laughs together. During a routine sigmoidoscopic exam, I asked her if she would like to have a look inside—as I have asked all of my other patients in the past when performing this exam. This would be accomplished by turning the scope so she too could look through the eyepiece, I explained. She replied, “That would be quite lovely.” 

As she peered through the scope, this cheerful British woman exclaimed, “This is quite marvelous. It rather looks like the planets, doesn’t it?” 

 “I have never thought of it that way before,” I replied. “But if you had to think of any 1 planet that it looks like, you’d have to say it looks like Uranus.” 

The nurse bumped into the surgical tray, instruments fell to the floor, and I began to think that perhaps I had gone too far in being familiar in attempt to joke around with my patient. Thoughts of calls to the Board of Physicians by my patient or the surgical nurse began to enter my mind. 

I didn’t see this patient again for a year, which convinced me that indeed I had offended her and prompted her to seek care elsewhere. When she did return a year later, I greeted her with a warm hello and told her that I thought she had fired me because of the comment I made during our last visit. “What? No, I am sorry,” she said. “I don’t remember that.” 

As it turned out, she moved back to England to care for a sick relative and had not given the off-colored joke a second thought. She and I were both happy to continue our special physician–patient relationship.

Richard Colgan, MD, is a professor at the University of Maryland School of Medicine in Baltimore, MD, and the vice chair of medical student education and clinical operations in the Department of Family and Community Medicine. He is also the author of Advice to the Healer: On the Art of Caring by Springer. 

References:

1.Osler W. The Student Life. In: Aequanimitas: With Other Addresses to Medical Students, Nurses and Practitioners of Medicine. Philadelphia, PA: P. Blackiston’s Son and Co; 1907:404-405.
2.Wagner-Martin L. William Carlos Williams: A Reference Guide. Boston, MA: G. K. Hall; 1978.
3.Williams W. The Doctor Stories. New York, NY: New Directions Publishing Corporation; 1984.
4.Taylor RB. Medical Writing: A Guide for Clinicians, Educators, and Researchers. New York, NY: Springer; 2011.

Further Reading: 

1. Colgan R. I am sorry I was late. Acad Med. 2002;77(10):946.