A doctor’s lessons on vulnerability
There are times when the art of medicine and caring for others involves the practice of a singular kind of expertise – a will to be human.
My work as an emergency physician has always seemed to me to be a fundamentally creative act. Caring for patients requires creativity as a clinical skill. This idea is neither revolutionary nor original. The medical encounter has been compared to improvisation for a reason: it’s unscripted and unpredictable, and requires thinking on our feet, curiosity, and following possible threads rather than closing them.
It is therefore not so surprising that the pandemic has been an eye opener for medical writers. Rare was the day, especially early in the crisis, when I did not read a powerful article or an op-ed written by a doctor capturing their harrowing experiences. However, many pieces soon began to blend into each other, striking familiar notes and describing similar experiences in similar ways. I felt like a terrible human being bored with another bit about the lack of personal protective equipment. Or worse, rush through another description of care for too many dying patients. Was it a manifestation of exhaustion on my part, or a desire to feel the burn more intensely?
The only thing I can say with certainty is that I felt needy, with a particular appetite for needs. What I was looking for and found missing in many of these otherwise expert stories was the vulnerability, the singular voice of another human who happens to be a doctor. Yet, paradoxically, I wondered if their expertise, the well-deserved banner that gives them authority, was part of the problem.
Tobias Wolff said, “When I sit down to write, I discover things that for some reason I haven’t admitted, seen, or given enough thought to.” During my career as an emergency physician, writer, and teacher, I have often wondered if the habits of mind that make excellent physicians in a healthcare system that values safety, efficiency, and reproducibility might interfere with writing as a form of discovery. For example, medical training emphasizes data and evidence from population research. However, this tendency to favor objective statistical methods, to look outside oneself for greater clarity, can make doctors less prepared for this inner journey of discovery, which often lacks benchmarks or safeguards.
Cognitive psychologist Jerome Bruner said that the purpose of the narrative is not to solve problems but to find them, it is “deeply about the predicament, the road rather than the inn to which it leads”.
Accepting risk-taking and getting lost as a necessary part of the creative process can seem unnatural and even irresponsible in the house of medicine, where risk is managed and minimized. The reflex to drive with facts and data can be a compensatory response or a defense against the discomfort and insecurity one might feel in finding trouble. Putting language and form into unmeasurable, complicated and intensely personal emotional experiences is a challenge. But that’s what I was looking for.
As the pandemic gripped New York, writer and emergency physician Dr. Helen Ouyang gave a masterclass in a surprisingly original and honest article that took the reader on her journey as she dealt with the imbalance. Through a propulsive narrative structure, weaving world events into personal experiences and offering insight into what is and what could be, she wrote about her struggles to make sense of it all. And she ends with a kick: “The only thing I can do – what I think will matter most, in the end – is just to be a person first, for these patients and their families. .”
Let’s face it, confessing what you don’t know can be hard when you’re a doctor and people read you because you’re wearing the mantle of an expert.
I’ve learned over the years that understanding messy experiences isn’t easy or pretty, and trying to get close to that search on the page is surprisingly difficult. In my book “Tornado of Life”, I take readers through moments full of uncertainty, contradictions and doubts. I describe times in my work as an emergency physician where there was no fact map to help guide me through the experience of another human. Expertise meant learning the practice of not-knowing and sitting with the chaos of a patient’s life.
When faced with uncertainty and ambiguity, physicians are prone to search for abstract ideas or point to reams of evidence in the medical literature in search of an answer. What a strange instinct, I always thought: to seek solutions to confusing situations by flying higher and further instead of making the necessary downward movement and asking better questions.
At the start of the pandemic, when personal protective equipment was scarce and our knowledge of SARS-CoV-2 was evolving, I explored why I felt safest working in the emergency room where I was most at risk of being infected. I wrote about waiting for the wave that was heading our way. I reflected on judging patients too quickly for behaviors perceived as irresponsible when in reality they frequently involved difficult choices, competing needs, and conflicting information regimes.
Anton Chekhov, arguably our most outstanding doctor-writer, wrote: “Only by being in trouble can people understand how far from easy it is to be the master of one’s feelings. and his thoughts. The word “emergency” comes from the Latin word emergence, which means “to bring to light”. There are times when we have no answers, when the art of medicine and of caring for others, patients and readers, involves the practice of a singular kind of expertise – a willingness to be a curious, imperfect and vulnerable human.
Jay Baruc is a practicing emergency physician, professor of emergency medicine at Alpert Medical School at Brown University, and author of, among other things, “Fourteen Stories: Doctors, Patients, and Other Strangers” and “Tornado of Life.”