"Bugle Notes" - A Serious Business

                                                                                                                                                                                                                                                                   

He stood silently, his eyes fixed on us, immaculately dressed in a dark 3 piece suit adorned with a gold watch and chain, hair meticulously groomed, a brightly colored bow tie centered perfectly on a freshly starched white shirt, wire collar stays in place, black wing-tip shoes glistening. Gold cuff links and military-like, sharply crease pants, with just a subtle break of the cuff on the shoe tops, completed the picture. He could have passed any inspection I went through at West Point! Then he spoke:

“Medicine is a serious business”, he said firmly. “You should never smile, joke or laugh with a patient, nor sit on a patient’s bed. At all times, you must be professional and maintain a proper distance physically and emotionally. You must not allow yourself to become emotionally affected by a patient’s condition, no matter how bad it may be, otherwise you risk losing your authority and your objectivity which could end up harming the patient.”                                                                                                          

He was my instructor in history and physical examination during my second year at University of Alabama School of Medicine in Birmingham. I was excited, as were my classmates with me, to take those first baby steps toward becoming a “real” doctor. His words burst that bubble of innocence. Speechless, we stood there, heads nodding dutifully, obediently, in unison. How could we respond otherwise and what right did we have to say anything? He was, after all, a world-renown cardiologist. We quickly understood our proper place in this intimidating new world of medicine in 1980.

I looked at him, in all his “glorious perfection” and thought, “This guy is full of crap! That’s one of the most ridiculous things I had ever heard.”  Only a few years out of West Point and having served 3 years in Germany as an Army officer, I had heard my share of “wisdom” from those above me. Most of the time I learned from it but sometimes….well, this was a sometimes. Of course, we all did exactly what he said those weeks under his omnipotent, omniscient presence. He was hard on us, too. We learned how to do a complete history and physical exam to his demanding satisfaction. We memorized every review of systems question, reciting them back to him time again. I was grateful for the high expectations he placed on us. We learned well. However, I knew that as soon as I was on my own caring for patients, I would be smiling, laughing, joking, and, heaven forbid, sitting on the side of their bed, as long as I knew it was okay with them. Being professional was not the issue.

For 30 years as an Internist, I did just that. I believe patients do not care how much you know until they know how much you care. All people have an innate need to feel loved, cared for, and treated as persons of worth and value. This is especially true than when they are most frightened, vulnerable, and dependent as during illness or injury. This forms the foundation of the “sacred trust” that is the doctor/patient relationship. This will only happen when compassion, caring, empathy, and “the warmth of love” are given and received. This is the “Art of Medicine” in its truest form. From trust springs hope. To live without hope is a terrible thing. The emotional pain of despair will soon follow. I know. I have experienced it both in the world and at the deepest level personally.

 The world needs more hope-givers. Be that person. In doing so, the joy you once had, you can have again. Medicine is “a serious business” but more importantly, it is a deeply personal, fully human endeavor. Humility, empathy, compassion, caring, and love are its fickle guardians. The busyness and business of medicine can easily blind you to this truth. We build walls and wear masks as protection from the heartbreak, the loss, the hurt, the pain that surely will come. May you take down your wall, remove your mask, and let people see who you really are, a person, a physician who cares, understands, and is completely present with them no matter the circumstances.

Yes, medicine is “a serious business” but far more than that, it is a privilege, albeit a hard one. Every day what you do is important and makes a difference in the lives of those you touch. Thank you for being that person!

Andy Lamb, MD