Wednesday, August 19, 2015

Deconstructing patients

We dismantle people as art experts deconstruct paintings. Instead of seeing families gathered by the lake of a park or the stars in the sky, we see the purple and pink dots, the gray shading, and the yellow highlights.

Eventually we apply these skills not just to diagnosing but also to interpreting everything in our clinical world. Deconstruction becomes our professional tool of understanding, and we rely on it to absorb increasingly complicated clinical problems. A patient in multisystem organ failure, when reduced to bodily systems—neurologic, pulmonary, cardiac, and so on—becomes manageable for even the most junior of residents. . . .

In the course of my training, I actually came to enjoy this deconstructing. It was mentally satisfying, like taking a box of jumbled puzzle pieces, organizing the, then arranging them into a perfect picture. The only problem was that I could not stop doing it. I did it almost constantly at work and then would find myself still doing it during my time off. I saw people in the grocery store or at restaurants, and my eyes would fixate on the loping gait, the barrel chest, or the finely wrinkled skin. Stroke, emphysema, big-time smoker, I would think. It was strangely thrilling, the way having X-ray vision might be.

Then one day my Aunt Grace, my mother's younger sister, asked me for some medical advice. . . .

. . .

The skill that had once simplified my life now left me very much alone, and the profession that had once promised the power of cure now made me utterly helpless.
Pauline W. Chen, Final Exam: A Surgeon's Reflections on Mortality  (New York: Alfred A. Knopf, 2007), ch. 6

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