My mother wrote with elegant calligraphy handwriting.
It was all I could think about during medical school today. In elementary school, it was impossible to fake her signature on notes from my teachers. This downside was balanced out by her help when fancy handwriting was a must on school projects. Her intricately developed script intensified the impressiveness of my Science Fair soda volcano.
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Here in medical school, our day to day emphasizes the characterization of pathology. We have moved from a year I emphasis on the “normal” to the year II emphasis on the “uh-oh”.
Part of our curriculum involves case based learning, where we work in small groups to fully characterize disease patterns. This week in neurology, our focus is on CIDP, Chronic Inflammatory Demylenating Polyneuropahthy (what a mouthful). Over the week, we become temporary experts on the course of the disease; representations of macrophages eating away at the glistening myelin sheaths of peripheral nerves cover the board. One student reports that successful treatment depends on early identification of the illness, and halting progression. “What about reversal of symptoms?” another student asks. Unfortunately, the freshly highlighted NEJM article provides no help; “I don't see anything about that” he half stumbles, half apologizes. Whether for his lack of knowledge or for medicines lack of cure, I am not quite sure.
The discussion moves forward, and we rattle off the associated symptoms of this progressive disease. Without treatment, most peripheral nerves will be destroyed beyond repair, leading to multi-focal sensory aesthesia and motor paralysis over time. In addition to the loss of gross movement in the arms and legs, fine motor skills are lost. It is a disease which, unchecked, will cause decades or more of total body paralysis, and eventually death.
Our time in tutorial is over; my classmates move to our next assignment.
But I am still - frozen in my chair. The case of the woman we are studying is invasive and
familiar. My mind retraces the pathology we have discussed and attempts to match it with my distant memories of high school, a time when I was a daily observer as my mother slowly lost her own sensory and motor function to this insidious disease. I linger over thoughts of how different the two perspectives of this illness are.
Today, I learned more about the pathology of CIDP than I could have ever understood as a lay-person. Years of science education have led me to understand (to the best of what science has found thus far) the objective “how’s” of her illness.
But, today I can’t find my breath. The veil has lifted and I recognize now how necessarily limited my medical education has been and will continue to be. In each case, we don’t discuss how illness breaks apart families and orphans children. We don't go over how often patients are never identified as having the illness and never treated. We don't mention that treatment doesn't work for everyone, and that disease often obstinately progresses forward unchecked by the best efforts of modern pharmacology. We don’t discuss what it’s like for patients to lose the ability to write in calligraphy. We certainly don’t linger over thoughts of how illness robs patients of their identity. And most surely, we do not discuss how illness and the frailty of our own humanity has refined and shaped us into the people we are today and the clinicians we will be tomorrow. Instead, we observe objectively and distantly, as though we are above the vulnerability to illness that is endured by our patients.
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I am certain both ways of seeing are necessary.
In fact, I doubt I could make it through medical school if I was acutely aware of how much suffering is actually endured by any given human being. I don’t know yet how to stand in awe of those who endure such suffering; who face the terrifying uncertainty that comes when our own bodies and minds betray us.
I am sure after this week I will gratefully go back to a more objective way of seeing. Still, my deep hope remains that as I come alongside people afflicted by illness - I will learn to be with them in our own vulnerable and precious humanity - while we are in it and until it ends.
