The Gift*

We can still remember that first anatomy class in medical school. Everything up to that point was abstract—on paper, or PowerPoint, or plastic laminate “mnemonic” cards—all intended to plug gaps in our medical knowledge. Professors stood in front and tried to help us connect the dots of Krebs’s cycles, Korotkoff’s sounds, or how to classify the stages of kidney disease. Clearly, it was stuff we were supposed to know

Some of it stuck. Some slid as quickly out of our consciousness as thrown Jell-O against a wall. We tried to pay attention, as though all of this was wisdom that only a select few could know. We thought this would all be important some day, when we were called upon to recite to our attending why this mattered. Why it was important.

Opening the heavy steel doors to the cadaver labs and taking in the first strong scent of formaldehyde gave us an olfactory clue that something was different. We gazed out upon table after table, holding the vessels of what used to harbor a soul. We touched what seemed cold and rubbery and realized that just days, or weeks before, this was animated. It possessed hopes, and dreams and could feel what we felt. It laughed at stupid jokes and cried when stirred by deep passions. It had life.

We began to realize why it mattered. Why what we learned, or failed to learn, made a difference. We were going to be responsible during those moments of life to make things better. We were going to touch living, breathing souls and apply that seemingly abstract knowledge in ways that would bring comfort. Or more importantly, hope.

The rubber had met the road. We became excited, animated about what we could achieve. We were truly scientists for the first time. What we did mattered. What we learned mattered. There was a connection of our impending knowledge with what we could do for fellow beings that could no longer be broken. We stood a little taller; the whiteness of our coats seemed a little brighter. We could each achieve greatness in our own way by how we applied what we learned. It was up to us.

Now, clinical medicine is a “health system.” Some say badly broken at that. Expensive, poor outcomes, affordable by some, unreachable by others except in an emergency, if then. The heavy steel doors are now opening in Congress, opening to a cacophony of voices demanding equality, cost containment, access and most elusively—quality. We’re told we need to “cross the chasm,” practice only what is “evidence-based”—but not ration care—and provide a “home” that is patient-centered. The science of medicine replaced by the art of drama.

Clearly this was not what expected in that first anatomy class. Nor is it now. We know what matters. We knew when we touched that first gift on those cold, steel tables. It is using science tempered by humility. It is striving to do what is right by and for our patients. It is the application through experience of what truly matters. We work without drama. We choose to honor the nobleness of the profession by always searching, always improving and never settling. We have connected the dots and understand the linkage between what we know and the gaps that remain. That is the art of medicine.

No drama. Just touching a soul and understanding how we bring healing and hope. We let others debate how new laws and regulations may hurt or enhance medical care. We are the stewards of the nobleness of our profession. Walking in that first day not fully comprehending our role until we laid hands on the gift before us.

Steve P. Sanders, DO, MBA

*(First published in Blood and Thunder: Musings on the Art of Medicine, University of Oklahoma College of Medicine, 2010)