The Pleasures of Medicine

The whole world was green. My driver's-side window let in the 3 a.m. buzz and click of a traffic signal and the surprisingly sweet smell of upper Manhattan drenched clean by the rain. Everything was so shiny and wet I had to stop a minute and just admire the green. Bone-tired but high as a kite, I still love that minute. I have never dropped acid but what drug could make that light more beautiful? I was high on 48 hours, 20 admissions, eight cases, four sets of rounds and going home. This was my training. I feel bad for the residents now — what the new restrictions on residents' hours stole they don't even know.

Sure, some of this is a glass of dirty water after a long, hard thirst, but the pleasures in medicine are intense. Never sought in themselves, the occasional delights of our field just suddenly surround us, like that green traffic light. And more than a fair share are a little lonely, happen at night and involve reflection.

If I go in for an emergency after midnight I will make a few rounds. This is often a pleasure. Patients never mind it — I hardly ever find them asleep — and they are more people, less fractures and "post-ops" in the quiet than during the bustle and noise of the day. People to visit, not patients to round — they tell jokes, show you pictures, give you cookies and gum. They'll talk about important things, hopes and repentances, their great ideas. Some will hear yours. Want to be appreciated and feel good? Visit folks in the hospital — at night.

Bodies are a source of much happiness in a medical life, particularly if you happen to be a surgeon. Much as light and gravitation are governed by consistent and perfect laws, so are the animate machines we spend our days probing and pondering. We learn this again and again as we look and poke. During carpal tunnel surgeries most of my patients are wide awake, with a local anesthetic keeping the two-inch-long opening in their palm comfortably numb while I work. Every once in a while one asks to "look inside." Not always, but when it seems safe, I tell the circulator to put a mask on the patient and pull down the drapes. And I have the pleasure of showing them around their hand.

There's quite a lot to see in a carpal tunnel. The nerve we're there to decompress is somewhat impressive — a yellow white ribbon of a thing, about the width of the rubber bands on broccoli. They can tell it's alive from the flood of sensation it brings as I touch it, ever so gently, with a smooth, blunt probe. But the glistening white tendons that lie alongside — the life in them fascinates. "Watch this thing — now slowly bend your finger — do you see how it works?" The tendon moves, rather like a pushrod in a steam engine, frictionlessly, efficiently, straight in its track. And the finger rises to the mind's command. The patient usually gets the idea, but whose idea can it be? Fear and wonder beat Charles Darwin every time at this game. An unforgettable catechism — each one who does this reminds me of it every time they see me, for years. It's a fun job.

Bodies do amazing things — bent bones straighten out (sometimes), and I have the old, crooked x-rays in the folder to prove it. Good tissues grow; I measure the circumference of a thigh and send the patient away with a physical therapy prescription. When he actually does the exercises, I measure again three months later and voila! there's more muscle there — I can prove it. The hand wouldn't close, the arm wouldn't rise, the fingers (those carpal tunnel folks again) couldn't feel — but then they work. The big secret? We physicians treat. But we all know it's someone else who actually makes the new bone, muscle, blood vessels and collagen — who heals. If you don't get a kick out of touching off what amounts to a small creative explosion, there's no hope for you in medicine. But if you do it's a kick in the pants.

Minds overcoming matter seem to make us happy. From "The Little Engine That Could" to Lance Armstrong, when we shoot straight, run fast, dance expressively, fish, sail, hunt, sing, paint or ski we impress our minds on the matter of the physical world. In these happy activities our choice, our will, changes the physical world. Though the changes might be temporary, and though nobody except the changer might notice them, the pleasant activities all produce changes that are unnatural — they would not have happened by themselves. Your timed mile won't get any faster, the ball will not go in the basket, the fish will not jump into the bucket on its own.

And every one of these unnaturally pleasant changes start with a message from your weightless, invisible mind to that most accessible part of physical reality, your body. Every doc knows the patient who seems to get better by sheer toughness, naked will, unbending before injury or disease. That patient is a lot like an athlete up against an adversary or an artist wrestling a great idea onto canvas or paper. If you like rooting for your football team or watching the inner mental war they call golf, just imagine our 50-yard-line seats at the game our patients play against Pain and Death. And they pay us to come!

There is, finally, the fun of being on the team yourself, of surrounding the woolly mammoth along with the rest of your tribe — melding minds and straining backs toward an enormous, shared goal. And despite his often saturnine tone, this writer is happy to note there remain some truly great people in America's mixed-up world of medicine. Nurses and doctors and secretaries who can make my day when the patients and the bodies (even the stop lights) still can't get me past the lawyers and the HMOs. I hope they're getting a little fun out of it too.