Medicine is a learned profession, but clinical practice is above all a matter of performance, in the best and deepest sense of the word. —Frank Davidoff, M.D.
Years ago I recall watching a television documentary on Arthur Fiedler, the conductor of the Boston Pops orchestra.
The camera caught Fiedler backstage, stooped and shuffling slowly about as he struggled with his tux in preparation for the evening performance at Symphony Hall. He looked like the old man he had become—tired, fatigued, worn out. But then, as he stepped out onto the stage, a miracle happened. Fiedler’s frame straightened, his head lifted squarely onto his shoulders, a big smile flashed across his face. Proudly, he assumed his position at the head of the orchestra, pumped up by the thunderous applause.
We are what we are; we become what circumstances require of us.
Fiedler’s transition occasionally flashes through my mind as I step across the threshold into an exam room to meet a patient. Almost always I offer a big smile and extend a hand in greeting. I attempt to hold my composure throughout the interview, adjusting my demeanor to reflect the emotional state of the patient. I become, as it were, a player on stage where the art of medicine is performed countless times in daily rounds.
I might move from an encounter with a new mother, freshly primed by a healthy, thriving infant to a silent teenager, subdued in the throes of a depression. In each case I’m cast as best supporting actor, called to muster my emotive repertoire at a moment’s notice.
Sometimes I don’t feel up to the task; I’m drained, exhausted, spent. Sometimes I want to turn tail and run as fast and as far as possible to distance myself from the suffering I witness daily. I want to cover my ears, shut out the woes, the aches and complaints, for I have more than enough of my own.
None of this is permissible, of course. The patient has come seeking expertise, care and compassion—what does it matter how I, the clinician, might feel?
Here Osler’s wise words of comfort seep into my mind:
Dealing as we do with poor suffering humanity, we see the man unmasked, exposed to all the frailties and weaknesses, and you have to keep your heart soft and tender lest you have too great a contempt for your fellow creatures…
Even I, a poor player who daily struts and frets his hours upon the stage of clinical medicine, am not one to wallow in self-pity. Ultimately, I can not run from the responsibility I have for those entrusted to my care.
I call to mind the image of Fiedler stepping out on stage. Once more I buck myself up, rap quickly on the exam room door and step into the limelight for my next performance.
It will be the best I have to offer.