The emergency department pages. They have a patient who is elderly and confused. He arrived by ambulance. The labs are normal, the radiographs are normal, but we can’t find any family members. Can’t you just admit him until they figure things out in the morning?
Sometimes my practice of hospital medicine is discouraging and I don’t believe I am healing anything, or anyone. What do doctors do at these times? I read philosophy, as did Boethius, a late Roman bureaucrat who penned these lines while in jail:
“I who once wrote songs with joyful zeal
Am driven by grief to enter the weeping mode.
See the Muses, cheeks all torn, dictate,
And wet my face with elegiac verse…
My hair untimely white upon my head,
And I a worn out bone-bag hung with flesh.”
How often have we felt like “bone-bags?” Early in the morning with a long list of impossible patients, families awaiting discharges, and new life-altering diagnoses to communicate? By the end of a string of shifts, or sometimes even at the end of a single day, my overused brain settles into a reflective mode in order to infuse sense and meaning into my work. I reflect on my actions and patients’ fates, how I think and how I know and what I try to tell patients. In short, I turn to philosophy. This is not Philosophy with a capital P such as one finds in academic departments, but simply informed musings on the meaning behind a day in the life of a modern physician. Somehow the musings refresh and replenish my ability to keep being a doctor, and they may make me a better clinician: more understanding, less likely to leap to conclusions, more nuanced, and with an active rather than moribund emotional intelligence.
My hospitalist practice has a wonderful tradition of sharing lunch together every day. No matter how crazy the census, we stop at 12:45, grab food and sit together in our call room. Conversations range from a specific clinical case to the state of American culture, and everything in between. More and more I realize that we are all philosophers, and that this daily reflection, sometimes poetic, sometimes incisive, soothes the angry fibers of an overtaxed clinical brain to set it back on the course to analytic compassion.
The current buzz calls humanism in medicine, or inner reflection, simply “preventing burnout.” But I think it may be much more; the goal of philosophy is Truth, not just feeling better. The quest for a very human truth is what brought us to medicine; maintaining that quest will not only save us, but save our profession.
Boethius led a quiet life as a philosopher, translating the Greek originals of Plato and Aristotle into Latin. He accepted a political post and within a few years found himself in prison, awaiting execution. Thus begat his Consolation of Philosophy, a long reflection on pursuing the Muse of Wisdom while engaged in the world. Perhaps this is a metaphor for physicians accepting leadership roles in their institutions? But perhaps not! I am hoping to avoid the execution, yet benefit from the reflection. Stay tuned for my next philosophical encounter; I look forward to grappling with your own in the comments.