essays

In the hospital I become acutely aware of what I'm good at and not good at. The latter list is extensive: picking up things on physical exam (I'm tone deaf! I can't tell whether that's dull or resonant. And why can't I elicit reflexes, ever?), immediate differential diagnoses, remembering yesterday's lab values, the finer points of the plan for a patient, interpreting radiological studies. Sometimes in these moments of incompetence (and also through the first two years of med school when I realized I knew about 1% of the basic science my classmates knew and was also 1% as quick to learn new information, resulting in an exponential lag between me and them), I think back to when my primary occupation was one in which I was relatively competent. That is, being an English major and writing about stories other people had written. There are a lot of ways I'm a shoddy English major (probably most of the ways one typically thinks of). I can't remember a lot of what I read other than how I felt about it, I can't quote anything, and I even get my eras of literature mixed up because my wayward sense of direction also applies to chronology before my time.

But I did like writing essays and like others taught in the form of close reading, could write a decent one. It takes me a long, long time to write one. I remember my college roommate pulling all nighters to write amazing papers, but it would be literally impossible for me to complete a good essay like that. This roommate visited recently, and we talked about missing essay writing. But even before that, when I screw up the many forms to be learned in medicine, I drift back to those days in our cozy house library, to when I had a system. I'd go through the text first: picking out lines, turns of phrases, images, structure of chapters--pay attention to why this word was chosen, what it conjures, where it's placed in relation to another. I'd type out all the quotes in a document; I enjoyed the false productivity of filling my pages with someone else's words and it helped me immerse in the text. As I did this I'd stream-of-consciously type my commentary on the quotes, and let my ideas and thesis emerge organically from what I found and thought. There's a certain rush after you've been chugging along, either with a boring stream of nothing much or with spurts of disconnected epiphanies, and you suddenly string things together. This begins a flurry of grouping related thoughts and possibly in a general order. And then the introduction can be written. Some say to save this for the end, but for me it was always the most time consuming and important, to know what I wanted the essay as a whole to say, and that's what the introduction does. Even as it sets up the structure for the rest, it's the most free flowing part of the essay too, because it doesn't require immediate, constant concrete evidence. It's just a promise.

In the midst of the forest of scraggly trees that is becoming a good doctor, it is sometimes nice to remember what it's like to take a complexity and reform a small part of it into an essay. An order with enough loose strands to keep it interesting and realistic but overall compact and from the bareness of your hands.

Here is one introduction from my favorite English class in college, a seminar on criminals and misfits in literature.

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The Real Prison of a False Identity

“He who is subjected to a field of visibility...inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.” -Michel Foucault, Discipline and Punish (323).

The cover of the 1995 Random House edition of Franz Kafka’s The Trial depicts a man’s face, colored in red, behind black bars. The image of a prison is evident, but whether it is the actual solid bars or the rectangular segments of the man’s face that comprise the prison is less clear. Initially, the black bars appear to restrict the man’s freedom, demonstrating a traditional view of imprisonment. However, the red face can also be perceived as the imposing force that breaks the unity of the black background. This dichotomy is similarly reflected in the portrayal of the “gaze.” In “Panopticism,” Michel Foucault asserts that power resides in a supervisor’s ability to view a prisoner while remaining hidden from him (321). Because his face is visible, the man on the cover seems to be the prisoner. Yet, closer examination reveals that he is likewise the supervisor: the prominent eye amidst a hazy face suggests that he sees more than is seen. Both the criminal in the Panopticon and Joseph K., the protagonist of The Trial, unknowingly exemplify this duality.

A man confined to a cell in the Panopticon is highly conscious of his lack of space and movement. K. resides figuratively in a similar prison but with one crucial difference: he does not see his boundaries. Whereas the prisoner in the Panopticon knows that he dwells in the periphery of the structure, K. envisions himself at the center. Neither person realizes that he also assumes the opposite role. Because individuality connotes one identity, these opposing forces negate the existence of a self. Unaware of this duality, however, the Panopticon prisoner and Joseph K. harbor illusions of self-identity which ultimately facilitate their self-destruction. The imprisoning structure maximizes its power by instilling in the criminal what is otherwise typically liberating--a sense of individuality.

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Looking back, I enjoy it as I did then. I also think, in the end, it is as limited as medicine can often be. The senselessness of semantics and vocabulary, creating complications, wondering what the use is. But each form of practice and expression pushes us to work beyond its parameters. I find that the real meat in writing an essay about a piece of literature or a history & physical for a patient isn't so much to come to a conclusion (even though we sound like we do and this is the stated, accepted and expected reason for doing it), as it is to grapple and stumble. I like how literature and medicine as fields complement, parallel, and contrast one another at different points in my life, my day. They can play tug of war with me the knot in the middle, or gang up on one side with me on the other, or it can be we three against who-knows-what. I'm willing to stumble a lot for that range of visibility.