When I was a kid I assumed that everyone wanted to be a writer. Anyone who did any other job was only doing it to earn enough money to keep writing. Non-fiction was barely writing, fiction was really writing, and poetry was the highest calling.
Including nonsense poetry and "bad" poetry. Limericks, for example.
It turns out that both my grandfathers had nonsense poetry memorized and would quote it. Genetics is mysterious.
In my forties it has been forcibly borne upon me that this assumption was incorrect. Details elsewhere.
I became a doctor because I thought I had to have a career to support my writing, that is, poetry. In part because I wanted children and I am female and I knew that half of marriages ended in divorce. I figured I'd better have a damn career. Some poets have a practical streak.
I chose doctoring because I liked science and math and language and I didn't want to write a doctoral thesis. I'm a generalist. Don't bother me with the damn details. I'm intuitive. After a time with any nurse I could stick my head out of a clinic doorway and say, "I want the, um," and they would bring me a ring forceps. In residency I really sucked at the butt-lick thing where you would memorize research papers and quote them to brown nose the faculty. However, once a pediatric cardiologist and I recited all of Dr. Suess's ABCs in unison on rounds, to the consternation of the rest of the team. I have one of those packrat sticky brains. Cool.
So I was trained in Evidence-Based Medicine. This is half working on being good science and half a way to distinguish allopathic medicine from all of the flakey woo-woo "natural medicine" that is around. No doubt some of it is excellent. Some, however, is flakey as hell.
Every so often, though, the evidence-based scientific side of the brain gets a message from the fuzzy poet side. "Do this." says the fuzzy poet side. The evidence-based side promptly shuts down and I write orders that I remember the next morning, but I cannot explain. And they are good.
For example, there is my patient V.
The first time V was on my schedule, the nurses said, "Oh, no, not V." This was 10 years ago. I said, "What's wrong with V?" They said that she was older, really fussy and had fired most of the doctors in town. Sounds like my grandmother.
V came to see me. It was very clear that she was interviewing me to see if I met her standards. I adored my grandmother so I didn't mind and found it funny. She deigned to give me a trial as her doctor.
I soon ran afoul. V called for an appointment. She wouldn't tell the front desk why. She wanted me and she wanted me that day. I was catching a baby at the hospital. I wasn't available. She had a tantrum at the desk when they tried to hand her to the nurse, another provider, the emergency room, anyone! My patient had a postpartum bleed and the rest of clinic was canceled.
I heard about it the next day and called V. She told me that it was unacceptable. I said that we always had to prioritize and the bleeding postpartum lady required my full attention. She was not mollified. I said, "What did you need to be seen for?" She said, "Abdominal pain." I asked, "Did you see someone else?" "No," she said. "Did you go to the emergency room?" "No," she said. "Is it better?" I asked. Long silence, then: "Yes." I let the silence rest a bit and said, "The lady in the hospital was an emergency. I cannot control when an emergency will call me from clinic. I deliver babies. We ask that our patients explain to the front desk or nurse why they need to be seen so that we can prioritize and redirect people to other providers if the person's provider is not available. Also, my patients need to treat the front desk personnel and nurses with courtesy or I ask them to find another provider. If this is not satisfactory, I hope that you can find a provider who meets your needs."
After that, she was a lamb.
I followed her over the next four years. When I returned from a week of vacation she was in the hospital. One partner had admitted her, another partner had taken care of her through the weekend. I took over. She didn't look right.
My left brain wrote the note. My right brain wrote an order. "Temporal artery biopsy, please."
Temporal arteritis is rare. The BAD thing is that it can cause blindness. My conscious brain is pretty vague on the details. Headache, temporal tenderness sometimes, um. I didn't even look it up.
My admitting partner called me. "She doesn't have temporal arteritis." "Um." I said. My second partner called, "Geez, what are you thinking? It's not temporal arteritis." The surgeon called: "Gosh, are you really sure you want to put her through the biopsy?" The pathologist called: "I've NEVER seen a positive." I was still not coherent but I'm damn stubborn, and nothing like opposition to get me riled. "Do the biopsy!"
It was scheduled for the morning. The pathologist called me in the afternoon. "It's positive," he said, disbelief all over his voice, "I can't believe it. I've never seen a positive. How'd you know?"
Well, um, I can't say. Some huge percentage of communication is non-verbal. I fell asleep in nearly every class second year of medical school at 40 minutes into the 50 minute lecture. Maybe it's all stored in my unconscious.
My male partners rather avoided me in the clinic halls for a few days. Wusses. Like they're scared of witches or jealous or something.
V, with her newly diagnosed temporal arteritis, was transferred to a larger hospital. "I knew you'd help me," she said, squeezing my hand.
I still haven't looked up the details of temporal arteritis. Apparently it is somewhere in my brain, accessible by the fuzzy poet. I don't worry about it, I'm just glad it works. The really funny bit is that I don't even realize that the other half of my brain has taken over until the next day. The conscious scientific side of my brain is surprised, but then remembers the physical act of writing the order. The scientific side tries to say "Why?" when I'm writing but the other side just says, "Shhhh. Don't worry about it." So I don't.