Hope for Mr. Lee.
(As aired on All Things Considered, July 23, 2002)

 

Sometimes I just loved a patient right away, like a man I'll call Mr. Lee. I loved patients for being kind or reflective or even for looking like someone else I liked. And for all those reasons, I loved Mr. Lee immediately. I still addressed him with the careful decorum of the medical interview: "Do you have any questions before we start, Mr. Lee?" But with a patient like him, even this formality begins to feel like just another form of kindness.

Sometimes a patient like Mr. Lee would tell me some promising news. If he had HIV, for instance, perhaps at last check, his viral load was undetectable even without the aid of drugs. Details like that might mean the difference between a pleasant life and much more difficult one or, in some situations, between life and death.

When I heard that kind of news from a patient like Mr. Lee, I would have to actively hold myself back from making some happy, joyous remark. I knew that this kind of information was not necessarily reliable. And even if it was true, it was often statistically likely to be temporary. But if I liked the patient a lot, it would stay as a secret pleasure inside me, even after I left work.

In fact, after work, thinking about it, I sometimes would begin to interpret the data in the best possible light. I would want just for a moment to go back to him, to get off the bus and take one going the other way, to run down the street from the bus stop to the hospital, to run past the ambulances parked outside and burst in the door out of breath to say, "Mr. Lee, Mr. Lee, maybe you're one of the lucky ones."

There's a whole literature of small, bright desires like this. It looks like science and it is science, but if I'm in a certain mood, it can seem like poetry. Charts, graphs, tables, in medical journals of AIDS, cancer, molecular biology, showing small sample after small sample of the beautiful exceptions to the horrible rules. The language of that literature is cautious and restrained, like the responses I needed to make when I heard similar pieces of news in the hospital. For scientists and doctors, to jump up and down and declare miracles is bad form.

Still, I can't help but think that there are at least a few research physicians up late at night, writing this stuff with the beginnings of tears in their eyes, remembering the beautiful faces of the patients they loved the most. I know already that this sort of hopefulness is what will make me most passionate about medical practice. I also know it's dangerous. A fast-growing tumor or a raging virus are what they are, whether I decide to love Mr. Lee or not.

It's not that I plan to try to cure myself of all my wishing for the people I meet. Surely, those who will train me can beat that out of me if the need arises. Until then, like most bright-eyed medical students, I want to be a doctor who loves patients and holds secret hopes for them.

But I can see a kind of wisdom in the doctors who become technicians, bioengineers; just show up and treat a virus or a tumor that happens to be inside a person. You do this, and then there's no fruitless desire. Just the data, the available treatments, the standard of care.

 

copyright 2002 joe wright
broadcast and transcript, copyright 2002 national public radio