As a long-time emergency physician, I must and happily subscribe to Henry James’ edict, “Try to be one of those on whom nothing is lost.” That is the nature of medicine, particularly in the frenzy of the ER. Also, I try to keep in mind what one of my colleagues so astutely said years ago about evaluating patients in that setting.
“Always think worst case scenario in any situation and you’ll never go wrong.”
Henry James, however, meant it in terms of writing. I had begun seriously doing just that to help me in the ER.
Early in my career, I came upon an unusual diagnostic resource: I took to noticing what my patients were reading when they showed up to be seen in the emergency room. This, naturally, was catalyzed by my own love of literature. More importantly, noticing what they were reading provided me some insights into their character. And, it was a hook for beginning a dialogue on first meeting, often in the setting of a potentially fraught medical encounter.
It helped me in terms of how I should talk to them. It also allowed them to develop their own trust in me. They would see that I’d noticed what they’d chosen to bring to read when they were about to enter an unknown, perhaps life-changing, or threatening, situation. Right away, we established ourselves as person-to-person. Not doctor to illness. We created an intimacy. And there was one more advantage: doing this gave me a clue into how they connected to the world. Most importantly, I realized at times it told me something about how the patient might see the story of their own illness.
I began to think about the reasons that people who are ill, or think they are, bring reading material, and what they choose to bring, when they are heading off for a medical encounter. I wondered if it was random or perhaps there was something to be learned from it. Something that other practitioners could make use of.
I thought there might be something on the edge there, the liminal part of an illness, an interaction between MD and patient that could be sparked by the book he or she was carrying. It was almost like a totem or voodoo doll (could a book be a new type of totem?) Do books have that much symbolism or are they trifles, just something brought along for the ride, randomly? Perhaps, because they are plugged into someone’s brain already, by virtue of the connection someone develops after/as they are reading something, does that then allow a pathway in for the practitioner?
What is the connection between the books, the reading, the narrative that a patient is telling themselves, and, my ability to understand what is happening, what they need? Might that shape my ability to connect with and heal them? Is it a way for me to leap into their conscious brains as a way of introduction, or is it deeper?
What about the words, or the preconscious area that the words are connected to? What happens when we get injured or are ill in those cognitive and emotional parts of our brain? It seems like, because I have gotten involved with healing, and writing (as so many of my predecessors, Chekhov, Conan Doyle, Somerset Maugham, and William Carlos Williams, only to name a few, have) that I’d stumbled upon something, but it often felt like I was still trying to peer over the transom, at the prize(s) just behind.
Long after all these ruminations began evolving, I finally stopped practicing emergency medicine and was working at an urgent care facility in Greenwich Village. On one of my first days there I walked into the treatment room of a patient and noticed he was reading the book, Call Me Ishmael (those words are the opening line of Moby Dick. The book was the poet, Charles Olson’s, brilliant thesis on Melville’s masterpiece).
This patient, a professor at a university in New Jersey, had come in because the night before he’d spent the evening with a friend, a gay male, who had contracted meningitis. At the time there were a number of cases of meningitis being reported in the gay community and my patient, also gay, was concerned about his risk of contracting the disease himself. He’d come in to see whether he needed to receive the rifampin prophylaxis he’d been told could combat that risk.
“But maybe that’s just a myth,” he said to me.
“No,” was my reply.
I pointed to the book he was reading. “That is a myth. Your needing meningitis prophylaxis is quite reality-based.”
We both laughed, he received his rifampin and I moved on to see my next patient.
As I entered the room I was taken aback. I had to check to convince myself that the book he had brought with him, and was reading while waiting to be seen, was in fact, Moby Dick.
If things like this hadn’t happened before I suspect I would have written this off to a coincidence, serendipity, or just to me having developed the habit years earlier, of paying attention to, and frequently commenting on, the books people bring with them. But it started me thinking more and more that there was maybe some deeper connection, perhaps synchronicity at play. And, it has helped guide me going forward, to have a more fruitful interaction with the patients I continue to treat.