Saturday, April 23, 2011

Dance Steps They Don't Teach in Medical School

So, here I am, finally back home and it feels like a typical Saturday. The dog, cat, and I snug in my study by the fire and there's snow falling -- on the day before Easter. The fire is a necessity since the furnace tends to treat this end of the house like something to be avoided at all costs, but the snow was a complete surprise. Alas, it doesn't show in the photo -- so much for good intentions.

On Monday, my Obstetrics-Gynecology -- OB/GYN for short -- rotation begins at Maine Medical Center. In the meantime, my head is still revolving around pediatrics, an experience that turned out to be as surprising as this morning's snow. I had some contact with children during my rural medicine rotation, although not enough to describe it as traditional family medicine. It was mostly an adult practice, but what I learned applied to every age group. A physical exam is still a physical exam, whether the patient is seven or seventy.

One thing I noticed from my first day in pediatrics was how much more fun it was, working with kids, than adults. I mean, you can play with kids and they appreciate it, even when they're sick. That said, playing has a significance few realize: it's not simply about being charming or cute. And this is something I knew going in, thanks to a number of children who, over the years, have been willing to be my tutors. Play is the language children speak, particularly with one another, and not all adults are familiar with it.

I love words, written and spoken, their derivations, structure, the interplay of grammar and syntax that may span what we fear is an uncrossable abyss of hurt feelings, anger, and disappointment. I love it, too, when communication sidesteps the vocal cords and heart to heart is the dialect spoken eye to eye. Play is like that. When you let down your guard and become genuine with children, allowing yourself to be as vulnerable as they are, you make connections and establish rapport, sometimes without even saying a thing. Not unlike psychotherapy.

Before this rotation, I wasn't aware how essential play is for me as a clinician. I mean, I've always tended to joke with patients whenever it was appropriate because humor can be disarming; it creates a space in which we may be mutually human. But with children, it's not so much about creating a space as it is stepping into one that already exists, and the question becomes, can we forget ourselves well enough to become real with children, and believably so?

The hardest part, it seems to me, is relating to kids in ways they find meaningful and their parents endearing while maintaining an air of professional competence at the same time. It's one of those dance steps they don't teach in medical school. I suppose that's also why they call medicine a practice -- even on the best of days you're never completely certain you haven't tread on a few toes.

(Photo copyright 2011 by the author)
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