White Coat, Blue Apron
There are two sounds I currently find most satisfying. The thwack, thwack, thwack of my forged steel chef’s knife through raw vegetables. The scratching of my pen across that archaically thin 1980s printer paper still utilized for progress notes.
I awake in the morning as a student doctor. I fire up the coffee pot, inhale a banana, and if for some reason I chose productivity over sleep, a rare choice, squeeze in a speed read of an article. Particularly on my psychiatry rotation, I find my stride. Interviewing patients with an often skewed perception of the world produces an interesting exercise in thought. In evaluating the psychiatric patient you must understand their take on their lives and cognition while remaining objective and grounded in our assessments. Like my lovely Alice, we often find ourselves tumbling down the rabbit hole of medical jargon, altered senses of reality, and competing definitions of care. Few other fields offer such a juxtaposition and opportunity to truly utilize the art of medicine, in which the application of data driven research meets the anecdotal presentation of the individual patient. I spend my morning rounding on my patients, then in care-team, assembling the clinical picture based on everyone’s individual experiences with the patient. Afterwards, I assemble my note, scrawling my signature along the final line with a satisfying rip across the page.
I spend most of my day in my head, or more fittingly in a simulation of my patient’s head. As every physician in training understands, the day is mostly about absorbing and processing as much information as possible. Application trumps memorization. The hardest question a third year medical student faces is not what is the diagnosis?, but rather, so, what do you want to do?
What do I want to do? The question echoes and reverberates within the neuronal channels through the course of the day. Each word penned in a patient’s chart serves not only as a record of the patient’s condition, but also shapes the patient’s care plan. As my hand dances like a coked up housefly across the page, my mind sprints miles ahead, thinking of the patient’s course.
To provide care is to consider the past, present, and future of the patient simultaneously. The true art of medicine enacts such care seemlessly by distilling the broad swaths of evidence based medicine to fit the individual patient’s pathology. And for that matter not just their pathology. Their physiology, their social circumstances, and their spirituality.
In his groundbreaking piece The Checklist Manifesto, Dr. Atul Gawande justified the presence of lists as a liberating force for medical professionals. By freeing the medical team’s concentration of the menial but no less significant tasks involved in setting the parameters of patient safety and treatment, the team is free to focus fully on the problem solving required to restore the patient’s health. In essence, the checklist, an outline, or an algorithm. The recipe of care is driven largely by these evidence based frameworks, so that the physician is free to process. To Plan. To Heal.
Thwack. My distal three fingers grip the knife handle, while my index finger extends onto the blade’s body, guiding it through slice after slice of the chilled poultry flesh. The sizzling of the hot oil crescendos in intensity as the diced garlic drops into the pan followed by the seasoned and sliced chicken filets. The spaghetti undulates in the boiling water. The kitchen fills with the rich intensity of fresh herbs tossed into the pan and greens thrown in to wilt before pulling off the heat and mixed with the pasta.
It’s an easy week night recipe. Found one time browsing the New York Times Cookbook on a break between patients. Weekends are for more extensive creativity. Weeknights are for nourishment. Both of body and mind. And of my restless soul. Coming home from clinic is like returning from space. I kick off my shoes, stretch out my muscles at the gym, and debrief myself by studying. I then close the airlock of my office. I cook barefoot, though I strongly recommend otherwise. Jeans and a t-shirt, stripped away of the professionalism of the day. Music or NPR usually blares in the background over the stove top fan.
I’ve made this recipe several times before. I no longer read it. Each time, I change or tweak the meal depending on my mood. Variations on a theme, like a musician. In my kitchen, I play. Sometimes the meal tastes superb. Other times, a fallback sandwich proves a more than worthy substitute. Failure, with only a party of one, matters little. Experience, both sensory and emotional, is paramount. Learning, kinesthetically most of all, is the enjoyable and most soothing element of cooking. Submitting myself to the zen of experience, flow as many writers preferably describe it.
Cooking is a real time manifestation of my creativity. It is also an exercise that runs parallel to my clinical life. With a recipe my mind is free to cook. With evidence based medicine my mind is free to heal. Though vastly different in goal and function, both aspects of my identity reflect my dedication to human experience and the preservation of such for all others.
From the white coat to the blue apron, I am and always will be the student. As we always should be. My white coat is my reminder of my dedication to heal. My apron is a reminder of why I do.
Thwack. Scratch.
