University of Utah School of Medicine, Salt Lake City, United States
Poet’s statement: The human midbrain is about emotion. The forebrain is about analysis. Human behavior results from a delicate conversation between the midbrain and forebrain. Medicine, primarily an analytic activity, is done largely within a data-enriched forebrain. The emotional midbrain is the ugly stepchild of medicine.
Young physicians are taught early to minimize the impact of emotion on their medical decision making. However, to deny the impact of emotion in any human endeavor is folly. After 38 years, I am still introspective about an intelligent, caring, beautiful young mother of three who succumbed to metastatic malignant melanoma under my care as a medical intern.
However, the emotional currents that underlie a daily medical practice must remain veiled. But emotions are slippery things. They are always seeking to find ways to move out toward the light of day. Personal, after-hours writing has always been the escape route for my professional emotions.
The act of embodying emotions by visualizing them on a computer screen or a piece of paper allows me to deal with them in a more open, concrete fashion. Rarely do tears interfere with the electrochemical pathways within my forebrain during a busy workday. But at night and on weekends, the hardcopy versions of my voiced emotions often end up damp and salty.
My poems and my prosetry have always been very personal endeavors. However, there is just enough hubris within me to feel that an occasional piece that has touched me deeply might have some meaning or value to others. The readers’ patience is requested in this regard.
He was a tall, thin, down-glancing man slumped low in a chair in the exam room corner.
His gray-haired wife sat primly next to him.
They were here with their adult wheelchair-bound daughter.
She for the past two decades had been under their constant care at home.
A chronic progressive disabling disease had wreaked havoc on the daughter’s body.
Her entire adult life had been held prisoner by this insidious illness.
She was having discomfort in the tail bone area.
Her parents thought that the pain might relate to her constant chair-sitting.
To examine her properly would require having the daughter arise from the wheelchair.
I glanced at my nurse quietly seeking silent guidance on how to proceed.
Without a word, the tall man was soon at his daughter’s side.
In a business-like manner, he asked “Do you want her on the exam table?”
“No, just standing up briefly will work.” I replied.
With a swift move of familiarity, he was in front of his daughter.
His lanky arms and trim frame quickly brought her to a standing position.
I was struck by the effortless grace and strength of his movements.
During my physical exam, the man’s stance did not waver.
His position was held firmly in place by decades of such loving exercise.
After I had concluded the exam, he gently lowered her back into the wheelchair.
The man then returned quietly to his slumping chair.
A tear crossed my mind as I silently processed what had just taken place.
Medical empathy can be viewed as a series of selfish, unstated thoughts.
“What if that were me …” What if that were my child …” Would I have been able to …”
Could I have been as strong as this selfless, very strong man standing before me?
I believe that a kernel of such strength does lie within me.
But would that seed have flowered to its fullest as it had in this man?
That hope lies within me.
But a ribbon of uncertainty also lies there, curling gently around the edges of that hope.
RICHARD D. SONTHEIMER, MD, a native of southeast Texas, pursued medical school training at the University of Texas Southwestern Center in Dallas, Texas in 1972. In 1979, Dr. Sontheimer began his professional career as a clinical faculty member in the Departments of Dermatology and Internal Medicine at UT Southwestern. His two-decade tenure there resulted in national and international recognition for his contributions to the understanding of the clinical significance of the skin manifestations of lupus erythematosus. From 1998 to 2004, Dr. Sontheimer served as the Head of the Department of Dermatology at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. He currently has a fulltime clinical practice in general and complex medical dermatology in the Department of Dermatology at the University of Utah Medical Center.