DISREPUTABLE CHARACTERS

My life as an Emergency Department physician has meant coming to terms with some disreputable characters.  Death, of course, is one of them.  I remember him walking up behind me in the anatomy lab on my first day of medical school.  "See these bodies?" he said.  "They're all here because of me.  Laid my hand on every one of them.  And I'll do the same to every patient you ever treat.  Eventually."

There was no arguing with that.  And so I nodded, knowing that over the course of my career he would show up when he damn well pleased -- would take who he wanted.  Sometimes I can cheat him, can make him go away for a while.  But he's out there, and it's best not to forget that.  The dude deserves some respect.

Uncertainty is another one I've had to watch out for.  He sits in the corner of every treatment room I enter.  Doesn't talk much.  Doesn't need to.  Medicine, he realizes, is not a perfect science.  There's a limit to what we know, to what we can predict.  The moment I become absolutely certain of anything is the moment he will teach me another lesson in humility.

There are others I've encountered.  Fear hangs out in the Emergency Department's waiting room, follows patients in when they're called.  Grief visits some families here, but also sits with the doctors and nurses on occasion.  We try to stay focused, to protect ourselves from the emotional turmoil of the job.  It's not easy -- not always possible.  We turn to humor, to one another, to our own families, or to darker, more self-destructive ways of dealing with the things we witness.

It's been like that with writing, I think.  A blank screen has a pure and sterile feel to it, like the spotless lab coat I donned in the parking lot before heading in for my first shift in the ER.  I wasn't a true doctor then.  I had yet to be tested, to be wounded, to be humbled in countless ways.  But then I began in earnest, immersing myself in the struggles of my patients -- and later, in the characters I was creating on the page.  That was when everything changed.

There's a danger, I think, in caring too much about the lives of others, be they patients in the Emergency Department or conjured soles existing only in the imagination.  It pulls us in, merges our worlds, leaves its indelible mark.  We become inextricably invested in what happens next.  It can change our lives forever.

Still, if there's an alternative way of doing these jobs, I want no part of it.  Because there's a limit to how effective one can be -- in medicine and in story-telling -- without that emotional commitment.  We must allow ourselves to be vulnerable.  There are disreputable characters -- fear, grief, uncertainty, even death -- who will visit us often, who must be counted among our colleagues.

The doctors and writers I know are different people because of it, their white coats now worn and tarnished, their minds unable to free themselves from fictional characters who have somehow become real.  This is as it should be:  the unspoken promise of what began on that first day of medical school, the prospect of a blank screen and where it might take us. 

It is, I believe, what we always wanted.