Let Me Tell You What Your Book Is About by Andrew Bomback

“Why are you so obsessed with him?” my wife asked. “Because he seems so content,” I answered. “He has life figured out.” “Based on his clothes?” she said. “You have no idea what happens to him after he gets on the train.”

That night discussing Jamison’s failed antiarrhythmic therapy and her cardiologist’s inability to pick up on her alcohol abuse wasn’t the first time I’d heard a doctor say, “When you’re a hammer, all you see is a nail.” Doctors often throw this phrase around when we explain missed diagnoses or a surgeon’s refusal to consider non-operative therapies or even a patient’s insistence that her headache is due to a brain tumor. But we’ve also employed this cliché to describe how we don’t turn off our doctoring outside the hospital or clinic. We wonder aloud if our neighbor has a pituitary tumor. We tell our uncle he will die of a heart attack before he retires if he doesn’t lose fifty pounds. We comment on the salt or fat or carbohydrate content of meals. We speculate on why some of our kids’ friends are always covered in snot.

I wonder if Marina Benjamin considered another title for her excellent book, The Middlepause. Specifically, I wonder if she thought about using “Mental Menopause,” a catchy moniker used by one of her friends as they discuss their mutual exploration of middle age and beyond. “It’s more a mental menopause I’ve been struggling with,” this friend shares, “with every significant choice I’ve ever made suddenly up for review – education, career choice, where to live, children; even your key relationship, which is so established, it requires work.”

These honest recollections, confessions of how the mind and the body will grasp at anything to survive the residency years, how Kalanithi found his “munching apples” moments in the trauma bay with some harmless jokes and a soggy ice cream sandwich, are why I consider When Breath Becomes Air essential reading for any doctor-in-training, why I push the book on so many medical students, residents, and fellows.

I asked Scalise this question (over email) after finishing his book. He’d never heard the term “patient role” but championed the performance aspects of illness encounters. “Medical interactions are theater,” he wrote back. “They are, in so many cases, very rehearsed on the doctor’s side, but also on the patient’s side, too. The ‘medical crisis template’ is so widespread in popular culture as a genre, and has been for so long, that its influence on real life patient-hood is pretty deeply ingrained. In that sense, slipping into that ‘role’ of ‘Medical Patient’ can feel almost reflexive. The transfer of control to the hospital staff, the ‘strong face’ one is expected to put on, the opinions about the food, the long-form small talk with your patient ‘roommate’ – it can feel stagey or rote in the way that being a commercial airline passenger can, which is unsettling, because you’re typically at a hospital for a very vulnerable, intimate, and (to you) unique reason.” He followed up on that answer: “My instinct as a patient has always been to destabilize role expectations between my doctors and me – sometimes in good ways, sometimes in ways that definitely did not work at all – if only to try and get us to something a little more human.”

On my feed recently, someone quoted @goftyler’s tweet – “The dog’s got a butt funk and he’s been shunned from the couch” – and commented, “most grotesque tweet I’ve seen in a long time….also a poem?” Yes, according to Lerner’s definition.

I sleep well most nights because I’m worried most nights. Sometimes I worry about my marriage, sometimes I worry about my sickest patients, and sometimes I worry about the admittedly nebulous concept of “life.”

Pretentiousness provides a justification for lying, which I do all the time as a doctor. I know that sounds awful, but it’s also entirely true, and not just about my doctoring but the doctoring of virtually every physician I know. If “lie” is too uncomfortable a word, then substitute “act,” as Fox does.

Helen Macdonald mentions D.W. Winnicott in H is for Hawk, but she does not relay the pediatrician’s famous line, “It is a joy to be hidden but a disaster not to be found.” Training the goshawk is a way for her to go into isolation after her father’s death. Lisicky pores through his friend’s old emails. Alexander lies in bed, after her sons have left for school, and dreams of her husband. Eventually, they all want to be found, which is why they’ve written these books. Likewise, I suspect my patients feel the relief of being found when they unburden themselves to me in the safety of my consultation room.