Hieroglyphics 101 for the Medical Archeologist
This is one from the Emergency Medicine News archives. My column used to be called Second Opinion.
Bonus: you can see a picture of me without gray hair at the bottom if you follow the link.
Hieroglyphics 101 for the Medical Archeologist
Leap, Edwin MD
Emergency Medicine News 32(2):p 14, February 2010. | DOI: 10.1097/01.EEM.0000368074.13981.51
I'm becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly and surely trained my eye to find them. There is little flint here so most of the pieces I find are made of quartz. It's hard to work with, but remarkably beautiful and almost always a brilliant white.
My kids and I walk the red clay paths, and look down for bits of stone protruding up, especially after a good, soaking rain. Elijah, my youngest boy, was the first to find one. He found what was probably the point of an atlatl, a kind of a mix between an arrow and a spear.
We look for rocks that seem shaped by human hands. That's the ticket: Look for something that seems to suggest a purpose or a history. Things with no shape, no marks from being worked, are probably not worth our time.
Medicine is like that. We learn to look for patterns, for shapes, for things that suggest meaning, that give us a way to help, to understand, to predict. From the way a patient breathes to the shape of his deformed extremity, we learn to find the pathology beneath the normality and sometimes vice versa.
But it isn't only true of things physical. Sometimes, it's true of things emotional, things psychological, things of the heart. Behaviors and lifestyles often have deep sources not easily uncovered. Soaking rains don't wash away the years that cover their origins. Why does this man continually use cocaine? Why does that woman become pregnant by different men over and over? Why is this beautiful child cutting her wrists with a razor? What pain is she hiding?
Of course, we could apply the same kind of insight to our colleagues. Why does this surgeon always treat me with anger and disdain? Why does that resident consistently fail to do her job? Why is this nurse perpetually downcast; why does that one make me smile? And why is this specialist always happy?
As medical archeologists, we can use our skills to find answers. But we have to look closely at what lies beneath. We have to do it purposefully, carefully, gently. And we have to be willing to accept that the answers may not be pleasant.
I recently saw a woman in withdrawal from years of morphine abuse. Year after year, she had injected it, but a few days prior to her visit, she decided to stop abruptly. I was impressed by her resolve, though she felt quite miserable.
While she shook and sweated, I saw the assorted track marks and scabs that are the artifacts of an addict's skin. But I saw something beneath, the faint lines and swirls of a burn up and down one arm. I touched her; I felt the texture of the lines and ridges that develop from burns and grafts. If she were another species, they would have been fascinating. The epidermis of a sentient alien. But she was not. She was one of us: Homo sapiens. The swirls just represented past pain.
“Is this how you started using?” I asked.
“Yeah, that and a bad car wreck,” she said between tremors.
In the feel of her once-burned skin lay the hieroglyphic explanation for much of her life's misery. Of course, it's true of so many. Beneath razor wounds, there may lie years of rejection. Beneath hostile drunks may lay sick children or unhappy marriages. Behind indifferent physicians may lay frustrated engineers or artists. A catatonic, depressed man may be concealing a childhood of sexual abuse.
Likewise, beneath smiling physicians, gentle nurses, and kind patients may lie years of experience, surmounted struggles, loving families, personal suffering, or deep faith. A calm exterior may be the fruit of unimaginable past pain, smoothed like that arrowhead by constant, intentional pressure and meaning.
We would do well to excavate a bit, to find the wounds behind the wounds that cover our patients, our co-workers, even our loved ones. We would do well to look up and down at all of those we encounter, trying to find the shapes of things, the history, the origins of pain, even the origins of joy. There are worlds of understanding carved in human lives and untold artifacts lying about for us to discover. And no profession is better trained for this than ours: We spend a lifetime of looking down in the mud of human troubles, trying to find something useful and beautiful.
My kids asked me not long ago, “What would you rather find? Atlantis, El Dorado, Avalon, or Beowulf's tomb?” I think I picked Avalon; we could use a little more King Arthur these days.
I'm sure when I go to work tonight, if I try, I'll find something almost as interesting. The trick is in wanting to look.
Great piece, Ed. Thank you for sharing!
I enjoyed reading this story for a second time. Everyone has a story to tell if we just ask and listen. Life is often cruel and uncaring. I often feel helpless in the ED, only able to place a band-aid on the real problems these people face. Thanks for great insights.