I became a writer before I became a doctor because no one can actually stop you from being a writer, whereas people can (and should) get touchy about unlicensed medical practice. Beyond the joke, there’s a deeper fact here: that writing can, and is, done by just about everyone, and that we can’t stop it and rarely try to. A baby will try to use a strawberry as a red pen. People made pictures pretty much as soon as we got thumbs, and we had to keep going until some of those pictures became stylized and consistent enough to work as signs, to transcribe what comes out of our mouths, our granaries, our ship holds. There are metaphorical gates around magazines, universities, and publishing houses, but my ability to create silent sound – a paradox and a miracle, like that of Saint Neot, who was said to be able both to have his fish in the well, and to cook and eat it, too – remains unstoppably mine.
Since there is an absolute liberty surrounding the act of writing – think again of the baby wielding the berry – it retains its childlike flavor, as well as all the boredoms and frustrations inherent in being a child that all of us can remember. The somehow embarrassing fatigue children sometimes experience when they are permitted to make-believe absolutely anything, but feel too sapped after a day of play to choose among pretending to be pirates, princesses, or jungle animals. Creative license is exhausting. Anything at all can go on the blank page, and this intolerable permission sends most of us running for rules and form as quickly as possible. The speed and arc of your flight towards these things says something about the kind of poet you are likely to become.
Doctoring, by contrast, begins within a highly gridded space. The body is a closed and finite set; with rare exceptions, we all carry exactly the same number of organs and bones, our bodies far more similar from person to person than they are different. Roughly a century ago, American medical education standardized itself such that in any given generation, fledgling doctors-to-be learn almost exactly the same things from school to school, and take the same standardized nationwide tests during and after their training. This is a relief, and a win for egalitarianism and justice: in theory, any doctor of the relevant specialty has been well-tested and is well qualified to treat you, “fancy” diploma or not, chic practice or not.
Yet the laudable, important conformity of medicine – the facts we all know, the protocols we all practice, the oaths we all take – can make certain kinds of people, myself among them, yearn for the runny, ripe strawberry pinched between thumb and fingers. The infinitude of writing calls out for some fencing. The exactitude and rectitude of medicine call out for the mess of the human imagination. An attraction of opposites, like many good marriages or cheese boards.
Where these practices, poetry and medicine, are not at all opposite is in their shared demand that I walk through the day telling myself continually, “I could be wrong.” The more often I say this, the less afraid I am that this is true. I simply know that it’s true, so the jump-scare quality vanishes. In medicine, we speak of some ventures as being both “diagnostic and therapeutic.” Let’s say that the test for a certain disease takes several days to come back. Or let’s say, for reasons too complicated to get into here, that it’s difficult to discern whether a patient’s kidney injury stems from dehydration or from an excess of fluid. In such cases, the treatment is the test – give a medication, or in the latter case, a dose of IV fluid, and see whether the patient gets better, worse, or unchanged. To someone outside medicine this may sound irresponsible – how dare we act without certainty! – but one unspoken but implicit tenet of clinical work is that waiting for certainty can occasionally be its own irresponsibility, its own danger. Knowing, or at least intelligently guessing, when it’s prudent to wait and listen further, or when it’s wiser to make an imperfectly-informed attempt, is one of the doctor’s and the poet’s core skills.
The word “risk” is thrown around as praise for poetry a little too often for my taste: with rare exceptions, one’s formal decisions or linguistic choices rarely endanger anything beyond the quality of the poem. But I do think that cultivating extra-poetic practices that involve weighing tangible risk – deciding, for example, whether a more aggressive and more failure-proof treatment makes more sense than a milder treatment that may not work – accustoms one to the rough, at times abrasive, texture of the unknown. I know how this abrasion feels in medicine: I have given a patient a medication I thought would correct their rapid arrhythmia only to watch her blood pressure plummet; I have prescribed an antibiotic that, through no particular fault or oversight of mine, almost destroyed a man’s kidneys.
The risks, the physicality of what decisions do in medicine is of course not unique among human jobs. Mattia Filice writes beautiful poetry about the effect the decisions he makes as a train conductor have on thousands of tons of metal and human cargo. Courtney Bush writes extraordinarily about working at a daycare center. Maybe it’s simply that in many of the so-called white-collar professions, we’ve sometimes lost our sense of a physical shoulder to a physical wheel. I feel profoundly lucky that my day job makes me put a thumb to a radial pulse; makes me sometimes inspect the color and consistency of phlegm, urine, and shit; make my hand sometimes push the button that summons a couple hundred Joules to jumpstart a heart that is more than figuratively broken. I can understand why, in the early nineteenth century, some doctors were disgusted by the invention of the stethoscope – even that short length of tubing seemed to put them scandalously far away from their patients, whose inner sounds they were accustomed to hearing by placing an ear to the skin. The directness of medicine – compared to the muddle of writing, compared to the muddle of so much of living – can feel like a glass window set in a mud wall. Losing any part of this directness can feel like a loss both of medicine’s charm for the practitioner and its truth claim held by both the doctor and the patient taking part.
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A few years ago it became trendy, then nearly ubiquitous, for the ID lanyards that physicians wear in hospitals to give not only their face and name (typically in small-ish font) but to state in loud, extra-large font, “DOCTOR.” Some of the initial arguments in favor of this shift were that physicians who are women, or young, or of color, are more likely to be taken for some other kind of employee, even when they introduce themselves and explicitly state their role. Patients deserve to easily recognize their physicians, and doctors can do their work more easily the more identifiable they are. I’m pleased by this design shift, even as some of the initial risk of misidentification recedes for me. (I’ve always been white and a bit of a tomboy; I’m also slowly, visibly aging in ways that seem to confer a mysterious and unwarranted authority that escaped me when my face was slightly younger.) I like the plain dealing of simply wearing in words what I am, “in plain American which cats and dogs can read,” as Marianne Moore famously said of our flat and nutritive domestic vernacular. “DOCTOR.” That’s me.
Imagine if I had a second ID lanyard that said, in the same humongous sans-serif font, “POET.” When and where would I wear it? During what times am I serving in my role as poet, and when would the lanyard come off? One of my poetic “practices,” to give it an inflated dignity, is that when I’m stumped mid-line, or between lines, I’ll walk into the kitchen, wash a few dishes, sort a few items of recycling, perhaps move a small amount of beans from their big jar to a tinier jar. Sometimes these small actions solve the problem. A word floats to the top of my mind the way a piece of grit sometimes makes itself visible in a sea of lentils. A phrase, even, streaming off me like oil off a sudsy pan. Sometimes nothing useful at all happens except that the kitchen gets marginally cleaner. Am I “being a poet” only during the instances when this trick works, or every time I attempt it? I think the answer is obviously the latter, though in that case “doing” poetry is so much thinner, slicker, more quicksilver than “doing” medicine.
Here, too, I see an opposition that is its own blessing: that one of my vocations, medicine, allows me to know exactly when I’m doing it (I’m hardly ever accidentally, or unconsciously, or inadvertently, being a doctor: I’m either in the hospital serving my patients, or I’m not) and the other, poetry, keeps that knowledge veiled even from me. I’m aware, of course, of physically gripping a pen or pecking a keyboard, but that seems only a part of the process. Exactly where and when composition starts and stops is unsayable.
To give a contrasting example, I know a thing or two about scribes who work in the emergency departments of the hospitals where I’m employed. Scribes are priests and priestesses of the present. “Seminarians” or “novices” is maybe more like it, since most are in their early twenties, taking an interstitial job between college and a healthcare degree. A good scribe notices exactly what’s going on, and takes down with lightning accuracy the attending doctor’s spoken-word account of the situation, with such devotion and near-spiritual stamina that there’s no room for past or future to exist. A good scribe is an excellent kind of writer, and consummately not a poet (at least when they’re scribing).
The poet, on the other hand, is often interested in oddities of temporal connection: moment touching moment touching moment, but slightly mis-concatenated. How did this dentist’s office fling me into world war and the birth of planets? (Bishop’s “In the Waiting Room”.) How did the horny weirdness of adolescence presage the long blizzard of life’s second half? (Chiasson’s “Tackle Football.”) Medicine asks me to smooth things out: to take a variety of clues and meld them into a homogeneous conception of the case and its solution. Poetry asks of me the opposite: that I jump, and fling, and let sense sometimes evade me. They are not my “good cop” and my “bad cop,” exactly, but more like two of my three Moirai, the Greek Fates: the one interested in endless spinning, the other interested in measurement and edge. I am glad of the odd, unanswerable questions that poetry asks me. Like, what would experience feel like if it were less like the contiguous viscosity of vanilla ice cream, and more like those novelty desserts that claim to be the fare of astronauts? Dots to dip from. Chromatically various. Disjunctive as stars.
