Walking into a doctor’s office, most of us feel that we are crossing into the domain of some manner of super being, an individual who has stared steadily into the eyes of humanity’s deepest and most primal fears, and walked away unscathed. Long familiarity, we reason, has made them unafraid of death and somehow above sickness, and their medical competence, surely, must remove them from the anxiety the rest of us feel over how to approach the care and treatment of loved ones. Yes, if anybody has the secret to walking through life with calm and sure equanimity and approaching death with level-headed resignation, it is our doctors and they, for their part, tend to do little to dispel that conception.
Of course, doctors are humans, and being able to think of them as humans can go a long way to improving how we interface with them in the pursuit of better health, but beyond the all-too-apparent fatigue of the profession and an endearing (nearly) penchant for abominable penmanship, most of us don’t have the slightest idea of how to even begin seeing the fragile human beneath the white jacket.
This is one reason why the genre of “Older Doctors Writing About Their Lives for the Benefit of Younger Doctors” is of such importance beyond the purely medical profession. In reading books like James Jackson’s 1855 Letters to a Young Physician Just Entering Upon Practice or the classic 1982 Letters to a Young Doctor by Richard Selzer, we non-doctors gain a crucial insight into how doctors see themselves, their work, and the impact of their profession upon their lives which allows us to approach them as partners in a common task rather than as over-awed supplicants.
This year, Massachusetts General Hospital physician Suzanne Koven has made a monumental contribution to the genre in the form of her Letter to a Young Female Physician (Norton 2021), a disarmingly honest account of what it has been like, over the course of four decades, to be a woman in the medical profession, and to be a doctor in the midst of tragedy. It is a book you have to steel yourself for, as Koven hurls the basic truths of existence, in all of their leaden inevitability, one after the other into your mental gut. Your parents will get sick, and this is how they’ll change, and this is all you’ll be able to do about it before all of it starts happening to you in turn, as the brute forces of biochemistry burn their way through the generations.
Coming to grips with these truths, and allowing yourself, as a doctor, to engage with patients as they struggle with them, lies at the core of Letter. It is a book less about the systemic nature of gender discrimination in the medical industry (though that is mentioned), and more about the stages of life that a woman passes through, and how those stages are colored and altered when you pass through them as a doctor.
As a young doctor, grinding your way through your internship shifts at the cost of anything resembling regular sleep, you’ll have a great decision to make: to prove to the men around you that you are the smartest person in the room by cramming down exhaustive lists of obscure symptoms and affecting the cold distance of a nineteenth century Victorian physician, or to allow yourself to become personally involved in engaging with your patients as people, taking time that you don’t have to go deeper into their histories, and focusing on broader aspects of their mental health and psychological needs, and thereby become a more effective doctor at the expense of being considered a “softer” one.
In middle age, you face the challenge of omnipresent caregiving, a challenge made more rather than less difficult by being a doctor oneself. Faced with the needs of children, and the deterioration of parents, and turned to by all as the familial oracle, the person that can be counted on to get down to the truth of the matter when institutions fail, all compounded by the still overwhelmingly prevalent expectation that women in a given family are the default caregivers of all those requiring it, a woman doctor is virtually set up for a cycle of inevitable self-recrimination that can take a heavy toll on her psychological well-being. Koven’s story of being unable to recognize her mother’s ultimately fatal heart condition, and the years of sharp guilt that followed, is a harrowing but instructive one, not only for young doctors who might learn from it how to be kinder towards themselves, but for the rest of us to see in our doctors humans whose special knowledge, and the expectations it gives rise to, are often as much curse as blessing in their lives.
In later age, you must prepare yourself for the gradual but steady resignation of those roles that have formed so much of your identity, for the moment when you enter a hospital not as one of the elite practitioners of the healing craft, but as just another patient among many, awkwardly engaged by former colleagues, and treated as just another old person taking up valuable time by a fresh flock of doctors who have other places to be and other boxes to check. In this sense, far from being immunized against the psychological effects of old age by constant exposure to its ravages, doctors have to face an extra set of challenges that the rest of us, accustomed to lives in the trenches as mere patients, don’t, and that is something that Koven believes we all, doctors and patients alike, would do well to remember. The simple realization that, someday, and not too distantly, they will be as their patients now are, can be a powerful thing in bringing doctors into the healing process with their patients in a multi-dimensional fashion, which Koven believes can only work for the good of all.
Beyond its role as a guide to navigating life through its various stages as a woman doctor, Letter is also a plea for the medical community to broaden its scope of interest. Koven, originally an English major, makes a strong case for a closer engagement of literature and medicine, whereby the study of the former can improve and deepen the practice of the latter. Writers are, at their best, magnificent observers of the human condition and of how all the pieces of a life stick together to create the persistent tragedy and occasional triumph of existence, and a study of their works is, Koven argues, a magnificent way to improve one’s understanding of the fragile humans in various states of profound distress who walk into your life and slap themselves onto your examination table. Life informing art informing the maintenance of life is the sort of positive feedback loop that Koven experimented with in her time as a physician, and now as a medical writer, and it is hard not to get swept up in the possibilities of a new medicine thus enhanced.
Letter is not a straight-forward, linear memoir, but rather a series of autobiographical essays surrounding important themes or events that took place during Koven’s career, which has spanned from her time as an intern witnessing the outbreak of AIDS among her patients, right up to the present pandemic. Years of reading scientific memoirs with the aim of eventually writing a Women In Science profile of the given figure have primed me towards frustration with books that reject a linear timeline and don’t regularly remind you of precisely when the events being talked about happen, but that is very much a me issue, and shouldn’t be a problem if you approach this book for what it is – a series of powerful vignettes about the unique fragility of the people we place on the front lines of our battle against sickness and death, and the strength we can all draw from it.
Image credit: Dale DeBakcsy, personal photo of his copy of the book