THE BLOG
07/31/2014 12:14 pm ET Updated Sep 30, 2014

The Doctor Who Remembers, or Doesn't

I walked into a patient's room one warm afternoon and found the phlebotomist there, hovering her butterfly needle at the crook of his left arm.

"Oh never mind me, I can come back," I said.

She said, "Oh, I know you."

I stopped in my tracks. We both stared at each other, my mind running through a catalog of names and faces in a rapid attempt to place her (always so embarrassing when this happens) when she wiggled her needle in the air.

"You were at the Mass General, weren't you? In the emergency room?"

"Yes! Yes!" I said, relieved at her having excavated the common ground. "You work there too?"

"Oh no, I'd come in with my boyfriend. He'd cut his leg. You sewed him up."

She suddenly smiled, and I reflected it back at her. How wonderful was that? As a medical student, I spent such precious little time rotating through different departments of various city hospitals, that such an encounter was rare, though probably inevitable. It had certainly never happened to me before.

"Yes! I do remember!" I said. "He was making you dinner, and the knife slipped. I certainly remember the cut. It was pretty impressive. How's he doing now, anyway?"

Well, she said, effusively, our patient wedged between us, watching this interaction with amusement. We exchanged a few more pleasantries and then I left, letting her have her space to do her job.

Back at the workroom, I swiveled in my chair for a moment, lost in thought. On our first day of graduating to finally seeing and treating patients, our curriculum director discussed the grand theater of the wards: how we would learn to match pathology to human faces, disease progression to human contexts. You'll learn more from your patients than you ever will from your textbook, was a refrain that I heard from multiple presenters. I was told that if I were like any of them, those master clinicians and educators, I would never forget the ones under my care.

But I had, hadn't I? I remembered a few things about that meeting clearly. It was only the second time I'd ever sutured something so I remembered carefully gathering my supplies. I remembered telling myself to look more confident than I felt. I remembered the cut all right. It was four inches at least, arcuate, clean, his leg split open with a red rivulet of blood that insisted on forming every time I took off pressure with my gauze to examine it. When I injected its margins with epinephrine in an effort to stem the bleed and the pain, his skin responded with a gentle swelling. I remembered that. And I remember suturing: dipping, diving, scooping, and laying my instruments flat after every knot, until the skin's original planes were revealed. I remembered feeling good.

Other than that my memory betrayed me. I couldn't remember my patient's face. I couldn't remember the answers to any of the small talk questions I'd posed: what he did for work, what they were making, if this had been a date gone spectacularly wrong. Later, I mentally filed him away as the four-inch cut.

Here are my excuses: It was a very brief encounter. Our interaction was defined purely by process -- my suturing of his cut -- rather than content. Perhaps if I'd been taking care of his cirrhotic liver for a week, I'd imprint all the nonessential details, no problem.

I glumly crunched on a pack of graham crackers and peanut butter that I'd nipped from the patients' cupboard, those small constants of every young physician's nutrient profile, as I considered other implications. If I were being honest with myself, of the hundreds of patients that I'd had the privilege of taking care of this past year, even the ones who stayed with me for weeks, I vividly remembered only a handful. With the rest, I might remember our conversations and perhaps being struck by particulars, something I saw or what they said, but nothing comprehensive.

To be fair, patients indulge in this kind of metonymy too, particularly those who see physicians in multiples for a bevy of bodily complaints. I've had patients refer to the whole bunch of us as "white coats"; sometimes more creatively, "stethoscopes." But more generally, many understand that we are all just patients and doctors, brought together in a room by the symbiosis of our roles, which transcend the need or impulse to get personal with each other.

There are cultural imperatives that dictate and define what a good doctor looks like. I believe they stem from this historical image: the kindly gentleman in a long coat and monocle, disembarking from his coach at your front door, ready to be both doctor and family friend when ministering to your ailments. I was struck by this when reading Leslie Jamison's The Empathy Exams, when she disparages her busy cardiologist, who despite giving her excellent medical care, must dictate into a tape recorder Jamison's social history to be able to remember on subsequent visits that the author was a graduate student at Yale, working on a dissertation, recently lived in Iowa, etc. Jamison described being embarrassed by the physician's methods, so mechanic as they were.

I get it. As someone who is mostly a doctor but sometimes a patient, I understand and endorse the importance of feeling connected to one's physician. It's important to me that I feel like I am being heard, really heard, when I describe my sickness. But the idea that every doctor I see, no matter how frequently, would need to memorize my name, face, and life history in order to qualify as an excellent, caring physician feels like a distorted sentimentality, an invented fiction.

There is good clinical care, there is warmth and respect, there is the sense created within an encounter, no matter how short, that you are important and that you matter. The doctor who is present for those few minutes has done her job, no matter whether her memories of this interaction stay as strong as her patient's years down the road.