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Physician-writers reflect on uncertainty in medicine

As resident Matt Stevenson, MD, read from his essay “I’m someone who cares” during last month’s Stanford’s Pegasus Physician Writers reader’s forum, soft piano music played in the lobby of the medical school's Li Ka Shing building. A medical student taking a study break was playing the piano, a gift to Stanford’s Medicine & the Muse program from the family of a current medical student. The piano music was a fitting background to the readings being shared with a broad audience by Stevenson and other members of the writer's group, as both represent aspects of the Medicine & the Muse program that help medical students and physicians develop and grow through creative expression, in this case, music and writing.

The theme of this forum -- “I don’t know: Uncertainty in medicine" -- is a difficult one, admitted radiologist Ali Tahvildari, MD, the session moderator. “We are supposed to have the answers," he said. "Patients look to us for that.”

The readings reflected times in physicians’ experiences when they didn’t know: In her essay “A coin flip,” psychiatrist Jessica Gold, MD, recalled her uncertainty over a patient who may or may not have been homicidal. In her poem “The difficult patient,” neurologist Kendra Peterson, MD, challenged herself to see through the notes in a patient’s record to the real suffering that had not been adequately addressed. And surgeon and Vietnam veteran Bill Meffert, MD, had the audience on the edge of their seats as he read “Incoming,” the story of a young soldier who arrived at the battlefield hospital with what appeared to be a hand grenade lodged in his chest.

The physicians answered questions from the audience, including one from a community member: “Do doctors ever really say ‘I don’t know’?”, which was answered with a resounding “Yes.” In those cases, Meffert explained, it's very important to include the family of the patient as plans are made to take next steps. Saying “I don’t know” can be particularly difficult for a radiologist, Tahvildari shared, because imaging tests are sent to the radiologist for answers, not for uncertainties.

Tahvildari’s poem “Of unknown origin” was met with appreciative applause from the audience.

The beads of sweat collect
at the notch below your sallow neck
your jaundiced skin
salted, where nothing can thrive
your feeble body probed again
and again
to understand perhaps for our sake
more than yours
what we can only call
an FUO – fever of unknown origin.

I stand across from you uneasily
leaning against
the cracked crimson paint
of the windowsill
each hiding behind our shields:
your thin parchment gown
and my flimsy white coat
starched for some semblance of control
over this fear of unknown origin.

Afraid that you’ll see
my confidence lacking,
that you’ll see me
as a confidence man
dismayed that with all our advances
we can remain so uncertain,
that you’ll never see
the rosy smile of your grandchild
I brush the coarse strands
of your auburn wig
from your shuttered eyes—
a favor of unknown origin.

There lay the roses
that you will never smell
the apple that you will never taste
and there in the corner
float the red balloons
that you might have liked
to release to the sky
in a fervor of unknown origin

Previously: Using arts and communication to help physicians improve health, avoid suicideMedical students and physicians share their writings on "becoming a real doctor"Physician writers share a "global perspective on healing" and Stanford's Medicine & the Muse event mixes music, dance and pediatrics
Photo by Roco Julie

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