A Funny Thing Happened on the Way to the Forum

A short while before I was supposed to get on a plane last week to fly to Chicago and participate in an event at Northwestern University, something I’d really been looking forward to, I started to have the sinking sense that the increasingly worse sudden pain in my lower right back that I’d hoped was just a back spasm was in fact a bit more than that. With some trepidation, I set off for the ER at the local small hospital, hoping I’d be checked out and told that it was just a spasm, handed a painkiller and waved onto my 6 a.m. flight the following morning.

It didn’t quite work out like that. It ended up being the first time I’d ever been admitted to a hospital. I learned some interesting new things. Among them, if an overweight man in his forties walks in at 9 p.m. with severe localized pain in the lower right abdomen, they get moved fast through the system. I actually waited to put in my name until a teenager who thought her wrist was broken (it turned out to be sprained) got her name in, figuring I wasn’t as urgent, but as soon as the desk nurse saw my description of what I’d come for, they whisked me in to the back. It didn’t turn out to be what they expected, which was a kidney stone or appendicitis. Instead, it was mild acute diverticulitis, an inflammation of intestines.

Don’t worry, everything’s cool now. Two days of IV antibiotics, a longer course of oral antibiotics and some advice about dietary changes (farewell to thee, o sesame seed…though I already forgot about that once, as I looked down in horror on a sesame seed roll that was already 3/4 on its way to my intestine).

Anyway, one of the things I kept thinking about during the experience was a familiar theme for me, which is the ongoing problem of the professions. Academia and medicine, it seems to me, share some similar problems. Academia’s issues I see from the professional’s side, medicine’s problems from the perspective of the clientele. The first perspective tends to put me in the position of an apologist, the second as accuser. Maybe between the two some kind of insight is possible, though when I add it all up, I’m left with the sense that many modern professions are simultaneously indispensible, a highwater mark of social progress and hopelessly screwed up in ways that can’t really be fixed by outsiders or insiders.

If lying on a hospital bed at three in the morning waiting for some kind of solution to wend its way into your lower intestiine so you can be run through a scanner while an IV bag is dumping fluids into your flesh via a needle in your hand has an upside, it was the charming doctor in the ER who turned out to be very interested in African history. (She asked: I didn’t volunteer.) It wasn’t just that this gave me a welcome distraction. It was more that this made me feel like a person rather than a slab of meat or a naughty child brought in for punishment and a stern talking-to. Other doctors have made me feel otherwise in the past, and this is one reason that I’m getting ready with some resignation to hunt for another primary care physician.

I know my own psychology well enough to know what kind of relationship I expect to have with a doctor, to know my own pattern of expectations and my own tendency to just avoid or evade professionals who violate those expectations. I want someone who treats me as something of a social peer while also being a professional who has skills and competencies very different than mine. Frankly, I want my pediatrician, who knew me really well but was also someone I trusted and allowed to cajole or criticize me as a teenager.

I can see this from the other side as well. Not all professors can be all things to all students. As I finish up my grading for this semester, I’m very conscious of the fact that there are students who don’t flourish under my laissez-faire policy of treating everyone in my classes as a presumptive grown-up, capable of deciding for themselves whether it’s worth investing time or effort in my class. Some students need a drill sergeant or a surrogate parent or a big brother or a boss. I can’t do that. I wouldn’t expect every doctor, in the same sense, to be able to malleably be the person that I need while also being the person that some other patient needs.

The problem in part is that it’s hard to figure out where the professional and personal character of doctors or professors ends and their institutional systems begins. Should I tell my primary care physician that I don’t like the peremptory on-the-clock office visits? That I don’t know whether to trust her scheduling me for tests or her prescription of medicines when she doesn’t really bother to explain to me what she’s thinking with either, or present me the alternatives? What if she tells me that’s just the way the system works at this point, that no one is going to give me anything other than that? I could sound like a student complaining about being in an introductory lecture-based course with four hundred other students at a state university where the professor is reading in a monotone from presentations prepared fifteen years ago and my only direct contact is with a bored teaching assistant. That’s the way the railroad runs. You can switch a small liberal-arts college, but you have to get in and you have to have the money. Or maybe you’re an even touchier subject: there are students who do spectacularly well only under very specific institutional regimes even at small liberal-arts colleges, or who can only connect with some very specific kind of pedagogy, and who knows where that is out there in the world?

As a client, I don’t even know any longer what a reasonable expectation about my medical care might be, or how fussy and particular a patient I really am. I don’t know whether my medical future primarily ought to be imagined as a case of enduring what I have to endure and avoiding the worst-case scenarios or whether the right set of professionals could deal with the puzzle that is me in some way that I can’t myself deal with. That’s what both therapeutic and educational professionals promise, after all: they will do something for you which you cannot by definition do for yourself. That’s what all the hubbub of assessment and outcomes-tracking is about: are the professions adding value? And are they adding value commensurate with the tolls (financial and otherwise) they impose on their clientele and their societies?