You can't podcast care

Our medical students want us to podcast our anatomy lectures.

I'm not quite sure what that means, but it ruffled my feathers anyway, because I think it means they don't want to come to our lectures. They want to sit at home and watch tiny versions of us on screens the size of Band-Aids. They want to mute us or fast forward us when they feel we're droning on too long.

I'm against the podcasting proposal because, as my husband says, medicine is a contact sport. I don't know that I'd put it that way, but here's what I would say: being a physician means being present. It means being close enough to touch people, to hear them and smell them, even if they're stinky or it happens to be inconvenient.

A few years ago, I took care of a tiny 80-year-old woman with a giant rectal cancer who push-mowed her half-acre lawn and wore a wig every day of her adult life.

It was obvious that she wore a wig from the minute I laid eyes on her.

For one thing, her hairline was way too far forward, and I couldn't actually see scalp, which can also be a giveaway. When I listened to her lungs, I furtively felt her hair. It was harder and spikier than old lady hair, and that confirmed my suspicion that it wasn't really hers.

I saw her daily for a while before she was ready for surgery.

Sometimes we talked about the surgery about which she was ambivalent, and other times we just chatted, which is how I found out that she'd never married, that she push-mowed the yard she'd inherited from her daddy, and that her minister brought her to the hospital because she'd never learned to drive.

She almost refused surgery, which involved removing her rectum and having a permanent colostomy bag. It seemed messy and undignified and unnatural to her.

In the end, she agreed only because the cancer kept bleeding and it hurt her almost all the time.

"I'm hoping I'll die in my sleep tonight," she said on the night before surgery as she slowly signed the consent form.

A bit later, as we finished her paperwork, she told me she wore a wig.

"Really?" I said, raising my eyebrows.

"Nobody knows," she assured me.

This very private person let me in on the wig secret because she was worried that people might find out about it when she went to the operating room. She was afraid that they'd take her wig off if they discovered it while she was asleep, and she didn't want it off, even for her operation.

She confessed all this to me so that I could help her keep her hair on.

It made me feel good to be enlisted as her co-conspirator. I'd been feeling more like her tormenter, as if I'd bullied her into surgery, although I knew she needed it.

Because I really liked her, I was a motivated co-conspirator. On the day of her operation, I made sure her wig stayed on and then I took out her rectum.

Both these jobs were important: taking her cancer out and keeping her wig on, but I got more pleasure out of the latter than I did out of the former. Taking her cancer out seemed like work. Keeping her wig on was a project, a little challenge that we shared, that distracted both of us just a little bit from the pain of her illness. Protecting her privacy made us both feel more human.

I earned the pleasure of being her co-conspirator because I spent a lot of time with her, because I was "present" for her in the days before her surgery, because I attended her. I want the medical students also to learn the importance of presence, to attend our anatomy lectures, to see us in the flesh and not podcast, so they can begin to be doctors, not just technicians and knowers-of-facts.

They need to begin to realize that in medicine, "being present" is really what it's all about.