What Page Are We On?

"The true art of memory is the art of attention." -Samuel Johnson

An Open Letter to All Those Who Love to Read:

Have you ever got involved in a good book, be it a mystery, biography or even a delightful review of the geological history of Mothership Earth, set it aside for a few nights and then realized that you can't recall what is going on?

Pehaps you have forgotten which relative Sir David visited before he was found with a cord tightly woven around his neck, or maybe you lost track of Teddy Roosevelt's activities prior to his election as governor of New York. If you're like me your powers of memory have an expiration date that when breached, dump everything into the recycle bin, leaving the owner wondering how he could have forgotten the plot of the last three chapters. Woe to those who pick this inopportune time to interrupt the reader, especially if they are about to ask for money.

I mention this because often the same dilemma occurs when practicing medicine. We doctors don't see our patients daily except when they are hospitalized, and even then we can become overwhelmed with the myriad of data accumulating by the hour. We lose track of the course of an illness by letting bits of information cover us like ash falling from Mount Vesuvius. Sometimes an illness is hidden behind a mirror that no matter how hard we look shows us only the reflection of our frustrated face. We forget things that happened to the patient in the past, clues that if uncovered can guide us to the right diagnosis.

With a little prompting most doctors can remember who they are and where they are, but sometimes when we are asked the bonus question "What is going on with your patient?" we look like a football player who just found out he scored a touchdown for the opposing team. When this occurs I can think of only one solution, that which was inspired by the nightly struggle to return in media res to my novel, rather than have to go all the way back to "Call me Ishmael."

The solution: swallow my pride and re-read the book. I must remind myself that when stymied by a patient's failure to improve it is okay to start all over - to review every note, every lab test and x-ray, to re-question the patient, to check up on the medical literature if the lares and penates of memory falter. There is nothing more rewarding than to discover that several seemingly disconnected phenomena are in fact all manifestations of a previously undiagnosed illness or complication. We who practice the healing art must never be afraid to go back to chapter one, this time to peruse with meticulous eyes, as a jeweler examines the most precious of stones.