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Presence Of Mind Essay

Regular Scope readers are familiar with Abraham Verghese, MD, one of Stanford's great polymaths. He's a writer capable of commandeering both your mind and your heart, leaving you wiser and more caring than you were just moments before, as well as a teacher of medicine, of a medicine that focuses on patients — and physicians — as individuals and as humans much greater than their diagnoses.

In an essay that appears today in Health Affairs, Verghese is in top form. He takes readers into a museum (the Anderson Collection at Stanford) and then into, figuratively, several modern art paintings (including Mark Rothko's Pink and White over Red, shown above). For Verghese, the art forces him — or perhaps welcomes him — out of his daily routine. These paintings housed in a new, sleek building seem far from the bustling hospital, the buzzing of residents and students, and the glowing computer screen, relaying the demands of the electronic medical records (EMRs) and incessant emails. He writes:

After nearly a dozen visits, alone and with others, even though I wasn’t consciously trying to relate the art to the pedagogy of medicine, I began to make connections. My tool is the medical gaze, the desire to look for pathology and connection, and it would seem there was no opportunity for that within a pigmented square of uniform color or a rectangle of haphazard paint splashes. But in me a profound and inward sort of observation was taking form.

For example, take Pink and White over Red. A quick glance reveals mere blotches of color, nothing that special. Here's Verghese:

But having learned to sit with the painting, to be present, I viewed it differently. It seemed to represent my interior space, what I see on the back of my eyelids when I close my eyes, the image still etched with the glow of the window through which I was gazing. It is soothing. It is the womb. It is emotion. It is pre-consciousness.

In the most cursory reading of Rothko, I came across this: 'If you are only moved by color relationships, then you miss the point. I’m interested in expressing the big emotions—tragedy, ecstasy, doom.' And: 'Art is an adventure into an unknown world, which can be explored only by those willing to take the risks.'

Similarly, medicine, the kind of medicine that Verghese practices and teaches requires an adventure into an unknown world — an inherently risky undertaking. After reviewing EMRs, doctors can order lab tests or tweak prescriptions, using their training and the body of scientific evidence to guide them. But just being with a patient, holding the hand of someone who is dying, noticing small details such as "the outline of a cigarette packet in the shirt pocket," as Verghese writes, these actions, or non-actions, are risky. They're time-consuming and may seem unproductive. Nothing happened. We talked about cupcakes. Or flowers. Or a grandson. Or just sat together. Verghese concludes:

There are a few things that are timeless in medicine, unchanged since antiquity, which we can keep front and center as we bring about reform. One is the simple truth that patients want us to be more present. We as physicians want to be more present with the patient, as well, because without that contact, our professional life loses much of its meaning.

It is a one-word rallying cry for patients and physicians, the common ground we share, the one thing we should not compromise, the starting place to begin reform, the single word to put on the placard as we rally for the cause.

Presence. Period.

Verghese has translated his passion for valuing bedside care into an interdisciplinary program at Stanford titled, appropriately, Presence. For a special treat, check out Verghese reading the essay in this podcast.

Previously: Stanford physician-author Abraham Verghese to receive National Humanities Medal, "I carry your heart": Abraham Verghese on the doctor-patient relationship and Abraham Verghese: "There is no panacea for an investment of time at the bedside with students"
Photo by Henrik Kam courtesy of the Anderson Collection

Presence of mind implies the presence of the thinking facul­ties in time of danger or emergency, which enable a man to think clearly and act promptly. It is usually found in those who are naturally good leaders of men, being one of the qualities which make them fit for leadership.

The suggestions of a man who keeps a clear head, when others are panic-stricken and know not where to turn, are the most valuable to be had at the moment and invest him with authority.

It is akin to courage, for the reasoning powers quickly yield to the tyranny of fear. It should be accompanied by ready wit. The presence of a mind that is worth­less is of little avail. A reckless and undaunted fool is of no more use than a man of intelligence benumbed by terror.

It is not uncommon to find men with some reputation for sagacity losing that reputation in the face of danger or emer­gency. Their faculties become paralyzed and they know not how to act.

Image Source: woaknb.wz.sk

Such men are unfit for responsible posts. The general who loses his head on the battle-field is at once discredited, and, however faithful and loyal a servant of the state he may be in other respects, he cannot be allowed to serve it any longer in the capacity of a commander of troops.

In commercial life, through rumours of wars and disasters or the manipulation of markets, panics are often created. Men rashly buy and sell shares and bankruptcies multiply.

The men who escape ruin are those who can look at the situation calmly and deliberately, and, instead of blindly imitating the mob, investigate the circumstances of the case and base their decision on the result of their investigations.

The mother who faints or sits down to scream when an accident happens to her child, may lose a child whom prompt assistance might have saved.

Presence of mind is largely an innate gift and only partly capable of cultivation. Nevertheless, the man who has developed his powers of thought by education, and keeps his body strong and able, is more likely to act in emergency with wisdom and promptitude than one whose mind and body are enfeebled by indulgence.

Then again, knowledge will prevent many foolish actions. Though we cannot possibly be prepared against all dan­gers, we can learn what dangers are likely to be met within our particular walk of life, and what steps are to be taken in certain contingencies.

The general, by a study of military history, can find out how others acted in difficulties, and the mother can make herself acquainted with the principles of first aid in case of acci­dent, and the remedies to be first applied in case of sudden sickness.

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