Monday, August 27, 2007

What You Get Is What You See

One time I was doing post-op rounds, dressed in regular / street clothes but with my hospital ID around my neck. One of the women I was visiting spoke only Spanish and was in the midst of sharing a very painful, personal story with me when a medical team of some kind walked in, also on rounds. I was sitting at eye-level with my patient, speaking Spanish to her in a low voice when the group walked in: an elderly male physician in a long white coat; a younger woman, also in a white coat; and a young man, probably a student or a resident, in a short white jacket. The woman in the white coat looked at us for a moment, then turned to me and said in a loud voice, in an exaggeratedly deliberate pace, "HI. We're from ONC-OL-O-GY. Do YOU speak ENG-lish?!"

For a moment I looked at her in a state of complete confusion. Do I speak English? I work here! I thought. My mind raced through why this woman was speaking to me as if I were both deaf and uncomprehending. I don't even LOOK like I come from a Spanish-speaking country - or do I? I've always thought I was too Asian-looking to be mistaken for Latin American, though I've seen some Latin Americans that I've actually mistaken for Filipino, so I suppose the lady wasn't way off-base.

Anyway, we got that sorted out, but it made me realize how easy it is to fail the Rorschach tests we get all the time in day-to-day life.


Here's what I've learned so far about interpreting the world: Every social exchange or situation is a Rorschach test. The way you read - or, the way you rewrite for yourself the story you hear or see, the life of the other person, the meaning of what's in front of you - says more about you than about the "text" or "inkblot" you're interpreting. Mauriac explored this idea in the novel I just finished (Vipers' Tangle): the kind of reader you are is the kind of person you are. Character and interpretation of meaning are interconnected.

Making assumptions is human nature and often a necessary part of arriving at some kind of understanding of a person or situation. Assumptions fill in the gaps. It's a well-known phenomenon that, given part or parts of a particular recognizable whole, the human brain fills in details so as to create for itself something it can perceive and interpret. I think that among our faults and failings as human beings, making some wrong assumptions is one of the most understandable, and perhaps one of the most insidious.

The one example I'll never forget of a doctor making assumptions about a patient - and getting the "inkblot" all wrong, because yes, there was a right answer and a wrong answer - also concerns a patient who was a native speaker of Spanish. I will call him Juan de la Cruz, in honor of the great Spanish mystic.

I was a resident assigned to provide anesthesia for Juan de la Cruz. I won't say what type of surgery he was about to have, but I will say that it was a somewhat unusual procedure, one you don't see every day in the O.R. I'll call it the Calvary Procedure, not because it involved a lot of suffering, but because the name reminds me of something in the procedure.

As I was looking over Juan's chart I noticed under the heading "Social History" something like this, after a description of his smoking and drinking habits and marital status: was a physician in his native country; currently works as a building custodian.

My heart ached to learn this, but I had a more practical problem at hand: should I address him by his earned title, "Dr.," and take the risk of dredging up a possibly painful past or of sounding insincere, or call him "Mr.," and take the risk of sounding condescending or disrespectful?

I don't remember how I handled the conversation. I remember our preop conversation only the way one remembers a hazy dream just at the edge of being forgotten. My memory cuts to the O.R., then, after I've induced general anesthesia for Juan, and someone asks me to say the final procedure verification out loud. I say, "This is Dr. Juan de la Cruz for a Calvary Procedure."

The attending surgeon was a woman with an Eastern European name but the accent and affectations of someone whose illustrious parents had sent her to study at Oxford or Cambridge. She was smug and imperious, and she turned to me with a look of annoyance when I said this. "He's not a doctor, he's a JANITOR."

I was a resident, but I wasn't her resident. I looked into her eyes and said, "He may be a janitor now, but he was a physician in his own country."

The lady surgeon appeared irate and protested again at the idea that Juan should be anything other than a janitor. Then she added, "He never told me that. Where are you getting this information?""

"From the chart," I said somewhat curtly. I wanted to ask if she'd even bothered to read it. Her tone and arrogant air and faux British accent were getting to me.

"Well," she muttered. "Goodness knows what it means to be a 'physician' in his country."

That pretty much killed the conversation in the O.R. for a while.

I knew I was supposed to learn something, a bunch of things, from the interaction, and I chewed on that exchange for a long while. One thing I needed to work on was to avoid letting snobby people get to me. But the more important lesson, I think, was again a lesson about human worth: how we judge others, the assumptions we make (or fail to make) about the stories that underlie human faces and circumstances, if and how we even see our fellow human beings.

We're surrounded by inkblots, texts, stories, mysteries. Someone please remind me every day to make the effort to read, and to practice good reading - the lectio divina of life.


Anonymous said...


Anonymous said...


Mulla Nasrudin went to a psychiatrist, who tested him by showing him symbols on a sheet of paper.
First there were three dots. “What do those stand for?” asked the doctor.
“Three wolves,” said the Mulla.
“And these dashes?”
“They stand for two elephants.”
“What do you make of these dots and dashes together?”
“They illustrate a herd of ponies and donkeys.”
The doctor told him:
“I am afraid that you are obsessed by animals, and we’ll have to do something about it...”
“Do something about yourself first,” said the Mulla,"for all these creatures belong to YOUR menagerie!”
from Idries Shah's The Commanding Self

AATF Eastern Massachusetts said...

I highly recommend François Mauriac's "Vipers' Tangle", a wonderful study, among other things, of mistaken perceptions of self and others, nursed over decades. It is available in paperback from Loyola Press.

Anonymous said...

Years ago when the world was young, I was a hospital chaplain. The MOST demanding part of the job was to be aware of one's preconceptions (being free of them is not an option) not letting oneself be blinded by them.

I failed often.