Surgical site marked, patient draped leaving a small exposed area of flesh, time out completed. The Cath lab’s lights dim, the spotlight on the small open area of the drapes. “You are going to feel a little pinch,” and with those opening words the performance begins. A patient, out of a Board exam, pain in his left calf when he walks the dog – his only exercise. Simple angioplasty, no biggy. It all goes so well, until of course, it goes wrong. Wire across the blockage, angioplasty balloon up and down. Quick completion picture before going home shows the entire artery once partially open now closed. Is it colder in the Cath lab, is that diaphoretic feel across my brow and down my neck the source or the effect? What to do? One stent, two stents, maybe a ‘full metal jacket.” An hour or so later, emotionally spent, momentarily humbled, the artery is open, “widely patent.” He will be able to walk his dog without problems. You’ve left your mark.
Craftsmen, makers in today’s terms, have been leaving their marks since they began to craft things. Drawing from Richard Sennett’s writings, we know that brick makers, those craftsmen involved in building ancient Greece and Rome left marks. First, in the variations in appearance and quality of the bricks, today’s cherish artisanal quality. And when possible actual marks upon the work – graffiti set in stone or mortar.
Makers bonded together in fellowship and for economic protection, guilds arose to protect their collaboration. Even in the anonymity of those days, makers left marks. You can find it in the details of Europe’s great cathedrals. And as medieval times gave way to the Renaissance, the collaborative commons gave way to the ascension of individuals. Guilds gave way to the workshop with unique masters – artists, names we know today Cellini, Stradivari, Michelangelo – the brand names of the Renaissance. In contemporary times, Michael DeBakey, Denton Cooley or the workshop-guilds Mayo Clinic, Johns Hopkins, Cleveland Clinic.
Another quick case, a consultation that was more ‘cover my butt’ then ‘I need your help’ and then back to the office. Four patients an hour, two or three if it is complex. “Doc, I get a pain in my leg when I walk the golf course, even when my ball stays in the fairway.” There is a pause; the patient thinks you are deliberating, considering the options. In reality, you are lost in time, re-experiencing those Cath lab moments and emotions. Physical intervention seems a bit more intrusive given those recent events. Your mark has its consequences; walking the dog will again challenge this morning’s patient. “Why don’t we being by considering a program of supervised exercise and maybe some medication at the same time?”
The mark of craftsmanship is a continuing dialogue with their materials; for physicians, patients and their families. The surgical adage, ‘You’re only as good as your last case,’ is unidirectional and doesn’t give full justice to the maker’s conversation with themselves. We left a mark on the dog-walker, but it is equally true that the dog-walker left a mark upon us. Call it experience, reflection or dialogue. We need to return the conversation we have with our patient experiences – our materials – to their rightful place. To craftsmen, that dialogue is more enabling than the latest journal articles.
Today, we are ‘professionals’, separate and greater than our craftsmen roots’ reflect. I think that we are mistaken in that belief. The social standing and economics of being a professional obscure our true nature, our medieval higher “calling.” Professional is simply a word we use for a much older concept. Most of us are not Cellini or DeBakey – but that is OK. Some of us may be parts of the new workshop-guilds. The majority of us are dutiful craftsmen, practicing in the collaborative guild of our commonality and anonymity, providing hand-work in service to others.