Freak! A Matter of Perspective

“… so it’s really kind of cool that there are ways we can tell that a person has multiple acid/base disturbances occurring, even if his serum pH is normal. If you look at the basic Chemistry panel you can calculate something called an Anion Gap that helps you know how many…“

“Honey? I love you, I really do, but I just really don’t care. I’m sorry!”

“Oh, that’s… okay, I guess. It’s just really cool.“

This conversation has happened in one form or another between my wife and I more times that I can count. It’s happened at the dinner table, in the car, while getting ready for bed, while lying awake in bed, while getting the kids up and dressed, while doing laundry, while packing our stuff up and getting ready to move.

My wife really does love me, she makes that obvious constantly, it’s just that I’m… well… kind of weird with respect to the things that interest me, at least when placed on the same scale used for your average-everyday-Joe-or-Jane.

It takes an immense nerd to really get into the things I find myself interested in, and I recognize that, but it’s easy to forget when I spend a good chunk of each day surrounded by other people with interests that are similarly outside the societal norms, and often closely related to my own.

That’s kind of the funny part about Medical School: it makes it easy to forget just how unusual our interests and knowledge really are, because we’re surrounded by other “unusual” people.

Recently, the reading I’ve been doing for fun has included a book on interpreting chest radiographs, journal articles about the ethics of confidentiality in cases of community HIV exposure, the details of retroviral-host genome integration, involuntary psychiatric hospitalization, and interpretation of arterial blood gas values and subsequent nomogram production.

And that’s just my medicine-related geekery.  I spend so much of my waking time with people that could sit down and talk about this with me and be interested in it, that I forget that once I leave the hospital, most people I’ll run into couldn’t give a fig about any of it.

In the words of the main character in an audiobook I’m currently listening to (John Cleaver, in Mr. Monster by Dan Wells), I’m a freak.

But, then… I’m not.

It’s handy for me to remember this dichotomy, and how easy it is for me to forget (in the right circumstances) that I’m unusual, because I’m about to start a career where, likely every day, I’ll be trying to help someone who doesn’t fully realize how far from the “norm” he is, or who is distressed at being reminded of it.

Commonality of differences between people and the “mean” in any given dimension doesn’t necessarily mean that those differences are unimportant, but that when they are important, it is for more than just the sake of difference. They’re important for how they affect the persons we are and how they affect the way we perceive and respond to life.

This is true for any medical condition, whether physical or psychiatric (or, really, both) as well. Knowing that a person carries a diagnosis of diabetes, or depression, or lung cancer, or schizophrenia doesn’t by itself give me any useful information about him. It’s how those diagnoses affect his life that is important.

I think, sometimes, doctors (something I will soon be) forget to think of our whole patients in our drive to know, understand, and treat diseases.

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