The Doctor on Screen

We were waiting for our next scheduled surgery. Assembled to watch the surgeons operate on the patient, standing on the sidelines trying to be as invisible as we could be. 

He walked himself in. The patient. The part I keep returning to. He walked himself through the ward, past the nurses' station, down the corridor, and through the doors of the operation theatre. On two legs, under his own power, for the last time. ‘Below-knee amputation’, the file said. Scheduled for ten. He was early.

Nobody made a thing of it. The ward continued around him. The usual noise, the usual smell of phenyl and something underneath the phenyl, a junior resident arguing quietly with a nurse about a drug chart somewhere to the left. He walked in and the doors swung shut and that was that.

I stood there for a moment longer than I needed to.

No music. No slow motion. No close-up on his face to tell me what to feel. Just a Tuesday morning and a man who knew what was on the other side of those doors and walked through them anyway. I had been in the wards long enough by then to know that this happened, that medicine was full of these moments, quiet and enormous and completely unannounced. And I still wasn't ready for it. I'm not sure you can be.

This is not what I expected medicine to look like.

For a long time, I'll admit, I expected it to look like the films. Not naively, I knew, intellectually, that real hospitals were different from reel hospitals, the way you know that real love is different from film love and real war is different from film war. You know it, and then you spend years absorbing exactly the opposite message, and by the time you actually arrive somewhere real you have a very detailed picture in your head of something that doesn't exist.

The doctor I wanted to be was specific. All-knowing, all-seeing. The one everyone looks to, because he can treat all their problems away. A quick, definitive fix, everytime. The one who walks into a room and sees what nobody else has seen. Who delivers the diagnosis in one sentence, clean and certain, and moves on. Who is never wrong, never tired, never standing in front of a patient thinking I don't entirely know what's happening here and I'm not sure anyone does.

The cinema gave me this doctor in many forms and I received all of them gratefully. The surgeon who operates with the focused calm of someone doing something he was born to do. The physician who names the rare condition in the third act, saving the life everyone else had given up on. The doctor who cries at exactly the right moment and not a moment before. I watched these men, they were almost always men, and I thought: yes. That. That's what this is.

The hospitals in those films were also something. Gleaming corridors. Equipment that beeped with purpose. Families who gathered in waiting rooms and received news and reacted to it in the approved dramatic fashion. Nobody waited very long. Nobody travelled very far. The patient arrived, the condition declared itself, the doctor met it. Clean in, clean out.

I don't know what a film hospital smells like, but I'm reasonably sure it doesn't smell like a real one.

Real medicine, I have learned, is largely about waiting. This sounds like a complaint. It isn't, quite.

Patients wait for consultations that are scheduled six days out and then pushed to eight. They wait in corridors on metal chairs that were never designed for the human spine. They wait with files on their laps containing years of someone's attempt to stay alive, blood reports, prescription slips, discharge summaries from three different hospitals, all of it held together with a rubber band or tucked into a plastic bag bought specifically for this purpose.

Some of them have come from very far away.

There was a child. Eight years old, severe asthma, who had travelled overnight on a government bus with his father to get to the outpatient department by morning. Both of them were visibly exhausted, the father especially, with the particular exhaustion of someone who has been awake and responsible for a long time. They sat in front of us and the child, when asked about his medication, demonstrated his inhaler technique unprompted. Proper technique. Spacer held correctly, breath timed right, the whole thing. He had clearly been taught and had clearly practised and was clearly proud of getting it right.

His father, a factory labourer who could not read, had maintained a small notebook. Inside it, probably in someone else's handwriting, a neighbour, an older child, a person at a medical shop who helped him once, was a record of his son's medication. Dates, doses, whether the inhaler had been used and when. Neat columns. Nothing missing.

I have a medical degree in progress. I have sat through pharmacology lectures and clinical postings and I cannot tell you I have ever been as prepared for anything as that father was for that consultation.

The patient before them had been from a more comfortable situation. He touched things he wasn't supposed to touch, interrupted twice, and left slightly dissatisfied with how long he'd had to wait. I am not going to make too much of this comparison. It makes its own point and then some.

Here is the part of the essay where I'm supposed to say something about what cinema owes medicine, or what medicine can learn from its portrayal on screen, or how we need more realistic representations of healthcare in popular culture. I've read essays like that. They're not wrong exactly. They're just not what I'm actually thinking about.

What I'm actually thinking about is the man who walked himself to the OT.

And the father's notebook.

And how the films I grew up watching had thirty years of stories about medicine and never once showed me either of those things. Not because they were hiding them. I don't think it was that deliberate. I think it was simpler: those things don't look like drama from the outside. A man walking down a corridor. A notebook with columns. An eight-year-old demonstrating correct inhaler technique to a room full of people with more formal education than he'll ever have.

You need to be in the room for it. You need to already be looking.

I still want to be a good doctor. The wanting hasn't gone anywhere. But the shape of it has changed, or is changing, slowly, with each posting. The all-knowing, all-seeing version has quietly receded. Not because I gave up on it, but because the wards kept showing me something that required a different kind of seeing. Less dramatic. More patient. The ability to notice what isn't announcing itself.

There's a version of that, I think, in the films too, somewhere underneath the gleaming corridors and the perfectly-timed diagnoses. A reason why people keep making stories about doctors and why other people keep watching them. Something about the desire to be in the presence of someone who sees you clearly and knows what to do. That desire is real. I felt it too. I still feel it.

I just know now that the seeing clearly part is harder and quieter and more important than any film made it look.

The OT doors don't have windows. I don't know why I keep checking for another patient coming in on his own.