Tuesday, September 27, 2011


My son is standing in a crooked line of students with violins dangling from their chins awkwardly. As all beginners, they don't yet know what to do. They fidget uncomfortably and wait for the teacher to approach. She appraises each separately. Lifting the chin of one. Lowering the arm of another. The parents sit in desks in the back corner. We search our children for hidden signs of excellence. I wonder who will be the next virtuoso?

I contemplate mastery.


The white coat is finely pressed and stiff. It slides over my shoulders but refuses to conform to the shape of my torso. I take the stethoscope out of the pocket. It gleams in the sunlight. It is perfect. Free of blemishes or scuffs. It has not been used yet.

I feel like an untrained actor in a play for which I don't know the lines. I neither understand the posture nor the rhythm. Doctoring, at this point, is an elaborate game. The work of children.

I stand with my fellow students and recite an oath. We are being inculcated into a culture although we are still foreigners in a foreign land.


Bows have now been tightened and rosin applied. Ten sets of horse hairs meet ten strings. Each moves back and forth across the body of the violin. Squeaks and squeals emanate as parents look as if they want to plug their ears.

This is practice. The place where beginners start on the rode to mastery. The violin produces music but it is immature, tentative. Movement is neither novel nor comfortable.

Practice is an evolution. In can last lifetimes. Some will never leave this forsaken phase. Some will reach mastery for moments. They will perfect one composition or set. But they will continue to struggle.


My short white coat has been replaced with a longer one. My stethoscope dangles around my neck. The ear pieces no longer sting when placed correctly. My blue scrubs are warn and have black pen scrawled in various places for later use.

The hospital has become a second home. I walk with confidence because I know my surroundings. But I am still maturing. History and physical, labs and x-rays, assessments and plans. They are separate sections which need to be assembled and rejiggered. There is a lack of fluidity. A loss of buoyancy.


The teacher picks up her violin. The room becomes silent as she begins to play. Her posture lacks the tension of the beginners. Instead of playing separate notes she performs the composition as a whole. There are no pieces...just raw sound.


After years of practicing I feel closer to mastery. The tools of my trade are no longer foreign or separate; it is as if my stethoscope has become another extremity.

Doctoring has evolved from a process of parts. There is only the whole. The dance between care giver and patient.

I think in terms of composition. Less history and physical and more rise and fall. My mind spurns process. It is free to expand and contract.

Science has transformed into art. Each encounter its own small performance littered with both structure and free style riffs.


We run a risk when we interfere with mastery. When we replace the intuitive with the laborious.

The process experts will tell you that it is OK to add extra steps. An electronic medical record here, a check list there. Adding and subtracting tick marks.

We must remember that these experts understand composition no better then my young son understands how to play violin. They have an inkling. Their knowledge allows them to see the parts.

But their lack of mastery is blinding

and they can't see past them.

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