authenticity

I grew up in a little, plastic bubble of a culture. A place where judgments sometimes fell from the sky, pounding imperfections and flaws and even illnesses into the dry earth. Life in this bubble was often based upon how things appeared to be and not necessarily how they actually were. People spent a great deal of time hiding behind plastic smiles and falsities, and words were spread around like jam on bread in order to cloak the taste of mold or hint of staleness.

I've interacted with plasticity for a long time.

Sometime in the past few years, perhaps in med school, perhaps influenced by a mentor bent upon transparency in medicine, I began shifting away from plastic-bubble world. Sure, my soul screamed out at the fakeness long before the authenticity lessons—the unnaturalness of the lipstick smiles, even as the eyes seemed to say something else, the pretensions of perfection, the pressure to not talk about flaws or mental illnesses but rather to package it all up in hair-sprayed, feathered wings and blue, eye-shadowed personas.

Bubble world didn’t have all that much space for authenticity; there was barely enough space for breathing oxygen. Rather than speaking honestly, much time was devoted to guessing at the meaning hidden behind words behind mouths lip synching things. No one really said what was actually meant. Generally, real meaning was buried somewhere underneath layers of niceties and hidden agendas. You had to read between the lines. You learned the art of suppression. How to do mental gymnastics in order to hint at what you meant, so that someone might get what you said, so that you could possibly get angry, in an-ever-so-loving sort of way, at their insensitivity. How dare they be so rude?

Perhaps, I shouldn’t be surprised that it was psychosis that squeezed my own brother’s authenticity to the surface in bubble world. Floridly out of his mind, he could freely pick the neurotic neighbor’s flowers or just park on the road in front of neurotic neighbor's house. He could say anything, be anyone, do anything for a time in a culture designed to squelch thinking outside the bubble. Seen from a certain perspective, his psychosis temporarily solved a few problems. Of course it also created a few problems of its own, too.

I think of my brother now as I step more fully into the role of doctor and while attempting once again to sort out authenticity.  I’m not sure how to be real as a doctor. I’m still figuring out the details of being a physician in the first place. I don’t know how to communicate competence and the fact that I’m still learning at the same time. I don’t feel especially doctoral. I feel uncomfortable not knowing exactly where the balance point lies between being present and yet professional. And my feeble attempts to balance atop this surfboard make me feel as if I’m pretending; playing some character in a TV drama, waiting for the moment when Meredith, the narrator’s voice over from the beginning, suddenly cues  back in and the plot ties itself neatly together, while the emotive music carries us through the teary-eyed part to the credits.

People want to feel confident that doctors have answers.

Somehow it cuts into our collective need to feel safe, to feel taken care of, to feel like all is well in the ocean of our lives. As if somehow all our sharking worries can dry up because somebody knows what to do about our cancer or our bipolar disorder or our Lou Gehrig’s.  The universe has been preserved. The beach is safe. The bubble has not popped.

But, if I’m authentic, I might have to say that I don’t have all the answers. Sometimes, I might even have to admit that I don’t have any answers. That the Tsunami might still crash on your shoreline carrying you out to sea and I cannot prevent it.

And you, holding your schizoaffective son in your arms, might crumple into a heap in the corner of my office.

All of these things make it difficult to be authentic, to surf the waves of both compassionate ache for your struggles in tension with one's human capacity for emotions, or irritability when appointments cancel themselves at the last minute. Or when compelled to be both real and honest about your prognosis and yet gentle and caring and humane at the same time. And so sometimes we wind up in a doctor bubble world of our own, struggling to find our way out, to connect with you, our patient, in a real human way. We might seem cold, or aloof, or distant, as if we have some sort of superiority god-complex; but in reality, we're often merely struggling epically to hold the complexity of our own humanity in such a way that won’t frighten you that we aren’t, in fact, god-like.