Each week, as a physician and adjunct clinical professor of medicine, I assign one or two essays to the medical students and residents in my charge. While many hours are spent teaching them the nuts and bolts of clinical diagnosis and treatment in internal medicine, these reading assignments are my modest effort to speak deeply to the oft-neglected culture and vocation of medicine. A 1924 speech from a British Lord on Law and Manners, a poignant poem from Robert Frost, a tragic essay from a small town family practitioner and a speech from the renowned physician, Sir William Osler, are just a few of the selections I place in my students’ hands. But while the sources and topics selected may vary, the message is often the same.
But what does that mean? Let me explain.
To be sure, there is so much you can regret or ruminate about the past. There is even more you can worry about the future. And while reflection is good and planning is necessary, our obsessive, distracted tendency is to leave the present moment (the only authentic time in which we can live) robbed of its true fullness. Now as a physician there is no question, patients can tell in a moment if you are distracted, disinterested or detached. We have enough struggles with obtaining a sound history, performing a focused exam, considering the diagnosis and treatment strategy all while typing and staying engaged within a fifteen to thirty minute time window. But we can never forget that it is vital in a vocation dealing with the most human of concerns and the most vulnerable of considerations to be present, to be engaged. If you have trouble with your cable television and call the help line, you can tell in ten seconds (if you can get through the maddening automated phone tree) if the person on the other end of the line can help you. Are they reading a script? Are they creative enough to work around pat answers? Do they seem to listen? Do they seem to authentically care? The difference between the person who grudgingly punches the clock and the person who is eager to help is the difference between someone doing what they need to do and someone doing what they ought to do.
Doing what you ought to, instead of simply what you need to is the essence of being intentional.
Sir William Osler, a brilliant and deeply compassionate internist who effectively put Johns Hopkins Medical School and Hospital on the map, spoke eloquently of a key feature of intentionality. In a speech he gave at Yale in 1913 called A Way of Life, he recalled,
Much worried as to the future, partly about the final examination, partly as to what I should do afterwards, I picked up a volume of [Thomas] Carlyle, and on the page I opened there was the familiar sentence – “Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand.” A commonplace sentiment enough, but it hit and stuck and helped, and was the starting-point of a habit that has enabled me to utilize to the full the single talent entrusted to me.
“Not to see what lies dimly at a distance, but to do what lies clearly at hand.” That means we must let go of our obsession with controlling the future or relitigating the past and to reassert our wonder at and engagement with the present. That is true intentionality.
But to live intentionally is an active process constantly encroached upon by fear and guilt and worry and fatigue. To live intentionally requires us to accept elements of uncertainty, to cope with the inextinguishable reality of imperfection (our own and that of others), to reasonably reflect on the past and prudently plan for the future, and to open our eyes wide to the rich but all-too-fleeting moments of joy and wonder in the here-and-now.
Too many people are trapped in the past and caged by the future. I, too often, am one of them. But while we are so fettered, our children grow up before us, our spouse waits, our parents age, our patients search us and our seasons drift from the fresh green of spring to the last death rattle of fall. Were we there? Were we present? Or did we miss the utterly vital for the infinitely trivial?
The masterful poet, Seamus Haney, epitomized intentionality in a portion of Clearances, a series of eight sonnets penned in honor of his deceased mother,
When all the others were away at Mass I was all hers as we peeled potatoes. They broke the silence, let fall one by one Like solder weeping off the soldering iron: Cold comforts set between us, things to share Gleaming in a bucket of clean water. And again let fall. Little pleasant splashes From each other’s work would bring us to our senses. So while the parish priest at her bedside Went hammer and tongs at the prayers for the dying And some were responding and some crying I remembered her head bent towards my head, Her breath in mine, our fluent dipping knives— Never closer the whole rest of our lives.
To be present to the moment – intentional – in an act as mundane as peeling potatoes with your mother, could yield an experience in which the boy and his mother were “never closer the whole rest of our lives.”
As I reflect on the essays and poems and speeches I hand to my students, I am by reminded William Osler and Robert Frost and Seamus Heaney and countless others that being intentional is not doctor’s work.
It is the indispensable work of each and every human being.
Today – right now – let us not strain to see what lies dimly at a distance.
Let us labor to do what lies clearly at hand.
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