Medicine and food.

I have been spending most of my waking hours at the hospital for the last two weeks, as my (patient, kind, generous) husband can attest to. The way residency works, I often have periods of time where I work nearly eighty hours a week, and these past couple of weeks has been one of them. July is also the month when new first-year residents start their training after graduating from medical school, so much of my time has been spent teaching new doctors. In some ways, it's a simple life of wake up, go to work, come home, sleep, repeat. Of course, with that kind of intensity, I always find it hard to turn my mind off when I come home, and there were nights where I woke up several times from dreams of being late to work, patients dying, and other things gone wrong.

Lying awake one night, I started thinking about the connection, for me, between medicine and food. Years ago, when I was first applying to medical school and my roommate at the time was in her first year of medical school, I mentioned to her that I felt like being a doctor was a lot like cooking. She told me, nicely, that she thought I was crazy. "Medicine is nothing like cooking," she laughed. She's a very good friend who often appreciates my strange ramblings, but this was too much for her.

I've thought about her reaction more than once during my medical education and residency. Sometimes I agree with her - medicine is nothing like cooking food. Medicine is scientific, evidence-based, and there are often great stakes involved. Cooking food is like creating art. But there are other times that I can't help but be reminded of my (naive) opinion at the time. I was thumbing through one of my favorite cookbooks, The Zuni Cafe Cookbook, recently, and I came across a recipe for Chicken Braised with Figs, Honey and Vinegar. In her introduction, Judy Rogers struck me as finally getting at this similarity between practicing medicine and cooking food that I have tried for so long to put into words:

Learning to identify good figs is an annual ritual at Zuni. As each year's fig crop appears, I always ask the new cooks if they have eaten many before. Often, particularly from those new to California, the answer is, "Not really," and I envy them the pleasure of what lies ahead. 

"Look at them. Feel them. Plump can be good, but not unless they are really heavy for their size and they need to be tender." 

A tentative squeeze.

"Taste it. How is it? And that cracked one. It's kind of light, but check anyway. How about that one, it looks flawless, and it's heavy, but is kind of hard. Taste it." 

After a wary nibble, "It's not that great." 

"Now look at that one. Shrunken and wrinkled is actually good, as long as it is heavy. 'Pristine' isn't usually a good sign. If you look for pretty, you may miss the best ones. Just keep tasting until you can tell. And then try to remember how 'that look' and 'that feel' taste."

This last applies to all produce, all meat, all fish, all cooking.

While there is a lot of emphasis in medical education on knowing the research and evidence, there is also a culture of respect for experience. What does a sick patient look like? When is an abdominal exam really concerning? There is so much uncertainty in medicine. As doctors, we are trying to piece together a story, a diagnosis, a treatment as best we can, every day, from the information we have and our experience. Soon, without even realizing it, these new doctors will start to trust their senses and ultimately, they will also know how to recognize that sick patient by just a look.