Lisa Freitag says:

(Dr. Lisa Freitag is a former pediatrician in Minneapolis, Minnesota. Her most recent guest post on medical advertising and the meaning of caring is here.)

I’ve always had trouble thinking of myself as a body. I mean, I know that I exist in space, visible to other people as a discrete solid mass, but I don’t think about it much, don’t examine it in mirrors and, as a result, I have a rather limited visualization of what I really look like. I prefer to think that I am actually my mind.

David Sedaris, in an essay about his sister, Amy (“A Shiner Like A Diamond,” in Me Talk Pretty One Day), hints that this is a guy thing. His sisters were continuously reminded about their appearance, but he and his brother got off easy. He puts it, “Our bodies were viewed as mere vehicles, pasty, potbellied machines designed to transport our thoughts from one place to another.” I suspect that I too was indoctrinated in the necessity of appearance, but recognized at an early age that it was a lost cause and then forgot about it. So I feel quite comfortable existing as a cloud of thoughts drifting from one place to the next in a body which rarely calls attention to itself.

The body as a sort of convenient machine is the current model for medical and scientific thinking as well. “The body is a marvelous machine,” was the chorus of a song I learned as a child, and I had no doubt that this is true. Considering myself a resident of one of those machines, I had no reason to question the overriding image taught in medical school. I learned the machine’s parts, down to memorizing the names of various cells. And I was taught how the important parts of those machines work, down to learning those bits of their chemical processes that are so far known. I even learned names and parts for the thing that holds my thoughts. And of course, I learned all the ways in which those things go wrong, stop functioning, or break. Supposedly I was also taught how to fix those things, though that didn’t always work out as well as might be hoped. I became a kind of mechanic, a body repairman. I became a doctor.

The only time this image was challenged was during residency, when I had a head CT scan after a bike accident. They let me see it, because I was already one of them. It looked exactly like every normal CT I had ever seen, which was unexpectedly astonishing, disconcerting, and vaguely disappointing. I didn’t think too much about this, and instead focused on the fact that it was a good thing that my brain CT looked like every other normal CT scan. That normalcy restored me to the safe company of my peers, putting aside my first very brief glimpse of myself as a medical body.

One benefit of being a doctor is that, though I have had the usual number of medical problems, I have not really had to be a patient. I have been a member of the club of mechanics who happened to be temporarily out of commission. My doctor has been a colleague, and any necessary tests were done by people who were well aware of (and often obviously nervous about) the fact that in real life I am Dr Freitag.

But I am no longer working as a doctor, no longer one of the “in” crowd. So when I went to an internist to check out an increase in occurrences of a benign heartbeat irregularity that I have had forever, I went as a patient, not as a friend. The experience was disconcerting, and made me vaguely angry. I suspect the reasons for this might reveal part of why doctors notoriously make such terrible patients, but that’s a different essay. Suffice it to say that I was not in a good mood. I was simultaneously afraid that some problem would be found, exposing me to more medicine, and that nothing would be found, which would expose me as a worried fool.

I was not surprised to learn that I needed an EKG. If I’d still been on the inside of the doctor crowd, I would have ordered it myself, and skipped the appointment. I am totally aware of the whole procedure of sticking detectors to precise points on the chest in order to record the electrical currents in the heart. I was a little disconcerted by the stripping down to bare chest part, but I knew it was necessary. I wasn’t prepared for the look on the technician’s face as she carefully applied the electrodes. Though her face was hovering near my left breast, her look wasn’t about embarrassment. She was not looking at me at all. She was concentrating on placing electrodes, seeing only a diagram of my chest, just like the one behind her on the wall, showing proper lead positions. She was not seeing me, or even a body in which the “me” resides. I might have been plastic, a Resusci-Annie, on which she was practicing EKG recording.  For those minutes, staring up at the fluorescent ceiling lights, I was made of plastic too. I was not there.

I have seen my colleagues wearing that expression, and I must have worn it as well. It is the distant, vague expression of someone looking through a body, trying to find specific orientation or information. It is the look you must wear when when you are feeling an abdomen and trying to imagine the organs inside it, or threading a needle into a vein, or looking at a sheet of lab test results. It reduces a person to, not just a body, but a body in which something might be broken. This has been referred to as the “medical gaze,” a term originally coined by anthropologist Michel Foucault, whose name seems to come up in a variety of interesting discussions.

Opinions differ on whether being gazed upon in such a way causes harm. As a general way of thinking, considering the sick body as a repairable item has led to enormous advances. The most obvious problem with this is the tendency to forget that the body is a container for a person or, to put it more poetically, the temple of a soul. Despite urgings to consider the “whole patient,” under the influence of medical thinking, it is very difficult to look past the enormous amount of physical data and widen one’s gaze to include the person in the body. Perhaps the harm, then, is to the mind of the gazer.

Inability to see the person has led to a sort of indiscriminate and expensive repair effort, a desperate drive to fix those things that can be fixed, never thinking about the other failing-but-unfixable parts. It has also led to a consumerist drive to find as many things as possible that can be fixed, because fixing is so profitable. An accompanying effort attempts to convert patients into consumers of medical care, but both patient and consumer are bodies submitted to the same scientific scrutiny and the same clinical invasion. I believe the harm here is mostly to society, as the process of providing medical repair becomes more expensive and less equally applied.

To suggest that there is individual harm in this new way of being looked at may be somewhat backward, sort of like being part of a primitive culture in which the people are afraid of being photographed. Perhaps being converted from person to patient is in fact harmless. People seem more than willing to undergo this change, despite the frequent accompanying discomfort and loss of dignity, in order to reap the benefits of scientific medical repair. On the other hand, they may not be entirely aware that they have just been made into a thing which is being closely examined in an attempt to discover defects. I suspect they would object if they figured it out.

My EKG, those squiggly lines that are both me and not me, was fine. I was able to look at them long enough to see that their recorded spikes and hills and valleys (all of which have names and definitions and indications) looked pretty much like they look in every normal EKG I have seen. Their normalcy means that I can go back to being me, for a while longer anyway, and postpone the need to submit again to a medical gaze.