The Urban Beat: Wearing Two Hats
I've blogged for four years, initially at Doc Gurley and, more recently, for the City Brights section of SFGate.com. For most of that time, I have deliberately written about lighter, breezier topics. It was only when I got a California Endowment Health Journalism Fellowship last year that I stepped forward and went after a topic close to home - or, I should say, close to homelessness. For my Fellowship project, I wrote a series of blog posts that examined the connection between loss of housing and death.
And now for two months on this site, I'll be continuing to walk the urban health beat in semiweekly posts - trading my journalism and doctor hats back and forth - in the hopes that it might help illuminate issues that may have echoes of meaning for your life, in your own roles as journalist, patient, reader, storyteller or even healthcare provider.
My ReportingonHealth editors suggested I use my first post to explain how I became a blogger.
The odds were against it. I am highly credentialed, which is to say I was on the fast track to be an über-specialist. I spent two years in medical school doing basic science research in Jerry Groopman's HIV lab. But when it came time at graduation to choose a life of hardcore research (curiously, hardcore is an adjective used frequently to describe both research and porn), I just couldn't give up that most addictive part of the practice of medicine patients. So I said no to the pure research career.
When it was time to pick a specialty, I couldn't find a fit. In every field of medicine, there is a constant tug-of-war between the tasks of diagnosing versus caring. I adore the puzzles of illness, drawing out the clues with gently probing verbal tweezers. But however much I like diagnosis, my internal image of being a doctor is more a hand-holder than a person popping off latex gloves as they hip-check a door open, hurrying to the next unconscious body. I am addicted to my patients' gift of story and their willingness to share their lives with me (which is just a nicer way of saying I'm a verbal voyeur). In the end, I am a practicing internist physician.
But surely there is enough in medicine to keep me occupied. What is it that brought me to writing about health?
Writing and Irrationality
At the end of residency, in one final foray into academic research, I did a Robert Wood Johnson Foundation fellowship in health services research, epidemiology, and public policy. I researched and wrote about a range of topics -the cost-effectiveness of different approaches to heart attacks, the identification and outcomes of isolated San Franciscans who are found helpless or unresponsive in their homes, and the health care of prisoners at Pelican Bay. Before I even finished my fellowship, I was recruited to start working for the San Francisco Department of Public Health.
I've heard it said that people who are drawn to public policy and public health are "attracted to the irrational."
That, folks, in a nutshell, is me. I am drawn to how our prison systems may be creating and concentrating homelessness in our urban areas, to the phenomenal death rates of homelessness, to creating a tool to help identify the 300,000 bodies that I smelled rotting, mourned and unidentified, in Port au Prince, Haiti.
The Clash of the Archetypes
My two roles - a doctor for patients in a homeless clinic and a blogger walking the urban health beat - are sometimes in conflict. While digging into a "serious" topic in depth over several months for my Fellowship project, I found that the conventions of the two professions, journalist and physician, often clashed in unpredictable ways.
For example, as a doctor, when I hear the heart-breaking story of the gritty, day-to-day life of a starving, terminally-ill homeless person, I have an internal, automatic solace built into my job: as a doctor, I can do something. Patients come to me for a specific issue, and usually I can provide something in return.
But acting as a journalist, I found carrying around those stories inside me to be much, much harder. What do you do with that burden if you don't really have any place to put it? After experiencing it, I felt like writing to each of you covering a tragedy or a devastated life to say thank you, and, frankly, I don't know how you people do it.
We each, at least on an abstract level, know that these two professions, doctor and journalist, have some weird, almost medieval legal protections. I found first-hand why these caveats are enshrined, but I also discovered how often they conflict with each other. Confidentiality is a huge and a tricky topic, trickier than most of us want to admit.
One of the most poignant clashes of the doctor and journalist roles occurred when I was interviewing a man for a Fellowship article two days before Christmas at a homeless service site. My interview subject only knew me as a journalist, but he shared with me, when I asked about his health, that he was living on a sidewalk while dying of incurable liver cancer.
After we finished talking and I was alone in the room, packing up my equipment, a nurse stuck her head in the door. In the small world of homeless healthcare, she and I had worked together in the past at my clinic. "Jan," she said, her voice edged with stress, "I don't have a doctor today. I know you're not on, but can you please come examine him? He's got belly pain. It could be really serious."
I stood, with my flip camera in hand, and felt in that moment all the colliding pressures that converge in these two roles. If I walked into a room and asked him to get on a table and pull up his shirt, he would never again trust his nurse, this service site, me, or even the clinic where I worked. Also, I realized, if I told him I was actually a doctor, and only a "fake" journalist, as time passed he would probably distrust how I'd heard his story, or begin to doubt my integrity or my motivations, or where I would draw the line between what he told me as a journalist, and the information I demanded from him as a doctor. Having your story violated by someone who seems like a "fake" journalist is a true betrayal, particularly when your story is almost all you have left.
I believe that within each of us, we carry an archetype of what it means for someone to be a journalist that is every bit as deeply symbolic and embedded as the archetype of the physician. There is a vulnerability, and a trust, that defines the relationship with each. And in this moment, the two were incompatible.
So what did I do? I told the nurse that we were going to pretend I wasn't there and that I didn't know this man. She was going to go back into the room with him, get all the information she could get, then come back to me without him knowing and talk to me as though she had randomly called me at my clinic, asking for advice, a process that we in medicine call getting a "curbside." And afterward, when she and I, together, formulated a plan, she would go back into the room and tell our patient that she had discussed his case with a doctor.
In this situation, I drew artificial lines. I took off one hat. And put on another. All behind closed doors.
Here on the Urban Beat, I'll be opening as many doors as I can for you. And I expect to be inexorably drawn to the irrational, particularly those topics related to extreme poverty –both on a local, city-sized scale, and on a larger, global scale. Feel free to comment with story ideas, the nature of the irrational, your own career choices, or even a frantic demand for the name of the world's most effective laxative (available only if you friend me on Facebook).
Next up: The Great Potassium Iodide Panic of 2011: Does saying "Don't panic" induce a panic?
Doc Gurley is a Harvard Medical School graduate and a practicing board-certified internist. Having completed a Stanford/UCSF Robert Wood Johnson Fellowship in epidemiology and public policy, she is also the creator of the Memoriam app - the first, and only, app to allow disaster-relief workers to speak for the dead. She is a recent California Endowment Health Journalism Fellow. Her writing has appeared in such diverse outlets as SFGate, BlogHer, and The New England Journal of Medicine. Jezebel calls her "indispensable." You can follow Doc Gurley on Facebook, or follow her on Twitter for pithy, real-time health news and tips. You can get more health posts at www.docgurley.com.
Photo credit: Ed Yourdon via Flickr