The Other Side of the Curtain

There is a professional invisibility that comes with being the person in scrubs who is not the doctor.

Not the nurse. Not the attending. Not the one with the stethoscope and the authority and the eleven minutes of focused clinical attention that the patient has been waiting for and performing for and rehearsing their symptoms for in the car on the way over. I was the surgical coordinator. I was the one with the clipboard and the scheduling system and the pre-op checklist and the particular brand of institutional competence that reads, to most patients, as part of the furniture.

The furniture sees everything.

This is either the central irony of my clinical years or its central gift, and I have decided, with the benefit of hindsight and several years of writing about what human beings do when they think nobody important is watching, that it is both.

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Patients perform for doctors.

This is not a criticism. This is a clinical observation delivered without judgment, because judgment would be both hypocritical and beside the point, and I have a limited appetite for both. Patients perform for doctors because doctors are the audience that matters, the one with the prescription pad and the referral authority and the power to name the thing and naming, as anyone who has spent time in a body that needed naming, is everything.

You want the doctor to take you seriously.

You want the doctor to find you credible.

You want the doctor to look at you and see a person with a real and documentable problem rather than a person who is wasting a Tuesday morning on a mild hypochondria dressed up in clinical language.

So you perform.

You organize your symptoms into the most legible narrative available. You use the right vocabulary, or attempt to, because you have been reading the internet at 2 a.m. and you know more terminology than is strictly good for you. You present yourself as a person who is unwell in a specific and reasonable way, not too dramatic, not too dismissive, calibrated to the audience.

The performance begins, usually, before the doctor enters the room.

The performance continues, usually, after the doctor leaves it.

In between: the coordinator in the corner with the clipboard.

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What they forget about me, which served my education enormously, is that I was there.

Not in the way of the doctor, not in the way that triggers the performance. In the way of the furniture. In the way of the woman with the scheduling system who clearly has administrative concerns and is clearly not the person whose opinion of your symptoms will determine the next six months of your life.

I was safe to be real in front of.

They were, consequently, real.

And the real, I discovered over years of being real-in-front-of, is considerably more interesting than the performance.

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What I learned, specifically, from the other side of the curtain:

People are braver than they present.

The patient who performed perfect composure for the attending — clinical vocabulary, measured responses, the curated affect of someone who has decided that falling apart is not on today's agenda — would, in the ten minutes before the doctor arrived, sit in the chair with their hands in their lap and their eyes doing things their face was not doing. The eyes are not part of the performance. The eyes forget to perform. The eyes will tell you that this person is terrified in a way the voice is currently declining to mention.

I saw the eyes.

I saw the hands.

I saw the specific, unconscious geography of a frightened person who has decided to present as a managed person, and I saw it with the complete, unobserved clarity of someone who was not the target of the performance.

What I learned from the eyes and the hands: everyone is frightened. Everyone who comes through those doors is carrying a version of fear that the clinical encounter will not fully contain, that the eleven minutes of focused attention will not fully address, that the chart — with its problem list and its assessment and its plan — will not record.

The chart records the performance.

I saw the rehearsal.

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People negotiate with their bodies in real time, and they narrate the negotiation out loud when they think the audience is non-essential.

This is a specific and reliable phenomenon that I observed across years of pre-op and post-op coordination, across the full range of procedures and patients and situations, and it never stopped being true. The waiting patient, believing herself unobserved in any meaningful sense, will have the conversation she cannot have with the attending. She will say, to the room, to her phone, to the person who came with her, to herself: I know this is nothing but I can't stop thinking it's something. She will say: I feel stupid for being scared. She will say: I didn't tell him about the other thing because I didn't want him to think I was being dramatic.

She didn't tell him about the other thing.

I know about the other thing.

I am not going to pretend I didn't file the other thing.

The other thing is almost always the thing.

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The person who accompanies the patient is a document unto themselves.

Entire dissertations could be written — perhaps have been written, in the clinical literature I was adjacent to without being trained in — on what you can read about a relationship from the waiting room behavior of the person who came along. The partner who sits close and says little and whose stillness has the quality of someone conserving energy for what comes after. The parent who has arrived with a list of questions on their phone and the specific, barely-managed energy of someone who has decided that preparation is the only thing standing between them and a complete loss of composure. The adult child who is realizing, in the fluorescent light of a pre-op waiting area, that the parent is older than they've been allowing themselves to notice.

I watched all of them.

I scheduled surgeries and managed paperwork and coordinated the procedural infrastructure of a medical floor, and I watched all of them, and what I learned about people from the other side of the curtain could fill a library and has, in a less clinical format, been filling pages.

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The most honest moments happen in the transition states.

Not in the waiting, which has its own performance economy, its own management strategies. In the transitions. The moment between the gurney leaving the pre-op bay and the OR doors opening. The moment between the recovery room and the patient being alert enough to know they're being observed. The specific, unguarded minute when someone is coming out of anesthesia and the defenses have not yet reassembled and they are simply themselves, in the most unedited sense available, in the body without its usual filters.

People say things in those minutes.

I heard them.

I am a writer.

I filed them.

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What the clinical experience gave me, which the writing program did not and could not have, is a specific and non-theoretical understanding of the gap between the presented self and the actual one.

Not as a concept.

As a Tuesday.

As a repeated, observed, documented Tuesday in which person after person walked through a set of doors and performed the version of themselves that the situation required and left the other version — the frightened one, the honest one, the one having the negotiation out loud — in the chair when the performance began.

The other version is the interesting one.

The other version is the one I write from.

The clinical years were, in retrospect, the most comprehensive character study available to someone who would spend the subsequent years trying to understand what people are actually made of underneath the management.

What they are made of: the same things.

Everyone.

Without exception.

Fear and love and the specific, unglamorous courage of a person who is frightened and shows up anyway, who performs competence over a substrate of profound vulnerability, who sits in the chair with their eyes doing things their face declines to do and waits for someone to call their name.

I called a lot of names.

I watched a lot of eyes.

I learned more about human beings from the other side of the curtain than from any other source available, including the ones that were supposed to be educational.

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The slit lamp, which I have written about elsewhere and will not stop writing about because it keeps being the perfect instrument for thinking about the relationship between clinical observation and human truth, requires proximity. Real proximity. The kind that does not happen in most professional contexts.

But the coordinator's chair requires a different kind of proximity.

Not physical. Temporal.

I was there before. I was there after. I was there in the transitions that the chart does not record and the attending does not observe and the official account does not contain.

The official account is the performance.

I have the other version.

I have been writing the other version ever since.

It turns out that the other version is the one worth writing.

Who knew.

The furniture, probably.

The furniture always knows.

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The coordinator in the corner has a clipboard.

The clipboard has a checklist.

The checklist does not include: what the patient's eyes are doing, what the hands in the lap are saying, what the person who came along is not saying, what was said in the transition state when the defenses had not yet reassembled.

The clipboard does not include any of this.

The coordinator included all of it.

In a different document.

The document you are reading.

The furniture has opinions.

The furniture has been waiting a long time for someone to ask.