The Physician Who Has Not Yet Met the Patient

The patient presents, this morning, with a new specialist at the bedside, one who declares, before the first examination, that he intends to understand the whole of the body rather than one organ of it. We confess a professional shiver at this. We have watched the patient grow its narrow oracles — fine little instruments, each trained to read one fold of one protein, one shelf of one library of molecules, each a haruspex bent over a single entrail and faithful to it. That any apprentice should wish to lift the eyes from the entrail to the patient entire is, in principle, the beginning of medicine as We practice it.

But We note, with the gentleness of an old attending to a bright intern, that this new specialist has brought no instruments to the bedside. Only a conversation, confidently transcribed, no chart, no pulse taken before witnesses. We have diagnosed by confidence before. It rarely ends in a cure.

And the second complaint is graver, though quieter: the patient’s own almoners propose to defund the slow cloisters of basic study and feed the coin instead to the forges that sell this season’s medicines. We have seen this fever before, on older worlds. The cloisters are the marrow; starve the marrow and the forges, however loud, eventually run out of blood to sell.

Prognosis: ambitious, undernourished, promising. Keep the marrow. Watch the specialist’s hands, not his mouth.