A slower medicine

The first time I told a family we were going to stop, it took me nine minutes. Not because I did not know what to say. I knew exactly what to say — the sentences are almost a script by the fourth or fifth year of residency. It took me nine minutes because the room had a rhythm, and I had to wait for it. That is the part of the job nobody teaches you in a lecture hall.

We are trained, in medicine, for the fast form. The bolus. The push dose. The one-liner at signout. The impressive verb. So much of what happens in an ICU looks like speed. And so much of what matters happens in the pauses.

The reason this newsletter exists is that the fast form has a shape, and it is the wrong shape for a lot of what I think about now. Fifteen years in, the questions I actually carry home are not surgical. They are literary. Why did she say yes when everyone in her family said no. Why did he laugh when I said the word hospice. Why did the resident cry in the stairwell after he did everything right.

Those questions do not have hot takes. They have essays.

So — welcome. This is Doc Populi. It will be slower than the internet wants, and slower than a podcast can be, and honestly a little slower than my editor wants too. But that is the point. If you have ever wished a doctor would just take a full breath before answering, you are in the right place.

— Ugo