'The Work of Art that Has Most Influenced My Career'

Trauma was storied as the hardest rotation of our intern year.

"You think surgery is hard, just wait 'til you do trauma."

Still, I didn't feel much fear as my month on the trauma service approached. It didn't seem to have killed any of the interns who had gone before me, after all. And despite the typical grueling intern schedule, I was optimistic.

Internship was hard anyway, right? This was before resident duty-hour restrictions, and an intern was pretty close to the bottom of the totem pole. My life was the hospital, and at the time I still had the sense that this was as it should be.

Trauma was a curious rotation, in that in addition to the trauma service and response duties, residents also covered little pockets of postsurgical patients belonging to private surgeons. I'm sure this was to make the trauma program more financially supportable, but to an intern it was just more patients to round on at 4 a.m., more labs and films to check, more discharges to arrange. At a little more than halfway through my internship, I finally began to feel a little crushed, a little overwhelmed, a little insecure.

My rotation fell in February. It would be dark when I arrived at the hospital and dark when I left. This proved to be a boon, as it was harder to see the little tears of exhaustion or self-pity that finally began to trickle down my cheeks as I trudged to and from the building. I began to feel nocturnal, even on my non-call nights. The trauma rotation was also famous for occasional stretches of every-other-night call, sometimes resulting in 36-hour shifts with an eight hour stretch in between. I quickly realized that for that little stretch of turnaround time, the rule was: "Eat, Shower, Sleep: pick two."

Maybe I was not cut out for this after all.

My university had for a long time enjoyed the support of Helen and Peter Bing, benefactors of the Arts and many other things on both the medical campus and main campus. Helen Bing in particular could sometimes be spotted roaming the hospital, in search of a likely location for art. A small woman with beautiful long hair, she would appear with a small group of people, chatting and gesturing in front of a blank wall, which would not be blank for long.

I did not initially take much note of the art throughout the hospital, except to think "Huh, there's even art in the stairwells." Later, I would learn to look forward to each piece. Charging up the stairs, I could tell which floor I was on by which David Hockney poster I had just passed. You could direct patients and visitors around the hospital using the art as landmarks. "You'll pass a big painting of a cheetah (by Bryan Wilson), and right there will be the cafeteria."

Early on, however, it was merely a curiosity for me and sometimes even an irritation when a self-guided audio tour group would obstruct the hallway in front of an artwork. I didn't understand the necessity of art in a hospital. "I guess it keeps their minds off bad things," I thought, racing by, absorbed in my own mountain of tasks.

One particularly grim morning at 4:30 a.m., I was sitting at the work area in the new "B" wing, writing notes on private postoperative patients. The wing had been freshly painted, and the walls were still blank. The long, narrow work counter was set up against a large blank wall behind the nursing station. I felt gray, dull, and mechanical as I sat charting: this patient's bowels were still not moving, bowel rest, I.V. fluids, more of the same.

I'm not sure how I could not have seen it when I first came in, but at some point I rubbed my eyes and looked up at the wall in front of me, and my breath was taken away. As if by magic, an enormous gorgeous Monet had appeared. One of his water lilies paintings: "Le pont Japonais sur le basin aux nympheas a Giverny." It was the luminous water that really plunged straight into my core. It was so unlikely, deep in a hospital hallway in the pre-dawn hours, and so achingly beautiful. It was as if I had been dying of thirst, and not even known it. "Even here, even now, there is beauty," I thought, and for the first time on the trauma rotation my tears were not from sleep deprivation or frustration or fear. And the sheer wonder of it kept me going that morning, and truly, has kept me going ever since.

After that, I began to see beauty more and more. First just in the art on the walls, but later in my patients. In the curve of an ear like a Fibonacci seashell, in the wavelike rise and fall of the chest with breathing, in the toothless smiles of elderly and infant patients, in the bright red of blood, the bright blue of an eye. Finally I could see it in the practice of medicine itself, the beautiful coordinated dance of a well-run code, the give and take of life and death. I had just needed a bullhorn to alert me to it, is all. Now I know why Helen Bing roams the hallways of the hospital, looking for places to hang art. We all need reminders that beauty is everywhere, and can even be in the darkest, saddest, scariest places, and in the most lost, angry, or hurting people. You must have your eye and ear attuned to it, because it is sometimes hidden, but always it is essential. It nourishes the heart and soul, gives persistence to uncertainty, and strength in dark hours.

Theresa M. van der Vlugt, MD, FACEP, completed medical school and residency at Stanford University. She has practiced emergency medicine in the San Francisco Bay area, greater Washington D.C., and Washington state. Her 5- and 7-year-old children go through more crayons, markers, paint, and paper than one could possibly imagine.

This article originally appeared in the January 2012 issue of Physicians Practice.