Barrett L. Dorko, P.T.
is a recording of his father's voice in a desk drawer
at home, and Tom Bear has no way of hearing it.
I have lunch with Tom a couple times each week, and despite the fact that he is an orthopedist, we get along remarkably well. Our topics of conversation have an amazing range and are punctuated with laughter. Over the years we've watched each other mature as men and clinicians and now we listen to each other speak of the demise of health care as we had hoped to practice it. We have no illusions about fixing this, but it helps to talk.
I mentioned a new book to him: Clifford Stoll's Silicon Snake Oil: Second Thought on the Information Highway. In one chapter Stoll points out that storing anything for future retrieval requires the invention of a format, literally a shape that can then somehow be read and translated to a form we can understand. The latest format we are generally familiar with is the compact disc and the advantages it offers have revolutionized the computer and music industries.
Stoll points out that although CDs may have decades if not centuries of life in them, this is not what determines their future usefulness, it's the reading mechanism.
My brother Kevin owns a collection of 78 rpm albums. They are carefully stored and perfectly sound but there is one little problem: he has no place to play them. That is to say he no longer owns a turntable that will turn at this rate and those that exist are increasingly rare and expensive.
I told Tom at lunch it had occurred to me that each of us individually is a format containing our history in the form of shape and size and tendencies to behave. The reading mechanisms designed to measure and decipher all of that information have become increasingly sophisticated (x-rays, EMGs, CT scans, MRIs, etc.) although our format remains the same. Unlike the audio or computer industries where changes in reading mechanisms have made some formats obsolete, the health industry strives to create new reading mechanisms for the same format. Clearly this is a testament to human complexity.
Tom said he can see that the insurance industry is beginning to eliminate the reading mechanism we call the doctor by no longer asking for a second opinion but only an MRI after a single physical exam. This despite the false negatives and positives known to occur with such tests. "They don't want my opinion, they want the machine's," he says.
Francis Bear's voice was imprinted on a "wire" recording back in the late 1940s. These preceded the magnetic tape most of us know. He died when Tom was 11 years old, and hearing that voice again would be a wonderful thing if only there were some way.
But I've heard Francis's voice. Tom spoke to me one day of how his father had taught him to pour oil from a can without spilling a drop, and of how he passed this specific skill on to his son. Listening to him speak and pantomime the movement, I learned myself. Perhaps we should remember that as humans we are formats, reading mechanisms, and pretty good recorders as well. When Tom tells me of something that his father once said, those words contain a human quality that only his son can give them, and although the wire recording might be more objective in a sense, I don't feel it would be more authentic.
The move away from humans as reading mechanisms requested by the insurance companies is predictable, cost-conscious, and sad all at once. What we end up with is often like that recording in the drawer. It is not the essence of the man, and it gives us little insight into what he was about. That recording is in Tom. And sometimes he plays if for me at lunch.