At seven years old I received a faceful of sputum from an angry octogenarian. This was in the ICU where Oscar, a Cuban diabetic who’d lapsed in both his insulin and sobriety, found himself under the care of the rounding internist—my father. Diabetic wasn’t the half of it: Oscar suffered from a low-residue diet, an amphetamine habit that could beggar nations, and a generally estranged cardiac arrangement made worse by bouts of rage. 

At the moment, one of these bouts was erupting in my direction.

“Oscar,” my father said with prideful enunciation, “I’d like you to meet my son.” He motioned me towards the bedside as an executioner would the gallows. Oscar glared at me in a hypoglycemic fugue, sputtering obscenities at random, reduced by anger to a creative shade of purple.

I was now firmly within striking distance and my adrenaline peaked. Why a healthy, uninjured seven-year-old would be subjected to all this was beyond me. The thought that it was aimed at instilling a love of medicine, or worse, a desire to pursue a lifetime of such unpleasantries, had not occurred to me. I saw only a nightmare of bodily dysfunction: IVs in, catheters out, and the ungodly mess between. I made a mental note to phone the local paper that very evening, beg for a small Classifieds entry, and place myself up for adoption.

“Oscar,” my father prompted, smiling coolly, “say Hello.”

Oscar growled. I may have squeaked. It was a meeting of farm animals. Oscar’s eyes fixed me in place as his shade of menace darkened. He favored me with a grin, a great inhale, and a globule of sputum ejected with a merry huff. 

As for a career in healthcare, it made for a somewhat less-than-attractive showing.

Medicine, not unlike crime, tends to be multi-generational. Hippocrates, “Father of Medicine,” learned from his father and trained his sons. Born to a successful physician, Paracelsus founded toxicology. Andreas Vesalius, a fourth-generation doctor, established modern human anatomy. Yet somehow my field trips to the hospital had failed to infect me. The baptism in Oscar’s sputum had not been a success. 

My view of healthcare as a drudgery only slightly preferable to coal mining, and my father as a man deranged enough to embrace it, persisted for several decades. During this time I distanced myself as much as possible, passing my days in the tortured extravagance of all self-appointed artists. I lived out of a van and serenaded half-filled dive bars. I wrote novels narrowly read even within my inner circle. I tried my hand at paint and poetry and film, but never sutures. There was a great wall, as I perceived it, between artists and academics; an immutable law of nature which served to cordon off physicians. 

In truth, the annals of medicine are larded with eccentrics. William Harvey, first known doctor to detail the circulatory system, would weekend as a warlock so as to socialize with witches. Reneé Laennec, medicine man by trade and musician from adolescence, stumbled on the stethoscope while carving flutes from boxwood. He went on to classify the music of infected airways with terms—rales, ronchi, and crepitance—that are still commonplace today. 

Or take Laennec’s mentor, Baron Guillaume Dupuytren, who gained prominence in Western Europe for treating Napoleon’s hemorrhoids (a distinction which was for some reason omitted from his headstone.) Baron Dupuytren was among the first surgeons to drain a brain abscess in a process called trepanation, a charming practice that began as a method of exorcizing evil spirits and progressed into a grotesque carpentry of bore-drilling into skulls. In Dupuytren’s day, trepanation claimed a whopping 20% mortality rate; though compare this to life itself, which boasts 100%, and it does not seem all that risky. One must simply refrain from nicking the brain or endangering it with infection. But this was in the eighteen-hundreds when backyard surgeries were all the rage. It was not uncommon for esteemed doctors to pose for portraits while brandishing a drill bit, as though plotting against their painters.

All this goes some way toward explaining my path from van to mountains. The ways of medicine are many, as is each student’s approach. I parlayed my artist’s existence into a passion for thru hiking. Frequent romps in the Sierra led to an interest in geology—namely for cliffs and sharp-edged gullies and their crop of injured hikers. Soon I was absorbed by firsthand accounts of hunters mauled, climbers impaled, and hikers stranded with femurs, phones, and spirits broken. Then came the leap from morbid curiosity to active interest, and my enrollment in a course for Wilderness First Responders. 

My college career should have warned against it, short-lived as it was, and marked by tardiness and absence. I had made the dean’s list only at the local cannabis dispensary. Yet here I was, committed to a curriculum with the intensity of med school—eight hours a day of lectures interspersed with active training. It occupied the unlikely intersection between university and boot camp. 

The course was held forty minutes west of Yosemite in a timbered gorge that allowed for approximately seven seconds of daily sunlight. We lived in constant penumbra, tenting and yurting through foul weather. Frost slicked the ground each morning. Fallen oak leaves closed the season.

The student body of twenty-five was colorful and motley. One kid grew up on a commune. Another rode stock through the high passes. A hunter from Alaska talked recipes for moose intestine. A pair of trail workers spoke a dialect of vowels, a sort of authoritative rumble, garrulous and unintelligible. Cloistered in our classroom and the bowl of hills beyond it, we were taught to render first aid at the first drop of a body. To achieve this under pressure one must circumvent most thought completely. To starve out common panic we had excessive protocol. There were prescribed stages to approach, from first assessment to wound inspection and irrigation, to proper spinal palpation, to documentation and reporting, all of which we memorized with the exactitude of scripture. It was not uncommon on the premises at any time of day or night to find a student stumbling aimless, lost in some whispered recitation. Live drills ensued ad nauseam. We approached the clean precision of medical automatons. When speaking to a patient we may have seemed outwardly human but had receded deep into a labyrinth of checklists and mnemonics. Acronyms nested in acronyms, delicate as Russian dolls, intended to cull from chaos some meagre diagnosis. 

To better mimic the elements encountered in the wild, this drilling was embellished with injury prosthetics and liberal doses of stage blood, all applied to volunteers who were then placed for us to find. A man screaming of compound fracture was hidden in a wooded glen. A hunter fallen from a tree stand writhed on a slope of shale. In a perverse take on theater camp melded with a treasure hunt, I and two fellow rescuers marched through a creek in driving rain to find a mass of bodies heaped in agonizing discord. Having tumbled down a mountain, bound in lengths of climbing rope, one patient has lost an eye in a showpiece of fractured bone; another lies prone, wholly unconscious; while a third bleeds from the mouth, struggling for breath and wracked by coughing. 

In the first of many errors, we ignore the unconscious man, favoring the eyeless climber whose frenzied acting is tremendous. The female patient coughs and seizes on the pretext of a pneumothorax. She informs us she has expired. My partners and I find this unacceptable. We urge her back to life but she refuses all resurrection. This will not help with our marks any. I suggest a trepanation. 

We repair to the classroom to take stock of our treatment. Did we test the unconscious patient for response to verbal stimuli? To pain? Did we immobilize the spine? Did we conduct a thorough blood sweep? It is safe to say our expertise is at this point highly debatable. 

On and on like this, toggling between lectures and live scenarios for eight hours a day, and every fourth day for eleven, until, as if from pure exhaustion, we run our protocol correctly. Improvised sprints improve in quality. Wound dressings are properly layered. Casualty rates plummet, as does all squeamishness and stage fright. In place of nerves, the class displays a fresh vulgarity of humor meant to stamp out latent weakness. We feign sympathy, of course. Coo reassurance to our patients while focused on our instruments: the steri-strips and makeshift tourniquet, the irrigation syringe. The rhythm of our practice is the beat of chest compressions. It is an art like any other in its compulsory obsession. Just as the ballerina must deliver grace under pressure, so too the doctor, the EMT, and the backcountry First Responder.

“You flip a switch,” my father told me. “It’s a different mode of thinking.” This was following a Friday dinner interrupted by nearby screams. He rushed from his table to discover a hit-and-run victim beside his driveway. My father, then in his sixties, administered chest compressions for thirty minutes. The face was too deformed for rescue breathing. The patient died in the ambulance. Following this my father did not cry or suffer fits of shaking. He changed his shirt and washed his face and hands and sat down to finish dinner. 

At the time, I found his dispassion shamefully offensive, but only as all sons find their fathers shameful in adolescence. I did not know him as a dedicated practitioner of craft, as steward of the city’s ailments, deprived the luxury of feeling. Camus wrote, “If it were sufficient to love, things would be easy.” Sadly, we must offer treatment; and should love fall by the wayside during healing, well, so be it. One cannot reduce an open fracture while weeping into the wound.

Ten days into the course and our sensitivities have blunted. We view footage of dislocated patellas, necrotic limbs, and ruptured eyeballs with the clinical remove of statisticians. Or psychotics. We swap horror stories with grade-school fervor and, gripped by a strange nostalgia, I tell the tale of Oscar’s sputum and the thought no longer pains me.

I pass the written and the practical and receive certification. There was a vein of weakness in me but it has mercifully been sutured. I drive back from the mountains, fairly thrumming with inspiration. The tensile blood-bond between father and son, once stretched to breaking, has been mended.

William Carlos Williams, renowned literary figure whose work defines modernist poetry to this day, practiced his dual arts in tandem, rounding on patients in New Jersey even while at the height of his acclaim. He said one’s purpose is to raise life to a dignified position. 

Whether he was speaking of art or medicine is unclear. 

Maybe of both.