Medicine, the novel, and the passage of time.

Doctors and patients move together through time, humble in the face of its dictates. Novelists allow their characters to enter time, revealing in the characters' particular, ongoing lives some universal truths about living. Both the medical chart and the novel capture individual human lives as they change and as they age, finding some meaning in the random events that happen in them. Literary critics who write about the novel provide useful frameworks for doctors who reflect on their practice. In this essay, I examine the medical charts of two of my patients in detail and describe the experiences I shared with them. As a repository of detail not only about the patients but about the doctors and nurses who cared for them, the charts provide rich and powerful evidence about the insides of practice and the meanings that clinical relationships accrue. Doctors might discover underlying meaning in their practices that would otherwise elude them by reading their patients' charts as if they were novels, looking for patterns and movements throughout a patient's life, and recognizing the deep connections woven between their patients and themselves. By placing great novels-by Henry James, Virginia Woolf, and Thomas Mann-side by side with actual medical charts, I suggest the usefulness of close readings of medicine's texts. The juxtaposition suggests the utility of brooding about the seasons of our relationships with patients. Perhaps not a luxury but a necessity for effective care, reflection such as this on our patients may restore to medicine some of its passion, its meaning, and its joy.