I had seen them, of course, on television and even in real life before. I knew what they were, what they were for, who used them, where they showed up in the world.
I never knew what was in them.
I never knew what they held, piled up in the main compartment, stuffed into little mesh compartments along the sides or way down in the bottom under other piles of stuff, forgotten and yellowing and crackling pieces of paper or boxes or maybe fine silver instruments.
I bought my first one just before I did a physical diagnosis course in medical school. As a fledging doctor wannabe, I was now ready to figure out how to get my nose out of books and my hands on people, learning that wonderful skill of diagnostic touch.
Part of that involved the use of tools. Like the contractor’s low-riding leather belt or the bike messenger’s waxed canvas bag slung haphazardly over shoulder and trailing speeding bike and body through the downtown canyons of New York City, I needed something to both symbolize my profession as well as to perform the mundane task of getting my gear from one exam room or clinic to the other.
It was small, compact, made of smooth leather, real leather her that smelled at first of outdoors and tanning and sunshine but years later of the mustiness of a profession going off the rails. At first, like me, its surface was perfect, uniformly colored and had no stains. Later, just before I disposed of it, in a sad fog of trying to hold on to my training and trying to embrace my middle age, it was musty and cracked and creaked a little every time I opened it. Like my old athlete’s knee, it could still perform its primary purpose, but its days of shiny public glory were long gone.
My first black doctor’s bag held a stethoscope, a beauty that had a shiny silver bell and dual flexible rubber hoses and adjustable and changeable ear pieces. There was a tuning fork, hummmmmmmmm, that I loved to place on knee caps and wrists. There was an odd little medieval instrument used to check perception of noxious stimuli, its tiny silver wheel of razor sharp teeth looking more like a shrunken torture implement than a diagnostic tool. There was a reflex hammer, red-headed as any woodpecker, silver bladed and perfectly balanced. I had engraved my initials into the handle, GES, and I used it for almost thirty years. I think it probably still rests in a drawer in a crisis center examination room, where I left it, semi-purposefully, some months ago as I said goodbye to another position. There was a sphygmomanometer, yes, one of those things, that I learned to take blood pressures with. It was made of fine Corinthian leather or naugahyde or some such 1980s construct that evoked a sense of luxury in my young physician life at a time where having two nickels to rub together would have made me rich.
My little black bag.
The outward and visible sign of a life forever changed internally. A symbol of power, yes really, of the power to come into a house, reach in, lay on hands, diagnosis and heal. No, my friends, I am not being dramatic here. This bag, as did other props of my profession, helped to shape me, give me form and function, help me to be comfortable in public with the fact that I was now a doctor.
I had been given a charge. I had also lost some of my innocence forever. Each time something came out of that bag, each time I heard a sick heart or a blocked carotid or looked in vain for reflexes that no longer existed, I became more skilled but less pure. Less innocent. The leather on that bag aged and cracked and grew dull from being thrown about in the back seat of a car and from being jerked out into the rain.
Fast forward a few decades, friends, if you would bear with me, please.
My last house call is long since behind me. I will never forget it.
My days of doing routine physical examinations and wearing long white coats are gone.
My days of doing a straightforward history and physical, a really, really good one, are gone.
Not because I can’t do those things. I still know where to put my hands. I still remember the lub dubs and the whooshes and what a tender liver versus a cirrhotic one feels like.
My career path and the government and my patients’ preferences and insurance companies and I suppose the moon and stars have all weighed in and changed medicine forever.
My black bag went from holding the wonder of hands-on medicine and Oslerian inquiry to ferrying boxes of medication samples to finally just being a repository of old needle caps and alcohol pads, still freshly sealed but never to be used to clean the earpieces of a Littmann again.
I parted ways with my black bag a while back.
I tried to display it, keep it on a shelf, contemplate handing it down to my grandchildren. I even had a fantasy, oh, so brief and sweet and nostalgic, about using it again. For what, I did not know. The thought carried me through at least one day, then went the way of the tuning fork.
When my granddaughter enters medical school one day hence, if she decides to, she will know of iPads and diagnostic scanners out of Star Trek and push button electronic treatment plans.
Much like the first time she held that tiny plastic stethoscope to her chest and heard her own heartbeat for the first time that Christmas far away, she will scan my retina, flinging a colored holographic image into the air and saying, “See, Papa, see what we can do now?”
I will talk to her and tell her stories of the old black magic.
She will tuck me in against the cold and tell me stories of the stars.