Beyond the Pain

Of all the details the doctor remembers, he forgot that a lunch appointment typically includes lunch. "Just a minute," said Alan Blum. "I want to show you something." He led the way to his office, where on the floor were several large boxes of scraps and tatters. They were faces mostly, thousands of faces, all staring out in a riot of anguish.

"What I do is draw how they look at me," Blum explained. "I don't see many smiles."

As he flipped through the papers, the minutes became hours, and lunch was forgotten. Blum has the look of a man who has forgotten many meals. He spoke quickly, often in sentence fragments, finishing thoughts in his head long before his tongue could get to them. He admitted he is "probably the most divvied-up person" he knows, but he didn't want to talk about his other passion. This was to be a story about the doctor's art, and if his anti-smoking work were mentioned, Blum feared people would only think, "Oh, there's that fanatic again."

But how do you avoid that? The many faces of Alan Blum all have Alan Blum in common, and it's impossible to separate one from another. His parodies of cigarette ads ("Emphysema Slims: You Smell from a Long Way, Baby") are as blunt as his portraits are subtle, but both derive from the same concern for the patient and for honest communication. The doctor does what he must to make his point; the full-throttle crusader is also a full-throttle artist. At Baylor Family Practice, where he works as a teaching physician, Blum stopped colleagues in the halls to ask what they thought of his art. One woman said it helped her to see patients as whole people again; another simply said Blum's sketches changed her life. The doctor took out a pad and wrote that down.

"I think there are novels in people," he said. "I think that listening to patients is like hearing a poem."

Blum once considered becoming a writer -- a journalist, not a novelist, he said, "because I like to do what I see." Over time, it was his doctor father who taught him that the art of medicine is actually the art of observation. Blum's father seemed to know everything about medicine, but he knew more about Rockaway Beach, New York. At the end of a day, the boy would ask his father whether he'd had any interesting cases; the answers were always brief until Blum began asking whether he'd met any interesting people. That's what most impressed the boy: the small talk his dad talked that had nothing to do with a patient's medical condition but everything to do with his human condition. What do you do? What do you enjoy doing? Blum's father asked simple questions and came to know what he was doing to whom.

So Blum went off to medical school, and there began doodling in the margins. His first drawing was of a statue, then there was a sketch of a parasite, and finally, Blum evolved to people. In the late seventies, during his residency at the University of Miami, he began sketching in earnest as he made the rounds. Whenever it seemed a patient wanted to talk, Blum would sit down and take out his ball-point pen and begin scratching across a folder or envelope or prescription pad. He drew the patients with canes and crutches and tubes in their noses, and he wrote down fragments of what they said. The work silenced him and made him listen.

Like I told my wife, maybe I made a mistake when I put some whiskey in that prune juice ....

I got things to do. I got Popsicle sticks I make things out of ....
They had the funeral last night -- all the ushers, choir, deacons and the white people he worked for ....

About the same time, Blum founded a group called Doctors Ought to Care and began traveling the country speaking on the evils and absurdities of tobacco. "Grimly serious and rollickingly funny," the Boston Globe described him. He "brings to medicine two things sorely needed," another observer wrote, "humor and social activism." In 1988, C. Everett Koop took notice and awarded Blum the Surgeon General's Medallion.

Doctors Ought to Care fights the causes of disease rather than just the effects, and that became Blum's approach as a physician: before you do the test, before you make the prescription, try to get some background, try to see the person beyond the ailment. At Baylor Family Practice, Blum pounds that point home with the residents. Each year, he rents a bus and shows them the town. They visit the jails and AIDS clinics and impoverished parts of the city, and in this way, learn about the people they'll be treating.

Blum learns the same thing when he sits down to sketch. With x-rays and MRIs, doctors often photograph parts of a body; to Blum, it only makes sense to first sketch the entire person. He files the drawings in boxes, and gradually the faces have piled up. In 1981, Blum pulled a few out to publish in the Journal of the American Medical Association. In 1987, he withdrew a few more for a faculty art show. Every few years, he'd take them out and show them around, but the doctor had no real commitment to his art until last year. In May 1994, when he presented his portraits to the American Society of Family Practitioners, he realized from the reaction that he was onto another something he couldn't let go. His art suddenly had meaning.

"I'm trying to remove the gap between the patients and the doctor," he said. "I'm trying to give folks an idea of what medicine is about -- the wonderful privilege of hearing people."

Last month, Blum presented a slide show at Baylor College of Medicine entitled Seeing Patients: The Sketchiest Details. His drawings were also the subject of an exhibit at Houston Community College, and they're due to appear soon at the University of Texas Medical School on Fannin and in the Journal of Family Practice.

Whether a doctor should reveal the confessions of his patients isn't a worry for Blum. Often the patients on display have died, and often, the words he attributes to one might have been said by another. Perhaps a journalist would offer the facts, but the artist offers an understanding -- in Blum's case, of what it means to be a patient, to be alive and not well in America.

The doctor-artist has a dream now. He wants to take his show on the road -- to memorize the lines, master the dialects, choreograph his movements across a stage. Not show biz, he clarified, but "performance art" -- something to help medical students see the whole patient, rather than just the parts. Something grimly serious, perhaps, and rollickingly funny.

"I'm not an artist -- I've never even played one on TV," says Blum, "but if I could get doctors half as involved with my sketches as I have with my tobacco work, I'd be very happy.


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