I’m diligently writing a detailed note in the patient’s chart as he speaks of his multiple concerns – severe depression, headaches, and dizziness. I’m not making good eye contact. Often this is effective because I can resist the allure of passively following his narrative to its own diagnostic suspicions. Instead, I can record his intuitive guesses without persuasion, formulating my own independent ideas even as I value his. Except that as I write in his chart I notice streaks of red blood appearing among the black script. Am I hallucinating? Am I capable of making paper bleed? Am I, the doctor, bleeding?

With closer inspection I notice three small cuts on my chapped knuckles and fingers, products of the incessant and obsessive hand washing compelled by modern medicine. We are obliged to wash our hands before and after each patient contact, which leads to about 60 hand washings per day. In the dry winter air this can become punishing to the integrity of the skin barrier.

I apologize to the patient for marring his chart, yet it almost seems symbolic – physician blood spilled upon a script of human affliction. I know I should tear the page out of his chart and write a clean new one, yet the scrawls of black ink and stripes of red blood look like art. It is a poem, punctuated with living iron and crimson flourish. Despite having made poor eye contact in an attempt to distance and strengthen my consideration of his symptoms, ironically I see the commonality of our bleeding.