Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Joyful Deficiencies

Artwork by Megan Gerber. Copyright by Megan Gerber.


Creative expression can provide needed counterbalance to the outcomes-driven world of medicine.

“Happy are the painters, for they shall not be lonely.

Light and colour, peace and hope, will keep them company to the end, or almost to the end, of the day.”

-Winston Churchill, “Painting as a Pastime”



It was one of those muggy summer days that doesn’t allow for the evaporation of sweat, or tears for that matter. I was sitting behind the student union, holding a piece of paper with “C+” written on it, quietly weeping. I took organic chemistry, or “orgo” as it was fondly known, over the summer to “get it out of the way.” I was 23 and certain I was already too old to be applying to medical school; I needed to speed up the process, get it done, and move forward. My history degree, art classes, political activism—all trappings of a true dilettante. And now I wasn’t going to medical school at all.


Despite this setback, I was accepted to medical school and again found myself focused on results: chasing grades, asking questions on rounds to look smart, striving for Honors constantly. I ceaselessly submitted to hoops that I managed to stuff myself through. All the wonders of medical training—a confusing stew of joy, fear, sadness, pride—bracketed by metrics and evaluations, which tried to capture my transformation into a physician in a summative evaluation.


Soon I was junior faculty, then not-so-junior faculty. My career trajectory was often described as “uncertain,” 22% of my patients had a hemoglobin A1C over nine, and too few were on moderate dose LDL. Even my favorite indoor cycling studio started rating my performance, and despite hiding my name on the leaderboard, I still snuck a peek at my overall class rank every single time. While I loved my work, I was usually exhausted by the end of the work week.


Three years ago, I returned to painting, a passion from childhood. Combing through our local adult ed course list, abstract painting caught my eye—this would be fun, foster that Holy Grail of self-care. When class started, not surprisingly, I focused on the end result, the final product, the take-home. At first, it was hard for me to actually finish a painting—I obsessed about lines, color, perspective, and fine details. I despaired that I had “nothing to show” for an art class, as I returned home empty-handed more often than not. I may not have truly finished anything my first session.


Over time, with guidance from our inspiring teacher, I started to attend to the process of painting itself. Moving the paint around on the palette, I got lost in just mixing colors. I reminded myself that I truly had no need for a finished painting. One evening our teacher introduced the concept of a host color, a technique used by Richard Diebenkorn and other modern abstract painters. With this approach, one “host” color is added in small amounts to all of the other colors on one’s palette. A leap of faith is necessary. This means that if the host color is magenta, for example, you are potentially adding a small amount of it to green, to black, to yellow. My first reaction to this was one of apprehension—mixing one color into everything?! Curiosity got the better of me, and I tried it. At first, some of the colors looked a bit muddy, so I varied the amount of host color and soon found this process produced nuanced colors that I might never have intentionally mixed. When applied to a canvas together, these colors logically harmonize, but in a subtle, unexpected fashion. In fact, colors I would never imagine being synergistic in any way now sat organically side-by-side.


As I gave myself over to unbridled color mixing, I was soon freer with paint. A parallel process in writing is developing character first and finding that plot follows. Ill-defined effervescent forms appeared on my canvas; I’d paint on a square canvas and flip it continuously to avoid directionality. Reminding us of the water solubility of acrylic paint, our teacher encouraged us to stand back and “take away” what we had painted. “Make mistakes,” she exhorted us, “happy accidents are the heart of abstract painting.” I soon abandoned my carefully selected brushes and began painting with rags and sponges.


Some weeks, I arrive home from work certain that I am too tired to pack up paints, easel, and canvas, and drive across town to class. But once there, I am soon lost in the paint itself. Disappointments of the day, unmet metrics, impossible schedules and deadlines all forgotten as I yield to mixing the paint and applying it to canvas. As Julia Cameron wrote in “The Artist’s Way,”


“Be willing to paint or write badly while your ego yelps resistance. Your bad writing may be the syntactical breakdown necessary for a shift in your style. Your lousy painting may be pointing you in a new direction. Art needs time to incubate, to sprawl a little, to be ungainly and misshapen and finally emerge as itself. The ego hates this fact. The ego wants instant gratification and the addictive hit of an acknowledged win.”



One evening I noticed my teacher nearby, standing off to the side just watching me paint. Suddenly self-conscious, I looked at her questioningly. Was something wrong? I’d been known to space out in class, miss instructions.


“I love watching your process,” she said.


Then it struck me. In a personal and professional life focused on achievement, outcomes, results, and milestones, I finally found a place where none of that matters. There is no known result, no measure or premeditated destination. There is just process and every so often a finished painting. I believe (though I am happily unable to prove it in any way), that painting has enabled me to be more fully mindful during patient encounters. While the time pressures and metrics in the clinic do not disappear, they seem to matter less in those precious moments.


“We cannot aspire to masterpieces.
We may content ourselves with a joy ride in a paint-box, And for this Audacity is the only ticket.”

-Winston Churchill, “Painting as a Pastime”