Performance Anxiety

I have recently developed performance anxiety -no, not the wide-eyed, heart-thumping, late night Viagra-requiring variety… although that does sound interesting. And not the more artistic type you would expect to get while standing behind the curtain backstage before walking into the spotlight to the expectant applause of a full theater. I don’t have that kind of talent. And anyway my more immediate concern there would be tripping. No, it’s far more… digital than that. Perhaps I should explain.

Ever since my days as a high school nerd, pocket protectors have epitomized my calling. True to the role, I tried to stay at the cutting edge of social ineptitude, but as I aged and morphed into an adult, I became aware that the plastic protector pouch looked silly and that, like a tail,  carrying too many pens was vestigial. The age of the nerd was ending and there seemed no one but me around who was at all nostalgic for it. It had become anomalous -a quaint but naive time in a world that had evolved beyond it.

I was able to keep up with the social awkwardness, however, thanks to my annoying habit of not watching sufficient TV to be able to talk sports at the parties to which I’m no longer invited, or by not using the latest slang expression properly -if at all- at work. I still can’t bring myself to say “No worries,” if someone bumps into me, and am more likely to excuse myself for being in their way. I have trouble knowing how to respond to a ‘high five’ gesture, and when introduced to someone new, have an amazing penchant for immediately garbling her name and then promptly forgetting it.

So it was with high hopes that I felt I would be riding a new and different wave with the Electronic Medical Records system I was reluctantly forced to install in my office. In spite of my hesitation, I felt I was about to reincarnate into Geek, the twenty-first century equivalent of my high school name.  I loved the word and immediately tried to parse it.

I have been writing for years on a computer, so I didn’t anticipate any problems with the transition. I do have to admit to a certain nostalgia for paper, though; crumpling it when you make a mistake is one of Life’s irreplaceable pleasures. Even the subsequent necessity of throwing it into some sort of receptacle -and hitting the target- is a form of release. A silent Cognitive Behaviour Therapy.

But I very much suspected that not having something to shuffle in front of me, to rumple up or underline with emphasis, not being able to free-hand a diagram with curved lines and arrows and otherwise describe difficult and obscure anatomical features in full view of a curious patient would prove disappointing. Nerds -extinct or not- have always been complex integrators -visual as well as cerebral. We didn’t just carry all those different coloured pens around for show. We used them -all of them- on different occasions, each with a purpose, like actors in a play.

And indeed, writing, drawing, and underlining while the written-about watched was part of the show. Part of the interactive play. By changing pens, or circling something scribbled on the paper, the person across the desk knew she had said something important. Something helpful. It encouraged her to continue, often with details she would not otherwise have supplied. And it’s a full eye contact game: the nodding head, the subtle but respectful smile, the slow reach for a lab requisition -all signs to the patient that she has succeeded in conveying her concerns. All boding well for an auspicious climax for the interview.

I had difficulty imagining that the clack -or lack of clack- of my fingers on the keys would elicit the same response. Somehow, restricting my interactions to a screen that only I can view seemed anathema to the relationship I was trying to foster. Since everything is printed and filled out in the secret bowels of the computer, there would be no moment of hesitation and then deliberate reaching for different coloured forms -each one invested with authority; no more wide-eyed admiration for the amount of  information I had been able to extract that she could see in her shared view of the chart from across the desk; and no more wonder at the ability of doctors to read their own handwriting -all part of the magic and method that is Medicine.

But when the moment came to transform the interaction from the smooth hiss of a pencil drawing a diagram, from the silent mating of pen on paper, from the sweeping elegance of an encircled thought, or an underlined, obviously critical datum -from, in other words, personal to digital- an unexpected problem arose. Something I could not have anticipated. Something not all the preparation, all the latest technology, nor all my previous experience with computers would have suggested: I simply could not type with another set of eyes staring at my fingers. I could feel the criticism with every pause to check the keys, the judgement whenever I slowed down, the silent mirth in her eyes whenever I chanced a look in her direction and made a mistake… And the more I thought about it, the clumsier I became. I typed like someone wearing gloves. I kept flashing back to the piano lessons I had as a child when I first discovered, to my shame, that I was distressingly ametronomic.

My older patients seemed to understand -I don’t think they even noticed my almost stochastic approach to the keyboard. They were too busy searching for my eyes. Feeling my pain. Like they had come to help me. No, it is the young who notice. But they are usually too polite to criticize openly, too amused at the unexpected levelling effect of shattered hubris to do other than smile. It is I who feel discomfited, I who feel I must apologize… And I who inadvertently delete the page trying to recoup my composure. Re-establish my rhythm.

Performance anxiety now has new meaning for me. It is the wave I am riding as I attempt to surf into the new époque. But I am philosophical about it, and I had a thought: could it be keyboard performance and not the other stuff that is really what separates the young from the grey? Something you don’t need a pill for because it improves with time? And hope sprung eternal… The golden age is before us, not behind us –as Shakespeare wrote, probably typing the whole thing without a mistake -assuming no one was watching from across his desk, of course…


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