Bow ties & Pipes

Welcome to the Sunday close. Enjoy a rest & reflection piece before the new week.

There’s a certain species of internal medicine attending that mostly exists in memory now. They wore bow ties. They carried pipes.

They spoke slowly, as if the diagnosis might reveal itself mid-sentence if given enough respect.

Their offices had bookcases. Not Billy from IKEA, but real ones. Not decorative Zoom backdrops. Shelves that sagged slightly under the weight of Harrison’s and an outdated PDR, old journal issues, dog-eared paperbacks, and books that had nothing to do with medicine at all.

You didn’t rush these physicians.

You sat with them. You didn’t interrupt them. You didn’t ask if you could go eat lunch at noon. You didn’t tell them about your plans for the day. You didn’t dare not do your reading assignment.

I had that attending. I learned from that attending.

You did not let them down.

It was okay to wait with them. Allow them to think.

I say this as an intensivist who spends most days surrounded by alarms, protocols, drips, and the constant awareness of the clock.

But deep down, I still love internal medicine’s tendency to pontificate.

To pause. To wonder. To ask, “Yes, but why?”

There’s something grounding about a good IM ramble. The kind that starts with sodium and ends somewhere between renal physiology and why idiopathic really just means “we named it after ourselves.” The kind that makes no apology for thinking out loud.

Of course, the bow ties and pipes didn’t disappear. They evolved.

Today, they wear fleece from Figs, Lulu, still carry pagers, and answer texts at impossible hours. We call them hospitalists now, but make no mistake—this is the same all-knowing internal medicine creature. The one who can hold twelve problems in their head at once, remember what happened three admissions ago, and still pause long enough to ask the one question no one else thought to ask.

Different uniform. Same mind.

Maybe that’s why the backdrop still matters: bookcases behind the desk. Not for show.

They give you license. License to think slowly in a fast world. License to value curiosity over efficiency, at least for a moment.

My ICU life demands decisiveness. Internal medicine taught me patience. With uncertainty. With narrative. With the idea that medicine isn’t just what we do, but how we talk our way toward understanding.

Bow ties and pipes weren’t fashion statements. They were signals.

We are thinking here.

So no Ink & Oxygen series this past Friday. And no heavy lifting tonight either, friends.

Just a quiet nod to the lineage of internal medicine thinking…past and present. I believe it still shapes how I practice every day.

Back to the alarms Tuesday. With gratitude,

— BOKA

Shoutout to Rosh for the visual / theme here. Reflection has been published on BokaMD.substack.com as well.