Author’s note: an expansion of this post has been published in the Spring 2013 issue of The Intima: A Journal of Narrative Medicine.

Chuck Jones had strong thoughts about strong lines, and anything on the subject from a man who could make a rabbit into Brunhilde should be closely attended. Here he is on his drawing education in 1989’s Chuck Amuck:

Chouinard in Los Angeles offered excellent schooling in the fine arts – painting and drawing in the classic traditions. But the most important and stunning discovery I made at Chouinard, one that has been shared by every artist, cartoonist, painter in history, from Cro-Magnon art to Claes Oldenburg by way of Leonardo, Goya, Frans Hals, Van Gogh, Herblock, and Beatrix Potter, was the ability to live by the single line – that single honest delineation of the artist’s intent. No shading, no multiple lines, no cross-hatching, no subterfuge. Just that line. Was it Feininger or Kandinsky who said, “My little dot goes for a walk”? Just so, every point on a line is of equal importance. That is rule 1 of all great drawing. There is no rule 2.

Maybe this assertion most impressed me because it nailed everything that was wrong about my own drawing. When I was in fifth grade I wanted to learn to draw, and acquired a book to that end. I had seen a tiny ad in the back of Boys’ Life that claimed to be able to teach drawing; your talent could be discerned by copying a smiling little turtle head wearing a jaunty cap, which you would send in to the address listed and await further instructions.

I was awful at it, but I do remember that the book advised making hundreds of tiny, light lines instead of bold ones. As I tried to copy the cartoony elephants and tigers, I did so with little scratches that made the outline seem faint, furry, barely there. When I got into art class in middle school, Mr. Foster (myopic, lavender sweater, stank of cigarettes) admonished me to knock that off: to make a single, confident line if I was going to make any line at all and stop dithering about. “Dithering” being the memorable word, suggestive of weak moral fiber and faint intention. Mr. Foster called me out for my indeterminacy as clearly as Chuck did. Stop scratching around the edge and draw, already.

We imagine ourselves drawing a strong line in our daily practice as caring professionals. The culture expects us to. Johnson & Johnson is running a powerful Campaign for Nursing’s Future right now, including several commercials. The first one I saw was muted, but the images did the work: a smiling woman confidently offering a drink to a bedridden one, strong, tender, knowing hands smoothing a blanket around and under tired, wrinkled ones. The stock teacher pictures that run next to every ed policy story in every newspaper show the same: smiling people in front of whiteboards and Smartboards, mouths open in mid-declaration of something surely known and asserted to a room full of occupied desks with raised hands. There she is again in Verizon’s “Telepresence” ad, which touts the wonderful advances technology can bring education but knows better than to mess with the smiling, confident teacher in front of the chalkboard.

In other words, effective caring professionals don’t dither. They execute with clear eyes and clean hearts (“no shading, no multiple lines, no cross-hatching, no subterfuge…”). But those who work to prepare caring professionals are beginning to see the dangerous shortcomings in training for such confidence. They include arrogance, inability to collaborate or learn from mistakes or, ultimately, to actually have a connection with the one you’re caring for. It’s well-documented in medical schools and emerging in nursing and social work – the push for expertise and algorithmic accuracy in diagnosis and treatment (“best practices,” we call it in education) tragically undermines the actual capacity to care.

I remember a simulated joint-care exercise I observed years ago at a medical school, where teams of students from medicine, nursing, OT, social work, and nutrition worked with a standardized patient who had been in a car accident. They would take history, then conference and develop a care plan before sharing the plan with the SP. As soon as the SP left the room, the single med student began barking orders to everyone else about what they should do next. The nursing student was first, and her to-do list was long. She listened until he was done, then asked respectfully, “Doctor, have you checked her for allergies? If she’s allergic, three of those medications could kill her.”

There it is: the uncomfortable notion that someone else might know something that your training has made invisible to you. That’s a truth that can and should trouble our equanimity as well-trained professionals. The real world has a way of doing that – messing up our best ideas and intentions with stubborn reality, asserting how the map is never, ever the territory (and we might not even have the right map).

Which gets us back to that unlovely word, “dithering.” What’s it mean? What can it tell us?

…one of the earliest [applications] of dither came in World War II. Airplane bombers used mechanical computers to perform navigation and bomb trajectory calculations. Curiously, these computers (boxes filled with hundreds of gears and cogs) performed more accurately when flying on board the aircraft, and less well on ground. Engineers realized that the vibration from the aircraft reduced the error from sticky moving parts. Instead of moving in short jerks, they moved more continuously. Small vibrating motors were built into the computers, and their vibration was called dither from the Middle English verb “didderen,” meaning “to tremble.” Today, when you tap a mechanical meter to increase its accuracy, you are applying dither, and modern dictionaries define dither as a highly nervous, confused, or agitated state. In minute quantities, dither successfully makes a digitization system a little more analog in the good sense of the word (Ken Pohlmann, Principles of Digital Audio, as quoted in Wikipedia).

Seen through these eyes, maybe “dithering” isn’t a distraction from effectiveness: maybe it’s a part of it. It helps aspirations to precision and comprehensiveness actually work out in the real world, making our best machines “more analog in the best sense of the word” by grooving the 1s and 0s of algorithmic practice into actual peaks and valleys (not for nothing is analog sound “warmer” to the audiophile’s ear than digital, methinks).

When I know to look for it, I see arguments for dithering in the many of the wisest words I know about teaching, caring, and living an involved life. There’s Parker Palmer, describing how one of the century’s most insightful scientists said her best advice to neophytes was to learn to “lean into the kernel,” to get a sense of the actual lived experience of the thing you hope to understand by introducing the unique noise of life into your analysis and deliberation. Over here there’s a powerful article in the Journal of the American Medical Association on how to prevent compassion fatigue through the important usual suspects (reflective writing, meditation), but also a startling description of “exquisite empathy,” a state of sustainable connection born of leaning in to the very situations and tensions we thought caused burnout in the first place.

And here we have Pema Chodron describing a state of equanimity before the daily travails of life – ceasing to struggle with the challenges of attachment, coming into abiding compassion with yourself as path to enlightened empathy with other.

The basic ground of compassionate action is the importance of working with rather than struggling against, and what I mean by that is working with your own untwined, unacceptable stuff, so that when the unacceptable and unwanted appears out there, you relate to it having worked with loving-kindness for yourself. Then there is no condescension. This nondualistic approach is true to the heart because it’s based on our kinship with each other. We know what to say, because we have experienced closing down, shutting off, being angry, hurt, rebellious, and so forth, and have made a relationship with those things in ourselves (pp. 146-147).

That would be the deepest admission of the noise of actual living into ourselves of all, would it not? Embracing all our personal human dithering as part of the ride, “leaning into it” and, therefore, embracing it in those we seek to care for?

So “dithering” is way deeper than being “nervous, confused, agitated;” it seems to involve talking back to the judgment of dissolute intention I heard in Chuck Jones’ call to a confident line as “rule 1 for drawing well.” Perhaps it even includes a “trembling” before what we cannot ultimately understand, an acceptance of how ultimately inaccessible the deepest human processes of “healing,” “learning,” “connecting” are to our most assiduous assays to understand and regulate and predict and contain them.

This becomes the province not only of Palmer, but also M.C. Richards and Rachel Naomi Remen, who have also begun to map the reality of lived experience with healing and teaching, how completely any honest student of either must eventually admit how little we know and seek a deeper connection to a greater power then oneself. I take interest (and not a little pleasure) in how each of these three wise ones began their career in the academy of traditional, rational knowledge, and after earning their impeccable “straight” PhDs left that world to seek better explanations for what they were experiencing. They listened to their “trembling” before what they could not fully grok with the tools they had developed, and left to try to create new ones. Chodron talks about the “refugee vows” taken by those of her Buddhist order – a commitment to leave the quest for security and instead trust the world’s unknown to bring you what you need. It takes courage to take such vows, and I have deepest respect and gratitude for the courage and example of these refugees, and the wisdom they now have to share.

I hope some of that wisdom is coming through here. Of course I still love a confident line and treasure it whenever I find it, in music as well as art. Somewhere I’ve got begun a little exegesis on the wonder of the rising swells of Adele’s “Skyfall,” and my youngest son could give you a better account of the joy of the strong line (a.k.a. “killer hook”) in fun.’s “Some Nights” than I could, which we agree is the single of the year and everything that’s right about pop music. Strong lines everywhere. Lovely.

But for actual connection with actual people, let us have less assertiveness and more attending; less fake-it-till-you-make-it and more reverence before what you (or we) really don’t fully know yet. That’s a unique and precious comfort we can offer. I wonder if it might not be part of the “maturity” the anonymous author of “Let Us Have Medicos of our Own Maturity” seeks in his caregivers:

Let us have medicos of our own maturity,

For callow practitioners incline to be casual

With a middle-aged party…

Let our medical attendants be of compatible years,

Who will think of us as in certain ways their peers.

Who know what we possible still have to live for,

Why we are not unfailingly poised to withdraw…

Then permit us to be appreciative and appreciated

A little in our final fruition, however belated.

Image from Michael Gordon’s blog on digital printing, with thanks.