It is not uncommon for doctors to question the reasons why we do what we do. The journey is long. The debts often seem insurmountable. The harsh lessons learned from a mistake made with best of intentions are an unforgiving punishment for “life without forgiveness”. Memories may fade, but the scars always seem to linger. On the one hand, like a relief pitcher in major league baseball, we must forget the last regretful pitch and be ready to face the next batter. In our case, paralysis by analysis is not a luxury we can afford. After all, I was told early in my career that MD stands for Makes Decisions. On the other hand, we must have memory of an elephant such that a fatal mistake is not repeated.
It seems as if “why” has been the opening line in all that we do. As we go through the different portions of our journey it always comes back to the “why”. During each of those stages, however, there appears to be a predominant “why”. When I was a medical student, it was always,
Why does it suddenly seem as if I’m an idiot and don’t know anything?
When I was an Intern, it was…
Why does crap always seem to roll downhill and gently rest on me?
As a second year Internal Medicine resident, the question moved to…
Why don’t they just embalm residents in coffee? After all, if the coroner cuts us open that is all he/she would find.
Finally as a graduating third year resident the question had changed to…
Why do I finally get to make more money and yet give it all back for those $#$@%# loans?!
Little did I realize that the questions don’t end with the termination of Residency training.
I started off as a clinical junior faculty member with interest in education and direct patient care. The first question was,
Why do I still have to go through the so called probationary period to remove the label from Clinical Educator to Assistant Professor of Medicine?
Since I allegedly didn’t kill anyone during my first year as junior faculty (at least no one that I’m aware of), I was promoted to Assistant Professor of Medicine which in essence is like graduating from Kindergarten. I thought everyone graduated from Kindergarten and at least when I was 5, I got cake and a party. No such luck in Academics. Questions, however, continued.
Why doesn’t the Chairman give me a raise?
After all, I’m now Assistant Professor of Medicine! Alas, no such luck for the official lowest end of the totem pole in Academia. As I learned, some myths are actually reality. The slowest route to promotion in Academia is to take care of patients and spend time with students or residents. Miracles, however, happen, even in academic medicine. After years of being the longest non-tenured Assistant Professor of Internal Medicine, I was promoted to Associate Professor of Medicine. I was overjoyed and the tears flowed freely. Alas, the deluge did little to dilute the questions in my head. By now a middle aged Attending with a rapidly receding hairline and an ironic growth of unwanted hair in all the wrong places, the “why’s continued”. The “why’s” had suddenly become philosophical. At times, I must admit the language seemed eloquent and foreign, especially coming from my mouth. Other times, not so much.
Why was I told the wealth of a soul is measured by what it feels and its poverty is judged by what it does not when it seems as if we are all poor clothed in a rich man’s garments?
Why doesn’t anyone give a #@%@%! I’m tired of all the $@#@%!
The medicine for my endless “why’s” arrived a few weeks ago in the form of an 8 year old girl. I was the Attending taking care of her grandfather in the hospital. He had presented with non-specific abdominal pain with a broad differential diagnosis. Neither the patient nor his daughter spoke English. Our instant translator was the granddaughter. From the beginning, it was obvious that her color was pink. It started with the Disney Princess blanket that she covered her grandfather with in the emergency room. The rest of the room was not too far behind including the suddenly matching pink back wall that I noticed for the first time. We had translators by phone and at times directly at the bedside. In all my years, however, I had never come across a translator like the Pink Princess. She was not only translating with words, but was the master of using all her non-verbal clues that clearly expressed how much she loved her grandfather.
Her grandfather was subsequently diagnosed with severe chronic mesenteric ischemia with celiac steal syndrome. He underwent successful surgical intervention without complications and was eventually discharged home. Little did I realize at the time that the 10 days her grandfather was on our service that she was also a surgeon. She possessed many surgical instruments that were visibly invisible gently stripping away all the scars and by extensions all the unanswered “why’s” from the last 25 years that I had gathered. First, there was the angelic voice. Her voice put us all at ease and reminded me once again the importance of tone when conversing with a patient. What followed next was the smile. I was actually graduating from kindergarten again. Not a single member of my team could forget the daily hugs. We melted in her arms as if we were silly putty. Finally, the magical transformation she had on the doctors was completed with the look in her eyes. The quote regarding the wealth of a soul suddenly made sense for her eyes were always enriching the lives of all those around her. We had finally met Professor of Because.
If a picture is worth a thousand words, I end with a simple photograph and hope that as this elephant grows older with time that he will forget the “why’s” but always remember the “because” that came in the form of the little surgeon.