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Sorry to go on and on. Folks don’t realize what it takes to do most other peoples jobs but I believe Medicine is different from the others. I suppose that is what attratcts many to it. A few don’t realize what they are getting into.

To illustrate, when I was a Neurosurgery Resident we had a young man in the hospital who had broken his neck in an auto accident. He and his cousins were celebrating his bachelor party and drinking and he was driving during the accident in which his cousin was killed. His family wanted the doctor to be there when he was told about his cousin’s death several days after the crash. I was called by the nurses that in 15 min. or so the family would be there and I was busy doing other things in the interval. Three minutes before the nurses called me to ask me to come to the room my wife called to tell me my father had just called to say that my brother had been killed in a car accident the night before. Three minutes later I was in a room full of people who were concerned about their family member’s emotional response to his tragedy. None of them would ever know what I was dealing with at the moment.

Being a doctor means you have to have a certain distance from other people’s emotional tragedies and we all recognize that at different levels and accept that and it is not all that difficult but you have to grow in your ability to do so and still have some empathy. Much more subtle and insidious is the difficulty one has in providing care to patients while realizing they have an accepted expectation of your doing so without YOUR emotional problems interfering with their care. One’s GPA isn’t worth much during this “Ultimate Test” because you have to completely surrender your “self”, be profesional, and do what has to be done no matter what is happening to you at the time. There was a neurosurgeon who finished most of the case but his crushing substernal chest pain just wouldn’t allow him to finish closing the skin. He turned to the nurse and asked her to call his associate who was some distance away to come do that but that it shouldn’t be a problem for the patient because the dangerous part was over. He then collapsed and died. Our profession requires that kind of sacrifice as an ordinary occurence. I can’t tell you how many times I have called another physician at 3 AM who has had to get up and come in to deal with some family’s tragedy. Whatever you are involved in at the moment has to wait to be dealt with at some other time and you have to do this over and over again. Your family has to understand and accept it. I know of a cardiac surgeon whose son committed suicide leaving a note that said, “I am doing this to punish you for never being there for me...” (Great sentiment for Father’s Day,huh?) I marveled that he could go on after that but he did.

From the outside this may look like a great life. The expensive car, the big house. It takes a great deal from you. It also gives things that money can’t provide meaning to. The relationships with other physicians that have a quality shared, I suppose, only by soldiers who have seen combat together. They can’t know going in if they “have what it takes” and by some miracle they survived when others didn’t and they spend the rest of their lives worrying that some of those who didn’t perhaps might have if only they could have been better at it when it happened but it all took pace in the matter of seconds and then was over with leaving them with a memory that shapes the rest of eternity. The big house and fancy car end up being pretty meaningless in the wake of that memory but today is yet another day in whch new memories are being made and today’s patients have to be taken care of, too.

I probably should have done something else with my life and I really don’t recommend medicine for anyone but most of my life is over now and new doctors have to come along and deal with the mess we have made. God Bless them. I don’t realy have any regrets, I have been able to get out of the heat and cold I worked in as a young man and I have been able to get the grease out from under my fingernails decades ago. I have enjoyed the colgeiality of friends with who I “share combat” every day. Tomorrow’s doctors need to have some appreciation for what they must do to preserve our profession. They must continue to be certain that medicine provides a remuneration that will provide fo “the big house and fancy car” because otherwise our best and brightest won’t endure what is required to do it. They must realize that they have been lured into a trap by bait that looked lucrative when it was on the hook but now that hook is in your gut and you can’t get it out. They have to understand that even so they have to carry on every day and do the thing they promised to do and do it cheerfully and with compassion. They have to learn how to do it knowing that they don’t really know enough to be as good as they should be and they have to learn how to resolve to do better tomorrow. They have to do their best to hand it over to the next generation as best they can when the time comes. They will do so and will do well for “the art is long and life is short...”