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There are days I hate being a doctor. OK, let's be honest -- there have been weeks, and with the current pandemic, the whole past year has been an entire theme park of emotional roller-coasters. I think a better description would be to say that there are circumstances in which I hate my role as a physician.
Being a doctor is my heart-song. It is my identity; it is my first true passion, it is my purpose. I love being trusted by patients to make important decisions with them, or even for them if they are too afraid to do it themselves. I love dissipating that fear. I want to be the person who makes them feel safe. I get to be that person so often that my job is actually incredible.
Why did I lead with "I hate being a doctor" if I am fulfilling my passion day in and day out and building meaningful relationships with so many people? I hate the bad news. I hate it. Delivering the worst possible scenario we prepared for but didn't think was likely is still destruction to me whenever I have to see the face of life just shattered.
It just happened again 3 days ago. I had worked a full week, closed my final charts, and signed the few remaining prescriptions before preparing for an 11-day spring break vacation. Then it popped into my inbox -- breast biopsy pathology results for a 40-year-old I have loved since I first joined my practice.
Invasive cancer.
It never gets easy. The sadness sinks you. Breaking bad news 1-hour lectures don't prepare you for what real life throws into your inbox on a Friday night before you leave for vacation. Picking up the phone that night was heavy. I had promised her a call as soon as I found out, even if it was after hours or on the weekend, but, I mean, what do you actually say? "I'm so sorry to tell you this. The results are unfortunately not what we hoped for. It is cancer [pause, let the patient breathe and hear me]; I am so sorry, how can I help?"
Medicine has so many rewards, and I have been beyond moved by unexplained miracles, catching the infamous medical zebras, bonding with entire families who come to see me year after year, delivering babies, and seeing the parents' faces the first time they hear their new child. It is magical, this art of ours. It is also maniacal. The lows mess with our hearts to such catastrophic levels that I truthfully know I hold back full emotion with close friends and family for fear of hurting too much when I lose them.
We are taught to move on to the next patient, pronounce a patient, sign a time of death, sanitize our hands, and move next door to continue rounding on the patients who need us. They need us. But we need them, too. We need their time, their stories, their gifts. It just hurts so much when they leave us, and we are the ones inducing a pain response 10 minutes after they said their goodbyes.
The weekend I got engaged was the last month of my intern year. I wore my new engagement ring despite worrying it might snag on my gloves. I was assigned the ICU, and we had 13 patients die in those 4 weeks. Thirteen. I stared at my ring underneath my glove as I broke through the diseased bones of a 30-year-old. I felt her heart soften into my palm as I performed what I knew was another futile round of compressions until my attending made the decision to tell our team to stop the code. The entire time, I was staring at my engagement ring, praying to disassociate and remember the proposal so I wouldn't feel what was happening right in front of me. We called the code. I took off my heavily blood-drenched gloves. My ring was shining and beautiful, and I hated it for what I had just done in desperate attempts of self-preservation. I washed my hands and immediately went to the adjoining room to see my next patient. My heart, however, I don't think has ever fully moved on since.
This is what we do as physicians. We try to proactively prevent disease, attack it in early stages to prevent complications, aggressively treat it with medication and surgical interventions, and hope our training and expertise help us save as many patients as possible. We are human, though, and we cry, mourn, feel guilt and fear and pressure and terror. And we love these patients through every step of the journey. This, I suppose, is my true heart-song.
, is a family physician.
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