Weinstein - A DOCTOR’S LIFE

In illnesses one should keep two things in mind, to be useful rather than cause no harm.

HIPPOCRATES, ON EPIDEMICS

It is for the younger people to meet the conditions of their generation in the way that appears to them to be wise and best.

WILLIAM J. MAYO M.D.

Never let routine methods become your master.

HAROLD GILLIES M.D.

The stories in this book are true. However, I have changed the names of patients and colleagues, sometimes adding features to their person that they did not possess, for obvious reasons. Some of the stories, while fundamentally true, have been told with some color added, like a little makeup, to highlight certain features and points, and all suffer from the eroding effects of memory. There is however one narrative in which I have consolidated a variety of factual interactions with a singular attending into one partly fictional episode. In this case, I have added a physical feature that he did not possess, not simply to obscure his true self but to better capture his character and the medical dogma that he espoused and personified, and which has fast become the bedrock, though not the cornerstone (the cornerstone will forever be the patient), of medicine in the twenty-first century. As for myself, I have changed nothing.

I have been writing this book in one way or another, storing away in my mind certain vignettes, extraordinary moments, observations and experiences, for many years, but it was only when my son entered medical school that the idea came to me that now might be the time to compile what I carried in my head into book form. What follows, therefore, was written with my son in mind, for him, but not as a father to a son but as an older colleague to a younger colleague (and so not to him alone) just beginning a life in medicine, a life I began over a quarter of a century ago. A doctors life is, in my own experience, far removed from other professional or conventional lives. It is not a nine-to-five life. The work is not bound by timepeople become ill regardless of whether it is day or night, and very often emergencies occur at the most inconvenient times. The work itself occurs at the very edge of the human condition, and in consequence becoming a doctor means leaving civilian life for parts unknown. This is not to assert that a life in medicine is any more important than any other honest work. It most certainly is not. The demands, however, in my opinion, are greater because the stakes are much higher. The closest I think any life comes to that of a physician is either in the clergy or the military, both lives that require leaving the civilian world.

Ideally, I have written something, if not in aggregate than in part, in the hope that my son and his colleagues, the caretakers of tomorrow, might discover something coherent that will both benefit and advance their own practice in general but the people they care for especially. For even if the administration of medical care is markedly different in the future, as I suspect it will be, there will nevertheless be one unfailing constant in its delivery, the most essential figure and raison d'etre for medicine itself, the patient who has come out of some concern, seeking care for some symptom, willing to put his blind trust in another, and is waiting to be seen.

He said it doesnt look good

he said it looks bad in fact real bad

he said I counted thirty-two of them on one lung before

I quit counting them

I said Im glad I wouldnt want to know

about any more being there than that

he said are you a religious man do you kneel down

in forest groves and let yourself ask for help

when you come to a waterfall

mist blowing against your face and arms

do you stop and ask for understanding at those moments

I said not yet but I intend to start today

he said Im real sorry he said

I wish I had some other kind of news to give you

I said Amen and he said something else

I didnt catch and not knowing what else to do

and not wanting him to have to repeat it

and me to have to fully digest it

I just looked at him

for a minute and he looked back it was then

I jumped up and shook hands with this man whod just given me

Something no one else on earth had ever given me

I may have even thanked him habit being so strong

RAYMOND CARVER

You have at last put on the short, white coat. A coat not of many colors, but a powerful coat. You are going to become a physician, a medical doctor, a healerlet that sink inand I hope you are very proud of yourself. You should be. You have worked very hard to achieve acceptance into medical school, and at a time when many of the best candidates are turned away on their initial attempt. You will soon be inducted into a tradition that stretches back millennia, and you will no longer be the civilian you are now. You will become privy to the most extraordinary experiences that few know. You will see, firsthand and up-close, life at its most joyous and at its most desperate and everything in between. But more than simply being there as an observer, you will participate in peoples lives and in their deaths, when they are well and when they are ill, sometimes making them well, sometimes easing their passing, but always in ways and in privileged positions unimaginable to those who are not physicians. You will care for men and women and children in their most vulnerable and frightened stateswhen they are literally naked or wearing threadbare gowns that make one feel more exposed than if they were wearing nothing. But also, on their most joyous occasions too. You will see how people bear pain and sufferingsurrender, despair and courage will become manifest before you. The very word, patient, is derived from the Latin, patientem: bearing, supporting, suffering, enduring, permitting.

* * *

You should know that the road you are embarking on is long and winding and without any destination. I say this with some caution and reluctancy. Not as a warning or to discourage. I say it simply because you should know what you will be dedicating yourself to and how much sacrifice such dedication will demand of youand your family. The making of a physician is a never-ending journey. The adage that the journey is the destination is very true for medicine. It is a high peak to aspire to, but, like all steep climbs, do not look up at the mountaintop too much because, unlike real mountaintops, the peak will forever recede further into the distance, into the cloudy heights. Moreover, the effect from such heights can be dizzying when one comes to understand that there is no summit. When I think of the path you are about to embark on and imagine myself beginning again at basecamp, retracing my steps to this point, with the summit still out of my reach, my stomach turns. Even so, I am happy I practice medicine. There is nothing more satisfying than caring for people. When you are an old man and look back on your lifes work, you can trust that you will not have squandered it or labored for ephemeral things that do not matter and in sum are of no consequence.

* * *

You will be the bearer of the greatest good news and the most devastatingly bad news. You will witness humankinds infinite capacity for hope and blind faith and observe what real fear looks like and not how it is portrayed in the movies. And you will share in the joy and in the loss that follows that hope, faith, and fear. This privilege and responsibility is awesomenever forget that. If my words sound overly dramatic, that is only because you have not yet experienced life on the wards and in the clinic, the life of a doctor. You have not yet had to inform a forty-eight year old woman, the mother of three children, the oldest just beginning high school, that she has cancer, and that the cancer is everywhere. You will know that she will be lucky to live six months, even three, but she and her husband, do not know that. For them, there is still hope. After all, a few weeks ago she felt perfectly fine, and insists she is still feeling well except for some nagging abdominal pain. Nor have you seen the raw, unjust, and underprivileged side of life. Just think, in very short time, you will be endowed with the power to declare a person dead; your signature, and yours alone, will be what legally certifies that this human being is no longer to be counted amongst the living. You will also deliver life into the world, be the first to hold it in your hand. Perhaps that polarity sums up what is to come perfectly.