There are times my words mark an inflection point in the lives of my patients and their families. This recognition takes time to fully appreciate, and I will never forget the first time it hit me.
I was a resident working an evening shift in the ED. The place was packed with a full waiting room and I was sitting in an incredibly uncomfortable chair staring at a computer screen. Staring back at me was both exactly what I’d anticipated and exactly what I desperately hoped wouldn’t be there – a cantaloupe sized tumor. In a kid’s belly.
You take a few minutes for yourself preparing for the conversation that comes next. You rehearse what to say and how to say it, how to be compassionate while projecting the confidence needed to help someone step through the abyss and onto the path to healing. All the while recognizing that after “cancer” these people’s world will turn sideways and you might as well be speaking Cantonese.
It was during those few minutes on that specific night that I realized for the first time I was about to divide someone’s life in half. The first half was everything up to that moment – the second was everything that happened after they learned their child had cancer. It’s the kind of thing you really, really don’t want to screw up.
Practicing medicine requires balancing a constant tension between two warring factions of the mind. We’ll call the first side Hubris. She bolsters your confidence and whispers in your ear that you’re an unstoppable force of clinical prowess and no one else in the world should be doing this thing (whatever it is) at this time other than you. The other side we’ll call Humility. She calls into your other ear with a reminder that – despite your delusions of grandeur – in reality you’re only human and therefore both fallible and penetrable.
Each of these muses is necessary but insufficient to both practice as an individual doctor and for doctors as a whole to advance medicine. Without the Hubris, it would be impossible to both have anything resembling a heart and muster the level of confidence and compassion required to deliver the kinds of news we deliver on a regular basis. The life-dividing kind of news.
Similarly, without this extreme level of confidence no human would have ever tried (much less perfected) the practices or procedures that advance all of medicine. Michael E. Debakey, the first surgeon to successfully repair a dissecting thoracic aortic aneurysm (and then decades later have the procedure performed on himself by a surgeon he trained) once told Esquire:
It’s important for a patient to go into an operation with confidence… the operation I did in ’53 for aneurysm of the thoracic aorta gave me great satisfaction. It had never been done successfully before, and lots of doctors took the position that you shouldn’t try it. You’ve got to push ahead in spite of them.
I’m not a surgeon, but I am 100% certain it takes some serious steel to walk into an OR and believe that you and only you can save a person’s life when all other surgeons have failed. And then do it.
On the other hand, without humility physicians would never acknowledge when we’re wrong (either individually or collectively). We also wouldn’t be able to accept the inevitable times when – even if we were right – disease humbles our every effort to thwart it, and our service must redirect from seeking cure to seeking comfort.
I cannot count the number of times I’ve had to tell parents that – no matter what we do next – their baby will die. The most painful of these conversations have been with expecting parents who are imminently delivering around 21 weeks gestation. They are so close, yet on the wrong side of the fuzzy line demarcating when all of science’s advances can give a baby a chance… and when it can’t.
More than once my body has physically trembled saying something to the effect of “It is my job to bring all that medicine has to bear to save babies. If there was literally anything I and the team of hundreds of NICU caregivers behind me could possibly do, I would do it. But I can’t. And I am infinitely sorry.”
There are few things more humbling than admitting you are powerless to change something. These conversations have been simply the most humbling experiences of my life. And I remember every single one of them.
Not too long ago a picture went viral of an ED physician crying in the parking lot after losing a young patient. The sensation made it clear that the world rarely sees physicians when we’ve been humbled. In part this is because life keeps moving. The next patient is waiting, and he’s relying on us reassemble ourselves and both confidently and competently care for him no matter what happened in the room next door.
We have improved in recognizing the toll that this takes on us (e.g., in the form of burnout) and have many more support programs now than when I started medical school nearly 15 years ago. But no program can change the reality that the practice of medicine will forever orbit between the dueling gravitational centers of unshakable confidence and earth-shaking humility.
Finding balance between these two great forces is what makes being a doctor both so incredibly fulfilling and so incredibly humbling, and why the pursuit of perfecting our craft has more than once been compared to seeking divinity.
In the immortal words of Cicero:
In nothing do men more nearly approach the gods than in giving health to men.