I’ve been playing with a book idea for a few months, writing and re-writing the introduction and toying with different ways to shape the chapters. It’s still not fully baked, but the concept at least is formed enough to see if it would resonate…
So, in the spirit of leveraging all the 21st century has to offer in the way of crowd-sourced feedback: Would you read this book? Feedback of all kinds welcome in the comments, and please Like/Share with anyone willing to send their thoughts this way!
Throughout the world, thousands of patients will experience an event today that divides their lives in half. Before and after the birth of a child. Before and after the death of a parent. Before and after the heart attack. Before and after cancer.
For most of us these events are exceptionally rare. But physicians play a role in shaping them for their patients many times a day, day after day, often for decades.
Medical school and residency equip us with the knowledge we need to identify and treat even the most seemingly insurmountable diagnoses, and superior clinical performance is crucial to being a great physician. What medical school doesn’t do is prepare us for how a life spent repeatedly bearing witness to these inflection points in other peoples’ lives will forever shape our own.
Imagine standing in cramped hospital room where an incredibly premature infant is dying. He’s barely 12 hours old and you’ve spent every one of those 12 hours trying to save his life. You have come to know his mother and father by first name and they know you by yours. Even in this short time they have grown to trust you, to depend on you, to celebrate with you, and to cry with you on a rollercoaster of emotion unprecedented in their lives. But not in yours.
You’ve prepared them for this moment since the beginning, and when an hour ago his blood pressure kept dropping no matter how many drugs you pumped into his (quite literally) pint-sized body, you told them his battle was nearly over. And – no matter what you or God or anyone else did next – he wasn’t going to win.
You managed to keep him alive long enough for his parents to fill the room with family-members crowded around in uncomfortable chairs. Grandparents, uncles, aunts and friends all without any idea of what to say or how to feel. Except sad.
After everyone has had a chance to hold him, nuzzle him, hug him and kiss him, his mother brings him close to her chest. You lock eyes and share a moment that makes it clear now is time. The rhythmic bounce of his chest stops as you gently remove his breathing tube, allowing his mother to see his face unencumbered for the first time. You both cry.
Within minutes he’s lost his pulse and you place the bell of your impossibly small stethoscope on his impossibly small chest for a full 60 seconds just like you learned in medical school. With no breathing and no heartbeat you again look up into his mother’s eyes and let her know that he’s gone. Time of death 2:37AM.
You all grieve together and then you leave so his family can grieve alone. In any normal universe you’d then wake your kids up on FaceTime to make sure they all still have a pulse and know how much you love them and process your own sense of loss, of failure, of grief.
But you can’t.
Instead your pager goes off and, without missing a beat, you run to another room where a new family is delivering another premature baby. A tiny baby girl joining the world 4 months before she was supposed to and whose entire life relies on all the skill, training, and expertise you and your enormous team of partners in caring can muster. You cannot stop – this baby and her family deserve your very best, and no matter what happened in the room you’ve just left you cannot let your best be any less for this baby. If anything, you feel a burning need to somehow be more.
Physicians fool ourselves into thinking we can live like this at work, go home, and then live our lives like normal people. Engaging deeply with each individual patient while having a deep enough well to move from patient to patient, from inflection point to inflection point, without carrying the weight of the last one. And the one before that. And the hundreds upon hundreds before that. This is what the profession demands, but it comes with both incredible cost and incredible reward and fundamentally shapes and reshapes who we are as people.
We don’t talk about this with our patients. We barely talk about it with each other.
So I will.
Each chapter in this book centers on how it really feels to practice medicine and a different way being a doctor shapes who you become as both a physician and as a person. The loneliness that comes with the responsibility for making life and death decisions, the deep humility that sinks in with the recognition that sometimes disease will win no matter how good you are, and the incredibly powerful sense of purpose and triumph of just making it through the night and keeping everyone alive.
In the end, writing this book is as much a personal journey for me as it is an effort to provide you a window into a world you’d otherwise never experience: what it’s really like to be a doctor.