The Next Generation
If I had wanted to make a lot of money, I would have gone straight into investment banking. If I were enamored solely of science, then I would have chosen a biology Ph.D. But I decided to apply to medical school. I felt a calling, a desire to be engaged in the special healing bond between a doctor and a patient.
At the same time I would have been blind not to notice a weakening of that bond and the ugly cynicism seeping into my chosen profession. The summer before I left for medical school, I read of walkouts by doctors in several states, induced by high malpractice insurance premiums and concerns about frequent lawsuits. I also heard about the rise of "boutique medicine" aimed at rich patients. Friends who had started med school a few years ahead of me already gave off a sense of aloofness and fatigue. When did this cynicism start, I wondered? And how do I maintain the sense of idealism I set out with?
My first two years, spent mostly in the classroom, nourished that idealism. To learn about the diseases that I would soon treat energized me. Even more important, I was surrounded by classmates who fueled each other's passion. Some taught science to disadvantaged students; others held health fairs for Hispanic and Asian children. On the last evening of our smoking-cessation group for the homeless, I felt a rush of hope in the room, for the participants who had thrown out their lighters and cigarettes--and for my classmates and our future in medicine.
Running into reality. But this year, my third, has brought a loss of some innocence. As I trained on the hospital wards, I was surrounded by unhappy, jaded residents--med school graduates doing their first stints as working doctors. These residents were my teachers, and they griped about the "bitchbox" or pager that they had to wear and about bothersome patients, such as "High-Maintenance Mom." Cynicism certainly catches on. I was stunned how quickly I had started to change. Just a few months in, I rejoiced with one young doctor when our frail, demented patient was finally transferred to a nursing home. We celebrated not because we had helped him--though we did, a little--but because we were relieved that he was finally off our hands. Another classmate ruled out a specialty she had long considered, because the patients were too needy. "Too needy?" she said. "I can't believe I am thinking this way, but they were just too draining."
But as much as cynicism is contagious, so are compassion, optimism, and hope. One professor required us to include in our case presentations what our patients like to do for fun. He understood that while wading through a sea of data about a patient, it was easy to dehumanize care. The woman with Marfan syndrome and a serious heart problem, it turns out, had been an avid hoops player. The man with cocaine-induced chest pain--he's a serious stamp collector.
One resident showed me that even while being bogged down with paperwork and beeping pagers, taking a few minutes to do what's not "required" is still possible--and can make a real difference. In the clip of a busy day, he found time to counsel a homeless patient, a former lawyer who was diagnosed with alcohol-induced heart disease, about the very serious cardiac consequences of his addiction. "I always thought alcohol was bad for my liver," the patient said, somewhat surprised. "I didn't know it could damage my heart." The patient was discharged, newly informed and newly hopeful, holding a list of local sobriety programs.
Fellow students have reminded me, as well, that we possess strong medicine--not the drugs we can give to patients but our words, the timbre of our voice, and the touch of our hands. A few months ago my classmate Julie, who was transferring her patient's care to me, brought me to his bedside to introduce us. A pungent sour odor wafted through the air. There was a pink tray by his side to catch his frequent vomiting. The thin, white-bearded patient greeted her like a close relative: "Julie, my darling, I've been waiting for you."
The man, recently diagnosed with end-stage lung cancer, was troubled. His wife had suddenly stopped coming to visit him in the hospital. He worried that she was too scared to see him go, that she could smell the aroma of death in the air. "Do I smell like death, Julie?" he asked, patting his lips after hocking up a small concoction of phlegm and blood. Julie placed her hand on his bony shoulder, bent over toward his straggly beard and took several deep whiffs. "Absolutely not. Don't you worry one more minute about that." He smiled, looking relieved, and then he thanked her. And I smiled too, to thank Julie for helping to restore my faith in this extraordinary relationship.
This story appears in the January 31, 2005 print edition of U.S. News & World Report.