I am starting to realize why certain physicians ask pre-medical students why they want to become physicians. I catch myself asking that of myself more and more often. I recently finished the book Bloodletting & Miraculous Cures, and the ensuing twenty-four hours really stressed me out. If I were to be honest, it still sort of stresses me out a little (a lotta) bit. I found myself walking in the shoes of two of the protagonists, Fitzgerald and Chen, more and more often as the book continued. The author’s writing transported me forty years into a hypothetical personal future – and it terrified me. Fitz started off drinking to handle his personal issues and he eventually became an alcoholic – I had started having night caps at the end of long days to take the edge off in recent years. Chen is no longer embarrassed as a staff physician that he drives a hulking doctor cliché, a CLK 430 Mercedes Benz – I came into medical school hell-bent on avoiding becoming a physician who cares about money and status. Will I inadvertently eventually turn out like Fitz or Chen? Am I doomed to walk in the path of my predecessors? Who am I to think that I will turn out differently? Would knowing about this possible future somehow immunize me against turning into a walking cliché? Something about the process of becoming a doctor must change people – it seems to me at times an unrelenting force bent on remaking us. Bent on taking out our living, bleeding, and fallible organs, and replacing them with shiny, confidence-filled mechanical replacements, which will enable us to work tirelessly, continuously, and with just enough emotional detachment such that we do not end up living our patients’ misery (but not so much that the patient would feel like we don’t care). These newfound organs will turn all of us into people who can withstand death on a regular basis, withstand patients who yell obscenities at us and threaten to sue and ruin our livelihoods and reputations, and who can withstand the crushing pressures of the expectations, hopes, and dreams of patients’ family members, communicated by their furtive glances at the doctor. All of this is to be carried on the physicians’ shoulders; to be ruminated over within our hearts in the quiet moments that we steal for ourselves.
When I catch myself asking that question (Why do you want to become a physician?) of a pre-medical student nowadays, I realize that I’m not really, truly, trying to determine whether or not they are worthy of joining our ranks as physicians (let’s be honest, they’re all probably smarter than me – each successive generation is smarter and better, just based on the increasing difficulty of getting into medical school over the past decades). At the heart of it, I think when I ask this question, I really am trying to communicate how difficult of a life it might become. I am trying to determine if they might become burnt out over time, with their original sense of compassion and empathy warped into the practiced dissociation of one who has crashed into the lives of their patients with life-altering diagnoses one too many times. But… how could I possibly predict someone else’s future, if I can barely get a handle on my own? It scares me that I catch myself thinking this, because I am starting to wonder whether or not my ideals and principles (however strong they may be now) can withstand forty years of practice. Perhaps the school made a mistake in letting me in – perhaps I will burn out after all, walking in the path of the mentors I have inadvertently fallen in step with – mentors who are physically stooped over and bitter about the way that their patients treat them. I no longer have the original worry from reading Bloodletting & Miraculous Cures – I no longer worry that Dr. Lam might be showing me a glimpse of a hypothetical future. The reason I freak out now about Bloodletting & Miraculous Cures is that I can understand the steps along the way which could turn me into either Chen or Fitz. What terrifies me now is not the conclusion, but the truth of the process. It is no longer imaginary – I can see the stepping stones which could eventually lead to a jaded and burnt-out physician. I have observed the clerk, the first year resident, the final year resident, the newly-minted staff, the veteran physician, and the final step: the physician holding on for dear life at the hospital until they can cash out and retire in peace.
I also realize the futility of this line of questioning. I remember before I became a medical student…When I was asked why I wanted to be a physician, I provided such optimistic answers and was so proud of the ideals by which I stood. I was so proud of my ability to explain to the physician why I should be allowed to join their ranks. I was so proud of my resume which detailed how great of a person I was, of my various volunteering activities which described my heart for the needy, and the ideals which would make me a physician for the people, as opposed to some money-grubbing power-hungry maniac. In my mind’s eye, I am now sitting in the physician’s chair. I am in this moment sitting across the table from my past-self, and as I hear the words coming out of his mouth, I can only shake my head in sadness at the naivety that the boy before me is displaying. And I can see the boy across from me reacts to this – he furrows his eyebrows, his mouth turns slightly into a frown, and his head tilts to the left in the way that it does when he wants to show concern but also deference to the individual he is talking to. He has interpreted my subtle shake of the head as a sign that his answer was somehow at fault, lacking, or incorrect. But I’m not sad because he gave the wrong answer – I am sad because he gave me all the right answers. I’m also sad because I know that he is just smart enough to make it, but also probably not strong enough of heart to come out of the forty years with the same high-minded principles and ideals. The boy across from me at the table will ask me what about his answer was off, in hopes of altering it such that it will be ready for the round of interviews that he had been invited to at the various medical schools to which he had applied. But I would only shake my head and ask the question again, “Why do you want to become a physician?”, because I am unable to articulate the weight of my feelings, ineffectively reducing them to a glib, seven-worded question.