Do You Want to Be a Doctor?

“I want to be a doctor. How do I do it?”

As a teenager, I was very shy and very awkward. Talking to strangers was a painful and anxiety-laden task, and I didn’t like to talk to strangers any longer than necessary. So when a pediatrician asked me, at a routine office visit, if I had any questions, I surprised myself by blurting out, “I want to be a doctor. How do I do it?” I had never seen the same pediatrician twice, mainly because most of them were residents-in-training. This one was caught off-guard by the question, so she rambled a bit. She talked about medical school and residency and fellowship, about job security and the logistics of working in a practice, about other things she must have been preoccupied with in the scope and span of her professional life, things that I couldn’t know. She finished talking and exited the room, leaving my mother and I to wait.

The two of us had recently been talking about my future career. She was a nurse, and though there were many positive experiences she would share at the dinner table with me, the impact of many negative experiences caused her to humbly and gently discourage me from going into the medical field myself. She would tell me how hard and how stressful it could be, how many of its demands were dirty, unforgiving, and intense. She was a similarly introverted person who chose the work for a very adult-like reason: it was good work that provided a good opportunity for migrating to America. She would tell me stories about her first day of nursing school in her home country, how the new students were led down to the large formaldehyde “pool” in the basement where an instructor immediately plucked out a dripping arm and began teaching. She told me that people promptly vomited and a third of the class dropped out that day, and that she strongly considered doing the same thing herself.

Medicine has changed in many ways. Though the hours and training have become more forgiving and humane over the years, other elements have actually become more noxious to the process: the ballooning price of education, uncertainty over major shifts in the landscape of health policy and insurance, the ever-increasing length of medical training, and the associated opportunity cost of lost alternative careers. This does not even begin to mention the fear of malpractice (not to be confused with the distinctly different fear of malpractice lawsuits), the burden of responsibility, the ever-mounting piles of paperwork, the erosion of patient-provider trust, the advent of the self-information (and dis-information), the loss of respect and autonomy in practice (and in relation to insurance companies). Any physician can (and perhaps is likely to) list an unending tally of reasons not to become a doctor in today’s healthcare environment.

It is therefore not surprising that it has become more and more difficult for aspiring students to describe why they want to become involved in healthcare, or even for current healthcare workers to describe why they continue to practice from day to day. At the end of the day, so much of it comes down to stories: abstract but intensely personal illustrations that capture the essence of an idea and what makes it so compelling even in the face of many practically demoralizing factors. It is why it is easier to describe and quantify the negative and yet so difficult to advocate for something positive and meaningful.

However, this is why there is something more to becoming a “Christian physician” than simply being a Christian and being a physician. We are created as both body and soul, as both the concrete and the metaphysical. Early church doctrine struggled to battle the heresy of Gnosticism because, as the Gnostics knew, there is something very appealing about the supremacy of asceticism and the idealized, intangible spiritual realms above that of the dirty, imperfect, and broken physical world we find ourselves in. And yet the message of the gospel is this: that God himself became flesh and took on physical form in the world, with all its impurities and imperfections, that we might have access to life:

So if there is any encouragement in Christ, any comfort from love, any participation in the Spirit, any affection and sympathy, complete my joy by being of the same mind, having the same love, being in full accord and of one mind. 3 Do nothing from selfish ambition or conceit, but in humility count others more significant than yourselves. Let each of you look not only to his own interests, but also to the interests of others. Have this mind among yourselves, which is yours in Christ Jesus, who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross. - Philippians 2

As that awkward teenager sitting silently in that sterile, clinical office, I must have looked pensive and puzzled. My mother watched me mull over the very grown-up words of a grown-up pediatrician. She looked at me directly, interrupted the silence and said, “David, she did not say the most important thing: you get to help people. And you help them when they need it the most.”

People often ask me what medical school and medicine are like, and I often find myself falling into adult lingo and babble. I babble about the cost of school, about the monetization of medicine, about the burden of responsibility and the terror of error. On my more cynical and jaded days, I will babble for quite a long time. But what I eventually aim to tell people is that the highest aspiration of the practice of medicine is to invoke and evoke the gospel: that through the physical engagement of Christ in our suffering, we have resurrection. In that, I find unending satisfaction.

Indeed, I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord. For his sake I have suffered the loss of all things and count them as rubbish, in order that I may gain Christ and be found in him, not having a righteousness of my own that comes from the law, but that which comes through faith in Christ, the righteousness from God that depends on faith— that I may know him and the power of his resurrection, and may share his sufferings, becoming like him in his death, that by any means possible I may attain the resurrection from the dead. — Philippians 3

[This is an introduction to a series on becoming a Christian physician.]

No medical students were harmed in the taking of this photo.
This is an actual picture of me at 6AM sleeping during my surgery rotation as a medical student.
Do You Want to Be a Doctor?

Abba

She wouldn’t stop crying, so I picked her up before realizing that the diaper was wet. The sun was setting and the room was dim and quiet, disturbed only by the peripheral noises of the hospital hallway and the sound of her distress. I gingerly held her up, setting her flat on the bed, and watched her arms wave from side to side as I puzzled over how to change my first diaper.

“Hey,” I whispered. “Stop crying.” She didn’t listen and I spent a few moments fumbling with the pacifier before sitting down in the rocking chair, swinging back and forth easily with the infant cradled in my arms. A plastic music box hanging on the edge of the crib’s stainless-steel safety bars began playing a lullaby. We rocked and swayed, rustling quietly in the dusky shadows of twilight. It was as if the hospital, that crazy world of light and noise and pain and angst, had rumbled off into the distance and lazily forgot to bother us for now.

At morning report, the infant was recovering well from whatever illness she’d had; I couldn’t recall the details, save the small fact that we were now responsible for her. We, meaning the hospital and the State of New Jersey, who were granted temporary custody as the parents were “currently indisposed of for the time being.” I thought about all the other rooms on the pediatric floor, each of which held two beds: one for the patient and one for the caretaker. Each room had its own guardian: an anxious mother or grandparent or cousin or other relative. Each room except this one.

I remembered the words of a nurse who stood by the bed at rounds, updating us on the baby’s condition. “She’s doing well,” the nurse reported, thoroughly distracted by the baby. The team continued talking about the details of custody and social work while the nurse remained preoccupied. She cooed at the baby. “Hey,” she said quietly, gently caressing the swaddling clothes: “It’s going to be a tough world out there.”

We had been rounding on this patient for several days and I, being overwhelmed with concerns about my own patients, had never paid much attention to this one. But that last comment caught me by surprise and disturbed the rhythm of my thoughts. One of the residents told us, “If you have time, come in and hold her. It’s okay.”

For the rest of rounds, throughout lunch and the bustle of afternoon errands and errata, my mind and feet wandered back to that room. Whenever I peeked in, I found someone at her bedside: a nurse, a social worker, another floor staff member. It seemed that word had gotten around and everyone quietly came together to do what they could. I didn’t get my chance until the end of the work day, just in time to hear a few cries from the crib.

And so we rocked, back and forth, and I thought and thought. Did she know how alone she was? What kind of person would she become? Who would rise up to defend her weakness, her frailty and vulnerability? If she met me in ten, twenty, thirty years from now, would she still let me hold her in my arms? Why couldn’t I adopt her? How different will it be on the day I hold my own child? Unfamiliar feelings of affection, of unknown protection and helplessness swilled around inside of me, centered but unfocused on this loose bundle of warmed clothing and weak, spastic movements. I didn’t know how to feel or how to respond. I still don’t.

I couldn’t wait to write this stuff down, mainly because I didn’t know what to do with all these ambiguous thoughts. I only held her for a few minutes and yet it’s taken me two days to articulate what I’ve been feeling. Who will love her? Who will dream good dreams for her at night? Who will give her the first cherry ice pop, the first kiss on her scraped knee? Who will keep her safe in this world of terrors?

I was walking outside my apartment tonight, thinking about these things. I stared through the bare branches of a budding tree and into the lamplight that stood fixed beneath a muddied sky. I asked my Abba, father, to provide one for her, and then realized that I didn’t know her name.

Abba

A Reflection on the Anatomy Lab

Originally delivered March 1, 2007 at the Anatomy Lab Memorial Service.

In preparing for this reflection, there were many sensations that came to mind: the dryness of dread in my mouth on that first day of lab, the sharp snap of latex gloves, the lingering smell of disinfectant on my hands, the gritty knot in my stomach unraveling after my first day of dissection. I remembered the overwhelming and unnamed emotions associated with those days in lab: the wonder and revulsion of holding a human heart with no life or a brain with no mind, the anger and sadness of having to employ the tool of detachment for the professional business of learning. Since then, I have been looking for some sort of closure, a tangible action or symbol to serve as a reference point for the coming day when I will once again be confronted with the paradox of professional compassion.

That search for closure took me back to a particular Saturday night that found me alone in the lab. Understandably so; few people enjoy spending their weekend nights in an anatomy lab. But sometimes laboratories are our special sanctuaries: a place where we can find ourselves alone with the silence of our thoughts, our observations, and the profound presence of something that is both familiar and yet so far removed from our comprehension that it might as well be holy.

As I was concentrating on the dissection, my hand brushed passed the cadaver’s hand. I paused momentarily and wondered how it was that only a month ago the thought of holding a cadaver’s hand sent chills down my spine. I wondered how my heart had come to treat the cadaver with an amiable detachment. It brought to mind a reflection written years ago by a friend when she first began medical school:

Hands that once held a teacup. Hands that once grasped a pen. Hands that once cradled the hand of a lover, patted the head of a grandchild, shook the hand of a friend. Where had those hands been? Whom did they once belong to? Is there a wife, a son, a daughter, a friend somewhere who yet mourns the loss of life in those hands?

I had this odd desire to cry in the middle of the anatomy lab, to grieve for someone I didn’t even know. As my humanity flooded back into me, I began to think about the friends and family whose hands I can’t wait to grasp again. Life… well, it is here today, gone tomorrow. Next time you shake someone’s hand, think of what a blessing it is to be able to do so… and of the Grace that sustains each and every one of us, giving us life and love and the hope of an eternity together in peace.

Hesitating, I reached out and held the cadaver’s hand. I held her hand, casually and leisurely letting myself warm up to the sentiment that it used to be human… was still human in so many ways. I thought about the friends and family that this woman – once filled with age and memories — held onto in her dying days.

I felt privileged to enter into such blind intimacy, but I also felt viscerally disturbed, as if the body gifted to me had somehow reached out and into my own soul. I realized that it was the first dead body I had ever seen, and it didn’t seem to be much of a body at all.

But in the quiet moment of this reflecting, I cannot help but realize that it was not only a cadaver; not just another laboratory specimen. It was a gift, a daughter, a mystery, a lover, a bundle of nerves and muscles, a house of memories. I look at my own hands with wonder. I see its own creases, etched by years of holding on and letting go. In the words of John Keats:

This living hand, now warm and capable of earnest grasping,

would, if it were cold and in the icy silence of the tomb,

So haunt thy days and chill thy dreaming nights

That thou wouldst wish thine own heart dry of blood

So in my veins red life might stream again,

And thou be conscience-calmed – see here it is –

I hold it towards you.

I held a human’s hand that night… and let it go. It has since become my reference point. See, here is my own, its purpose yet unfulfilled. It too is something familiar and foreign: my own paradox of humanity. Grasp it and leave it as you wish; I hold it out towards you.

[Archived post]

A Reflection on the Anatomy Lab