Three months or so after you finish your premedical studies and graduate, you will be seated in a large auditorium on the campus of the medical school you selected, and you’ll once again be a freshman awaiting orientation. The school will have taken a flier on you, after reviewing your grades, accomplishments and extracurriculars and reading your personal statement, because you fit their notion of the type of physician they want to produce. There you will launch the final leg of your journey, just four years away from fulfilling your dream.
Some may wonder whether this dream might be a nightmare about to come true. So, stop for a moment. Pick up a pen. On a blank sheet of paper, slowly and painstakingly write your signature. Now add the letters M.D. or D.O. after it, and stare at it. While you are staring, think what this means to you, your family and, most of all, the many patients who will come under your care.
You haven’t yet worked up (as we in the profession say) a single patient. I’ve been a physician since before you were born. I wonder what workup I’m on by now — my 400,000th? I also wonder if I haven’t made at least some difference in the grand scheme of things. I hope so. For that’s what this dream of medicine is all about, making a difference in the lives of our brothers and sisters on this planet. Medicine affords us the opportunity, like no other profession, to do just that — to get to know people in the most personal and intimate way and make them better off for having known you. I hope you take that signature just as seriously when you’re done with medical school as you do now.
You probably applied to several schools, and some asked why you want to be a doctor. You might have hesitated to say that you “want to help people,” thinking that those who read your application would think your reason naïve, hokey or unimaginative. But it’s what you should have meant, whatever the half-truth you wrote in your essay.
And it goes deeper than that. Medicine should be an expression of a genuine love of your fellow person — a real willingness to relieve someone else’s suffering regardless of the danger that the effort might pose to you. Regardless also of how the suffering person got sick; of whether, in your opinion, she brought the illness on herself; of the hour or whether or not you were on call; of the patient’s beliefs or anything else about her; and especially of whether she can pay you. I am reminded of the brave physicians who cared for tuberculosis patients with tenderness and compassion more than a century ago, knowing full well that they would likely get TB at some point themselves. “Greater love than this no man hath, that he lay down his life for his friends.”
Anyone can want to help people who are trusting, cooperative and agreeable. Who doesn’t want to take care of great patients who are stoic, who share your philosophy of life, who are attractive, who are celebrities of one sort or another or are members of the Augusta National? But what about the disheveled, belligerent drunk with rotten teeth and fetid breath who has ruined his life and whom you are called to see at 4 a.m. because he is sick? This is the sort of patient who separates the real doctors from the mere “health care providers.” How will you speak to your colleagues about him? Will you call him a troll or a gomer or a dump from another hospital or a train wreck or whatever disparaging term might be in vogue when you hit the medical wards?
I hope not, because here is an opportunity to show what you’re made of, born of the conviction that I hope brought you to where you sit now: genuine love and respect for your fellow man. However unlikely it might be, your kindness and compassion might just turn this man’s life around — and your lack of it could harden him further.
The bottom line is this: If you do not have genuine love in your heart for people, get out now. If you are in it for prestige or for a certain lifestyle or because your mother or father was a doctor, you may be brilliant and skilled and have all the tools, but medicine is not your true vocation. Go do something else.
For those of you who believe being a physician is your destiny, don’t let medicine devour you. Don’t take on more patients or responsibilities simply to make your car payments, mortgage payments or country club dues. You may hurt someone when you are overwrought. Instead, take good care of the number of patients you can handle and be content with the income that brings you. You won’t starve. Your family will need you at home. Your children will need to be able to recognize you on sight.
Finally, don’t allow yourself, like so many students, to suffer through med school, to be mean-spirited and cutthroat-competitive, to hope others did worse on an exam than you did, to whine, complain and count the days until you are through.
When you do hit the wards, don’t be sucked in by an intern or resident who is angry at the world and considers a good night on call one when no patients need admission and who talks about patients as “hits” — as in, “How many hits did you get last night?” Some love of your fellow person that is.
You and I may not even be here tomorrow. If today is our last day on Earth, let’s make it a day we can be proud of, when we live with a joyful outlook, give our responsibilities our best effort, and make the people who play a part in our life better off for having encountered us. And those people might be your patients, or they might be classmates, or your professors, or even the people who sweep up.
Tomorrow will take care of itself. It’s not easy to live this way, but you know I am speaking the truth. And if you embrace this philosophy, you will not find yourself wishing your life away as so many people do. You’ll close your eyes each night less anxious about some far-off goal and really enjoy all the great people, moments and beauty on your life’s journey. And one of these days, the Good Lord willing, you will sign your name with an M.D. or D.O. after it and really know what that means.
John Fisher M.D. is an infectious disease specialist who teaches at the Medical College of Georgia near his home in Augusta.