At ACP, physicians came together to tell their stories of what keeps them going in medicine. There's a unifying message in all of them.
Since 1990, the Annals of Internal Medicine has regularly published “On Being a Doctor,” a selection of short stories and essays submitted by its subscribers. Though different in structure and narrative, the stories commonly highlight the gift of practicing a profession that can change the lives of patients.
The stories also highlight the intimacy between physicians and patients. In an age where physician satisfaction is at an all-time low—where 30% of residents are clinically depressed—the stories are a reminder that medicine is indeed a noble profession, and its practitioners are a chosen few.
On the eve of the American College of Physicians (ACP) 2019 Internal Medicine Annual Meeting in Philadelphia, PA, 10 current and future physicians presented their own “On Being a Doctor”-inspired story of an event that has inspired them throughout their careers.
The presenters were across the spectrum of the medical field—from a second-year medical student, to a physician in his 80s.One story involved the dilemma faced by a doctor on a medical mission to Bhutan. He met a Buddhist patient who had a large intestinal parasite in his stomach which was slowly killing him. The patient refused to be treated because he felt it would be bad karma if he were to kill the living creature.
The physician had to convince the man that he would be the one to kill the worm, thus leaving the patient’s good karma intact. And by stopping the worm from killing the man, the doctor reasoned, the worm would also have good karma. The Buddhist consented the doctor to place the antiparasitic medicine in his mouth, and both man and worm retained their karma. The doctor, though—well, he was a non-Buddhist, and his karma didn’t matter. A woman recalled being tasked with discharging a patient hospitalized knee replacement surgery. The patient, a burly longshoreman, was told by his orthopedic surgeon that he could go home once the internist cleared him. The internist, young in experience and small in stature, came into the room to find the patient already dressed, packed, and waiting for his ride home.
Upon review of his charts, though, she noticed his raised pulse oxygen—the patient had tachycardia. When she told the longshoreman he wouldn’t be able to leave until they conducted a scan for a pulmonary embolism, he became irate. Her efforts to reason with him were for nothing, and he threw out of the room. Eventually, cooler heads prevailed, and he gave his consent to the scan. It returned positive—he had a potentially lethal bilateral pulmonary embolism.
Six years later, the doctor, now more experienced and assured in her work, was summoned to the 5th floor by a charge nurse; apparently a patient was demanding to see her. Busy but curious to know why, she headed to the patient’s room ready for the worst. It was the longshoreman, fighting through tears as he told her how he spent years tracking her down to thank her for saving his life.
The feeling of inspiration and elation that came from the once-stubborn patient’s gratitude washed over her quickly. She thought back on how obvious the diagnosis was that she made, and realized the thanks were due to the patient himself. It’s been 26 years since that interaction, and his need to appreciate her work has continued to remind her that medicine is worth practicing.As humbly as he could, the young medical student explained to the audience how his venture into medicine has made him a hero in his family. As he progresses closer and closer to his degree, his loved ones have relied on him more and more for guidance in health—an experience most aspiring and young physicians go through.
When his grandmother sought advice on her recent shortness of breath, he gave her what he knew to be the best advice. Just a week later, she died suddenly. Her death was unrelated to his advice, but it burdened him all the same to see how important his career will be.
I could related. When I was a young resident, I told my favorite uncle that the treatment he had been getting for his heart attack in 1960 was now obsolete in 1984. I advised he talk to his cardiologist about stopping it. He didn’t bother to ask his doctor, but listened to what I said and stopped medication on his own. Three days later he died of a massive heart attack.
I was still correct: his treatment was obsolete, and his death probably coincidental. But I will never know. I was devastated when I heard the news, and to this day I can’t feel comfortable around any of his family due to guilt. It’s a hard lesson to learn, but one I wouldn’t have learned without it happening. No well-meaning advice would have kept me from trying to help mt relatives like that.
Everyone’s life is a story. As physicians, we have a daily opportunity to become part of a story. Being with people when they are born, when they are sick and recovering, and even when they are dying, is a tremendous privilege.
Part of the job is learning that we can’t always fix people—that the medical miracles we take credit for often happen despite of our efforts, not because of them. Sometimes, our best efforts aren’t good enough or even cause harm. But somehow, we go on. There is always another patient to see, another chance to be part of someone’s story, and to make a difference in its ending.
These essays touched on how powerful becoming part of our patients’ lives is. It also makes us forget our frustrations from EMRs, how unfair insurnace companies can be, how devastating and demeaning malpractice can be, and even how disrespectful patients can be. Becoming part of the story of our patients—our heroes—makes it all worth it.
Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.