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Yes, it’s a long read. But if you are having a rough time, it may help.
Other than my AMA, I’ve only started one other thread on SDN. This is my third. I think it’s important to write, given all of the posts I’ve seen from people struggling with medical school and wondering if they did the right thing.
If you are one of those struggling people, bear with me for a few minutes, and I will tell you a story from my perspective as an attending, someone on the other side who was in your shoes not so long ago.
Click the "spoiler" link below to read the whole thing, and a story about a patient named Jack.
Other than my AMA, I’ve only started one other thread on SDN. This is my third. I think it’s important to write, given all of the posts I’ve seen from people struggling with medical school and wondering if they did the right thing.
If you are one of those struggling people, bear with me for a few minutes, and I will tell you a story from my perspective as an attending, someone on the other side who was in your shoes not so long ago.
Click the "spoiler" link below to read the whole thing, and a story about a patient named Jack.
It is easy to get bogged down in the endless hamster wheel of studying, lectures, exams, the terror and self doubt of step 1, research, rotations, evaluations, etc. I’m not surprised so many trainees, both medical student and resident alike, lose sight of why they entered this field in the first place.
I’ll be the first to say that altruism is not always our primary driver. Prestige, money, pride, cultural expectations, etc. are all factors to some degree, for all of us. And no permutation of those factors is wrong or right. Your drivers are your own. If only saints got admitted to medical school, our adcoms and professors (@LizzyM @gyngyn @Goro) would be out of a job.
But I would like to think that on some level, everyone who chooses to become a physician gets joy, a sense of worth, from helping patients.
But it is difficult to help patients when you are a student, or even a resident. You have no real power or decision-making abilities. You are somebody’s bitch, often used for scut work or closing wounds, signing scripts and doing discharge summaries. Patients barely remember who you are.
On top of that, during our training years, most of us struggle with health problems, both mental and physical. Some of us move away from our families, skip holidays and birthdays, miss our children’s milestones. Some of us lose relationships, get divorced, cheat, or get cheated on. Many of us (including me) have lost friends and colleagues to suicide, have been depressed (also me), and seriously considered suicide, enough to require treatment (yep, also me).
These years are long, they are tiring, they are demoralizing, and most people who have not gone through it have no capacity to understand what it is like. Yet people who have not been in the trenches have no problem saying that we are too arrogant, or make too much money, etc. It’s not a nice thing to hear, given the level of sacrifice physicians make.
Oh, and in residency, it gets worse before it gets better. Remember that.
So why, year after year, do people enter this field? Many of my friends say that no amount of money would be worth it. What are these physicians seeing that so many of us lose sight of? It can’t be that having gone through it, we all have Stockholm syndrome and suddenly fall in love with something we hated. (Certainly some part of that is true, but not all.) There is something deeper.
As a surgeon, I’m one of those lucky enough to see my results very quickly. It appeals to my impatient personality. But the fleeting happiness of getting a good reduction on x-ray or a quick “thank you” didn’t feel sustaining. And the amorphous concept of “self-worth” didn’t seem solid. Even as an attending, if somebody had asked me, “why did you choose this?”… I didn’t really have a fantastic answer. I could tell you why I chose orthopedics over all other medical specialties. I could say, because it’s cool, because I make money, because I get to fix people… But the soul of it eluded me. And if I myself could not answer why I was a physician, having already gone through residency, what kind of doctor was I?
My residency was brutal, and I know there are even worse ones out there. (Looking at you, gensurg and IM.) It seriously sucked the life out of me, and only bullheaded stubbornness kept me going at times. I wasn’t eating or sleeping, and at some point I had a BMI of 18. I survived call by eating soggy ER patient sandwiches (I still gag, thinking of that). I was far from my family and had no friends outside of work in my city. I broke off my engagement, and made many mistakes in my personal life. I wonder if at some point, I had known why I was going to be a doctor, and with the constant beating of stress on my soul, I just forgot.
And now I’m going to tell you a story, about Jack. (Not his real name, hipaa compliance.)
Jack was a laborer who sustained a bad open fracture of his tibia. I fixed it, but he was not healing. He had done everything right, quit smoking and stayed off it, but gradually his leg was bending sideways. I was sure that he was infected, and so I decided to take him back and do a two-stage procedure: hardware removal and bone biopsy and cultures first, and then if he didn’t grow anything, revision later.
I was not excited to tell him it would take (at least) another two surgeries to get him healed, and more if he was infected. He’d already been through 3 procedures with me, and every time I saw him in the office, he looked at me with skepticism (and who wouldn’t, after 3 surgeries?) I could have all the discussions I wanted, but Jack hadn’t gone through ortho residency and didn’t know how difficult open tibias could be, that they had a tendency not to heal. All he saw was his sideways-bending leg, and a (young) surgeon whom he had no reason to trust.
Additionally, over months of treatment, Jack had said maybe a total of fifty words to me. His wife did most of the talking. I stared at the leg. And Jack just stared at me. And that’s how our visits went. It was uncomfortable. Most of my trauma patients love to talk. Not Jack. When he showed up on my clinic schedule, I dreaded it. I felt like he didn’t trust me and would even sue me (even if I had done everything right). I couldn’t tell whether he was sad, angry, scared, happy, hopeful—nothing. It was always the same face.
But when his stubbornly non-healing leg became impossible to ignore or “give more time to heal,” I decided to go for broke, resting-serial-killer-face be damned. I was gonna give Jack the rundown of what I planned and how we were going to heal his leg. I drew his fractures on my sawbone skeleton and brought it in to show him, gave him all the options.
The only thing he asked me, after 45 minutes, was what kind of factors would cause his leg to be amputated. I told him, and said we were very far away from that. He said, “ok.”
Fast forward to the day of the surgery. I didn’t want to delay him any longer than necessary, so I scheduled him for a light day in the OR. Which also happened to be the day my husband was having (minor) surgery.
Of course, the two of them were scheduled as first cases. Facepalm. The night before, I tell my husband, “I’m going to quickly drop you off and hide so he doesn’t see me out here.”
Not so lucky. The moment I drop my husband off in the preop waiting area and hug him, there’s Jack hobbling in the door, and of course I feel obligated to tell him why I’m there, hugging some dude. So there we are in the waiting room...me, my husband...and Jack. They get put back into their respective little patient rooms and I go to “preop-check” Jack. The first thing he says, “so is your husband’s surgery serious? I just want to make sure your head is in the game.”
Now I feel like an idiot...I should have just delayed him, now he’s going to think I’m not gonna do his surgery right (even though I’ve spent weeks thinking about it). I assure him that he’s the only one I’m thinking about and that my husband’s surgery is minor outpatient.
Surgery goes well, first stage. I get the cultures, and plan on sending him home. In the PACU, I tell him things went well and that I will return to tell him more as he’s still sleepy from the anesthesia. He says, “I understand if you don’t want to talk to me.” I tell him that I do, I just don’t think he will remember what I tell him. But he seems lucid enough, so I start going through our plan again, and how I got tons of cultures and what will happen if he’s infected, etc. it’s the same as every interaction we have had: I assure him we will take care of this, he stares, and then we move on.
As I’m going through my spiel, Jack suddenly reaches out, and grabs my hand, which is resting on the railing of the stretcher. I freeze. It’s not a hard grab, just a gentle hold. He doesn’t say anything, just stares at me. I look into his eyes and suddenly realize—this man is terrified. It is the first sign of emotion he has shown in the many months I’ve treated him. My brain reverts to those dumb ethics lectures in med school where you are supposed to touch the patient and make them feel better.
I’ve never been touchy-feely, and those lectures always felt a bit patronizing. The “there, there” would piss me off if I were a patient. But there I am, and I know I am expected to do something. He is showing me what’s behind the wall, and what I say next will make or break this relationship. I know it with complete certainty.
I don’t try to break out of his hold. I don’t pat him, either. Instead, I just look at his face, and hear myself say, before I’ve even had a chance to formulate a proper answer, “no matter what happens with this leg, we will get you through this. We will fix it.”
He lets me go, and lets out a breath. “Thank you.”
I’m not gonna lie. I’ve seen people die, or lose limbs. I’ve had a lot of “thank you”s, and a lot of “f*** you”s in my life. I rarely get emotional. But when I left that pacu, it took all I had to keep myself from crying. No lecture can prepare you for another human suddenly and completely relying on you to help them. It’s not just a thank you, the way you thank your barista when they make your coffee just right (though believe me, my Dunkin people keep me alive). It is a baring of the soul, the ultimate human connection that occurs outside of family ties.
And that’s why it is worth it. No other feeling, save for perhaps the one you get from your loved ones, is more satisfying. It’s hard to imagine it when you’re in residency, or med school...maybe you’ve never had it. Maybe you won’t, until you are an attending. The feeling that you are worthy of this great trust that people put in you. So when you struggle, and hustle, and suffer, and (sometimes) almost die....remember, your own version of Jack is out there. Ultimately, the treatment itself doesn’t matter. Whether that leg is lost or saved, it is not what you did, but how you did it. Your own Jack doesn’t even know you exist yet, but the time will come when he will be scared, and upset, and angry, and it is you who will come to him during the dark hour and say, “I will help you.” Keep thinking about him, and the hundreds and thousands like him, whom your dedication to your work will touch during your lifetime. This is the light at the end of the tunnel. It is the only light that truly matters.
I’ll be the first to say that altruism is not always our primary driver. Prestige, money, pride, cultural expectations, etc. are all factors to some degree, for all of us. And no permutation of those factors is wrong or right. Your drivers are your own. If only saints got admitted to medical school, our adcoms and professors (@LizzyM @gyngyn @Goro) would be out of a job.
But I would like to think that on some level, everyone who chooses to become a physician gets joy, a sense of worth, from helping patients.But it is difficult to help patients when you are a student, or even a resident. You have no real power or decision-making abilities. You are somebody’s bitch, often used for scut work or closing wounds, signing scripts and doing discharge summaries. Patients barely remember who you are.
On top of that, during our training years, most of us struggle with health problems, both mental and physical. Some of us move away from our families, skip holidays and birthdays, miss our children’s milestones. Some of us lose relationships, get divorced, cheat, or get cheated on. Many of us (including me) have lost friends and colleagues to suicide, have been depressed (also me), and seriously considered suicide, enough to require treatment (yep, also me).
These years are long, they are tiring, they are demoralizing, and most people who have not gone through it have no capacity to understand what it is like. Yet people who have not been in the trenches have no problem saying that we are too arrogant, or make too much money, etc. It’s not a nice thing to hear, given the level of sacrifice physicians make.
Oh, and in residency, it gets worse before it gets better. Remember that.
So why, year after year, do people enter this field? Many of my friends say that no amount of money would be worth it. What are these physicians seeing that so many of us lose sight of? It can’t be that having gone through it, we all have Stockholm syndrome and suddenly fall in love with something we hated. (Certainly some part of that is true, but not all.) There is something deeper.
As a surgeon, I’m one of those lucky enough to see my results very quickly. It appeals to my impatient personality. But the fleeting happiness of getting a good reduction on x-ray or a quick “thank you” didn’t feel sustaining. And the amorphous concept of “self-worth” didn’t seem solid. Even as an attending, if somebody had asked me, “why did you choose this?”… I didn’t really have a fantastic answer. I could tell you why I chose orthopedics over all other medical specialties. I could say, because it’s cool, because I make money, because I get to fix people… But the soul of it eluded me. And if I myself could not answer why I was a physician, having already gone through residency, what kind of doctor was I?
My residency was brutal, and I know there are even worse ones out there. (Looking at you, gensurg and IM.) It seriously sucked the life out of me, and only bullheaded stubbornness kept me going at times. I wasn’t eating or sleeping, and at some point I had a BMI of 18. I survived call by eating soggy ER patient sandwiches (I still gag, thinking of that). I was far from my family and had no friends outside of work in my city. I broke off my engagement, and made many mistakes in my personal life. I wonder if at some point, I had known why I was going to be a doctor, and with the constant beating of stress on my soul, I just forgot.
And now I’m going to tell you a story, about Jack. (Not his real name, hipaa compliance.)
Jack was a laborer who sustained a bad open fracture of his tibia. I fixed it, but he was not healing. He had done everything right, quit smoking and stayed off it, but gradually his leg was bending sideways. I was sure that he was infected, and so I decided to take him back and do a two-stage procedure: hardware removal and bone biopsy and cultures first, and then if he didn’t grow anything, revision later.
I was not excited to tell him it would take (at least) another two surgeries to get him healed, and more if he was infected. He’d already been through 3 procedures with me, and every time I saw him in the office, he looked at me with skepticism (and who wouldn’t, after 3 surgeries?) I could have all the discussions I wanted, but Jack hadn’t gone through ortho residency and didn’t know how difficult open tibias could be, that they had a tendency not to heal. All he saw was his sideways-bending leg, and a (young) surgeon whom he had no reason to trust.
Additionally, over months of treatment, Jack had said maybe a total of fifty words to me. His wife did most of the talking. I stared at the leg. And Jack just stared at me. And that’s how our visits went. It was uncomfortable. Most of my trauma patients love to talk. Not Jack. When he showed up on my clinic schedule, I dreaded it. I felt like he didn’t trust me and would even sue me (even if I had done everything right). I couldn’t tell whether he was sad, angry, scared, happy, hopeful—nothing. It was always the same face.
But when his stubbornly non-healing leg became impossible to ignore or “give more time to heal,” I decided to go for broke, resting-serial-killer-face be damned. I was gonna give Jack the rundown of what I planned and how we were going to heal his leg. I drew his fractures on my sawbone skeleton and brought it in to show him, gave him all the options.
The only thing he asked me, after 45 minutes, was what kind of factors would cause his leg to be amputated. I told him, and said we were very far away from that. He said, “ok.”
Fast forward to the day of the surgery. I didn’t want to delay him any longer than necessary, so I scheduled him for a light day in the OR. Which also happened to be the day my husband was having (minor) surgery.
Of course, the two of them were scheduled as first cases. Facepalm. The night before, I tell my husband, “I’m going to quickly drop you off and hide so he doesn’t see me out here.”
Not so lucky. The moment I drop my husband off in the preop waiting area and hug him, there’s Jack hobbling in the door, and of course I feel obligated to tell him why I’m there, hugging some dude. So there we are in the waiting room...me, my husband...and Jack. They get put back into their respective little patient rooms and I go to “preop-check” Jack. The first thing he says, “so is your husband’s surgery serious? I just want to make sure your head is in the game.”
Now I feel like an idiot...I should have just delayed him, now he’s going to think I’m not gonna do his surgery right (even though I’ve spent weeks thinking about it). I assure him that he’s the only one I’m thinking about and that my husband’s surgery is minor outpatient.
Surgery goes well, first stage. I get the cultures, and plan on sending him home. In the PACU, I tell him things went well and that I will return to tell him more as he’s still sleepy from the anesthesia. He says, “I understand if you don’t want to talk to me.” I tell him that I do, I just don’t think he will remember what I tell him. But he seems lucid enough, so I start going through our plan again, and how I got tons of cultures and what will happen if he’s infected, etc. it’s the same as every interaction we have had: I assure him we will take care of this, he stares, and then we move on.
As I’m going through my spiel, Jack suddenly reaches out, and grabs my hand, which is resting on the railing of the stretcher. I freeze. It’s not a hard grab, just a gentle hold. He doesn’t say anything, just stares at me. I look into his eyes and suddenly realize—this man is terrified. It is the first sign of emotion he has shown in the many months I’ve treated him. My brain reverts to those dumb ethics lectures in med school where you are supposed to touch the patient and make them feel better.
I’ve never been touchy-feely, and those lectures always felt a bit patronizing. The “there, there” would piss me off if I were a patient. But there I am, and I know I am expected to do something. He is showing me what’s behind the wall, and what I say next will make or break this relationship. I know it with complete certainty.
I don’t try to break out of his hold. I don’t pat him, either. Instead, I just look at his face, and hear myself say, before I’ve even had a chance to formulate a proper answer, “no matter what happens with this leg, we will get you through this. We will fix it.”
He lets me go, and lets out a breath. “Thank you.”
I’m not gonna lie. I’ve seen people die, or lose limbs. I’ve had a lot of “thank you”s, and a lot of “f*** you”s in my life. I rarely get emotional. But when I left that pacu, it took all I had to keep myself from crying. No lecture can prepare you for another human suddenly and completely relying on you to help them. It’s not just a thank you, the way you thank your barista when they make your coffee just right (though believe me, my Dunkin people keep me alive). It is a baring of the soul, the ultimate human connection that occurs outside of family ties.
And that’s why it is worth it. No other feeling, save for perhaps the one you get from your loved ones, is more satisfying. It’s hard to imagine it when you’re in residency, or med school...maybe you’ve never had it. Maybe you won’t, until you are an attending. The feeling that you are worthy of this great trust that people put in you. So when you struggle, and hustle, and suffer, and (sometimes) almost die....remember, your own version of Jack is out there. Ultimately, the treatment itself doesn’t matter. Whether that leg is lost or saved, it is not what you did, but how you did it. Your own Jack doesn’t even know you exist yet, but the time will come when he will be scared, and upset, and angry, and it is you who will come to him during the dark hour and say, “I will help you.” Keep thinking about him, and the hundreds and thousands like him, whom your dedication to your work will touch during your lifetime. This is the light at the end of the tunnel. It is the only light that truly matters.
Sent from my iPhone using SDN mobile
Last edited:
(sorry sorry I can’t stay serious for long)
. There will be a doctor that will treat me with respect, humbleness and compassion. And most importantly put the bones back in place 
