My Last Day As A Surgeon

Discover Your Odds of Getting into Medical School
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Currently reading "When Breath Becomes Air" and highly recommend it, and not just for future doctors. Dr. Kalanithi was a gifted author -- his writing is profound and his story is, needless to say, moving. Really forces you to confront the idea of your own mortality and the relative insignificance of a lot of what we worry about on a day-to-day basis...
 
What people generally refer to as "midlife" really isn't given average life expectancies.

...but given that residency is a sort of death I have no idea why you would want to experience it twice when facing your own mortality.
 
carpediem22 said:
Currently reading "When Breath Becomes Air" and highly recommend it, and not just for future doctors. Dr. Kalanithi was a gifted author -- his writing is profound and his story is, needless to say, moving. Really forces you to confront the idea of your own mortality and the relative insignificance of a lot of what we worry about on a day-to-day basis...
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The part about the insignificance of our worries reminds me of something Henry Marsh said in "Do No Harm"; he said he tried to keep his troubles in perspective by comparing them to his patients, but that he ultimately believed it to be a futile effort. He said something about human empathy not having reached the level where we can be affected by this type of reflection, at least in the long term. It was one of the few things I disagreed with.

Maybe I'm a softie, but stories like these stay with me. Obviously as time goes on they affect us less and less, but I still return to them. It's important to remember just how good many of us have it.

I'll also have to read Dr. Kalanithi's book, the article was excellent.
 
This is my favorite paragraph from all of his articles -- it's referring to what message he would hope to send to his infant daughter:

"That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing."
 
Avicenna said:
my biggest fears about my grand aspirations: dying during residency, without ever reaping the rewards of working as an attending
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He actually died shortly after graduating from residency, but same outcome I suppose.

Just finished the book... it's amazing and thought-provoking (while also being incredibly sad).

Another favorite line:
"The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence."
 
It's sad to think he didn't get to live his life to the fullest; however, he has helped people and he also had time to prepare for death.

Not enough people in this world get to feel like they make a difference, ever have a chance to even make it to adulthood, or prepare for their death.

So much feels today. I want to go curl up into a ball.
 
Yea, this is the kind of stuff I can't finish reading. To imagine going through undergrad, getting into medical school, and then losing your life at the end of a grueling residency... Makes you realize that being a physician is only a piece of your life; cultivate the other pieces.
 
Its like spending years to save up and buy a nice gift for your girl only to find her eloping with another guy last minute.
osckey said:
Yea, this is the kind of stuff I can't finish reading. To imagine going through undergrad, getting into medical school, and then losing your life at the end of a grueling residency... Makes you realize that being a physician is only a piece of your life; cultivate the other pieces.
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Pinkertinkle said:
Poor guy got scutted out till the very end.
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Avicenna said:
my biggest fears about my grand aspirations: dying during residency, without ever reaping the rewards of working as an attending
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Dr Tony T. Chopper said:
Its like spending years to save up and buy a nice gift for your girl only to find her eloping with another guy last minute.
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It's disappointing and yet sadly not surprising that this seems to be one of the most common pre-allo reactions to his story.

I'd suggest re-reading it (or even just the passage below), but I suspect the message will still be lost.

carpediem22 said:
This is my favorite paragraph from all of his articles -- it's referring to what message he would hope to send to his infant daughter:

"That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing."
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SouthernSurgeon said:
It's disappointing and yet sadly not surprising that this seems to be one of the most common pre-allo reactions to his story.

I'd suggest re-reading it (or even just the passage below), but I suspect the message will still be lost.
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Brilliant gestalt change here. Would whatever really matters to you change based on ending up having less time for it matter?
 
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I literally can't read it. I know his story and it gets me in the feels way too much. It's my greatest fear come to life for another man.
 
SouthernSurgeon said:
It's disappointing and yet sadly not surprising that this seems to be one of the most common pre-allo reactions to his story.

I'd suggest re-reading it (or even just the passage below), but I suspect the message will still be lost.
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To him, medicine was a purpose unto itself. To many, it is a means to an end. Not all will find the same fulfillment in the outcome that his life has come to, because for him, medicine was a great part of that fulfillment. For many others, it just isn't. I'm glad he found peace in the end, and wish his family well, in any case.
 
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Nietzschelover said:
Brilliant gestalt change here. Would whatever really matters to you change based on ending up having less time for it matter?
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From my own experience with recently losing a loved one and having that person's terminal illness greatly impact both his priorities and my own decision to drop my prior career and pursue medicine, it seems to me that all but the most self-actualized people are going to have some shifts in their priorities when facing the announcement that you have far less time than you thought (whether it's for yourself or the time you know you will have with a loved one).
 
Nietzschelover said:
Brilliant gestalt change here. Would whatever really matters to you change based on ending up having less time for it matter?
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I think it would. Don't you?

Would you go on living exactly like you are right now if you only had another year or two to live? If someone told me that I was going to die with 100% certainty in two years, it would definitely change how I do things. So much of life and medicine is planning for the future and reigning in spontaneity and impulsive nature for longer term goals. If those goals ceased to be attainable, wouldn't that affect your outlook?
 
ridethecliche said:
I think it would. Don't you?

Would you go on living exactly like you are right now if you only had another year or two to live? If someone told me that I was going to die with 100% certainty in two years, it would definitely change how I do things. So much of life and medicine is planning for the future and reigning in spontaneity and impulsive nature for longer term goals. If those goals ceased to be attainable, wouldn't that affect your outlook?
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No doubt about it, in my mind at least.
 
Nietzschelover said:
Brilliant gestalt change here. Would whatever really matters to you change based on ending up having less time for it matter?
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I can't shake the feeling that a user called @Nietzschelover would have some opinions on this matter.

The things that really matter to me would not change but my attitude towards them certainly would. For example, I value my family greatly and I try to prioritize going home when I am able to spend time with my parents. If my life was to be cut predictably short it would become less a matter of going when I could and doing everything I can to spend as much time as possible. It's hard to imagine what I would do in such a situation. If I had a job i would probably keep working but as a student I wouldn't keep going to school.
 
SouthernSurgeon said:
It's disappointing and yet sadly not surprising that this seems to be one of the most common pre-allo reactions to his story.

I'd suggest re-reading it (or even just the passage below), but I suspect the message will still be lost.
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The reaction in pre-allo isn't necessarily wrong. We structure our lives based on what's most important to us, but also on the time horizon that we think we are most likely to have. Very often we sacrifice our highest priorities in the short term so that we can do our best by them in the long term. When you guess wrong, and you have less time than you thought, its a double tragedy: not only do you have to face the immediacy of your mortality, you need to face the completely underserved guilt of having neglected the things that mattered most, because you were trying to plan for a long term that is now never coming. Dr. Kalanithi understood that:

Dr. Kalanithi said:
The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”
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The message you take from a tragedy like this depends on how you relate to medicine. For someone like who is a lot like Dr. Kalanithi, a gifted surgeon who loved his work, the message may be to treasure the days and the hours you are able to practice. For another physician, who deeply loves his family but who doesn't find great satisfaction in medicine, the message might be to make his job a less important part of his life: to skip the fellowship, and to try to figure out how he can start working part time. Neither reaction is wrong.
 
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ridethecliche said:
I think it would. Don't you?

Would you go on living exactly like you are right now if you only had another year or two to live? If someone told me that I was going to die with 100% certainty in two years, it would definitely change how I do things. So much of life and medicine is planning for the future and reigning in spontaneity and impulsive nature for longer term goals. If those goals ceased to be attainable, wouldn't that affect your outlook?
Click to expand...

I'm in the middle of reading the book so it's possible my thoughts will change....

I wasn't suggesting that there is a one-size-fits-all reaction/decision, or that there is a right decision. I was responding to SouthernSurgeon's comment, which I took as a reaction to the posts suggesting "the poor guy was cheated, didn't get the rewards, I wouldn't have finished residency if I knew since it sucks so bad anyways..."

This was a guy who is not to be pitied. This is my take....the acute prospect of death threw into relief -- magnified -- what was most important to him rather than changed what was most important. He cared about his daughter more, with a keen sense of what she meant to him, and what he might in the future possibly mean to her. Caring about her more doesn't necessarily translate into quitting his profession to hold her more. Becoming a physician, becoming a neurosurgeon was part of who he was. He had to finish his residency, just as he had to write his book. He of course was the kind of person who could do both, which certainly sets him apart.

The timing and phase of life when something like this hits I think also matters. If I was 3 months from defending a doctoral dissertation then of course I most likely would want to finish. If I'd already been practicing for 10 years, then maybe the answer would be different. Do I want to do even more of what is most important to me at that point (which might or might not mean not practicing), or do I want something radically different, like a bucket list kind of deal or all the things I wished I'd done but never did? My father, a surgeon, died of pancreatic cancer at 63. He died inside of 3 months of diagnosis, most of which was spent in the hospital with failed procedure after failed procedure to put a dent in his horrific pain. Before his first cordotomy, he was terrified by the knowledge that he would never practice again which was all he wanted to do. Before the the second cordotomy, he was focused on never being able to drive or play tennis or do anything "normal." In his last 2-3 weeks he only wanted to know if his estate was going to be distributed as he wished and whether his family was going to be OK.

I think the "means to an end" philosophy/strategy is highly overrated, and leads to an endless chase of never-ending goals, and an eventual realization (or not) that the real living inside the journey was missed. We're using up the little time we have from the start. Spending 30-35 years to start living at some point in the future doesn't make a lot of sense...might as well make the journey part of the living instead of a prep step for eventual living down some road (which is really an illusion anyway as the "steps" never stop presenting themselves). There is no magic point where living becomes really living, like some long prep period as like a layaway deal for really, really living later.
 
Lucca said:
I can't shake the feeling that a user called @Nietzschelover would have some opinions on this matter.

The things that really matter to me would not change but my attitude towards them certainly would. For example, I value my family greatly and I try to prioritize going home when I am able to spend time with my parents. If my life was to be cut predictably short it would become less a matter of going when I could and doing everything I can to spend as much time as possible. It's hard to imagine what I would do in such a situation. If I had a job i would probably keep working but as a student I wouldn't keep going to school.
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If your dream was to be a physician, how do you know your family would want you to stop pursuing your dream if you/they knew you might not (or would not) get to the finish line?

The prospect of death is always true. We tend to live day to day as though that is not the case....as though there is always plenty of time or that time is endless. But death is what makes time matter, what makes time (and lives) meaningful. Events like a terminal illness don't change that....they only throw the truth of that into acute relief.
 
Womb Raider said:
Oooo huge assumption there, not sure I agree with this!
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Let me put it another way (and this isn't me, it's Heidegger). There is no meaning without temporality. Infinite lives would be meaningless lives because all choices and actions could be re-lived, changed, whatever infinitely.

And from what I've read so far, Dr. Kalanithi understood this.
 
Nietzschelover said:
Brilliant gestalt change here. Would whatever really matters to you change based on ending up having less time for it matter?
Click to expand...

If I was diagnosed with something that only gave me 1-2 years left to live, the day that I received that diagnosis is the day that I would resign my residency position.
 
NickNaylor said:
If I was diagnosed with something that only gave me 1-2 years left to live, the day that I received that diagnosis is the day that I would resign my residency position.
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What if you had a year to live and were 3 months from your MD degree?
 
Nietzschelover said:
What if you had a year to live and were 3 months from your MD degree?
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Then I would finish it, because M4 is more or less a blow-off year anyway. Same thing if I was close to completing my residency position. But as it stands, that isn't the case, and there are things that I would much rather do with my time (like write) and potentially accomplish than continuing on with training that I am likely to never complete.
 
Nietzschelover said:
Let me put it another way (and this isn't me, it's Heidegger). There is no meaning without temporality. Infinite lives would be meaningless lives because all choices and actions could be re-lived, changed, whatever infinitely.

And from what I've read so far, Dr. Kalanithi understood this.
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SMBC summed up my feelings on this better than I ever could

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NickNaylor said:
Then I would finish it, because M4 is more or less a blow-off year anyway. Same thing if I was close to completing my residency position. But as it stands, that isn't the case, and there are things that I would much rather do with my time (like write) and potentially accomplish than continuing on with training that I am likely to never complete.
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Totally understood, and at least to me, entirely consistent with the idea that what matters most is heightened more so than changed. I'm guessing your motivation to be a psychiatrist has some overlap with your desire to write (and what you want to accomplish via writing).
 
I wonder why Atul Gawande bothered to write a book called Being Mortal with the subtitle Medicine and What Matters in the End.
 
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