The Top 7 Reasons Why It's GREAT to Be a Doctor

Brand new doctors are graduating this week! HalfMD wrote a good-bye to his old white coat, and Graham at Over My Med Body! posted his commencement address to the graduating class.

Both of these posts make reference to the many woes facing doctors, which is a shame when these young docs should be celebrating their accomplishments. In honor of them, I offer the following Top 7 reasons why it's great to be a doctor:

7. You'll never be bored

Boredom is one of the most stressful of human states. I would much rather be exhausted--and I often am--than bored. The great thing about being a doctor is that interesting things are ALWAYS happening around you. Once, I was standing at the Med-Surg nurse's station, feeling the mid-afternoon malaise that always afflicts me. I am a naturally siesta taker, I think. Anyway, suddenly there was a Code Blue called overhead:

"Code Blue, Pain Clinic. Code Blue, Pain Clinic."

???? Our Pain Clinic is a few feet away from Med Surg. I walked over there as a whole mob of respiratory therapists, ER docs, house supes, and looky-loos converged upon the suite of rooms that make up the Clinic.

One of the nurse anesthetists was working the Clinic that day. He and a nurse were standing around a gurney on which an elderly woman was napping.

"What's going on?" I asked.

"She suddenly got lethargic after I did an LESI," the CRNA told me. "This is a big change to her mental status"

I had already reached for her radial pulse, which was strong in the 70s. The patient was opening her eyes. Someone came running with a crash cart. The RT was unwrapping a self-inflating bag-mask ventilator. "Hold on," I said. "She's breathing."  I turned to the CRNA. "What's her name?" I asked.

"Violet," he said.

"Oh, Violet," I said, patting the patient on the hand. "Hi Violet! How are you?"

"Oh, fine," said the patient, looking curiously at the gathering around her.

"Look at all these people who came to see you," I said, gesturing to the crowd. "You're a celebrity!"

The ER doc let out a snort as nurses started moving Violet to the ER for evaluation.

"I just wanted some other people to take a look at her," the CNRA said, sheepishly. I felt kind of sorry for him.

But see? Not boring. Pulled me right out of the mid-afternoon malaise.

6. You get to do some AMAZING things!

Athletes and adventurers talk about "peak experiences." I understand some people scale mountains, others jump out of airplanes, and still others get beaten to a pulp in extreme wrestling competitions--all in a pursuit of peak experiences: that sense of being more than yourself, better than your best.

Well, you're never going to catch me doing those things. As a well brought-up Asian woman, I will not jump out of an airplane, even if it is on the ground. I'm just a cautious person, so I thought I'd have to sacrifice peak experiences for a sense of safety.

Then--I delivered my first baby. I was a fourth-year medical student and I'd been waiting in the wings for weeks to catch a baby, and after it happened--after that new person slipped into my hands--I felt high for hours. Being at a birth is still a peak experience for me. Sometimes, I'll find myself watching a baby crowning and realize I've got a giant grin on my face.

(Opening up a sebaceous cyst is pretty fun, too.)

5. You will test the limits of your mind

This might be an incendiary remark, but I suspect most people don't care if they ever challenge their minds. Sometimes I'll see a young woman aimlessly flipping her cell phone cover open and closed, and I'll wonder: Is she pondering the origin of evil? Or devising an alternate approach to Fermat's Theorem? I always feel a bit deflated when I realize she's not.

Doctoring is different. You do not have the option of not thinking. People expect you to think. And even if you lean towards being a cell-phone flipper, you may discover the pleasure of applied inquiry. There is a certain satisfaction in evaluating a patient, developing a differential diagnosis, looking up the different entities, and pursuing/excluding each entity until you arrive at a working diagnosis. Especially if you turn out to be right.

If you flex your mind, it will become your best resource. Here in Rural, CA., we often run short on hematologists who are willing to consult on the weekends. Once, I was following a woman with severe thrombocytopenia. I did a huge amount of research, worked her up, and diagnosed her with idiopathic thrombocytopenic purpura. I tried steroids--didn't work. Then, after a whole lot more research and discussion and cogitating, I gave her IVIG. Her platelet count gradually increased, but slowly. Another doctor was critical of my decision to administer $45,000 worth of therapy that didn't appear to be helping the patient. I felt bad for days, then--her platelet count finally normalized and stayed normal.

Next thing you know, everybody thought I was a genius. Don't believe it. But I do get credit for thinking.

4. Deserved or not, you will earn respect in your community

I remember I wasn't ready to be called "Doctor." The first day of internship, a nurse called me "Doctor Chan" and it took me a minute for me to realize she was addressing me. It took even longer for me to introduce myself as Doctor Chan, but now I do it often because I find it causes less confusion than introducing myself by my first and last name, which has always been my preference. Oh well.

In a small community, it doesn't take that long for a doctor to be a person of standing in the community. People will drag their mothers across the room to introduce her to you. Next thing you know, you'll run into a local business leader who will say, "I've heard good things about you" and you will be tempted to burst out laughing. But you can't, because they're serious, and they want to hear your opinion on things. This is both a blessing and a curse, but it is a tremendous tool for doing good.

3. Speaking of doing good, you will do some--even if you don't mean to

Yesterday, the discharge planner for our hospital called me on my day off. There was a patient on the hospitalist service who was at the end of his life, and his family wanted me to offer a second opinion regarding his prognosis, which I knew to be terminal. The family knew me from the many conversations we'd had when his wife was was dying, and they trusted me.

So I went to the hospital and spent 45 minutes talking to this family, whom at this point seems like an extension of my own. I called the patient "Dad" and referred to his late wife as "Mom." We spent a long time talking about Dad's poor condition, his worsening uremia, the futility of continuing tube feedings, and what his values in life were. "I asked Dad, 'Do you want to go see Mom?,'" said the patient's daughter.  "He said yes."

I explained that uremia is thought to be a relatively merciful way to die. I explained that they might see him moving his hands, or "tilting at windmills," as I like to describe the uremic arm movements some patients make. I explained that this was a natural process Dad was experiencing, that there was nothing going wrong, nothing to fix.

We agreed to make Dad comfortable. I had the feeding tube removed and ordered some morphine drops. Not long after his family left for home, Dad died.

Now, I have to admit, I was motivated to have this conversation because I wanted to avoid the horror of coding this man, and the subsequent agony of talking to the family about withdrawing care. I was thinking about myself and the staff at the hospital, who really take it to heart when they unsuccessfully code a patient. So I wasn't intending to do a good thing for the family.

When I walked into the hospital this morning, I ran into the discharge planner, who told me Dad had died. "The family really appreciated your talking to them for so long," she told me. "It helped them to know he wouldn't suffer."

I got credit for doing something selfless and good for the family, when in fact I was motivated by completely different reasons. Perhaps the two sets of motives overlapped in some advantageous way, but I still marvel at the opportunity doctors have to do good without meaning to--by offering a kind word, a pat on the shoulder, or an extra five minutes to listen.

2. You get to work with some great people

There are a few cranks in every organization, but for the most part, working in healthcare introduces you to some wonderful people. Let me tell you about Alison, my favorite ICU nurse.

Last year, I helped take care of a really nice woman in her 60s who came in with recurrent pneumothorax. Because it kept happening, we had the pulmonologists and surgeons working with us to figure out why. "You'd better be quick," she told me. "We've got a trip to Hawaii planned in six weeks. I've never been to Hawaii." 

Her husband had just completed a long round of radiation therapy for lung cancer. He'd been sick for so long, between surgery and rounds of radiation, that they hadn't gotten away very often. Now that he was completing radiation, they were going all out and taking a cruise to Hawaii.

We made back-up plans in case she wasn't able to travel on her reserved days. "That's OK," she said. "It might be nicer to go in April anyway." She was always upbeat and funny about it.  Her husband said he really wanted to go, now that he felt better. "She's been taking care of me for a couple of years, now it's my time to spoil her."

The pneumothorax sealed over, but her pulmonary function worsened. Our pulmonolgist worked her up extensively and identified a rapidly-progressive autoimmune pulmonary fibrosis. After three weeks of high-dose steroids, it was clear we weren't going to be able to reverse the process. Instead, the patient asked us to call hospice. 

She stayed in the ICU during the days before she went home to die, because Med-Surg was full. She had an isolation room with some measure of quiet and windows faced out to the nurse's station.

The last time I saw her, I knocked quietly and slipped in. "Just came to say hi," I said, in that uncertain yet cheerful way we speak when we have nothing left to offer.

She looked at me. Her eyes were sunken. She could only take tiny gasping breaths. "Thank you for coming." She took my hand and held it. We looked at each other, moist-eyed.

I think I needed to break the intensity of the moment, so I looked around the room at the photos of her grandchildren and children. "Oh look," I said in that trying-to-be-cheerful way. "Someone made you a palm tree." A jagged-edged cartoon palm was cut out of construction paper and taped to the window.

"Alison did that," she said. Alison was the young nurse who'd been following her case for the past several weeks. Tall, funny, passionate and loving, she is the kind of nurse who combs and braids the hair of a coma patient, and trims the moustache of a dying homeless man.

"She did?" I asked.

"Yes. That one too," said the patient, pointing weakly to the small window on the door.

I looked. She was pointing to a blue doughnut-shaped cut-out taped to the door. A piece of nylon rope was tied in a bow at its base, and someone had written, "Bon Voyage!" in felt-tip on the lower half of of the doughnut.

I scanned the rest of the room, more than a bit confused. There were palm trees, dark blue-and-green waves out of which leaped tropical fish, and an island with another palm tree perched on it. And then I got it: it was a construction-paper diorama of the Hawaiian cruise she would never get to take. Alison had brought the vacation to her, in two dimensions, but I swear I could smell salt in the air

It makes me cry just to write about it.

1. Some patients will change your life forever

I could just tell you to read the story in #2 again, because it demonstrates the point of #1 as well. But since this is a graduation present, I'll give you one more story.

Somewhere during the first half of my intern year, I got called to the Extended Care Unit of our hospital to pronounce a patient dead. The ECU was essentially a skilled nursing facility in one of the distant wings of the hospital. We often sent patients there after an acute hospitalization as a transitional stop before returning home. Some of the patients had been there for years, however, and were known and loved by the ECU staff. The dead woman was one of the long-time residents. "Can you please come over soon?" the ECU nurse asked me. "For Roberta's sake?"

My third-year resident reminded me what to document in a pronouncement of death: 

• Absence of pupillary response
• Absence of spontaneous respirations 
• Absence of pulse 
• Absence of response to noxious stimuli 

I walked to the ECU running these four points of exam through my mind. Running in parallel was the self-conscious thought that I was going to declare a person's life over. It seemed like a heady task. Someone who had occupied this world at least three times longer than I had was now dead. I felt obligated to meditate upon my own mortality, so I paused on the threshold of the patient's room to offer a bodhisattva's prayer for the release of all beings from suffering.

Feeling somber and dignified, I approached Roberta's bed. She was covered with a sheet. I turned on my penlight and drew the sheet back, intending to check her pupils. What I saw stopped me in my tracks.

Roberta had been a skin-and-bones, white-haired old woman, but her face was made up with florid red rouge and matching lips. Crooked false eyelashes peeled away from her eyelids, and the sunken eyeballs they veiled stared up at me. I imagined her winking. As I pulled the sheet back further, I found she was wearing a red satin teddy trimmed in black lace.

Roberta was quite a character. Pulled me right out of my self-important meditation, I can tell you that.

There's a million more stories about people like Roberta, Dad, Violet and the woman who almost made it to Hawaii. Go find them.

CONGRATULATIONS, GRADS!

Comments

[Jenny]

Hi Theresa, so glad to see that you are back to blogging. I was an avid reader of your Stillpoint blog, and really missed it when you stopped. I was a resident at the same time as you were, so I had many similar experiences, and also a knitter.

[James]

Thanks RD. I'm about to start residency here and being a doctor is starting to seem less and less great all the time. I may just pull up this post for inspiration every day or so :)

[Jessica Bond]

Growing up in a rural community, physicians are perhaps even more important. People appreciate doctors who make their homes in small communities and most will work hard to welcome you. As for rural medicine, physicians practicing in these areas certainly face more interesting situations due to lack of specialists. I hold rural physicians in the highest regard as they often handle some highly acute situations on their own which requires a high level of expertise and commitment.

Thank you,
Jessica Bond

[Doctor David]

What a great post, RD! It gets so tiresome reading all of the negativity about medicine. Despite it all... I can't imagine doing anything else with my life. It's a great career!

[Theresa]

Thanks everybody. I really mean every word. Even my worst day has a moment of grace and amazement in it.

[janemariemd]

Great post! I agree completely. There aren't many careers where you get a ringside seat in many a person's life, and they will be grateful to you for it.

[Brandon Wood]

This was truly an excellent post, RD. In fact, we gave you the Scrubby Award this week at Redscrubs.com because it was so good.

In addition to being recognized as the top medical blog post of the week, the award also includes a free pair of red scrubs. Just email me and I'll send you the form so we can get them to you.

Sincerely,
Brandon

[Theresa]

Wow! I've never been Scrubby before.

[Marta]

All of your seven points are true of my profession (sub "readers" for "patients") as a writer and I didn't have to spend 10 years in school. I respect doctors; both my parents are physicians, but I do get a chuckle at how self important they are.

[Joanna T]

You are so inspiring! I'm just writing my personal statment (I want to apply to a medical school) and I have to say although I have not experienced anything important yet, I agree with everything that you said! I wish there was more doctors with your approach in this world.

Take care

Joanna

[Jennifer]

I really, really enjoyed this top 7 list (#2 made me cry while reading it). I was just wandering around on the student doctor network while avoiding studying for my micro exam and came across a thread about med students dropping out. Someone posted a link to this, and it was a really nice thing to read as a reminder of exactly all the reasons I am here. Thank you.

Sincerely,
Jennifer (MS-II)

[Bruce Fletcher (Stronsay, Orkney UK)]

We live on Stronsay, a remote island in Orkney (UK), population about 400. Dr George McKay, our General Practitioner, is retiring next year and so far there is no sign of a replacement. Any qualified GPs who would like a year or two in a beautiful part of Britain with a moderately stress-free practice could do worse than contact me via my website's guest book. My only connection with the health service is as a very satisfied patient!

[Erik]

Wow! I just found this site and I love it! I am a 3rd year FP resident, looking at jobs in rural practice and find your articles very interesting and quite funny. Thanks for the writing!

[Jeannie]

This was really excellent.