For My Son

We tell ourselves the stories about our lives that make it bearable, or better yet, magical, mystical. When my father died unexpectedly I was seven and there were no stories that made sense. How could I explain how this loving father of three and devoted husband could be taken from this earth so quickly and with so little warning? It was a question that puzzled me throughout childhood.

As I grew older, I eventually formulated an answer. When my father died, I was seven years old and he was my idol. I copied his movements, his words, and then I copied his profession. My father was a highly respected oncologist and often treated the sickest patients. He received many accolades as well as the love and respect of his colleagues.

I always wondered, if he had lived longer, would I have grown less enamored? What would have happened when I reached the age where boys question their fathers and become disillusioned? Would I have changed my mind and wanted to be a sports star or a policeman? I’ll never know.

The idea of becoming a doctor stuck with me. It carried me through successes and failures. It created a confidence that never questioned if, it only questioned when. It built a story of my life that made sense. My father’s tragic death strengthened my calling to become a physician. I would carry on the tradition and touch countless lives. From death would come rebirth. By helping others, I would turn my sorrow into beauty.

2

When I started residency in July of 1999, I felt confident that I was doing my life’s work. I came to the hospital early the first morning. The chief physician brought me to the third-year resident who was covering the patients who would become mine. This was the resident’s last day of training. I will never forget the phrase my chief used when introducing him.

He said, “This is John. You’re taking his patients. Today is his last day of residency. He can’t be hurt anymore!”

My thoughts raced. What did he mean “can’t be hurt”? Who was hurting him? And why couldn’t he be hurt anymore? Unfortunately, I would eventually learn.

3

In my second year of training, I was given more independence then before. I worked in the intensive care unit without direct supervision. During the day the ICU attending and fellows were available, but at night I was on my own.

One evening, early in my first month, I faced a situation that changed my life. One of the patients had severe respiratory problems and needed to be placed on a ventilator. He was elderly and I wasn’t sure what was wrong.

Before I began the procedure, I paged the anesthesia attending on call as a precaution. Within moments of getting started, things went terribly wrong. I couldn’t get the endotracheal tube in correctly! I kept trying, but it was useless. And, although we called over and over again, the anesthesiologist never showed up

My anxiety rose as I placed a mask on the patient’s face and delivered life saving breaths. I could feel the confidence leaving. I struggled for what seemed like hours before another resident, walking by the ICU, came in and helped. After flailing for another fifteen minutes, we finally got the patient intubated.

Within seconds the patient’s blood pressure dropped. We started CPR and injected epinephrine without benefit. The heart monitor went flat and he died.

Later that evening, I held back tears as I rehashed each moment of the hopeless code. Had I moved too fast? Had I deprived my patient of too much oxygen while fumbling to ventilate? Did I over sedate him? I will never know the answer to any of these questions.

4

The remainder of the night was a blur. I couldn’t sleep because I was busy with other patients. The man’s wife and family came and went. It wasn’t till the next morning that the phone calls started to roll in.

Apparently my patient had three daughters from a previous marriage who were unaware of what happened. I took three calls that morning. I told three young women that they had lost their father. I waited patiently as they broke down. As I listened to their sobbing, I remembered what it felt like to lose my father. Each call lasted less then five minutes and left an indelible mark on my soul. I had never experienced a grief so pure and innocent as those young women’s. I will always feel responsible.

And this is what the chief meant by being “hurt.” If you practice medicine long enough, you will make mistakes. You will accidentally harm people. You will work long hours and deal with the most primitive human emotions. At some point you either learn to sublimate, learn to move on, or get crushed.

When we say that someone “can’t be hurt,” we’re saying that they can work 36 hours in a row without sleep. They can deal not only with the annoyances of hospital life, but also with the fear and sadness. And still, at the drop of a dime, they can make critical decisions involving people’s lives. It also means that we learn how to be hard, learn how not to cry. We drop our emotions and sentimentality to survive. We change who we are.

When I became a physician, I unwittingly made this sacrifice for the sheer good that I could accomplish. I could deal with the stress, sadness, and culpability, as long as there was a pot of gold at the end of the rainbow – being the kind of physician my father was. I could give up the tenderest side of myself to avoid getting squashed by my experiences.

So that day, in the ICU, amidst the phone calls and grief I stood at the abyss. I could either let momentum and sadness carry me down or I could step away. At the time, I thought I was choosing life. I didn’t realize that I was lost.
I found myself again October 25th, 2004. The day my son was born.

5

After the ICU incident, the rest of my career had been rather mundane. I left residency and joined an internal medicine practice. My days were straightforward. I crammed as many patients into as few hours as possible to stay afloat. The malpractice crisis was a constant worry. Malpractice rates went up. Physicians were forced to see more patients in less time to cover overhead. The quality of care went down. There were more lawsuits. The downward spiral went on.

People were less happy with their doctors. I often found my patients to be angry and distrustful before they even met me. There was a constant barrage of paperwork for unknown reasons. I was repeatedly questioned by insurance companies. I rarely felt like I was helping anyone.

Physicians were also changing. Because of the lower income, decreased respect in the community, and family obligations, they were becoming less responsible for their patients’ well being. The days of your doctor meeting you at the emergency room late at night were long gone. Most young physicians believed that after the workday was over, their patients were someone else’s concern.

And I thought that I was okay with all of this -- until my world radically changed with the birth of my son. When I looked into his eyes looking back at me with complete trust, the barriers that I had erected since that horrible day in the ICU came down. I could cry again. I didn’t have to protect myself anymore.

And that left me with some hard questions. Why was I staying in medicine? Why did I give up an important part of myself for a profession that promised so much and delivered so little? Where had I gone wrong?

And what did this say about the state of healthcare today? I had come into the profession with the hopes of helping humanity. I trained at some of the top institutions in the world. I received various awards both for academic rigor and for clinical acumen. I was considered bright, caring, and hardworking. These are qualities that society expects from great physicians. But they are not enough.

The day of my son’s birth, the story that I had told myself about my life once again shifted. My father’s death had brought me to a profession that I would no longer pursue. As my son was born, I would leave medicine. I would make the change in time to teach him what is really important. I had changed once before, for the worse. This time I would be restored to my former self.

But in my heart of hearts, I eventually told myself something completely different. Maybe I truly was meant to be a physician and help humanity. Maybe it wasn’t me but medicine that had changed.

As the years pass and my son grows older, I continue to practice today. I realize that who I am is a result neither of my father’s dying nor of that horrible night in the ICU. They are sad tragedies that will neither define nor hold me back.

It’s time for me to take responsibility and embrace who I have become. For my son’s sake.