The Temple Of Medicine

I woke up this morning at the usual time.   But instead of driving to work, I waltzed out the front door and walked toward the station.  Ten minutes later, I was rocking gently back and forth with the motion of a train car. I was looking forward to wandering around the city, although, in reality, my path would be just a short hop to the testing center.  I was taking my Maintenance of Certification exam for Internal Medicine.

Ten years ago, I had taken a similar test.  I was fresh out of residency, and had just started practicing as an attending physician.  I was used to being tested back then.  It seemed like every year there was a Step I or Step II.  But now I'm out of practice.  After the original board certification the tests had ended.

As I sat down at the computer to begin, I couldn' help but feel a strong sense of nostalgia.  A decade has passed and my life has changed.  Two jobs and a couple of kids later, I'm a different person.  I remember how pure my intentions were then.  I bowed at the temple of my profession.  I still held the mistaken belief that most problems were solvable, most diseases curable.  I was naive, but happy.  There was no field I would have rather studied.

Years later, medicine has lost it's luster.  An imperfect devil, she laughs as we inferiorly toil at her feet.  Unlike the test questions flashing up on the screen, real life is much more messy.  The answers are less clean and the consequences more apparent.  You never killed anyone by missing a question here or there.

The test is woefully unlike the real practice of medicine.  There is no multiple choice on what to do when the chronic debilitated back pain patient uses up all her medicare days and only qualifies as an observation stay.  There are no useful suggestions on how to stave off the fears of malpractice that whisper in your ear when your are trying to sleep late at night.  Apparently such skills as anger management, grief counseling, and maintaining calm when being insulted, are to difficult to test.

I finished the exam a few hours early.  It was challenging, but I'm sure I passed. 

It now feels like I have a love hate relationship with my profession.  When it's good, there's absolutely nothing like it.  But most of the time, it's like seeing a beautiful car in the distance.  As you get closer, your eyes adjust, and you notice the paint is chipped, the bumper is dented, and the exhaust pipe is barely hanging on and rattling against the ground.

It was never that fine in the first place. 

Your mind was just playing tricks on you.