Evolution

You won't at first.  But then you will.

It will start innocently.  Probably even before medical school.  You will have a morbid curiosity about passing ambulances and motor vehicle accidents.  Your original empathy for the victim will disappear when you begin to think of them as patients. Test cases.

The commodification accelerates during the early years of medical school.  Anatomy, pathology, and physiology provide you a vocabulary to replace human pain and suffering.  In gross anatomy you violate the viscera even as you hear your fellow students snigger in the background.  You may not take part in their school-boy antics, but it loosens in you a certain callousness that you were previously cautious to recognize.

During the clinical years you will learn to build walls with the most rudimentary artifacts.  Your first death.  A mistake.  Your resident standing over blaming you for the post op infection and eventual demise of a beloved patient. Your hands will scramble as you crouch amongst the linoleum of some hidden dark corner of the hospital ward, collecting dust and discarded gum.  Your eyes no longer seeing, your heart trying desperately not to feel.

Residency is when you will become the master builder. Unslept nights.  Missed meals.  Standing on the front line wading through the intolerable excrement and blood of actual healthcare.  You will learn not to cry, not to contemplate.  To traipse from life to death wearing the same distracted grimace.  And you will yell at that poor medical school student about the post op infection for which you secretly wonder if you caused.  You now work with brick and mortar, clay and stone.  Your tower rises above and beyond, up to the sky, encircling you.  You are alone.

Your expertise will be so great by the time you are an attending physician, nothing will penetrate your ironclad barriers.  Unlike those walls, however, your heart will be porous and ooze sadness, anger, and despair.  Trapped inside that small space.  Devouring you.  And love, and family, and friends, and light, and oxygen will all be awaiting on the other side.    

A breath away, a mile apart.

If you're lucky, you'll fall to your knees to the grit and grime and start clawing with bloodied knuckles.

Brick by brick you must undo that which you have built.

That which has been built for you.