Crozet Annals of Medicine: The Long Goodbye

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Hello Crozet! It has been a year since my last column. I wrote this piece a year ago but never got around to sending it in. I would like to share it with you now.   

A physician’s career path is defined by profound transitions. The first big transition comes on the first day of medical school. Before you lies a cadaver, a dead body; your companion and teacher for the next year. Over that year you will dissect every nerve, vessel, muscle, organ and tissue that made that person who he was physically. You can read some of his life story in the condition of his organs, the cancer that killed him, the band aid still stuck on the crook of his right elbow where he had his last blood draw. What were they looking for in his labs on the last day of his life? 

Communing so intimately with the dead breaks a strong societal taboo and changes you, robbing you of a certain squeamishness that would interfere with your ability to treat the worst that humans suffer.     

Eventually you stop practicing on the dead and transition to caring for sick, living people in your third and fourth years of medical school. 

Caring for complete strangers does not come naturally, and yet it will come to consume your every waking moment for the next decade of training. It will eventually become completely natural.  

After four years, you become an MD or DO, not quite ready to practice unsupervised but still expected to shoulder some of the life and death decisions that will eventually be yours alone. 

That transition to full autonomy rushes at you after three years of residency. You are kicked out of the nest and go to practice on your own for the next thirty or more years. You can expect to care for more than one hundred thousand patients. You will see death and suffering, hope and compassion, resiliency and weakness. If you are attentive, you will receive the education of your lifetime. You will learn how to live and how to die.    

Well, all that has now passed for me and I am contemplating some final transitions. 

Emergency Medicine is a younger physician’s game. The average age of retirement for an ER doc is only 50 years old and so at some not-too-distant point I am going to have to leave my full-time practice. If you have read my past columns, you will recognize how much teaching the residents and caring for the patients means to me and so I am already nostalgic for it. I am not fully there yet, but I can certainly read the tea leaves. This leaves me in a contemplative mood.

One evening last week I was sitting around a blazing camp fire surrounded by two dozen resident physicians. A light drizzle was falling, but no one seemed to mind. The occasion was our monthly “journal club,” a sort of book club for nerds wherein we dissect three or four of the latest medical articles and apply them to our real world experience. It was sublime to see the camaraderie of this tribe together, telling stories, sharing food, celebrating successes, supporting failures and above all seeking knowledge to better help others. This is what I will miss.       

I have been sharing my professional life with you readers of the Crozet Gazette for the past 18 years in almost two hundred columns. It has been a pleasure and a privilege and I thank my patient editor Mike Marshall for the opportunity and the guidance. (And the grammar.) As I transition into fewer professional obligations, I would like to change the trajectory of my column to a more interactive forum. I would like to hear from the readers about topics they are interested in. It has been a bit of a one-sided conversation and I need your ideas. Send your questions and thoughts and experiences and stories to me and we can discuss them each month.    

This brings me finally to my most profound transition yet. Sooner or later all doctors will become patients. After being in charge, holding all the power in those one hundred thousand encounters, it is a humbling experience to enter the health care system as a patient and entrust that power to another physician. It is humbling, but it is also amazing to see the practice of medicine from the other side. I am profoundly grateful and profoundly impressed with the care and compassion I have received at the hands of our healthcare system and the people who show up every day to do the work. And not to worry, I am on the mend and doing fine.  

In a sense I am now transitioning back to where I started, standing hat in hand at the edge of medicine, hoping for some guidance. In learning how to be a patient I am becoming a better doctor. A patient doctor.    

Happy New Year Crozet. It is nice to be back. Send me your thoughts at crozetannals@crozet gazette.com! 

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