Becoming a Doctor

Starting medical school was a kind of weird experience for me. I started wearing a white coat and a drug company gave me a stethoscope I didn’t know how to use, but mostly I just tried to imagine what it feels like to be a doctor and then act that way. School seemed mostly to be about knowing or understanding things and it felt like no matter how much I knew, it would not be enough to be a real doctor.

As I went through medical school and into my internship and residency training in psychiatry, I found that I began to understand or interpret things that had been opaque to me a couple of years earlier. Knowing the things I needed to became less of a problem, but emotionally, I often did not feel the way I should about my patients.

On a nice day, with a good night’s sleep and a cup of coffee, if I had an appreciative patient and a manageable schedule, I could get into the zone; focused on the patient and exhilarated by a feeling of energy confidently directed at a challenge.

But if it was late in the day, and I wanted go home, or a patient was needy and acting grumpy, much as I might try to be civil and professional, it was as if my bones were screaming at the patient to stop bothering me and get out of my way.

As time went on and I finished my training, I learned that I had to portray an attitude of patience, or it could be costly. If a patient felt I was rushed it slowed them down and could even make them become hostile. So I got better at “seeming” un-hurried, focused, and concerned. I was aware, however, that my internal self was often split from the figure I was portraying. I could act like I had no thought in the world but the patient in front of me and like I wanted nothing but to help that patient better express his or her concerns so I could address them. But internally it was like a clock ticking away as this patient’s needs were interfering with my own. “I know you are hurting… but I want to go home and get my dinner” pleaded a restless inner voice.

I was not pleased with myself. Much as I wanted to feel different, I could not lie to myself. I was not living up to the standard of the doctors I most respected.

In 2007 my father was admitted to Sarasota Memorial Hospital with pronounced dyspnea. My wife, my sister and I flew down from Philadelphia. My brother flew in from Oregon. We met in his room along with my mother and my Sarasota sister. I opened my laptop and got on the phone with a childhood friend who was medical director of an intensive care unit in Boston. I discovered the combination of my medical degree and forty years of psychiatric practice, a personal ICU consultant, and the miracle of digital medical information was the perfect formula to become a good medical ombudsman. I won’t say my father could not have survived without my input, but it sure did not hurt.

It was not easy to see my father in such a depleted state. He was fully cogent and had a remarkably positive attitude. But he was a 92 year old man who had been swimming three or four days weekly a month ago, and now he became hypoxic getting up to urinate.

Oddly my father seemed less concerned with his medical condition than I was. He was working on a project to establish an annual prize in the arts in partnership with the Hermitage, a Sarasota artist retreat. He wanted me to understand the nature of this project that seemed more important to him than life itself. I would come upon a medical issue to suggest we talk over with his doctors. He would patronize me in agreeing and then change the topic to his project.

In retrospect, I think my father’s optimism was actually in part, hypomania caused by systemic steroids, which were also causing the congestive heart failure that put him in the hospital. I would have the good fortune to see him recover, resume his swimming, and complete the project. But on that day, my father’s friends and grandchildren and great grandchildren came to his room for what they thought was possibly a last visit. As evening fell and the family prepared to leave my father gestured me over to him as if to bring me in on a secret. “Would you be able to stay overnight?” He asked, “I’m not comfortable having a female nurse help me pee, and I sure don’t want to ask your sisters.” Of course I would, I told him. I only felt embarrassed I had not thought to ask.

Later that night everyone was gone and my father was asleep. Lying in the second bed in his room, it occurred to me if this had been thirty years earlier, I may have acted the same way, but I would have been restlessly waiting for morning when I could leave. ..(yes, even for my own father) Now, there was nowhere in the world I would rather be.

Lying in that bed, I realized it had been many years since I had worried about my emotional reaction to my patients. Something within me had shifted so that I had become instinctively drawn toward people who were hurting, even the difficult ones. When I was tired and it was late in the day, a person in trouble who might have once seemed a burden, now had become a source of inspiration and energy.

I had been practicing medicine for nearly forty years and I was feeling like a real doctor. The transition had been so gradual that I had not noticed.