Hi Everyone,
I’m on Jeopardy this weekend and, as the hours melt away, it looks like I’ll have one last free day before starting step down tomorrow.
On Friday, an intern asked me how I’d chosen my career- a question I’ve fielded many times before. While becoming a doctor was largely pre-ordained by my parents and life circumstances, becoming an internist was an accident.
I was supposed to become a pediatrician. I’d spent years seeing doctors for childhood asthma, my older brother was a pediatrician, and I’d been a camp counselor for years- so pediatrics seemed right. By September 1987, my residency applications were in, but for reasons lost to time, I signed up for a month-long MICU elective at St. Luke’s Hospital in Manhattan and unexpectedly discovered my calling.
The St. Luke’s MICU was a dim, crowded unit with pale green walls, where patients were shielded from one another by flimsy curtains. An attending rounded briefly in the morning but, otherwise, residents were on their own. Students were given responsibilities that seem incomprehensible today. One of my patients was a giant man with a massive PE who needed urgent thrombolysis. Because of his size, I ordered most of the pharmacy’s stock of urokinase, a medication dosed by weight. We lined the vials up in a long row along the unit’s back windowsill while the nurses prepared a drip. Within minutes of starting the infusion, the man developed chest pain, but his blood pressure rose, which told us the clot was breaking up and he was going to live.
Another patient was a teenager named Maribel who had pyelonephritis, septic shock, and ARDS. The morning I met her, she was watching cartoons on a tiny TV to the right of her bed, an endotracheal tube protruding from her mouth. It was more than a decade before low tidal volume ventilation was introduced and she quickly needed bilateral chest tubes for tension pneumothoraces. Before long, she had renal failure, DIC, and shock liver, and my resident deemed her calculated mortality to be 100%, a prediction I refused to accept. When Maribel coded, I stood by, weeping helplessly as residents and nurses lined up for chest compressions.
I fell in love with the drama, teamwork, and focus of adult critical care. Every discussion, every detail, and every decision mattered. We took all comers, with all conditions, however complicated.
So, I switched to internal medicine, completing residency and a fellowship in PCCM. Afterwards, I directed the MICU; promoted multidisciplinary rounds, joined colleagues to fight H1N1 and COVID; welcomed APPs into the fold; taught trainees to place lines and lead family meetings; led teaching conferences; celebrated birthdays, holidays, and retirements with nursing and respiratory therapy friends; and accompanied hundreds of patients and families through big decisions and tearful good-byes.
Last week’s Grand Rounds Speaker, Tyler Johnson, explored how physicians find meaning in medicine. On his podcast, The Doctor’s Art, Dr. Johnson has interviewed physicians who share their gifts across multiple specialties. You can work in an office or hospital, become an investigator or teacher, make diagnoses or perform procedures, take care of the young or old—or do a bit of everything—and find your calling.
Regardless of the path you choose, your destination is assured. The hours will be long and few of us will become rich, at least financially. We will subsume our needs to those of our patients and colleagues, and inevitably we all learn that it is in the giving to others that we bring meaning to our lives.
As trainees, you may still be exploring how to contribute and some of you will find, as I did, that your original plans need revision. But whether you know the direction you’re taking or just starting to chart your path, I encourage you to open your minds and hearts to new and sometimes surprising, accidental opportunities.
Enjoy your Sunday, everyone. If I don’t get called into the unit (as it looks like I won’t be), I’ll be headed out to the Farmington Canal for a long bike ride.
Mark
P.S. What I’m reading:
- Lincoln in the Bardo by George Saunders
- My Son and Gus Walz Deserve a Champion Like Tim Walz by Tina Brown
- Meaning at the Fingertips by Dr. Vincent Quagliarello (mentioned at Grand Rounds)