Category: Essays & Poetry

Sometimes I don’t know if I can handle another one. Another uncomfortable pause, another sudden shift in body language, another dance of “did you get the vaccine” and “no, it was too quick,” “no, I don’t know what’s in it,” “no, and I will not.”

I wish it were just a simple question and an answer – like all the other checklists in my patient visits. I can ask a patient about their home life, diet, drug use, and sex life and get an answer so nonchalant I have to double-check that they’re listening. But, the same person might nearly freeze when I ask about the vaccine. It’s almost as if I can see their spine straighten and their muscles tense, prepared for Battle with the Know-It-All Doctors (and their Students). Their walls come up and suddenly we are miles apart. That’s what I hate the most. Not even the uncomfortable conversations, but the sudden distance, the instant formality as if it is no longer two people speaking in a tiny room but instead, a hot-seat interview on a news channel.

This is not to say they are all the same, they are definitely not. There are those genuinely seeking information, truly torn between a desire for safety and a fear of complications unknown. There are those paralyzed not by their own fear, but their daughter or sister’s fears. There are those with bookmarked Facebook posts, ready to brandish a vaccine horror story like a knife. There are those who I wonder about the most. Those who strongly and firmly state “no” and offer no further engagement. Then, there are those who I feel like begging. The 34-year-old pregnant woman, the diabetic 65-year-old headed for dialysis, the elderly 83-year-old in the emergency department. With them, I walk the thin line between persuasion and disillusionment, hoping I don’t trigger the dreaded blank stare. I think of my unfortunate patients. The 31-year-old guy who was finally cleared to go home after a 60+ day hospital stay, only to suddenly pass away from hospital-acquired COVID 1 day before discharge. Sometimes, I refuse to walk the line at all and I simply move on.

Honestly, it all depends on the day. On good days I feel kind and patient, mindful that we all crave the same health and freedom. Other days, I am tired and frustrated. Tired of all the cracks in the system, like the fact that students aren’t supposed to see COVID positive patients yet I spent countless days in the ER listening to the lungs of patients incidentally found COVID positive 15 minutes later. Tired of spending my days as a medical student next to a doctor on a laptop telehealth visit instead of floating between exam rooms as my predecessors did. Tired of the relentless acne from wearing a mask for 8-12 hours daily. On these days, my brain reverts to its primitive schema mode and determines the status of each person: either With Us or Against Us. I know, I know that this is not the reality. I know that everyone supports healthcare workers and vaccine hesitancy is remarkably multifactorial. Still, compassion fatigue is real and it permeates hospital halls like its own disease.

I try to imagine what the vaccine is to them. Often, it seems impossible we are talking about the same thing. What is to them a dreaded and dangerous trap is to me a golden ticket, a precious shield in a chaotic war zone. It absorbed some of the helplessness that we were drowning in. It gave me a guiding light, a dream of an education unmarred by a new virus. The “truth” outside the politics, fear, and hopeful dreaming, probably lies somewhere in the middle. The vaccine is neither a magical cure-all nor a manufactured lie. It is just a little piece of nucleic acid that travels into cells to become a protein that WE HOPE MAKES A DIFFERENCE.

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**This piece was selected and performed at the inaugural Stethoscope Stage production in 2022**

Sometimes, it is nice just to sit and listen to the wind rustle the leaves.  The cooling temperatures linger in the air like a prelude to the winter ahead.  I never thought I would find myself here, and I cannot help but smile through tired eyes.  How many times have I missed the movement of life around me because of the movement around me?  The enigmatic distractions surround us, poisoning the purity of the simple beauties of life.  I admire the leaves in the fall.  Of course, their color change inherently captures my attention as a reminder to stop and ‘smell the flowers,’ in a similar way a set of olive-green eyes might remind me to sleep, remind me that I have to eat three times a day, to try not to clench my teeth, and that, really, it will all be ok.  In the end, there is an undeniable elegance to the falling of the leaves; a gentle but self-assured poise to each and every leaf that, when the time is right, plucks itself from its roots, and bravely sets sail on its solitary, yet sui generis voyage.  The time must come for all leaves to embark on their journey, and though the trek may route through a previously undiscovered, and albeit, arduous, path, just as one cannot stop the leaves from changing colors, this too, embraces its own inevitability.  How valiant, to stare down the fear of falling, to trust the make of their ship, to sail alone.  Their destination is clear, their conviction clearer.  The winds may blow, swaying their ship, aggressively rocking the foundation in an unrelenting manner.  But, clever as the leaves are, flow with each windy blow, like water around a stone, never deterred from their ultimate goal, but ebbing gently with each test from the wind.  No matter how hard the winds may blow, how laborious each challenge may appear, or how many bruises each leaf must endure, just as one cannot stop the leaves from changing colors, this too, embraces its own inevitability.  As the leaves quietly, yet confidently, make their way to the ground, leaving behind the branch which had been their home for so long, so too must we all embark on our own journey.  Which then begs the question, what is the ground?  What is the ultimate destination?  Worry not, the end is neigh.  Rather, memento mori, only in as far as it gives purpose to life.  For what is light without darkness, peace without war, and love without hate.

Perhaps I, too, can learn to be more like the leaves.  The fears seem insurmountable, of being left behind on the tree, of falling, of never having the grit to jump when my time comes, of oblivion, cascaded by volume of inexplicable worries that flood every available space in my mind.  I am sure the leaves feel similar.  How beautiful that expedition must be, though, I think to myself; to experience those tests of life.  The wind, with its capricious and fickle self, brings the blowing challenges that provoke us to breathe deeply and suck the marrow of life with each deliberate adventure.  We are all meant to thrive so Spartan-like yet gentle, as the leaves do, staring deep into the eyes of falling, knowing we were made to live the life set forth in the path that is unraveling itself before our very eyes, that the make of our ships can and will endure the journey, and to jump, bravely and boldly, heart racing, with a smirk.  Perhaps that smirk is to spite the inhibitions, perhaps it is because of the joy of finally jumping from our branch, or perhaps both.  Sometimes, it is nice just to sit and listen to the wind rustle the leaves.  I cannot stop the leaves from changing colors, and I cannot stop the fear that lingers in my mind.  When I think about it, none of that even matters.  My heart could flutter, butterflies flapping in my stomach, as I wipe the sweat from my brow.  What matters is that we jumped anyway.  We jumped off our branch, flying into our odyssey, highs, lows, and in-betweens, tears, laughs, and far too many unforgettable memories to recount, living the life we were meant to live, so that when it comes time to meet the ground, we will not discover that we have not lived.  So here we go, with ill-fitted blue scrubs, a set of scuffed-up clogs, and a little too much caffeine, I catch a glimpse of myself in the sliding front doors of the hospital; tired-eyed smile as I sneak back into the resident’s lounge, just a leaf, riding the wind.

When I was little, I spent my pre-teen summers with my grandfather in Korea. He was a retired salesman who spent his time coaching the local high school soccer team. In the hot, humid summers, he would coach me in an equally intensive sport: gardening. His backyard spanned half an acre of trees, ferns, and cabbage. But his most labored love was his grapevine. Together, we built fences eight feet tall, allowing for her to expand her leaves reaching for the sun. She protected me from the heat like green clouds in the sky, dropping sugary fruit from the heavens.

One day, my grandfather handed me garden sheers with large rusty blades. He said we would prune vines that day. Unsure of what pruning was, I followed his direction: cut each branch he pointed at. My sheers would slice the darkened bark and reveal a white-greenish core, where glistening sap dripped at the center. The grapevine’s branches would fall to the floor with a thud and all the grapes would scatter like marbles.

My grandfather pointed to various branches of the vine, “This one is infected. This one has been eaten by insects. This one is too small.” I nodded with each response but could not understand the differences between the branches we cut and the ones we spared.

We came onto a large branch that was sturdy and strong. Its bark was like the thickness of a tree and would not break under my grandfather’s bare hands. I prepared to move on to the next branch until my grandfather placed his hand on my chest. He pulled me to the branch and said

“Look, it’s dying.”

I was confused. “How? It’s so big. It must be alive.”

He considered, “You’re right. It is alive and growing well. But, if we allow this one to grow, it will steal the energy from the main branch, and go in a different direction. That’s not where we want to take it.”

For the first time, I saw the grapevine as one connected system, and I understood. This sturdy branch deviated almost exactly at a 90° angle. Like a rebellious teenager, she wanted nothing to do with her parent. Allowing this one branch to grow meant the entire grapevine would die. Her growth would be her downfall.

My grandfather noticed my childish stubbornness and assured me that this was for the whole grapevine. It’s better this way. Not wanting to cause trouble, I moved on and began to squeeze with all my might to cut this rebellious branch.

Snap!

Fluid began to pulse out of the old artery with an almost desperate will. I put away my scalpel and began to sheer away more of the fat deposits surrounding the heart. Years later, in the cold air of a cadaver lab, the grapevine had taken shape, manifesting itself into an aorta branching into its capillary beds. I dug a blunt tool underneath an artery, pulled it towards the surface, and deciphered its Latin name: External Carotid; Subclavian Artery. As I followed the arterial branches, I snapped the artery in two, suspended in air with no grapes to fall.

Once again, I viewed all the blood vessels as one connected system, and I understood. My cadaver died from a stroke, specifically from cancer that had both blocked the brain’s artery and redirected new arteries for itself. This was the sturdy branch who became greedy, stealing the energy from the main branch. Her growth became her downfall.

That night, I got a call from my family stating that my grandfather had passed. He had died in his sleep. We learned that “dying in your sleep” is most often because of a dysfunction of the heart, that, for some reason, simply ceases to pump.

You would think that his body might have learned from his years of pruning. That he would know which branches were to be cut and which were to be spared. You would think that I would have remembered to return his calls.

I wondered who would care for the grapevine now. How she could grow without her pruner? Would she meet the same fate as my cadaver?

Many years ago, I asked my grandfather, “what will happen when the grapevine dies?” He turned to his vineyard and reached out, picking off one of the green grapes. He showed it to me, “Even if this grapevine falls, its sweet grapes scatter out leaving sweet memories with everyone who eats it.”

He tossed the grape in the air and I caught it in my mouth. The taste of sweet memories.

The man on the table was a stranger to me as many patients tend to be in healthcare. I had never heard his voice nor seen him awake. He was already prepped and draped in the typical sterile fashion ready for his liver transplant. Although I had never met him, I knew several scraps of information about this person. I knew that he had a MELD score of 39; without this new liver, he had over a 50% chance of mortality within the next 3 months. I knew that this operation had the potential to extend his life by many years, decades even. I knew his family was waiting to hear how the surgery went.  

Approaching the table, I examined the yellow stomach sticking out from the blue tarp marked with a large, backwards L indicating where the incision would be made. Steel and electricity unceremoniously made short work of the previously untouched muscle, fat, and blood vessels. The surgeons peeled back layer after layer, made suture after suture to control the destruction they were causing to extract this rubbery, bumpy liver. This was not my first time spectating during a surgery–nor will it be my last–still, I could not help but wonder about the role of pain in medicine as I watched these well-choreographed events unfold. How could therapeutically hurting a patient play into the role of being a healer? 

I think everyone who goes into medicine wants to help people who are suffering. The idea of being the source of that suffering seemingly goes against the vow of beneficence and non-maleficence providers take. In a much less theoretical sense, it makes me uncomfortable to hurt someone even with good intention and sound reasoning. Take, for instance, minimally invasive surgery. We are told that laparoscopic procedures are lighter on the body and yield quicker recovery times. I remember one patient describing feeling like he was just beat up by a bunch of baseball bats after his robotic gallbladder removal. Statements like that put larger, more aggressive procedures into perspective on how a patient feels afterwards. Imagine how someone must feel after an hours long open procedure — the kind with midline incisions that are the full length of the abdomen. This does not even include the anxiety someone might feel just having to go into the operating room for a surgery. Suffering is not limited to surgery either. Medicine is rife with discomfort and pain due to various procedures that range from benign to absolutely life changing. Range of motion tests cause patients with rotator cuff injuries and muscle sprains to wince. Medications we may prescribe can have severe side-effects. It is not uncommon to break life changing news to patients and families causing stress and psychological suffering well beyond just one individual. Inducing some level of discomfort for the patient is common as a physician. Yet all of these, and more, would be considered standard practice. It seems that many of our solutions require things to get “worse” before they get better. 

Perhaps what makes this whole concept so strange to me is the idea that it will not be long before any one of us in my class will be expected to do these things. I find myself wondering who am I to inflict this pain on someone? I am just one human in a room, hoping to have letters behind his name someday, trying to practice medicine on another human in the room. In any other context these incisions, maneuvers, and causing general psychological stress could be deemed illegal or at the very least unethical. In a hospital they are expected. Patients trust doctors to do what is best – even if that treatment comes at significant personal cost. That burden becomes even heavier when realizing that there will be suffering no matter what happens. The question is just how much will occur. The 4-year medical school curriculum and 3-year minimum residency training are both testament to the fact that these practices and procedures are anything but random. The gold standards are tried and true in improving people’s lives. We will all be highly skilled after our training is complete – a knowledge built on an infinite series of trials and errors. Still, despite the current triumphs in medicine, outcomes are not always predictable despite a physician’s best efforts. 

I saw firsthand how extreme this iatrogenic suffering can be. Unfortunately, this liver transplant case was one of the rare instances where the patient did not survive the procedure. He tragically expired on the operating table despite enduring more than five hours of surgery and multiple rounds or brutal CPR. He did not even get to use his new liver since blood flow was never established. Seeing that chaotic scene will stick with me forever. No errors were made. Everyone involved was highly skilled and competent doing the things they have done hundreds of times before with great success. Seeing everything unfold opened my eyes to just how little a non-medical person knows about the almost violent nature of medicine at times; ignorance is bliss. Liver transplants have a high success rate. 75% survive the first five years after their operation. This is a marked improvement from the mere months this man had without this donor organ. As with any procedure though there are implicit risks that need to be balanced with any potential gain. There were high stakes with the procedure. The decision to proceed was the correct one; to get this new liver was to live for many years to come. Yet had the family known he would not survive, or had they seen the extent of the damage inflicted on his body from advanced cardiac life support, perhaps they would have simply chosen to enjoy those last few months with him instead. Hindsight is always 20/20. It may have been his alcoholic cirrhosis that brought him to the table, but it is hard to shake the feeling that it was medicine that killed him.  

Stitching up a recently deceased person is a strange sensation. Perhaps stranger though was the sense of closure it offered with the situation. Medicine is not perfect and our means to achieve our goals can be savage. Yet, we are doing our best with the odds ever stacked against us. We work hard to ensure that people suffer to the least extent possible. Situations may go from bad to worse, but the intention is there and the knowledge and skills backup every decision that is made. Yes, suffering is inevitable, but surely it can be minimized. Just like with this man before me, the sutures were a feeble, but well-meaning attempt to make things better. Ultimately, it makes me think about the role of striving to do better as a physician and a person. At the very least, he will be presentable for his family to see him one last time.
 

A mother and son duet.  
Mom draw her staff, Linea nigra noting her fertile tune 
Blue lines track his song, and purple hers. 
Yellow contractions, thunderous cymbals 
Time for the concerto to close, burgundy drapes to be drawn 
and a new solo to begin. 
 
Intermezzo 
Blue absence  
He won’t play, their performer is listless 
a much crasser show must begin. 
 
Hands clasped, like sterile prayers given 
Mentally reciting verse from text, medical bibles. 
Expectation of what is to come. 
Human hope to be the unwritten exception, an unforeseen statistic. 
 
Gospel gives way to staccato 
cutting 
ripping 
tearing 
and 
 
 
Silence. 
no cry, no croone.  
Red, iron metal, bloody, crimson afterbirth 
A former home, the drumming of maternal’s love 
a welcomed cacophony 
giving way to 
 
 
Silence. 
still. 
discarded tissue. 

Resilience
by Peggy Godfrey

No promises the wind will make
Unto the tender grasses
Nor leave a trace or memory
Nor count the time that passes.

     In gentle breeze or howling storm
     Passion ebbs and flows
     Resisting not, the grasses bend
     Tremble, sing, and moan.

Without the wind the grasses
Never have a chance to know
Their grace or range of motion
Songs of joy or woe.

     As though in battle with the wind
     The lifeless creak and grown
     Stiffly clattering in the breeze
     To break beneath the storm.

But, oh, to watch the living
Bid welcome to the wind
Wind and grass so separate
In union once again.

Peggy Godfrey is my exceptionally talented sister, Colorado rancher, and respected cowboy poet who has published four collections of her authentic cowboy poetry and prose including Write ‘em Cowboy (1993), Write ‘em Roughshod (1994), Write Tough (1995), and Stretchmarks (2003). Resilience is one of my favorites. The visual and auditory imagery of the grass and the wind reveals Peggy’s keen observation of nature and awareness of her environment. More importantly, she reflects on her life experiences which have ebbed and flowed as the grass bending in the wind. Her lyric captures this certainty: without stress, we cannot develop our full potential of “grace or range.” The weak, rigid, and inflexible, unable to learn and adapt, will fail in the storm.

Resilience is the ability to endure, recover, and grow stronger in the presence of adversity. All worthy endeavors, especially medical school, residency, and the life-long role of physician require resilience. We confront adversity and endure; face failure and recover; accept the “no’s,” adapt, and become stronger. Brilliance and skill alone are insufficient to sustain us through training and medical practice. Like the grasses, we must “bend, tremble, sing, and moan” to find our “grace or range of motion” in our “times of joy or woe.” It is no coincidence that Coach Thu and I are paired in Team Resilire. My sister and I were truly blessed, as children and well into our adult lives, to learn to be resilient from a father who lived to 104 years.

Our father was the personification of “The Greatest Generation” and a gold standard role model for resilience. He was a small-town boy from Arcadia, LA, who in his teens endured The Great Depression of the ’30s. He attended Louisiana Tech at the age of 16, playing football and boxing. He subsequently attended medical school at LSU School of Medicine in New Orleans where he met “Scooper.” They married in 1941 – the same year he was called up to serve in the violent WWII battles in the Pacific. He served as a front-line physician in the Philippines Islands. Despite the grave adversities of war, he advanced to Regimental Surgeon and earned the Silver Star, Bronze Star, and Presidential Unit Citation for leadership and uncommon valor saving wounded soldiers under fire. Later in his life, he treasured the reunions with “my boys” the dozen or so remaining medics who were in his command during WWII.

After the war, he completed another two years of residency training before becoming a family physician in Homer, LA in 1947. (Tom, Jr arrived in 1948.) It was a difficult and demanding life of frequent house calls day & night, superimposed on long hard days in the office and hospital. In establishing his medical practice and as a community leader and moral voice, he faced adversities with wisdom and grace—enduring, recovering, and growing stronger.

As a child, I felt no calling to medicine – a difficult profession that demanded so much of my father. I recall thinking, “I never want to work that hard.” However, he thrived in the joy of his intense physician work-life. He was also a prolific writer, reflecting often in prose and poetry on life’s joys and sorrows. His reflections encompassed his World War II experience, my mother – “Scooper,” the love of his life, family, and his role as a small-town family physician, community leader, and man of faith. His passion for medicine, joy in his work, and his unconquerable resilience were ultimately the reasons I altered my choice of profession from research chemist to physician four years after college graduation.

Here is an excerpt from a letter I wrote him in 2014 when he was 98-years-young and I was just a kid of 66:

Dad, I cannot tell you how much it has meant to me to have you as a model of a caring physician devoted to your patients and profession. I share your enthusiasm for the diagnostic challenge. It has been such a satisfying career. I cannot imagine my life if I had not found my way to medicine. For that, I am most grateful to you and your great example. I treasure the notebook that you prepared in 1946 to start your practice which summarized the current therapies of the day. A chair from your office waiting room is in my home study to remind me of your successful medical career as a beloved family physician.

My Dad died in May 2020 at the age of 104, my father, my role model of resilience finally let go. He died peacefully in his sleep of unknown causes and in perfect health. I would have described his cause of death as “resilience exhaustion.” He left this verse in reflection, his variation on Tennyson’s Crossing the Bar.

Sunset and evening star,
When I put out to sea
When I go across the Bar,
I want no tears for me.
For I am very much alive,
Though I lie with unseeing eyes,
I lie not dead…

I am forever thankful that he gave me his name, his profession, and his resilience which does indeed live on.

Thomas M. Deas
1916-2020

After three months of excruciating hours, ailing patients that had been stuck in the hospital for weeks, and intimidating attendings who peppered us with questions out of the blue, the transition to outpatient has been smoother, calmer, and, well… Boring.

Rather than rounding on patients with appendicitis, sepsis, or aspiration pneumonia as I had during my time in the hospital, I am now doing medication reconciliation, hand holding, and counseling – So. Much. Counseling. While I’d always loved talking to patients, I find myself constantly having to redirect patients to the questions at hand to prevent them from getting sidetracked. Half the time I feel like I am learning how to be a therapist instead of a physician.

This lament is what is running through my mind as I’m sitting in my oversized white coat in my preceptor’s office, glancing absentmindedly at the ever-growing stack of papers on her desk. I’m thankful, yet again, for the surgical mask on my face that hides my occasional subtle yawn when she walks in.

“Helena, I have some bad news to share.”  She is looking down at her desk, her shoulders drooping beside her. Even as someone who is training in medicine, I find her words so doctor-ish.

“Okay,” I say, a little distracted. I had been going over my to-do list in my head. Pick up the groceries on the way home, 100 more flash cards, 20 practice questions…

I take a deep breath of the stuffy office air. I have been yearning for the pace of the hospital. I missed constantly seeing patients and scrubbing into surgeries. Lately I’ve found myself agitated at the idea of spending 40 minutes with the same patient. ‘I miss just getting to do medicine all the time’

“Mr. Smith has died.”

A jolt back to reality. “That’s terrible.” I mumble. A reflexive response. But it is not before long that my mind is reeling. Mr. Smith was my panel patient—I had been assigned in my first year to follow him throughout his medical journey. I’d accompanied him to appointments, gotten to know his family, and called him regularly to check in. I was in the room for his diagnosis. I watched as he stared in disbelief upon hearing that he had metastatic lung cancer. “But I’ve quit smoking!” he’d said, “All of my last scans were normal!”

I remember his oncology appointment. I remember how rushed it all felt, and how it was to sit with his daughter in the waiting room. I remember her telling me about her son’s hobbies and her pet’s names and her father’s pride in being the patriarch of their family.

I also remember wiping away tears as I drove to my afternoon clinic. I remember missing questions in all of my other clinics because I was so distracted. I remember missing sleep as I tossed and turned, wondering how much time he might have left.

Most of all I remember feeling angry: at cigarette companies; that I was assigned to such an emotionally heavy case. Angry at myself for not being better at compartmentalizing.

This moment highlights the schism between the fantasy and the reality of being a medical student. In medical school, you inevitably become the recipient of a hefty amount of praise that you’re not entirely sure you deserve. The myth goes that patients look up to you, your friends from high school envy you, and family members gush with pride at reunions, showering you with compliments about your intelligence and dedication. In a lot of ways, you are society’s idea of perfect. You are young, successful, intelligent and hardworking – many of America’s most highly valued ideals wrapped into the two-word title — “medical student”.

Then there’s the other side of being a medical student that only you, your classmates, and your family members will understand: the constant pressure to be perfect. The pressure to make it look easy. The fear that if it’s already this hard, it will only get harder. The assignment you missed because you only got three hours of sleep for the fourth night in a row. The messy, run-down apartment with dishes that have been in the sink for God knows how long. The feeling of never having it together and never being good enough. It all serves as a constant, sobering reminder: you are anything but perfect.

As we progress through our career grappling with these personal demons, the human aspect of medicine often fades into the background. But today in my preceptor’s office, it calls me back. The first day I met Mr. Smith was perhaps the worst day of his life. I was sitting in the same seat in my preceptor’s office six months ago when she had looked up at me and said, “We have a patient coming in today, and his last CT showed metastatic cancer. We don’t know the origin of the cancer right now, but the prognosis doesn’t look good. I am referring him to oncology.”

I tensed up as I pictured myself in the room watching her give the news. I hated the thought of it, watching for the sake of learning, without having to endure the pain of lived experience. I tried to rationalize with myself. ‘Relax,’ Deep Breath. ‘You’re only a student. You’re just here to learn.’

At the time, my preceptor and I walked into the patient room together and greeted him with smiles and brightly asked him how his day was going. This time it felt wrong. There was a sucker punch coming and only we knew it.

Shortly after the niceties, my preceptor sat down at the patient level, took a breath, and said with compassion and efficiency, “We’re reviewed the results of your CT. I’m so sorry, but it looks like you have cancer. At this point we don’t know where the cancer started from, but it seems to have metastasized.”

A pause.  “Okay” the Mr. Smith responds. His face remained hardened and strong, though there was no one with him for him to be strong for. He waited for us to say more.

“I’ll be referring you to an oncologist,” my preceptor continued. “It’s really important that you go to that appointment as soon as possible. I want to make sure that you aren’t delayed in treatment if that’s what you choose to do.”

I watched as his face changed from blank, to angry, to confused. My preceptor didn’t realize that the news has not yet landed.

“I don’t understand,” he responded. “I quit smoking and I had a full CT less than a year ago! And there was nothing there! Nothing!”

As I watched the scene unfold, I felt a sense of dread wash over me as if I was a small animal backed into a corner. I wanted to leave the room as fast as possible. ‘I shouldn’t be here, I shouldn’t be here.’ I kept thinking. ‘This is private. I shouldn’t just stand here and watch.’

But despite this anxiety, face-to-face with true vulnerability, I was honored to be a witness to medicine at its most human level. I stood quietly as the patriarch in front of me slowly appeared smaller, more honest, and more fragile. True imperfection. In a way, it was beautiful. Pure.

A few weeks after Mr. Smith’s diagnosis, his daughter and I sat together during his first oncology appointment. She told me her husband had recently left her and she was caring for her father and her son on her own. When they called his name for the appointment, she grabbed my hands in hers, looked at me and pleaded, “Please. None of this medical stuff makes sense to me. You understand it. You can help us.”

At the end of the day, I chose medicine. I continue to choose medicine, in the words of philosopher Emmanuel Levinas, “For others, in spite of myself, from myself.” Even when the diagnosis is beyond our control, even when following patients hurts, I choose this field because this is important work, because it needs to be done, and as I continue to learn over and over, it needs to be done with compassion. I did not change Mr. Smith’s prognosis. I did not prolong his life. But I provided a comfort to a family in struggle. I was a strong hand when someone needed strength. And in doing so, I became a part of his journey, and now he is a part of mine.  That alone is a gift.