On Being There

I have always loved hospitals.  I love the smell - alcohol and carpeting.  I love the way they look, too - the avocado with milk colored paint on the walls, the worn vinyl chairs, the scuffed walls of the elevators.  In fact, the very happy feeling I always felt when visiting a hospital was really the biggest reason I knew medicine was the career for me.  I didn't tell people that on my admissions interviews, because it sounds deranged.  But it was the truth, and I never examined the why of it until I was well into my life as a doctor.  One day I had an epiphany and realized that my love of hospitals is really connected to my fears of abandonment.  I like hospitals because 24/7, 365, you can go there for help.  And it will be open.  And the people there will do their best.  That is an amazing and comforting thing to me.

 Probably the best story I can relate that connects this abandonment stuff to being a doctor involves me as a little kid, when my family spent every summer in Japan.  We’d visit my mother’s family and drive around the country visiting the historic sites.  There are many festivals in the summer in Japan, so at night there was traditional folk dancing capped off by giant displays of fireworks, shot off from ships at sea.  I have a lot of fond memories of these trips, and at least one moment that changed my life. 

On our way to visit a Buddhist Temple, we stopped for a picnic lunch by the side of the road one day.  A car stopped near us and a pretty young woman got out of the car.  She was holding a small dog, and she put the dog down on the tarmac.  Before the dog knew what was happening, she got back into her car, slammed the door, and sped away.  The dog chased after the car, running as fast as he could.  The car kept going and the dog kept running down the road until I couldn’t see them anymore.

I’m sure as a little kid I cried and pouted about a lot of things but I don’t think I ever cried as much as I did when I saw that woman abandon her dog.  I will never forget how profoundly I felt that dog’s abandonment.  I felt it to the bottom of my nine year old soul, and I think about that dog and that woman to this day.  

My parents remember this incident as well, because neither one of them understood why I was so upset.  My parents both grew up on farms, so maybe they just weren’t very sentimental about animals.  My father grew up during the Great Depression and my mother during World War II era Japan, so maybe they were surprised to find their daughter was such a emotional lightweight.  My mother’s brother in law, who was chauffeuring us around in his car that day, eventually went to a dime store and bought me a doll to see if that would get me to stop crying.  And eventually, I guess I did. But after that day, I knew what it was like to feel very strongly about something.

I feel very strongly about being a doctor, of course.  I don’t know how you could do this job if you weren’t called to it.  Sometimes it’s hard to put my finger on just exactly what keeps me going during the hard times – being a doctor and trying to do my best at it simply gives a lot of meaning to my life.  Recently, though, I was looking through some old family pictures and I found one of my mother and I that was taken right after that roadside lunch in Japan.  My mother looks vaguely irritated with me.  My eyes are red and I’m clutching the doll.  When I looked at that picture it hit me right between the eyes – what I felt watching that woman leave her dog behind and what keeps me true to my profession are not just similarly strong feelings – they are the same feeling. 

I’m talking here about the need to work against cruelty and have empathy for the abandoned.  I cried when I was nine because I couldn’t do anything about that that woman did.  I cried imagining how that dog must have felt – frantic and desperate and alone – thinking that surely she had just forgotten him, surely the car was going to stop when she saw him galloping behind in her rear view mirror.  And instead of crying about the cruelty of life, now I’m a doctor and I help people deal with the cruelty of the diseases they do not deserve to suffer.  And instead of standing by the side of the road feeling abandoned, I protect my patients from abandonment.  Their health may leave them, and their families may leave them, and their wealth may leave them – they may even feel like their God has left them – but I’m not going to. 

I come to work every day, even when I don’t feel like it, because I want my patients to know that I am around.  I stay late if I have to for the same reason.  I may not be a medical genius every day – or even most days – but I’m there.  I answer my pages because I want people to know that I am available. I couldn’t live with myself if I thought I was cutting corners on being there for patients.  I think it’s a big part of why I love being a hospitalist – unlike the clinic, the hospital never closes. Every hour of every day – the patients can count on – if nothing else – the company of other people.  I like being part of that. 

When I was an intern, I showed up and hung around because I didn’t really have anything else to offer.  I listened to people and tried to explain to them what was going on with their medical problems.  Later I learned enough to do quite a bit (of both harm and good), but the moments I remember are not so much interesting diagnoses or remarkable recoveries but the times I spent supporting folks as they dealt with the cards life dealt them.  I’ve come to realize that as good as you might be at medical knowledge and patient care, that stuff is almost trivial.  It’s an intellectual challenge for me and something that might help the patient.  The heart of the matter for me is standing next to the patient, protecting them, educating them and sticking up for them when times are tough.  You have to do that before you can do anything else – and all it takes is the strong feeling that you are committed, above all else, to simply being there. 

For me, the tough thing about being there is that it’s a constant job.  You can’t be there sometimes.  You have to be there time in and time out.  You have to be there when you really don’t want to.  You have to be there when your family and friends really don’t want you to.   Sometimes the sacrifice is easy – you skip lunch, or stay a few minutes late.  Sometimes the sacrifice is really painful.  The thing about it is, though, that your worth and reputation as a doctor is not about what you are doing currently.  It’s about what you’ve been doing all along.  I’m about 20 years into it and I feel like I’m just beginning to see how worth it all of that time and sacrifice was.