[Editor's Note: This submission, from Katherine Bakke, an MS4 at the University of Michigan Medical School, was my personal favorite of the 117 applications. Perhaps it is because I could relate to looking out the windows at the Arizona sun rising and setting multiple times during the same 36 hour shift. Maybe it was the memory of staring at a trauma patient with 3 limbs in splints and two chest tubes and thinking I needed that bed more than he did. Perhaps it just reminded me of those moments of sitting on the curb in the ambulance bay with tears in my eyes after telling a family their 17 year old son was dead despite all I could do. Whatever it was, I thought it was excellent, and it explains much of the reason why I continue to practice medicine despite the fact that I no longer have to. Many of the judges agreed. Katherine's prize for third place is 10% of the cash, or about $2500. Hopefully that will help with interview expenses this Winter.]
During the second week of my surgical rotation, I tried to wash my face with toothpaste. I had always considered myself a morning person, but 4:30 AM was too early, even for me. I had just started my clinical clerkships in the hospital, a hands-on apprenticeship of practicing medicine that begins in one's third year of medical school. Despite the excitement of finally getting to care for patients after two years of study in the classroom, I was struggling to accept the fact that most of my days would now start before the sunrise.
When you spend twelve or more hours in a hospital, it is easy to forget the time of day. The long hours contribute to this sense of disorientation, as do the windowless team rooms, located centrally in the hospital and lit with the yellow glow of fluorescent light bulbs. The rooms with windows are, rightly so, reserved for patient and located along the periphery of the hospital. But couple the long work hours with this degree of sensory deprivation and it is easy to become not only disoriented, but also disillusioned. Patients start to blend together, writing progress notes becomes tedious, and the lack of thanks can wear a person down. Call me weak, but after a month of 4:30 AM wake-ups, I was beginning to feel a little numb.
In this time of emotional and physical challenge, I found myself focusing on light. While rounding with the surgical team, I stole glances out of each patient's window. The hospital, 12 stories high, sits on an East-West axis and afforded incredible views of the rising and setting sun. Each morning's sunrise and each evening's sunset were different depending on the wind patterns of the day. Cool oranges and blues signaled an arctic air force, while jewel-toned purples and pinks meant a southerly jet stream. I found calm while watching the vibrant colors dissipate into pale hues, like food coloring in water, across the sky. At the beginning of night shifts, I watched the sunset from the vantage of a sky bridge which connected the main hospital to the cardiac center. The bridge, encased in glass, trapped the warmth of the sun’s rays throughout the day, and offered me a warm embrace in an otherwise overly air conditioned hospital.This calm and this warmth spread throughout my whole person, steadying my hand in the operating room, my voice when talking to senior surgeons, and my heart when counseling distraught patients and worried families. The day I worked 30 hours straight with the trauma surgery team, I watched the sunset from the hospital cafeteria and wondered what the night would bring. When I left the hospital at 6 AM the next day, I sat on my porch and watched the sunrise before going to bed, meditating on the capacity of the human body to withstand tremendous strain, be it illness or injury (or in my case, hours on my feet and lack of sleep). In that moment, I realized I couldn't be happier with my life and with my work, and I was grateful.
In those two months on surgery, the celestial cycle grounded me, affording me a rare moment to myself. It offered a moment of beauty and serenity amidst the cacophony of beeping hospital pagers and the ugliness of disease. Perhaps most importantly, it provided me with a moment to reconnect. The sunrise and sunset awed me, moved me, humbled me. In the midst of difficult days full of sick patients, the warmth of the sunlight and the vibrancy of its hues reminded me that I chose this profession to care for others in their most vulnerable times.
If the product of our efforts in health care is time–the years we give to the patient with heart disease to grow old with his spouse, the handful of months we give to the patient with end-stage renal disease to see her first grandchild graduate high school, the few hours we give to a dying patient whose family is traveling to the hospital to say goodbye–then our work is sacred and our purpose is good. I love this profession because, for the effort and sacrifice it demands of me, it gives me time in return, time to reflect on life’s most profound and provocative questions: What is my purpose? What is my responsibility to others? How can I be courageous and compassionate? Am I doing the right thing?
These days, as I change into my scrubs and drape my stethoscope over the back my neck, I pause and look out the window. Watching as the sun dips down into the horizon, or lifts its circumference into the sky, I take a deep breath—thankful that I am able to do so—and start my shift.
What do you think? What do you love about practicing medicine? Is it worth the headaches? Why or why not? Comment below!
Beautifully written. I still remember the camaraderie of watching July 4th fireworks from the roof of one of the hospitals from my residency program. You have to find a positive when the work is overwhelming.
It would be interesting to hear what the resident on that surgical service would say after 5 years of waking up at 430.
This is beautiful. I remember interviewing in a hospital with a gorgeous atrium and windows everywhere. While the program didn’t end up being my top choice, I appreciated the spirit behind providing such a thoughtful environment for healing.
Instead, we substituted cookies in the cafeteria of a new, dark, windowless behemoth. I got a great education, but I’m glad to be back home in the sunshine these days with only 8-12 hour shifts.
This essay struck a cord with me. Which doctor/resident/medical student hasn’t looked around at 4am and found themselves the only person on the bus to work. The quiet solitude walking down the street to the hospital, the gorgeous sunrise that seems yours and yours alone. The best part is you get to enjoy it alone again when you’re off 24 hours later and finally on your way to get much needed sleep!
Off after just 24 hours? What has the world come to?
I’ve had my share of 44 hour shifts as well. Did it use to snow uphill both ways in the hospital back when you were a resident? 🙂
In Tucson? No. But it sometimes rained really hard. 🙂
Seriously though, the worst parts of a 36+ hour shift were not the last 6 hours, they were the hours between 3 and 6 am right in the middle don’t you think? Kind of an “it’s always darkest before the dawn” phenomenon.
Eloquent essay.
What do I love about practicing medicine? Gratitude. Trusting patients and family members. Camaraderie among the perioperative team. Respect. These are the non-monetary rewards, and they are not universally present, but do make the exhaustively long days seem shorter.
Is it worth the headaches? Tough question. I used to think so, but that was when I needed to earn money to support a family. I keep reading that financial independence allows to appreciate the job more, but I find myself wondering more and more why I continue to do what I do, despite the good vibes from the people I work with and care for. Eventually, I plan to change up what I do, and live the life I want to live.
Best,
-PoF
I enjoyed this essay, but I have to nitpick with one of the final sentences. I understand the sentiment of the writer, but it irks me that anyone would suggest that the field of medicine rewards us with time. As a surgeon in practice for 3 years, I have to say that I disagree with the sentiment that our profession gives us “time” in return, in any sense of the word.
Yes, the field of medicine enriches us with experiences upon which we can reflect and from which we can grow. Yes, as a trainee, the novelty of the odd hours and moments of solitude can trigger intense introspection. However, those moments are not bonus minutes that the profession provides as a reward. The field of medicine gives us everything BUT time.
Time is the ultimate sacrifice required of the physician. Time to eat, sleep, exercise. Time to see your friends. Time to celebrate holidays, anniversaries, birthdays. Time to take your wife out to dinner. Time to bathe and feed and hold your newborn daughter. Time to walk your 4 year old son to school in the morning, to catch him awake in the evening to ask how his day was before he goes to sleep.
A recent question about surgical ethics published by the ACS discussed the following scenario: you operated on a patient last year for a bowel obstruction and he presents to the ER again with a recurrent episode. All clinical signs indicate that he needs emergency surgery. Unfortunately, it is the morning of your daughter’s high school graduation. You are in the ER and discuss with your patient that you are not available and that your partner is covering for you and he is equally qualified to perform the operation. Your patient begs you to stay to take care of him. Is it ethical to go to your daughter’s graduation, or are you morally bound to take care of this patient?
The fact that this is even up for discussion speaks volumes of the demands faced by the physician, and the priceless sacrifices we are sometimes ask to make. Time is truly the most important currency of life, and while we can sometimes give years to another soul through our work, it often comes at a price to ourselves and our loved ones.
I know what the right answer to that ethical question is. Surprised enough surgeons find it difficult enough that it would merit publishing.
What the heck are you doing in the ER when you’re not on call and your daughter’s graduation is starting? You should have never answered the phone, much less actually come in.
At any rate, while I agree with all your points, think you misunderstood what the essay said. The time being given wasn’t being given to the doc, but to the patient. There’s no doubt time is something the doc gives, not gets.
WCI, I agree completely with you about what the right answer is. When we discussed this in conference, there was a clear dichotomy between the younger surgeons and the older surgeons. The points you raised were the among the arguments made by the junior staff.
Some of our mentors were adamant that they would take care of the patient. “My daughter has been raised to understand the bond between the patient and doctor,” was one comment. “She wouldn’t be surprised or upset at my absence.” Many people talk the talk, but the physician who said this was the kind of man who walked the walk. His devotion to his profession and to his patients was unwavering. I alternated between admiring his commitment, to being appalled by the lack of balance in his life.
This kind of culture will be an interesting relic, however. Work hour restrictions for trainees do not extend to attendings, but trainees raised in the safety of these regulations will one day run the show and there will gradually and eventually be a paradigm shift. That ethics question (as straightforward as it sounds to me now) will be completely laughable in the near future.
I’m taking this way off topic, sorry. Just got hung up on the “time” comment, especially since it was emphasized stylistically in italics. Overall, I really liked the essay and admired the prose as well. Great job to the writer, and wish her the best of luck with her career!
Agree with NYMD. The author’s use of the word “time” was odd. She may have meant “contemplative opportunities”.
Oh, I see what you two are referring to now. I was focusing more on the first half of that paragraph. Good point.
Via email:
You know – I really embraced and enjoyed the challenges of medical school and residency prior to beginning my practice in [the 80s]. It was common then to work up to 48 or 60 hours in a row (not very healthy, of course). Mostly, for me it was the intellectual challenge that I liked, and the long hours were part of the deal. It seems to me that the balance between the love of medicine and the “headaches” you mention are related to one’s length of time in practice. The longer in practice, the more that our early expectations of medicine are no longer being met. Younger graduates have different expectations that I think are easier to meet. For now. New challenges will arise with time, testing one’s love for medicine.
Once the “headaches” of increasing litigation, less time with patients, more time with paperwork, and greater challenges of running a small group practice tipped the scales away from clinical care, I chose to reduce my exposure to those challenges. Over time, I made the transition into administration as a hospital chief medical officer, where I could still have a very positive impact on patients and on physicians within my sphere of influence.
We clearly need more altruistic, inspired, bright, young students to embrace medicine. We also need to prepare them to anticipate the challenges (many unknown) that they will ultimately encounter. Hopefully, they will then continue to contribute when the “headaches” begin to outweigh the growing mountain of unmet expectations.
“If the product of our efforts in health care is time–the years we give to the patient with heart disease to grow old with his spouse, the handful of months we give to the patient with end-stage renal disease to see her first grandchild graduate high school, the few hours we give to a dying patient whose family is traveling to the hospital to say goodbye–then our work is sacred and our purpose is good.”
I absolutely loved that. I think it’s okay to let us young bucks be a little delusional about the beauty and mystique of medicine. We need this perspective in order to push us, motivate us and drive us to go through the otherwise unpleasant experiences that will one day allow us to be old and jaded and slightly more realistic. Our work IS sacred and our purpose IS good, and there’s nothing wrong with focusing more on that than the “headaches” while we are still young and idealistic. I don’t understand the motivation to force young doctors to be bitter before our time. Let us bounce off the walls with optimism, we’ll have our own experiences in time that will ground us.
Great essay and what a beautiful style of writing.
That isn’t to say we mustn’t be prepared adequately. Just that there’s an undertone of condescension whenever junior docs express being anything less than frustrated that is frankly a worrying trend. Forgot to add that. We absolutely need information, but what we don’t need is discouraging.
A touching and well written piece.
Many thanks for Dr. Dahle for his kind words about my essay, “Focus on the Light.”
Many thanks, as well, to the donors to the scholarship and the judges
who offered their time to this endeavor.
It has been truly rewarding to read the comments about my essay posted by WCI readers. I’m humbled by the praise, and by the ways in which the strange wonderment of medicine resonates with so many.
Some readers are unsure about my use of the word “time” in the essay’s conclusion. I’d invite readers to blur the definition of time as we commonly think of it–as the seconds, minutes, and hours in a day, the “time” which we feel we never have enough. Without question, medicine demands much of our “minutes-and-hours” time. Yet, medicine also allows us to bear witness to life’s most singular moments and ponder their meaning and importance. This has been a gift to me, allowing me to reflect upon the things which I really value. As a result, my time spent in solitude, with family and friends, and in pursuit of things which I enjoy is much richer. In this sense, I feel as if medicine has given me, and I hope many others too, a great deal of time.
Again, my sincerest thanks to all.
Katherine, redefining a word is a cheap rhetorical trick.