When I left Wall Street to pursue a career in medicine, I had some understanding of the long and winding path ahead of me, but I never anticipated our current strange reality leveled by the destructive force of the SARS-CoV-2 virus. We now face surreal uncertainties, including the shutdown of large swaths of our health system, hospitals running out of protective medical equipment, and frontline health care workers succumbing to the very disease they were fighting. Like many dual physician households during the COVID-19 pandemic, my wife and I wrote our wills, discussed awful possibilities and ultimately, got our affairs in order. Many colleagues and I wrestled with core questions of personal safety, the tension between duty at work, and obligation to our family. Was it fair to my children for me to continue working in health care at a time like this? Had I ultimately made the wrong decision in choosing medicine? Everyone grapples with such questions of disillusionment in their own way, and for me, it has forced me to look back at my career path and what my time in medicine has given me. In this way, the pandemic has powerfully shaped my small corner of the world, both inside the hospital and outside, making me reflect on my core values and who I want to be as a physician and a father.
As a fresh college graduate turned mergers and acquisitions investment banker, I spent long hours buried in financial statements, complex computer models, and business presentations. I was paid well, offered a promotion, and was slowly moving up the proverbial business ladder. While finance and business are fundamental to the operation of our society, I had also never felt so disconnected between the work I did and a sense of improving someone else’s life. Perhaps it was the idealism and naiveté of youth, but I didn’t want a job, I wanted a career with a purpose that I cared about. Medicine made sense in many ways, and as I wrote on my medical school application, I wanted to use science for the direct betterment of others. Over the last 18 years since then, I have tried to do just that, all the while both humbled and inspired by the nature of the work.
Just recently, I cared for Mrs. M, a previously healthy 31-year-old woman admitted with newly diagnosed hyperthyroidism and congestive heart failure. She was jovial and energetic, a manager at a local fast-food chain that worked 50 hours per week and in the prime of her life. She was diuresing well and feeling better, splitting her attention between her family and me on FaceTime on rounds, since the hospital did not allow visitors due to the pandemic. But then overnight, she endured an unexpected large right middle cerebral artery stroke resulting in left-sided hemiparesis and near-total aphasia. She tested negative for COVID-19. We discovered a patent foramen ovale as well as a new pulmonary embolism, suggesting an occult venous clot had paradoxically embolized to her cerebral vasculature. While I did my best to explain her complex situation, she now only half-heartedly looked in my direction, instead gazing forlornly at her iPhone that showed her two-year-old daughter gleefully rolling on the ground. As I saw the tear stream down Mrs. M’s right cheek, I couldn’t help but think how much her daughter looked like my own. It is the lived experience of witnessing such suffering that blurs the distinction between physician and patient, bringing awareness of our own fragilities and a poignant reminder to appreciate what is most dear. For health care providers, this sentiment is ever more relevant in the uncertain period of the COVID-19 pandemic.
In health care, we see the human condition in its most vulnerable state, watching ordinary people like Mrs. M deal with extraordinary pain and loss. Although much is asked of us, it is this intimate witnessing of profound suffering that cuts most deeply. While some would say this aspect of our profession is a burden, it is also undeniably a privilege of trust and human connection. Moreover, these experiences gift us with a heartfelt lesson, teaching us that our circumstances can dramatically change in a moment’s notice, from being a busy, working mother one day to being unable to speak and lift your child the next. A career in medicine offers these powerful opportunities for self-reflection, to not take our lives for granted, and genuinely appreciate what we have in the present. Even if only for a short time, we must take a moment to cherish those we love, value the things we have, and be thankful for what remains of our health. Becoming a father has only deepened this sentiment. At home, I watch my children grow and begin life’s journey while at work, I care for many others at the end of theirs, a humbling juxtaposition of life’s impermanence.
I left Wall Street because I wanted to be part of something greater than myself. Like many generations of physicians before us, we are in the perennial mission of service, helping those in need. While such idealism can get jaded through the years, it is in times such as these that I am reinvigorated for this calling. Although they are too young to fully understand, my children see my wife and I still working for our patients, hear us discuss complex cases, and feel our empathy for others. Moreover, as I walk through the hospital, I see people of all ages putting in their effort day in and day out, keeping the complex machine of health care running. We are among the silent heroes of the COVID-19 pandemic and a testament to the interconnectedness that we rely and thrive on. In the end, it is precisely for my children that I am incredibly proud to be in medicine and to be part of this collective mission to make the world a better place. And in so doing, this journey with all its blessings and hardships has led me to not only become a better physician, but also a more engaged, thankful, and better father.
Kartik Agusala is a cardiologist.
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