It occurred to me towards the end of our conversation that there was a large gaping hole.  We had talked about physician burnout, career choices, and his current plans.  He had drawn a map of his future.   It originally shot like a straight arrow towards clinical medicine, but now veered precipitously.  I took a moment to first clear my thoughts, and then my throat. Medicine, I explained, is still as ...

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Being your doctor is exhilarating. Every day I wake up to a schedule brimmed with purpose. The door of my office is a portal into the richness of the human experience. I become a thread in the tapestry of other's lives. I bear witness to the joy and pain, laughter and heartache, and mundane daily routine. I spend my days bouncing between art and science. Paid to be the wily detective, my ...

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shutterstock_104930039 There was once a little boy who loved to draw.  He would wake up every morning, pull out his box of colored pencils, and let his hands explore the promise of a pristine sheet of blank paper.  For him, the canvas was anything but empty,  images and ideas exploded out of his mind and magically appeared on the pages in front of ...

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shutterstock_193958318 Like two ships passing in the night, we sidled up to each other at the nursing station on the hospital telemetry ward.  I had already been home, ate with the kids, and returned, while he hadn't left floors all day.  We typed away at our computer stations, and chatted from time to time. After we exchanged common pleasantries, we jumped into local politics. ...

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shutterstock_96934004 It was only afterwords that I wondered if I had been condescending.  The words had come out so naturally.  We were sitting across from each other in the nursing home.  It didn't take a doctor to recognize that his leg was visibly less swollen.  I had seen him walking down the hallway with the physical therapist.  His face a mix of pain, ...

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shutterstock_124029454 Jim almost convinced me.  The burning in his chest, after all, could have just been gastroesophageal reflux.  He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums.  I couldn't, however, ignore that it seemed to worsen with activity.  The pain was bothersome enough to drag him into my ...

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shutterstock_166576619 As I have said before, when done correctly,  doctoring is an act of love. It is founded on the most basic of human interactions, intimacy.  Patients open their doors and closets revealing a treasure trove of brutal humanity.  Physicians dedicate themselves to healing, to upholding a sacred covenant born of tears and blood.  It is a partnership, a carefully rehearsed ...

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shutterstock_124482742 The insurance company insisted that they would be saving money in the end.  So they sent the PA (physician assistant) to my patient's house.  They didn't take into consideration that I was just there a week before.  Or that I made home visits on a regular basis.  In fact, they didn't even inform me about the appointment. My patient later told me ...

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When I began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms.  How else could I explain my patient's willingness to suspend all social rules and norms upon passing through those magical doors?  They would sit down in front of their baby faced-doctor and talk about things.  Private things.  Scary things. Conversations occurred that would be unthinkable if two strangers were to ...

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Loitering in the hallway of my son's school awaiting his parent-teacher conference, I completely forgot that the woman introducing herself and shaking my hand was an alcoholic.  I forgot that she had visited me in the office a decade prior for a consultation.  I forgot all of it. What I remembered is that we had gone to high school together.  We had grown up in the same city, in the same ...

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The whole thing was rather awkward. I have to admit that I was nervous. I perused the records before he walked through the exam room door. These conversations were always difficult and felt out of place in the office. But I had looked at the numbers over and over again. There was a glaring deficiency that had to be corrected. I planned to jump in right away, but we got sidetracked. He ...

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shutterstock_148398755 We both agreed that it was unfortunate. I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After ...

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shutterstock_210331261 It's metoprolol. m-e-t-o-p-r-o-l-o-l The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering. I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal ...

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Everything eventually expires. I looked down at the bottle of natural spring water in astonishment.  It had an expiration date.  Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad?  It had no living parts,  Nothing that serves as nourishment for wayward bacteria or fungus.  The container was sealed.  Pristine. I figured it was another fiscal hoax, perpetrated on unsuspecting consumers.  ...

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shutterstock_222269452 I assumed she asked because besides being a hospice volunteer,  I was a medical student and wouldn't get spooked by a dead body.  She probably didn't realize that it was my first week of classes, and I hadn't experienced much yet. She walked into the room with her head slightly bowed forward.  She was physically and emotionally exhausted.  Because of a scheduling ...

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shutterstock_192230474 The American Board of Internal Medicine is irrelevant.  It has always been.  I realized this when I first certified in internal medicine in 2002.  The test was largely fact-based and filled with information that I would never need to know in practice.  It did not measure my diagnostic acumen, or my physical exam skills, or my ability to listen and empathize ...

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I remember being more confident that most of my peers.  The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me.  Maybe it was on account of my lifelong pursuit of medicine.  I felt nothing but elation at the newly branded "M" and "D" that came after my name on the hospital badge.  I was no longer a volunteer, no longer a ...

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I used to think that there was a communication gulf between doctors and patients.  Somewhere in the hubbub of the harried office visit some secret sauce was missing.  A divide that was so fundamental that both parties often left the room feeling disjointed and uneasy.  Patients wondered if doctors truly heard them.  Physicians wondered if anyone was listening to what they were saying.  The tension ebbed and flowed but never ...

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Behind every doctor is a little boy or girl who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet.  She swore that when (if) she got older she would protect the innocent from such things.  Her vow was the ...

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shutterstock_141318316 I understand that there is a difference between perception and reality.  I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status. Nonetheless, I am amazed at how history seems to repeat itself.  Year after year, while sitting in the shade and relaxing by the pool, ...

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