Deciding to be a doctor

The process of becoming a physician is a long and gradual process. Scattered through this glacially slow and often painful process are episodes that are transformational in every sense of the word, experiences that impact what kind of physician one becomes. Or even, whether or not one becomes a physician. 

I was a fourth year medical student working in an intensive care nursery for a month. Dr. Bachman, my preceptor and the chief of the unit, was a superb clinician and a great teacher. He had a way with frightened parents in crisis that I have still never seen equalled. He was quiet, but when he spoke it was always worth listening. I respected him and wanted to ‘grow up’ to be a doctor in his mold.

Fourth year students in a critical care nursery can have a limited role, at best. Most of my time was spent watching others do the work, frequently doing things like writing notes or examining infants or attending high risk deliveries ‘in parallel’ to practice the process while someone else did it for real. As the rotation progressed, students could expect to gradually be given more real responsibility - but rarely without a ‘real doctor’ standing right there. The hours were long and the stress levels varied from moderate to intense. I was chronically tired. 

After a grueling 36 hour stretch with only several hours of sleep, mostly in catnaps in a chair, I was looking forward to going home for a rare two day weekend off. My last assignment of that Friday afternoon was to review the week’s progress of a preemie in the nursery, write the weekly summary note, and call to update the primary care physician in an outlying town who would be assuming care for the infant in a couple weeks when she was discharged. This was a regular protocol, a weekly summary documented in the chart including a rough projection of tasks for the next week, usually with calls to the parents and prospective primary care physician.

From my perspective, it had not been a terribly eventful week for the infant who had been born very prematurely and had struggled with a series of complications early on, but was now mostly in a growing phase. The report did not involve examining the patient or writing orders and did not feel to me like a key part of the care process. (In retrospect, as a PCP, I recognize the value and suspect this conscientious communication was part of the success and popularity of the NICU throughout southern Wisconsin.) I wrote a brief note in the chart, probably 3 lines, saying that the infant had progressed with feeding and had experience no complications and that discharge home was anticipated in 10-14 days if growth continued. I did not call either the parents (who lived several hours away in Ripon) or the PCP. As I put the chart in the rack and headed for the door, the nurse asked if I was done already? Ignoring the clue, I said yes and went home.

When I returned to work on Monday, the NICU charge nurse said that Dr. Bachman wanted to see me in his office before I started rounds. With great anxiety but no clue about the issue, I walked down to his office where the door, as always, was open. He looked up at me, gestured to his little couch where he often had parents sit while he discussed grave issues in their children’s course, and asked me: “Do you want to be a doctor?”

I didn’t really understand. In fact, I first thought he was asking me in preparation for giving me a new level of responsibility. I said I certainly did, I was feeling better about medicine than in the first two non-clinical years, and was beginning to believe I was going to be a good doctor, and was always looking for more opportunities for responsibility. He paused for what seemed like a long time, and then handed me the piece of paper on which I had written my (inadequate) weekly summary note before the weekend.” “What happened Friday?” he asked.

I tried to explain that I had been exhausted, that the task was pretty much just paperwork and didn’t involve actual medical care, and that I had assumed that the resident would be writing the ‘real’ weekly summary anyway. It sounded incredibly lame when I said it.

“Here’s the thing,” he said. “Being a doctor means being responsible. Not just for the big things or the fun things, not just when you are fresh or it is convenient. If you want the responsibility of patient’s lives and souls, you have to be responsible. Walking out is not responsible. Ever.”

Silence. He could not have been more right, and I could not have been more ashamed.

He went on to say that, in fact, the resident had later made rounds, written the note and made the calls, that no patient harm had been done by my action, but that the NICU nurse had alerted him to the fact that I had not followed through. He told me he thought I was bright enough and had the potential for being a fine doctor, but first I needed to decide if I wanted to be a doctor enough to assume the responsibility that comes with the job. He told me to take the day off and go home and “Do whatever you do when you have to make a big decision. Think on it. If you want to be a doctor and are willing to take it on, come back tomorrow. Otherwise, don’t bother coming back. This is just between us. Or, rather, it is between you.”

As I headed to the door, he said: “One more thing you should know. I really hope to see you here bright and early tomorrow morning.”

Surprisingly, it was not a difficult decision. The decision made itself, once he had laid it out that way. I returned the next day and found that he (and the charge nurse) had covered for me by telling the nursery staff that I had been ill. Over the next two weeks, my role in the nursery gradually expanded, even to include some opportunities for actual independent clinical work. But that is another story.



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