“What do you wish you knew when you first started practice?”
There are so many things that I wish I had known when I started in medicine, things that unfortunately are unknowable until you have spent some time in practice. There are some things that you cannot know until you have walked this path for a while. It is like a pair of shoes you plan to take hiking, you try them on, walk around the store, climb the fake rock to see how they fit going up and down, and make your best guess. The felt good while you walked all over the REI, looking at everything, but when you hit the trail you find they are not quite right. The break is a little too far forward on the foot and so after 20 KM the midfoot is sore, as are your toes. There are so many things like that in the world, they require first-hand experience to understand.
In 1990 I began my medical journey and have been on it without pause for the last 28 years, and in truth, I am not sure the pause will come until the breath fails me. I enjoy the work, and it gives something to me that I have not found anywhere else, a sense of purpose. What surprises me most are the unstated needs that were filled for so long that I was completely unaware of and how that purpose has changed over the years.
When I graduated from medical school 1995, I was given a wonderful quote from a friend’s mother. Her father had been a physician in New Orleans and she had this quote framed for me to display.
When the final history of the world is written, the physician will stand alone in the variety of his economic usefulness, his field apart, yet touching at all times the toga of the citizen, the robe of the priest, the periwig of the advocate, the scarlet of the judge, the mask of the executioner—each shadowing his life with the mixt bitterness of reproach at the limitations of his ability in the midst of so great a field of labor and of so large possibilities of accomplishment, while always the whisper of the succored child, the prayers of the convalescent and the glory in sharing the salvation bring the ray of light which lends the soft harmony of gentleness which should be the signal standard of the true physician, as, at the end, he stands a sad and thoughtful actor in the Human Comedy.
-Isadore Dyer, MD New Orleans 1910
I remember reading this when I first opened it after graduation, and thinking to myself ”Who is this kind of person? Who writes this kind of work, and what does this mean?” This has hung over every desk I have ever used for the last 23 years, I see it every day, and I think about it often. Dr. Dyer has been my unofficial teacher for this journey. I reference our conversation often when I find myself in a place where I wonder what I should do. I look to him when I think about how I might approach this problem, how to talk to this patient, to find the words that I need for a conversation. His words have prompted me to slow down, to take a little more time, to ask one more question. His words have pointed me in directions I would not have gone on my own quite so easily, or so quickly.
When I think about the young man who was starting, when he first landed in medical school in 1990, when he might have asked me this question, “what do you wish you knew?” It is like I am seeing him through the wrong end of a telescope. He seems so far away, and the pictures of him I have collected in an old box, look so young, so very, very young. When I look in the mirror I see him looking out at me through my eyes, but the face that surrounds has changed. It is less sure and more kind, it is less hurried and more thoughtful, it is confident in what it knows, and confident enough to own what it does not know. There’re so many things I would tell this young doctor, so many valuable things I would say to him…. Don’t be in a rush, it is a long road, there will be many steps, and you have a long time to get there. You do not know half of what you think you know, and you do not know a fraction of how much you truly do not understand. Your heart is going to be broken, again, again, and again. Your heart is going to be broken so completely that it will have to regrow in a new and bigger way. You are going to come close to dying because of your hubris, you are going to hurt people because of your ego, you were going to be the kind of doctor you promised never to be… and it is important that you do this, so that you can grow the kind of compassion that you truly want to have. This journey that you had committed yourself to is insane, and if you were smart, he would turn back now. But I know you won’t, you have a fire in your belly that can only be quenched by walking to the source. And so, I wish you the very best of luck on your journey and I will see you when you arrive.
And though I’ve been in practice for 23 years now, I have not found words that speak better the story of the physician than those that I was given on the day of my graduation, and I have found no words clearer in their direction to me of how I should conduct that life.
Namaste my dear friend....
This is the first in a series of letters to a young doctor form so long ago, please follow along with me as we explore together this life in medicine and touch the history that has formed in the process. If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).