Many years ago I was asked to see a young woman everyone thought had appendicitis. I didn't agree and after observing her it was apparent her problem was a ruptured ovarian cyst which did not require surgery. A few years later her younger sister, a talented musician, tripped at home and fell into the fireplace seriously burning her hands, arms, upper torso and neck. When she was sent to the Yale New Haven Hospital emergency room the family asked them to call me to care for her.
Her hands were disfigured and she was very depressed knowing this would end her musical career. I admitted her to the hospital and each morning would debride her burns while she screamed at me, "I hate you." She really made me think about why I had become a doctor and did I want to continue if this was the reaction patients had to me. Her mother told me years later that one morning I said to her, "Madeline, maybe someday you'll love me." I do not recall that moment.
I wish medical schools helped us to analyze our healthy and unhealthy reasons for becoming doctors. I liked people and wanted to fix their problems. Only to learn you can't fix everything and really begin to wonder why our Creator made a world filled with problems and diseases which couldn't be cured. I really feel if these things were part of the curriculum we would all be better doctors and Kevorkian wouldn't have ended up in jail because of his issues with death and I wouldn't have wanted to quit surgery and become a veterinarian.
I still recall a child, whose facial nerve I injured while removing a facial tumor, smiling her crooked smile during my port operative visit and so I apologized and announced to her and her mother, "I quit. I can't take this anymore." They both told me I was not going to quit and gave me therapy. There were other cases too where my errors in judgment led to more pain and suffering for my patients and I still think of them. Yes, I apologized and didn't make excuses and they forgave me as I learned from my mistakes. I truly feel the best doctors are ones who are criticized by nurses, patients and family. They do not make excuses and learn from their mistakes.
I can recall walking into one patient's room and she said, "What's wrong?"
"Why are you asking?"
"Your face and forehead are all wrinkled."
"Yes, I am thinking about how to help you."
"Think in the hallway and smile when you come in here."
On another occasion a patient I was about to discharge said to me, "I am giving everyone who
cared for me a bottle of liquor but not you."
"I do not miss the liquor but why are you not giving me a bottle?"
"Because you are always angry."
"That's because I didn't like what happened to you and I didn't like what I had to do to you."
"Yeah, but you took it out on me."
"I'm sorry."
"Okay you can have a bottle of liquor."
As I walked away from his room I thought that he could have been discharged and having nothing more to do with me but he took the time to talk to me because he knew I was hurting and needed help. He became my teacher. I learned to let my patients and others who were experiencing illness teach me, the tourist, what the natives knew. When I thought I had prepared one of one children for surgery, which I performed because I was the pediatric surgeon in town, by showing him the hospital and the people he would meet he awoke after surgery and said, "You didn't tell me it was going to hurt" and when he had a bone tumor, at age seven, I thought was a sarcoma and was totally depressed he said to me, "Dad, you're handling this poorly." He taught me how to enjoy the day and not live in fear of the future. His tumor turned out to be rare and benign and I learned a great deal.
I have learned from the children. When one teenager dying of cystic fibrosis asked me, "Why am I different?" I answered, "Tony, because it makes you beautiful." He loved my answer because he knew full well how much he had done for the world and that he would be immortal through his love and the fund raising of those who knew him hoping to find a cure for cystic fibrosis.
We all need to understand that loss is inevitable and learn to use it as a beginning, just as a graduation is called a commencement. Death is not a failure and I am not a veterinarian because when I approached one of my patients, who was a vet, and asked him to help me make the change he responded, "Don't because people bring the pets in."
Now back to Madeline and how wounds can heal. One summer day, when the temperature was well over ninety degrees, into my office walked Madeline for her routine visit. She was wearing long sleeves and a turtle neck sweater so I asked her why she was dressed that way on such a hot day and she said, "Because I am ugly."
She also told me she was looking for a summer job and I said, "Oh, I know a nursing home which needs some aides. If I can get you a job there are you interested?" She said yes and I worked it out and called her back a few days later to give her the information. What I knew was that she would have to wear a uniform which would reveal all her scars to the people she cared for.
At the end of the summer in walks Madeline for her office visit and I asked her how the job went.
Her response, "No one noticed my scars."
"Madeline when you are giving love you are beautiful."
Madeline became a nurse and years later I received a phone call from her.
"Doctor Siegel I am getting married. My father died a few years ago. Would you be my father at the wedding?"
I can still feel the tears I shed when she said that to me. Of course I said yes and the greatest gift to me was when we danced after the wedding to Kenny Rogers singing, "Through the years you never let me down, you turned my life around," that song helped me to heal a lifetime of wounds. But I do not forget them because as Thornton Wilder wrote when an angel refuses to heal a doctor and the doctor can't understand why he shouldn't be healed too, "Without your wound where would your power be? It is your melancholy that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In loves service only the wounded soldier can serve. Draw back."
On the way home the doctor realizes the truth of the angels words as people say ask him to stop and talk to their family members because he is the only one thy will talk to. So I have learned to become not an M.D. but a C.D. for the wounded people I meet. Yes, a Chosen Dad who may not like their behavior but loves and reparents them and helps them to heal their lives and find self-worth and self-esteem and save their lives. For almost every unloved child becomes self destructive and diseased by midlife and not so those who felt loved by their parents. So I learned to always hug my patients and give them return appointments, no matter whether they filled my prescription or not, so they would know I cared and research shows the benefits of compassion for both the doctor and their patients.
As an associate of mine likes to say, we need to make a shift from "impairment" medicine to "empowerment" medicine and I would think that a large majority of doctors would agree that the practice of medicine is much more than just getting people better. If you make people better without giving them the tools for living better, happier, healthier lives, then you're just sending them back out there to repeat - with greater energy and vigor - the things that landed them in your office in the first place!
Also I believe that we'll never be done learning in life. And the amount of money one makes or the initials behind their name really have little to do with their wisdom in life. When we stop learning we stop living right?
I agree, medical school should offer courses on "Why do you want to become a doctor"?
For all too many, the answer is................................................money.
Perhaps the most common question that patients ask about me, personally, is, "Why did you become a cancer surgeon? It must be very difficult." In response, I tell them that it is such a wonderful feeling to know that something that you have done for another person has made the difference between, literally, life and death for them. When the inevitable follow-up question, "But not everyone survives, right Doc?," is asked, I then respond by acknowledging that there are also times of great sadness and grief, and times of sober self-reflection over my decision to spend my life caring for those with cancer. But, I am quick to add, I long ago learned that the people who entrust their very lives to me also enrich my life in ways that, after more than 20 years of practice, still continues to amaze me. Among those who have taught me the most about what is important in life (and what is not) are those who ultimately lost their battle against cancer.
Robert A. Wascher, MD, FACS
Author, “A Cancer Prevention Guide for the Human Race”
My favorite part:
"For almost every unloved child becomes self destructive and diseased by midlife"
If only we could all understand this one point. BTW all adults are still children at heart.