In the midst of my clinical clerkships for medical school, as I sat here studying at times what feel like endless articles, as I sat here typing countless notes for my patient's charts, I procrastinated and scrolled to another window with Dr. Paul Kalanithi's post-mortem publication in the New Yorker today: "My Last Day as a Surgeon."
And suddenly I remember why I filled in those MCAT bubbles, ordered that stethoscope.
Dr. Kalanithi was an extraordinary example of human life at its kindest and brightest, who performed the roles of neurological surgeon and narrative author at Stanford University and passed last year from lung cancer.
Inspired all over again, I went digging through old boxes in my closet with print outs of the things that inspire me most, and dug out a printed copy of his blog from after being diagnosed: "Before I go."
A paragraph strikes me again:
"Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed." -- (Stanford Medicine, Spring 2015)
As medical students, we have many ambitions to achieve, and we are far from his finitude. On ward teams we round, sometimes it feels like we run around, circling the ward. We put on sterile garb, we take off sterile coverings, we present people to doctors in soliloquy, we run through assessments of people and plans for what will do next for them. We become excellent do-ers. We get things done efficiently, we help make decisions and convey them eloquently, and sometimes people get better because of decisions we recommended. And then we read about people, we read about what's wrong with them, we read about how to fix them. We go to conference and learn new ways of repairing their physiology or anatomy, we go home and read some more, we go to sleep, and then we do it again tomorrow at 7 a.m.
I think it becomes easy in medical school to choose to just be a do-er, to have the primary goal to be the best do-er. To perfect the efficient and empathetic patient interview, to perfect the patient note, to perfect the morning presentation of each patient to the team of supervisory physicians. To perfect our knowledge, to perfect our skills, and to master the treatment guidelines and differential diagnosis for each patient we see.
We must do. Doing saves lives. But we must not get lost in the wind.
In many rooms we enter, we stare in someone's eyes who has less tomorrow's than we have. The infant or adolescent with a terminal genetic disease, the grandfather with chronic obstructive pulmonary disease with weeks remaining. Reflecting on the few minutes each morning in which we form brief moments of their stories, seems both impervious and powerful. We cannot really understand what they are going through, or what Paul went through. And yet a deep reflection yields a reminder of our impermanence, and the necessity of reverence for each moment -- even moments spent doing.
One day, we will become physicians, and we will be experts, and save many lives with our knowledge. We will be entrusted with making decisions with immeasurable magnitude. Yet both today and tomorrow, we must also be present. Seeing a baby giggle on morning rounds, having a father open up to us about the pains of watching a child die, we must not forget to have reverence for the mere tenets of human life itself. Let us not forget, we took an oath neither to fix nor repair, to be neither perfect, nor efficient. Our oath is to alleviate human suffering. Doing these things matters, but we can't get lost in the wind. We must not wait to live in Paul's "perpetual present."