This is the week when new residents start their training. Around the country, newly minted DO and MD physicians are walking into hospitals to really learn their professions. They have absorbed much in their 4 grueling years of medical school. They have seen disease and suffering and they have learned more than the basics of caring for the afflicted. But there is much more to learn; much in general and much specifically related to the specialties that they will ultimately practice.
The practice of medicine is a strange thing. When our friends and families urge us along into this career, I fear they sometimes think they are sending us off into tidy offices with nice waiting rooms, or pristine surgery suites where everything is well controlled. They envision kindness and calm, smiles and appreciation, as well as wealth and ultimately ease for the work we will do.
This may have been what my father envisioned. It may have been the reason he often urged me, well into my career, to "Go back and do a residency in internal medicine or surgery." Those were the things he knew. Medicine was a shirt, tie and jacket, a lab coat, respect, and position. This is not to condemn him; it was the era in which he came of age.
But medicine -- so much of medicine -- from training to retirement, is chaos and struggle. I certainly have lived that in my work as an emergency medicine physician. My tidy office involves mundane care of coughs and colds, as well as restraining the meth overdose, trying to stop the bleeding from the knife wound, managing the frantic schizophrenic, or arguing with the exhausted on-call specialist. Sometimes it involves praying for a break in the weather for a helicopter to fly out the sick child. One time it was caring for my own senior partner after his fatal car crash.
The point remains. Our new physicians are entering a strange world, which is changing all the time and not always for the better. (Oh, the science is often improving; it's the politics and culture that seem to poison it all.)
They are going to see more of what they saw in school. And they are going to be increasingly responsible for the things that happen to their patients. Residency is a time when we learn accountability. When slowly, surely, lives depend on the physician in training, to prepare her or him for being in charge of what happens when they are, one day, all alone.
These doctors in training will have to navigate the troubles that medicine can cause in their personal relationships. This will be perhaps the most important thing they do if they hope to be happy and thriving. It's a hard lesson to realize, too late, that your marriage mattered more than your credentials.
They will also have to care for their own mental health (oftentimes with few others being interested). They will (hopefully) learn to manage money as doctors are notoriously bad with it. They will realize how often medicine is a place of conflict, between physician and physician, patient, administrator, and even attorney.
This immersion in humanity will teach them that there are wonderful people in the world, and that there are terrible people. That those in suits can be more dangerous than those in shackles. But they will have to provide excellent care to both.
Along the way they will also learn that death and disability are ever stalking humanity. Despite their training and compassion, their patients will cross out of this life, often as they stand at the bedside, helpless for all of their efforts.
Ultimately, what I mean is that medicine is a hard and beautiful gift to those blessed to be a part of it. There are those who, forgetting the lessons of history, have embraced the idea that our goal in life is ease and comfort. They are deceived by social media and entertainment. They imagine that the ultimate good is to lounge by the ocean, drink in hand, day after day, night after night, with no struggle. And while that may sound nice for a bit, it would also be soul killing.
Medicine forces its practitioners to do the opposite. They will delve into a life that is difficult but rewarding. A life that is crushing and elevating. It is a job which, if done properly, can secure material goods. But if done even better, can secure emotional and spiritual depth beyond our reckoning.
Through medicine we can learn to trace the shape of the fantastic anatomy of humankind. We can comprehend our fellow creatures' staggeringly complex biology. We can bring healing and comfort; sometimes snatching life from death.
This work leads us deep into human trials so that we know how hard, how miserable are the lives of so many. Done with the right heart, this will break and reshape a physician so that the suffering of others prompts us to greater compassion and action than we could have by watching it all from the periphery, or from the news each night.
Medicine trains our eyes and hands so that even walking down the street we can find ourselves applying diagnoses to those who pass. "It looks as if he had a mild stroke," or "she seems to have emphysema." We can identify the look of psychosis, the shuffle of addiction, the limp of amputation, the scar of cancer. This can be, itself, life-saving as we see the patient clutching his chest and sweating, or the woman whose swollen leg and shortness of breath suggest a blood clot. To know these things is to use the knowledge of suffering to help interdict suffering. This will matter in the care of strangers; and before one knows it, in the care of friends and family.
So, as this first week rolls on, I would say to our new physicians, "press on, dive in, learn and love and care." This job is a calling, is a journey. It may or may not leave you with wealth and ease. But done properly, it will give you a life well lived among those who come before you, wounded and sick.
Welcome to the adventure. For all the trials, it's worth it.
Edwin Leap, MD, is an emergency physician who blogs at , and is the author of and . You can read more of his writing on his Substack column, , where a originally appeared.