The Chance to Try

Part 2 of speech given at residency graduation. Organization and phrasing reflects oral presentation.

“Why does anybody tell a story? It does indeed have something to do with faith. Faith that the universe has meaning, that our little human lives are not irrelevant, that what we choose or say or do matters, matters cosmically.” – Madeleine L’Engle

In high school, I realized four years of college, plus four years of medical school, plus a minimum of three years of residency equaled a lot of years. What about other healthcare careers? By sophomore year of college, I narrowed the options down to PA school and medical school.

I agonized over those two years post-college versus seven. It’s just a touch ironic, given that I’ve now completed a five year residency and have chosen to do a fellowship.

A patient helped me decide.

Let me preface this story by saying it’s a devastating one, and I’ve changed details to protect the privacy of the patient and family involved.

Over break my sophomore year, I shadowed an emergency room doctor in a small regional hospital on the coast. To his eyes, most of the presentations were ordinary, but you guys know how excited I get over patients now, so imagine me then.

We treated vaginal bleeding, chest pain, minor lacerations, etc. The most thrilling patient shot himself in the knee with a nail gun; the nail entered the joint space and bent.

We had to knock him out to extract it, which was the first time I’d ever seen a sedation. Thick white liquid, like melted ice cream, placed into an IV, made the patient senseless. Completely ordinary now that I’ve watched a thousand anesthesia inductions, but at the time, it seemed like magic.

So, one afternoon, EMS calls ahead about a water trauma. It’s a kid. He was playing at the beach with family, when he lost footing on slippery rocks, hit his head, and fell into the frigid water. He was submerged. He’s cold. They’ve been resuscitating him for 30 mins.

The flurry of preparation begins. The trauma room fills with people in gowns and gloves, someone cranks up the thermostat, IV fluids steam in the warmer.

EMS roll in with a boy on a gurney, CPR in progress. We take over. I had never seen a human being that color of pale. “Fishbelly white” is inadequate. The team worked tirelessly for an hour, which felt like minutes and days all at the same time.

I think most people knew the outcome before we started, although I didn’t. The boy did not survive. My heart ached for the family. I still think of them every year when the season of their loss returns.

After the code, the doctor finished up paperwork and prepared for the arrival of the family. A physician assistant said to a nurse, “That’s why I wouldn’t want to be the doctor.”

A decade of retrospection leads me to believe he was talking about the paperwork, but at the time, I thought he meant he wouldn’t want the weight of responsibility of calling the end of the code and talking to the family. I had an immediate visceral response: “I want the chance to try.” That devastating day propelled me toward medical school.

N.B. To my colleagues and friends who are Physician Assistants, I have the deepest respect for your profession. This anecdote is simply meant to illustrate a moment in time that catalyzed a decision for me. I don’t know what this individual meant, or whether his words were merely a response to the stress of the day. At this stage in my career, I recognize that many of you do in fact bear this kind of responsibility in your daily lives. Thank you for everything that you do for your patients.