Being over ninety years old, I have a long list of things to be grateful for. I’m especially grateful for all the lessons I learned over the years that helped me become a better practitioner.
Much of this was acquired fortuitously. The era in which I began my practice. Having four dedicated children who taught me to be fully present by never hesitating to tell me when I wasn’t.
Then, there was my work as a coroner and my interest in bioethics. One pathway of bedside bioethics care included the question, “Why am I wrong?” This question is often avoided in modern medicine, but early in my career I served as a deputy coroner, and this forced me to deal often with existential suffering.
When patients left my practice, I always tried to find out why. I learned a lot from that.
Another learning opportunity occurred when we expanded medical mortality rounds to include not only errors in diagnosis and treatment, but also errors caused by systems deficiencies, such as delays and miscommunication. I took courses on listening and learned important lessons from mediators, actors and union negotiators. I studied narrative medicine and learned about the art of medicine.
However, the most important lessons–and rewards–came from the patients and their loved ones. The aha when I zeroed in on the narrative aspect of a person’s medical complaint. The expressions of appreciation when I gave a eulogy for someone I had treated for decades. The grief counseling I offered my patients through the years; I did not charge for this, but it was richly rewarding in other ways.
There is little question that the systemic and structural problems in caring for patients have become increasingly complex and burdensome, and they obfuscate the ability to sustain a meaningful relationship with patients and their families. Over the last two-to-three decades of my fifty-eight-year practice, my colleagues increasingly asked why I would choose to stay when so many physicians chose to retire earlier. I was the oldest practitioner at a large hospital when I retired.
What kept me from retiring was the deep sense of meaning and satisfaction I experienced when I took the journey through disease and death with my patients. This was more than enough to counteract the increasingly challenging environment in which health care is practiced.
Madison, New Jersey