Reminders of my Why

Twenty years.

That's how long it has been since I graduated from medical school.

It blows my mind. In so many ways, I find it difficult to believe that so many years have passed. There are times when it feels like medical school was only yesterday. Moments of that — at times dreadful — ordeal still feel so fresh and raw.

Other times, I consider everything that has happened in that time, and I struggle to believe that it was only twenty years.

Fourteen years ago, I completed residency. And started my practice. That baffles me as well. I recall feeling so frustrated and ready for some change about five years into my time here. It was a sense of needing some type of change. I'd never done the same thing for more than four years continuously. Each year of medical school was something different. And while I was a urology resident for four years (after two long, awful, miserable years of general surgery), every year was a little different.

But now, I have been doing the same thing, in the same place, for fourteen years.

I am grateful that I have. I love my job. I think I have an amazing, challenging, and fulfilling job.

It is also hard. So hard some days.

The stress of being the one in charge, the one where the buck stops, of having to make the tough decisions, is exhausting. In a clinic day, I can see thirty people, tell a handful of them they have cancer, tell some they are now cancer-free, and tell some they are still cancer-free.

I never would have guessed how often I am talking to people about their cancer, past or present. Residency was compartmentalized. You talked about cancer when you were on the oncology service, because of course you did. But not on benign, or recon, or stones, or lap/endo, or female, or peds (not in urology, hardly ever, thank goodness). My view of how often cancer was part of my job was distorted by that compartmentalization.

It is sobering.

Those conversations, the new cancer diagnosis ones, are always difficult. I have to be honest, but optimistic. Realistic, but hopeful. Encouraging, yet supportive of their grief.

It is a tightrope to walk.

And it can be so draining.

That doesn't matter, though. It doesn't matter that I leave one room, completely drained, and have another one to go into. I don't say that negatively. It is just the fact of it. It doesn't matter because I need to go into that next room and offer the exact same empathy, encouragement, and clarity of thought to that next person.

That is what they deserve.

I do it gladly. Gratefully. Honored by the trust people place in me. People who, having just met me a few minutes ago in some cases, are picking a date for me to cut them, stick my hands (or robotic instruments) inside of them, rearrange their insides, and then send them home, often less than 24 hours later.

It, too, is sobering.

And then.

Then there are the times that make it all worth it, and then some.

Last week was one of those times. See, here is the thing: people don't thank us doctors all that often. It's okay. I don't expect it. It is my job. But considering what we do, we hear a sincere "thank you" rarely enough that when it happens, it sticks with you.

I heard it last week.

I'd taken out her kidney. She'd trusted me to do just that. The moment she met me. Grateful that I could tell her about it in her own language, she'd placed that confidence in me.

It was a difficult case, but went well. She was cancer-free when it was over. She still is. And I told her that. She smiled. Her daughter smiled. There were some tears in the corners of their eyes.

Not mine. That is part of who I am. My wife has accused me, on more than one occasion, of being emotionally constipated. She's not wrong. In this case, I was happy to see their relief, but that was it. I can't feel too strongly. The visit was over. Good for another year. We all stood to leave the room as I prepared to enter another one.

Then the patient reached up to me. The top of her head maybe reached the middle of my chest. I towered over her. Her arms literally were held straight up over her head. As she reached for me.

To hug me.

To put her head on my chest and to say thank you, with tears in her eyes.

Now there were tears in mine.

Some days, it is all worth it. All it takes is something so small, so simple. It becomes something that will sustain me. That reminds me.

I have the best job in the world.