Living the Dream

Well, that was an unexpectedly long intermission. I wonder if anyone will ever read this post. 

The last time I wrote here, Joe Biden had been president for all of six months. COVID vaccines still felt like a miracle. Facebook was still something that college kids did. I was barely a neurology resident, and I was convinced that life would begin the moment I finally arrived.

I knew the place. The destination. The dream. The mythical point somewhere over the horizon where all the years of sacrifice would finally make sense.

For me, that place always looked remarkably specific. I wanted to become a Sub-specialist in Neurology, practicing in America. I wanted to spend my days caring for patients with Parkinson's disease and other parkinsonian illnesses. I wanted to work at an academic center. I wanted to teach. I wanted to build something of my own.

And then, somehow, after decades of relocations, exams, training, overnight calls, impossible rotations, and enough self-doubt to power a small nation, I am here. This is it. This is the dream. And for the most part, it is every bit as wonderful as I had imagined.

There is a particular privilege in being allowed into the lives of vulnerable people. Every day, patients walk into my office carrying their fears, their uncertainty about the future, and place them in my hands. The trust that is implicit in that act continues to humble me.

I have been embraced by central and southern Illinois in a way I never expected. This region was starved for a Parkinson's specialist. Almost overnight, I found myself becoming a minor celebrity of sorts. Patients drive hours to see me. Families bring me photographs. They remember my birthday. They hug me in grocery stores. No one tells you that part. No one tells you that medicine, at its best, is still profoundly human.

And that, strangely enough, is where trouble begins.

It takes only one angry person. One grievance. One individual determined to misunderstand your intentions and assign motives you never possessed. One person who walks out of an encounter convinced that you are not merely wrong, but “horrible”. And suddenly, despite hundreds of grateful patients and thousands of hours spent trying to do the right thing, you find yourself lying awake at three in the morning wondering whether any of it is worth it.

Recently, I had an encounter that has occupied far more space in my mind than it deserves. Objectively, it was insignificant. One deeply unpleasant interaction. The sort of thing that happens every day in every hospital and clinic across the country.

Yet somehow it followed me home. And then into the next day. And the next.

What fascinated me was not the complaint itself (“patient felt unheard” after a documented 90-minute clinic visit!). Complaints happen. Human beings disappoint one another every day. 

What troubled me was how easily a single encounter managed to overshadow hundreds of others. 

The arithmetic of human emotion has always been peculiar. A hundred kindnesses weigh less than one cruelty. A hundred people can thank you for changing their lives, and one person calling you “horrible” will somehow commandeer the microphone inside your head.

I have spent a great deal of time recently wondering why.

Why modern medicine in America seems to have elevated patients from participants in a relationship to consumers in a transaction. 

Why every disappointing clinical encounter must label the physician as a villain.

Why physicians are expected to absorb unlimited hostility while maintaining unlimited empathy.

Where exactly did the boundaries go.

Somewhere along the way, medicine became a customer service industry. The language changed. Patient satisfaction. Patient experience. The patient is always right.

Except sometimes the patient is not right. 

Sometimes the patient is frightened. Sometimes the patient is grieving. 

Sometimes the patient is angry. 

And sometimes the patient is simply behaving badly. 

Those realities are not mutually exclusive. 

Yet acknowledging them feels oddly forbidden.

Meanwhile, the inbox grows. A multitude of messages waiting. Prescription requests. Prior authorizations. Questions. Forms. More questions. Messages sent at 11 p.m. on Friday and followed by a second message on Monday asking why nobody has responded. Entire weekends consumed by chart review and electronic correspondence. Work that is invisible precisely because it is done well.

Patients see the twenty minutes in the examination room (or in my case 90 or 60 as the case may be). They do not see the hours before and after. The preparation. The documentation. The phone calls. The insurance battles. The endless bureaucratic trench warfare fought on their behalf. Nor should they have to. But I sometimes wish they knew.

Over the years, many well-meaning mentors, colleagues, and friends & family have offered the same advice. Develop a thicker skin. Take the lesson. Discard the rest. Put it in the garbage. Move on. Stop caring.

Perhaps they are right. Perhaps that is the only sustainable way to survive. But I suspect, the day I truly stop caring will be the day I hang up my boots.

Because caring is not the problem. Caring is the entire point! The trust. The responsibility.  The unreasonable hope that another human being might suffer a little less because you showed up. Without that, medicine becomes a transaction. And I have no interest in transactions.

So perhaps this difficult encounter arrived at precisely the right moment and forced me to think more carefully about the kind of physician I want to become during the next chapter of my career.

The answer, I think, is surprisingly simple.

I want to remain the sort of physician who still cares.

Because if this is truly as good as it gets -  and surprisingly, that is no longer a depressing thought to me - then perhaps the challenge is no longer building the life. Perhaps the challenge is learning how to live in it.

And on most days, despite the inbox, despite the bureaucracy, despite the occasional difficult encounter, I can admit something that would have seemed impossible to my younger self.

The dream came true. And it is, indeed very, very good.