How to Save a Life

And I would have stayed up with you all night–Had I known how to save a life.

The Fray, “How to Save a Life”

The tenth season of Grey’s Anatomy premieres tomorrow night.   For the cognoscenti, this means we will find out what happened after the cliff hanger of last season:  Will April really leave Matthew at the altar, for her first love plastic surgeon Jackson?  Or will the handsome paramedic who loves the doctor unconditionally and quite unbelievably without ego issues, win his lovely bride?  After all, he organized a flash mob for his proposal to her.  He deserves his beautiful red headed pig farming sweetheart.  And why do I watch these things?  Is it because the women wear makeup and heels and do their hair and the men are so very handsome and no one looks tired, and lives are saved quickly, with great valor. As Hemingway’s Jake says at the end of The Sun Also Rises, “Isn’t it pretty to think so?”

The song, “How to Save a Life” by the Fray, was used in an episode of Grey’s second season, and afterwards became an anthem for the show itself.  My favorite rendition is a home video with a hand held camera, of the actual cast singing the song at a benefit—you can view it here:  http://www.youtube.com/watch?v=KX3AjiqFA1s   Yes, I know they aren’t “real” doctors. But I suspect that if you act like a doctor for ten years of your life, it might be hard in the end to tell the difference.  The emotions are all right out there, in the video and in the show.  And that’s the real answer to why I watch Grey’s Anatomy—I get it all out in front of my own television set so I don’t have to do it in front of my patients.   I don’t think it’s helpful to have your doctor cry while she is giving you bad news.

Friday, February 28 will be my last day at work.  I am officially retiring, at age sixty. My staff and my patients have been asking me why for several weeks now.  They make very complimentary proclamations like, “But you look so young!” and “But you’re so GOOD at what you do” and “How can we replace you?”  The answers to these questions are “thank you,” “thank you,” and “No one is irreplaceable.”  The truth is that I feel like time is running out.  I have had some extremely joyful experiences over my last thirty two years in Radiation Oncology and I have witnessed some incredible success stories, many of which I have told here.  I know that miracles DO happen.  But I have also seen some terrible things, and there is not a doctor alive who would say that we don’t take our failures personally.  We do.  What I have come to realize, at least for me, is that the sad times are not getting easier as I am getting older.  Facing the deaths of loved ones this past year–patients, relatives, friends and pets—has left me with an acute sense that the clock ticking in the belly of the crocodile is ticking for me, and  I am no Peter Pan.

So I will leave my practice in the best of hands, and I will read and I will write and I will travel and see more of my children and all the other people I care about.  There is a line in “How to Save a Life” which goes, “And you’ll begin to wonder why you came.”  There is one thing that I am certain of, when it comes to my career.  I will never ever wonder why I came.

THE FREEDOM TO BE NEEDED

Doctors lie all the time.  Call it hubris “I can do THIS for you!”, call it denial  “I KNOW you are going to get better!”, call it what you want.  But nowhere do they lie more than when you ask them if they want their children to go to medical school.  Most of them come right out and say, “Never!  If he goes, he’ll be $200,000  in debt when he finishes.  And besides, you know the practice of medicine is not like it used to be—it’s all about paperwork, and insurance authorizations, and seeing your quota of “X” patients per hour.  Get ‘em in, get ‘em out, don’t look back.  I DON’T want my kid to study so hard for 4 years, and then another 3-6 years of residency where he’s paid a subsistence wage, to finally finish and deal with the sorry state of affairs we have now.”

My husband and I were pushed HARD by our parents when we were kids.  As the eldest children in our respective families, many expectations were placed.  It wasn’t enough to do well in school  (“What’s the matter here—you have all A+’s except in math—you got only an A?  What happened???) or in athletics (“Go swim next to Marilyn, and BEAT HER!”)   It was pervasive and it was truly unpleasant.  Both of us left home when we were 17 years old, and never moved back in again.  And we vowed, repeatedly, that we would NEVER do that to our own children.

So when our eldest went to college, and showed a strong interest in film and photography, we did not bat an eyelash when she decided to major in film studies.  And when she graduated and could not find any paying job in the industry (“no, honey, I will NOT support you while you spend the next year as an unpaid Go-fer for a screenwriter, no matter how famous she is!”), we said “yes” when she decided to go to cooking school in London, spending the last bit of cash I had set aside for her to go to graduate school.  And we were supportive and enthusiastic when she returned from cooking school and got a job as a line chef at a fancy downtown restaurant, despite the fact that she made minimum wages and had no benefits whatsoever—health or retirement.

Sometimes epiphanies are hard to come by.  Mine came after my sophomore year of college where I was an honors English major.  I was backpacking and youth hosteling through Europe with my roommate and we were on a train from Brindisi to Rome.  By the time we ran for the train as it was pulling out of the station, there were no available seats.  So we stood up in the aisle the entire trip, which was overnight.  Unlike my horses, I do not know how to sleep on my feet.  An overnight trip surrounded by sweaty co-travelers reeking of garlic would not SEEM to be conducive to self- exploration, but oddly it was.  I thought about what I wanted to be when I grew up.   I loved English literature, particularly poetry.  And then I thought about what teaching jobs were likely to be available to me—perhaps a job teaching remedial English at a local junior college?  Or a low level editor at a publishing house (back when there WERE publishing houses)?   I knew already that there were people in my class who were destined to teach at the Ivy Leagues—they had won poetry awards, they had developed a new way of looking at Chaucer, they could read and speak five languages—in short, they were brilliant.  That was not me.  On that hot July night, on that train, standing up swaying and lurching, it came to me that when I was in high school my most rewarding experience had been working as a candy striper at a spinal cord rehabilitation center.  I was APPRECIATED.  I was NEEDED.  And that was the night I decided definitively to go to medical school.  And besides, I knew that Daddy would be so proud.

I think that my daughter had a similar epiphany.  Cleaning splattered grease off the ceiling from a ladder in that hot kitchen at the restaurant at 2 am, to take home a wage that would never allow her to move out of our home, she assessed her skills, and her history, which was that she was always the care giver—to her animals, to her brothers, and sometimes even to her parents.  She knew that she was very good with knives and with her hands.  And without much ado, and very much like her mother before her, she decided to go to medical school.  Which I am not ashamed to admit, pleased me greatly.

My daughter will finish medical school in less than a year.  Right now, she is in Zambia, at the CURE hospital there, working with my father, a retired plastic surgeon, on correcting birth defects, and lessening contractures in children who have suffered horrible burns from the main resource for cooking in that country—charcoal.  She is the third generation in my family to go into medicine, fourth if you count my grandfather who was a dentist, and my husband’s grandfather, who was a veterinarian.  This trip will be life changing for her—of that I am certain.

When I was a medical student, a very smart man who was doing his Pulmonary fellowship at Stanford said to me,  “Medicine is the freedom to be needed”.  That is a statement I have never forgotten.   And if you ask another doctor whether they would want their kid to become a doctor and they say “No”, trust me, they are lying to you.