Those who do this work in medicine move towards situations that many others tend to avoid. When someone is in trouble or in need, especially someone a person doesn’t know, a lot of people tend to pull back or look the other way. But people who go into medicine have a different sort of response. We are magnetized into such situations, not because of what we know but because of something much older than our expertise, something that causes us to recognize that in times of need and trouble, we somehow belong there. I often wonder if this work is actually a calling.
When I teach, I often ask medical students and doctors: “How old were you when you first realized that the needs of a living thing — an insect, a plant, an animal, a human being — mattered to you?” “How many people were between the ages of 20 and 25? How many between 15 and 20? How many between 10 and 15? How many people were younger than 10? Over the years I have asked these same questions of many thousands of physicians and students. The great majority of those I have asked say that they were under 15 when they first responded to the needs of a living being with intent to make a difference. About half of any medical group was under 10. So perhaps medical expertise is only the most recent set of tools with which we have responded to the needs of the life around us. We responded long before we were experts, from the time that we were very young. Perhaps we are in this work not because of what we know but because of who we are.
I love asking groups of medical students and physicians to share their earliest memories of befriending life. Most of these stories are very simple. A trustee of the AMA once told me that when his mother gave him his lunchbox each morning before he went to school, she would also give him a clean folded handkerchief. He remembers that whenever she would do this he would ask her for a second handkerchief “in case someone else needed one.” He was in kindergarten at the time. Doctors in white coats have told me how important it was to them as children to be able to catch flies in their hands and take them outside before others in their family would notice them and kill them. Many of these stories are about a natural caring and compassion. Some of them are deeply moving. One internist remembered that as a little boy his mother often took him to visit his elderly neighbor. He hated these visits because the neighbor had an old dog that smelled bad and was blind. He didn’t like the dog because it snapped at him and often barked for no reason and frightened him. But once his mother and the neighbor were in the kitchen drinking tea and he was left alone watching TV in the living room with the dog. He remembers noticing that the dog was rubbing its eyes on the edge of the couch, slowly and patiently, over and over again. He remembers thinking that the dog was trying to see, hoping to see, and suddenly realizing that it was hopeless, that the dog would never be able to see again. He felt his heartbreak and he burst into tears. His embarrassed mother took him home because he could not stop crying. He was about four at the time. Sometimes the stories are about going along with the guys and hurting an insect or an animal. And carrying the memory to this day with the kind of guilt and shame that comes from violating your most basic values. For many physicians, values such as compassion, caring and the intention to make a difference to the needs of others, go back to their very beginnings. Perhaps this is what a calling actually looks like. Not some miraculous happening but just discovering, when you are very young, a set of innate values in yourself that will eventually determine your direction in life.
These deeply held values underlie the practice of scientific medicine and form the foundation of a community of service that is more fundamental than the expertise that divides us and more universal than our nationality or our religion. These values come alive in our stories
Our Finding Meaning in Medicine (FMM) program encourages groups of doctors to meet on a monthly basis and share with one another stories about their common experiences as doctors. Stories of compassion, of grace, of love, of healing, of courage, of loneliness and of commitment and valor. These stories enable doctors to remember who they are and what really matters to them. A good story is like a compass which points to something unchanging and reminds us of how we might live our lives. If you go into your day carrying your stories and the stories of your community with you, you have a permission and a support to live closer to the values that have been important to you ever since you were a child despite the pressures in your everyday work.
I believe that the real stress in today’s medicine is in large part the outcome of a conflict in values. It has to do with a system, an infrastructure that makes it difficult for people to live by their life values and relate to others in ways that express their calling. Our present system imposes a value set, which is driven by economic and time pressure and the policies and regulations that come from these sorts of concerns. It makes people unable to practice their medicine according to the best they know and the best that they are, not just scientifically, but also spiritually.
When you separate people from the values that they have held closely from their earliest childhood, they lose their sense of meaning, integrity and commitment. They feel helpless. They become cynical and depressed, hostile and alienated. Medicine is a way of life. It can survive as a work of integrity only as long as the innate values of those who are called to this way of life — of compassion, caring, service, harmlessness and respect for all beings — are supported and nurtured by the system itself; passed on and strengthened from teacher to student, from generation to generation. In the words of Maimonides ”Inspire me with love for all of thy creatures. May I see in all who suffer only the fellow human being.”