Tuesday, October 23, 2012

"When did you know you wanted to be a physician?" by Kenyon Railey, MD

When did you know you wanted to be a physician?

I knew at that moment my father had lied to me.
The chief complaint said it all: “to talk.” With my eyes closed and hand hesitantly turning the door handle, a dreadful deep breath filled my lungs.  As I opened the door, I exhaled insensitively from my nostrils.  Nearly two years out of residency, and I had already developed a list of chief complaints that bristled me before I even entered the room. “To talk” was a simple euphemism for “depression” or “anxiety.” These were the code words I associated with missed lunches and late evenings.  As I stood outside the exam room, I knew I did not want to be a doctor. I suddenly wanted to call my dad, a Family Physician of over 30 years experience, and ask him why he never told me there would be days like this. 
As a matter of fact, medicine has been a part of my life for quite some time, but perhaps not in the way that many physicians’ children experience it.  I never shadowed my dad or spent long hours at his office. I did not interact with his staff.  It seemed that he even discouraged this—most likely from a fear that his chosen profession would somehow influence mine.    Family was first; his job was secondary.  He made it a point to be at every school function or sports activity.  I write this only to make it plain that his daily duties at the office had little effect on my personal life. As a child, the encounters outside the four walls of his office moved me the most towards a medical career.
In those early years, my exposure to medicine occurred in the strangest places—at the department store, in church, or even at the park.  No matter where I went, it seemed to me his patients were everywhere.  We could be in the middle of the grocery store aisle when I would hear a wavering voice whisper from behind, “Dr. Railey, is that you?” 
Medicine influenced me at a young age simply because my behavior became intimately intertwined with a fear of being found by one of his patients. Everywhere we went, my sister and I could not escape those intent on thanking my father for his help while showering us with exhortations about how small we used to be or how fast we had grown. Usually, they eventually slipped in a question concerning dad’s medical opinion about this thing or that. “Doc, can you look at this rash?”  It became embarrassingly obvious that my father’s job traveled with him. Although I did not like behaving based on who might see me, I now see that another feeling surfaced with the embarrassment. I was proud that so many people knew my dad.   I could tell he was a part of something special. Perhaps this realization was the forerunner of a deeper revelation regarding the connection between care and community.  Even at a young age, the desire to choose this type of job soon stirred within me.
As I grew into adolescence, my father began to share stories to match the strangers. There were nights when the dinner conversation would start with the words “Son, let me tell you why today I’m glad I’m a doctor.”  As I listened, he began to reveal anecdotes about patients he had helped, family members he had cried with, my best friend’s grandmother whom he had taken care of until she died.  His life and his livelihood were stories of pain and suffering, yet hope remained. I wanted my own story. It was not until I became a patient that I had one. 
As a result of a torn ACL my first year in high school and another major operation one year later due to complications, I discovered firsthand the hopelessness and frustration associated with disease. My professional basketball career had ended before it even began, but the two-year relationship I developed with my Orthopedic physician was worth the trouble. As a result, I was personally exposed me to another aspect of medicine—one where doctors actually influence outcomes and fix what is broken while becoming counselors and sometimes friends. Up until that point, becoming a physician was simply an idea.   After being a patient, it became an ideal.
Nearly verbatim from my medical school application personal statement: “The alleviation of pain for the benefit of prolonging people’s lives is a physician’s main purpose.”  As I progressed through medical school, however, I realized that preventing pathology was only a small piece of the puzzle.  It became apparent that medicine was just as much about health as it was about hope. When the time came to choose a specialty, there was no choice—it would be Family Medicine.  In my opinion, no other specialty satisfied my need to combine science with service.  I longed to be a part of that community I was exposed to as a child and I looked for ways to provide the same counsel I had received as a patient.
By the time I had finished residency and started work in a busy community based practice, however, those wishes began to wax and wane.  It seemed that patients had problems everywhere.   There were just too many complicated co-morbidities, compliance issues and cost related challenges. While my medical knowledge and experience grew, the passion I previously had for medicine did not.  The pressure to see more complex patients with multiplying problem lists and the constant reminders about productivity was not what I expected. The visceral reaction that occurred when I read chief complaints like “new patient, back pain” or “stress, can’t sleep” were real and too often.   Burnout was on the horizon. After all this time, a doctor was the last thing I wanted to be.  Why did my father not warn me? 
I am back in the room with my patient. With my eyes closed and my hands firmly holding his, a deep breath filled my lungs. I exhaled as an empathetic wave flowed through my chest.  We were praying together.  At least 30 minutes had passed since I had walked in the room “to talk.”  In that time, this patient had opened up about his battle with depression, his pending divorce, and the fear that his children were moving to another state permanently. He told me that a friend recommended me as I had apparently helped him or her with depression. Without many friends in the area and his children 400 miles away, this patient had nowhere else to turn.  He was considering suicide. By the end of the visit, however, things had changed. The patient was sure that with counseling and medication, things would get better. He thanked me for praying for him; he had never had a doctor do this.  He was glad he had listened to his friend and made the appointment.
As I stood outside of the exam room of the next patient, I was reminded of the many other times “to talk” or “back pain” turned into a chance to save a life. I had a strong desire to call my father and tell him “Dad, let me tell you why today I am glad I am a doctor.” When I truly think about, I guess he always told me there would be days like this.

Kenyon Railey, MD

Kenyon Railey is a Family Medicine physician who completed his residency at UNC Family Medicine. He lives in Durham and is a contributor to the UNC Minority Men in Medicine Blog. He can be reached for comment at askdoctork@gmail.com