Doctors’ Work: Eulogy for My Vocation

Abstract

I, like so many of those who filled the first ranks of family practice, often described my career choice as a calling, a vocation, something more than a meal ticket. It was a source not only of pride and conviction but also resentment and resistance to change. By mid career I was largely out of step with new movements in family medicine that veered from the generalist approach toward focused fellowships, added qualifications, and office practices that opted out of obstetrics and hospital work. As often happens, it was a patient of mine who brought the issue into focus and showed me the potential that lay in each encounter. We long for connection—doctor and patient alike—and for the skill and compassion to express it without judgment or self-denial. There is no higher calling.

What the world needs is people who have come alive.

Howard Thurman¹

I don’t remember it slipping away, only the shiver of certainty it was gone. A personal calling—the vocation to medicine—was my collateral deposit on a career that promised both conviction and sense of fulfillment. Now it was scattered like the lofted pieces of a jigsaw puzzle. What remained was the gift to see my work differently, less chiseled in stone or latched to some sacred destiny.

It is hard for cradle Catholic to discount the pledges recited on graduate day—the Prayer of Maimonides, the Oath of Hippocrates, the Declaration of Geneva. They are grave, ethereal, and lasting. One is fashioned to be a doctor, not trained to meet performance standards. One is chosen forever, not certified or employed for the length of the contract. One is vowed to the life-long pursuit of perfection. When all this was cast into doubt, I did not rush to the dark side. Work has remained more than a meal ticket, servility to a role, contractual obligation, or family tradition. It is a work in progress, as much defined by those I care for as by those who labor beside me.

GIOVANNI

An old artist came to see me. He reported that his creative juices had run dry. He could no longer sculpt and, as a result, had trouble maintaining his income and reputation. It had been better for him at University, where he taught for many years. There he had a train of admiring students, made regular rounds on the lecture circuit, and married a younger woman when their difference in age was more flattering than problematic. Then, as if overnight, he began to see himself as old, forgotten, and ineffectual, even in the bedroom where he once prided himself to be the master.

Diagnoses ran through my mind. I knew which tests to order, the drugs I might prescribe. As Giovanni railed against his misfortune, tears welled in his eyes…and mine. I sensed that something more was at stake: a tug at my own self-confidence, the gravitational pull on the arc of my career.

We make choices. We are boxed by our abilities and temperament. We are caught in currents stronger and deeper than we dare to imagine. To paraphrase Freud, the important decisions of personal life are governed by the deep inner needs of our nature.²

PARALLEL PROFESSIONS

My partners and I recently gave up our hospital privileges “to focus on other interests,” I often felt it necessary to add, But honestly, I was tired of the scrutiny, the liability, the bureaucracy, and after-hours call. And there was plenty of work to do in the office, where the pace and personalities were more to my liking. Yet doubts arose: Could I afford to slow down? Would I lose professional respect? Was I more than the sum of my diminishing parts?

I had been preparing for a career in medicine since fifth grade. A wrinkled photograph shows me dressed as a country doctor for the Rolfe, Iowa, Centennial Parade. My father—a GP—provided the props, which I would later inherit upon his sudden death. The new specialty of family practice hooked me with the promise of caring for the disenfranchised, and my Catholic upbringing assured me that I had a calling.

But I was called too often. Away from my wife and kids. Away from the self-satisfaction of enjoying a job well done, or reflecting on the deep inner needs of my nature. At mid career, the shelter of a vocation was splintered by the prophetic words of Howard Thurman, “Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.”¹

So I have softened my mistrust (and envy) of younger colleagues who changed the rules, took the more competitive offer, and worked part-time in order to parent and pursue other interests. They still face the age-old challenge: how to put food on the table and get ahead without worshipping the gods of consumption and achievement. Nor do I disparage those who wear their profession like a suit of armor. Let’s eulogize our differences, not bury them, and talk of the deep dimensions of our lives.

AMATEURS

The old sculptor belonged to our wider circle of friends, so it did not surprise me when we met again at a dinner party. The conversation soon turned to careers and the challenges faced by aging professionals. “Too much competition,” he pined; “everyone claims to be an artist these days without life experience, or training, or the self-discipline to create nuanced and dialectic art.” Or, as he saw it, real art. Admittedly, this logic was the loaded gun I once brandished against midlevel and holistic practitioners.

Then, by way of analogy, I waded into a minefield of my own. The professional ball player and sandlot amateur, I argued, share much in common. Both love the game and strive for personal glory, self-improvement, and peer acceptance through their sport. But there is an essential difference, more poignant than salary. It is the difference between having a vocation or an avocation. For the major league player and most professionals, work becomes their identity.

Eventually my friend may see his career as more than reputation, salary, portfolio, influence, or lasting contribution. His work is also teamwork. It is meant to please his fans. Work is our open door, our best shot at feeling fully connected, loved, and a servant for others. He, like the rest of us, may see his work as a means to an end. Or come to believe that feelings of connection and love flow from who we are, not from what we do. They stem from an inner nature that cannot be taken away from us or exhausted in our fervor to bestow it.

I look to you, Giovanni, and ponder the 10 years that precede my retirement, just as you reflect on a decade hence. We cannot repair the crumbling pillars of our faith, whatever the convictions we once held. Nor can they be easily replaced. You must know that the idea of vocation has been a struggle for me, too. This Catholic, this orphan, this good and able child who fell far short in earning the love he desperately sought. I am learning the art of tolerance, tolerance especially for the sorrow, longing, and imperfections that have taken up permanent residence inside me.

We are not the only ones who worry about a legacy. Every day I listen to patients who lament their lost dreams and the cruel twists of fate. Yet somehow we are all surviving, helped—I believe—by a mutual desire for honest conversation.

This is my life’s real work, the great corpus, the body that I and so many of my colleagues offer the patient in unremarkable ways. It is, of course, our own body—just us—sitting behind closed doors with another who is equally muddled or maimed. Another who—to our joy and surprise—is able to come alive.