4.01 A Change Is Gonna Come
In the practice of medicine, change is inevitable. New surgical techniques are created, procedures are updated, levels of expertise increase. Innovation is everything, nothing remains the same for long. We either adapt to change, or ... we get left behind.
Change; we don't like it, we fear it, but we can't stop it from coming. We either adapt to change or we get left behind. And it hurts to grow, anybody who tells you it doesn't is lying. But heres the truth: the more things change, the more they stay the same. And sometimes, oh, sometimes change is good. Oh, sometimes, change is ... everything.
In the hospital, we see addiction every day. It's shocking how many kinds of addiction exist. It would be too easy if it were just drugs and booze and cigarettes. I think the hardest part of kicking a habit is wanting to kick it. I mean, we get addicted for a reason, right? Often, too often, things that start out as just a normal part of your life at some point cross the line to obsessive, compulsive, out of control. It's the high we're chasing, the high that makes everything else fade away.
Still, they say you don't kick the habit until you hit rock bottom, but how do you know when you're there? Because no matter how badly a thing is hurting us, sometimes letting it go hurts even worse.
4.03 Let The Truth Sting
Doctors give patients a number of thing. We give them medicine, we give them advice and, most of the time, we give them our undivided attention. But, by far, the hardest thing you can give a patient is the truth. The truth is hard. The truth is awkward and very often the truth hurts. I mean, people think they want the truth. But do they really?
The truth is painful. Deep down, nobody wants to hear it, especially when it hits close to home. Sometimes we tell the truth because the truth is all we have to give. Sometimes we tell the truth because we need to say it out loud to hear it for ourselves. And sometimes we tell the truth because we just can't help ourselves. Sometimes, we tell them because we owe them at least that much.
4.04 The Heart Of The Matter
In life, only one thing is certain, apart from death and taxes. No matter how hard you try, no matter how good your intentions, you are going to make mistakes. You're going to hurt people. You're going to get hurt. And if you ever want to recover... there's really only one thing you can say.
Forgive and forget. That's what they say. It's good advice, but it's not very practical. When someone hurts us, we want to hurt them back. When someone wrongs us, we want to be right. Without forgiveness, old scores are never settled... old wounds never heal. And the most we can hope for, is that one day we'll be lucky enough to forget.
4.05 Haunt You Every Day
There's a reason surgeons learn to wield scalpels. We like to pretend we're hard, cold scientists. We like to pretend we're fearless. But the truth is we become surgeons because somewhere deep down we think we can cut away that which haunts us. Weakness, frailty, death.
It isn't just surgeons. I don't know anyone who isn't haunted by something or someone. And whether we try to slice the pain away with a scalpel or shove it in the back of a closet ... our efforts usually fail. So the only way we can clear out the cobwebs is to turn a new page or put an old story to rest.... finally, finally to rest.
4.06 Kung Fu Fighting
There's this thing about being a surgeon. Maybe it's pride or maybe it's just about being tough. But a true surgeon never admits they need help, unless absolutely necessary. Surgeons don't need to ask for help because they are tougher than that. Surgeons are cowboys, rough around the edges, hard core... at least that's what they want you to think.
Deep down, everyone wants to believe they can be hard core. But being hard core isn't just about being tough. It's about acceptance. Sometimes you have to give yourself permission to not be hard core for once. You don't have to be tough every minute of every day. It's okay to let down your guard. In fact there are moments when it's the best thing you can possibly do... as long as you choose your moments wisely.
4.07 Physical Attraction, Chemical Reaction
Before we were doctors, we were med students, which meant we spend a lot of time of studying chemistry. Organic chemistry, biochemistry, we learned it all. But when you're talking about human chemistry only one thing matters: either you've got it or you don't.
4.08 Forever Young
There comes a point in your life, when you're officially an adult. Suddenly, you're old enough to vote, drink and engage in other adult activities. Suddenly, people expect you to be responsible, serious, a grown-up. We get taller, we get older. But do we ever really grow up?
In some ways we grow up; we have families... we get married, divorced... but for the most part we still have the same problems that we did when we were fifteen. No matter how much we grow taller, grow older, we are still forever stumbling... forever wondering, forever... young.
4.09 Crash Into Me (1)
We go into medicine because we want to save lives. We go into medicine because we want to do good. We go into medicine for the rush... for the high... for the ride. But, what we remember at the end of most days are the losses. What we lay awake at night replaying is the pain we caused or failed to cure. The lives we ruined or failed to save. So the experience of practicing medicine rarely resembles the goal. The experience too often is ass backwards and upside down.
4.10 Crash Into Me (2)
We go into medicine because we want to save lives. We go into medicine because we want to do good. We go into medicine for the rush... for the high... for the ride. But, what we remember at the end of most days are the losses. What we lay awake at night replaying is the pain we caused or the ills we failed to cure. The lives we ruined or failed to save. At the end of the day reality is nothing like we hope. The reality is, at the end of the day, more often that not, turned inside out and upside down.
Some days ... the whole world seems upside down. And then somehow, and probably, and when you least expect it, the world rights itself again.
4.11 Lay Your Hands On Me
In the beginning, God created the Heaven and the earth, at least that's what they say. He created the birds of the air and the beasts of the fields, and he looked at his creation and he saw that it was good. And then God created man, and it's been downhill ever since. The story goes on to say that God created man in his own image, but there's not much proof of that. After all God made the sun and the moon and the stars, and all man makes is trouble. And when man finds himself in trouble, which is most of the time, he turns to something bigger than himself. To love or faith or religion to make sense of it all. But for a surgeon, the only thing that makes any kind of sense is medicine.
As doctors, we know more about the human body now than at any point in our history. But the miracle of life itself; why people live and die, why they hurt and get hurt is still a mystery. We want to know the reason, the secret, the answer at the back of the book... because the thought of our being all alone down here is just too much for us to bear. But at the end of the day, the fact that we show up for each other, in spite our differences, no matter what we believe, is reason enough to keep believing.
4.12 Where The Wild Things Are
We like to think that we are rational beings; humane, conscientious, civilized, thoughtful. But when things fall apart, even just a little, it becomes clear we are not better than animals. We have opposable thumbs, we think, we walk erect, we speak, we dream, but deep down we are still routing around in the primordial ooze; biting, clawing, scratching out an existence in the cold, dark world like the rest of the tree-toads and sloths.
There's a little animal in all of us and maybe that's something to celebrate. Our animal instinct is what makes us seek comfort, warmth, a pack to run with. We may feel caged, we may feel trapped, but still as humans we can find ways to feel free. We are each other's keepers, we are the guardians of our own humanity and even though there's a beast inside all of us, what sets us apart from the animals is that we can think, feel, dream and love. And against all odds, against all instinct, we evolve.
4.13 Piece Of My Heart
Great surgeons aren't made. They're born. It takes gestation, incubation, sacrifice. A lot of sacrifice. But after all the blood and guts and gooey stuff is washed away, that surgeon you become: totally worth it.
Giving birth may be all intense and magical and stuff, but the act itself: it's not exactly pleasant. But it's also a beginning... of something incredible. Something new. Something unpredictable. Something true. Something worth loving. Something worth missing. Something that will change your life... forever.
4.14 The Becoming
There's this person in my head. She's brilliant, capable, she can do chest-tubes, craniotomies, she can run a code without freaking out. She's a really good surgeon. Maybe even a great surgeon. She's me. Only so much better.
It was a good day. Maybe even a great day. I was a good doctor, even when it was hard, I was the me in my head. There was a moment when I thought I can't do this, I can't do this alone. I close my eyes and imagine myself doing it, and I did, I blocked out the fear, and I did it.
4.15 Losing My Mind
The problem with being a resident is: you feel crazy all the time. You haven't slept in years. You spend every day around people in massive crisis. You use your ability to judge what's normal. In yourself, or anyone else. And yet people are constantly asking you to tell them how they're doing. How the hell are you supposed to know? You don't even know how you're doing.
Don't wonder why people go crazy. Wonder why they don't. In face of what we can lose in a day, in an instant, wonder what the hell it is that make us hold it together.
My mother used to say that, for a surgeon, a day without death is a rare gift. Every day we face death. Every day we lose life. And every day, we are hoping for a stay of execution.