There is no more important medical job than simply being there

I am a (proud) intensive care doctor. My job is—much like the diplomatic core—all about hearts and minds. Accordingly, it is worth highlighting that the most useful and memorable lecture of my medical school sojourn was not cardiac, pulmonic, vascular, or cerebral. Instead, it was colorectal. In plain language it was about diseases of the backside, and the profound effect that they have upon quality of life. The point is that we need to focus on what truly matters, even if— perhaps especially if—it fails to get attention or adulation. Thirty years on, these lectures still remind me that what truly matters for our patients rarely makes the nightly news. 

These lecture were not only necessary, regardless of one’s chosen specialty, but they were also the antidote to a medical school curriculum containing a barrage of future “certainties”: robots, designer drugs, and lazers—lots of lazers. Most of those flash projections have not yet come to pass. What is still just as true is that patients still need doctors and nurses who listen, examine, and care. Our lecturer also outlined a series of diseases that could actually be cured, and for which patients are grateful beyond measure—even if they never say so. Those lectures were about doing the simple stuff right, and being silently proud to have played a small unheralded part.

This same lecturer was also pretty adept with the maxims. He taught our class that the top third of the medical school class makes the best professors, the middle third makes the best doctors, and the bottom third makes the most money. Thirty years on his comments are still spot on. Regardless, let’s review what we ought to mean when we say the “best doctors”. Firstly, it has less to do with a gigantic brain and more about a capacious heart. It is more about managing decline and the certainty of eventual death, rather than merely searching for the miraculous cure. Doctors often do little more than distract the patient while nature decides whether to make them well. With a wink in his eye this lecturer also reminded us that no job is done until the paperwork is complete. He also reminded us that the patients will tell us what is wrong if we shut up long enough to hear it.

Despite your best efforts you are going to receive a lot of crap, by which I really just mean (understandable) pushback, criticism, denial and frustration. It is, for example, much easier to hate the doctor or nurse than cancer. Doctors and nurses at least sit down and try to explain. Instead, cancer just shows up uninvited and takes what it wants. Doctors and nurses also regularly face Brandolini’s law, namely that the amount of energy needed to refute nonsense is an order of magnitude bigger than to produce it. Part of this unglamorous, but remarkable job includes the revelation that inconsolable grief is the cost of love. A career in medicine ought to empathize that it’s not about you, but rather about a person whose life no longer has certainty. While we shouldn’t just sit there and absorb undiluted anger, nor should we be surprised. It is not your fault, but, because you signed up, it is often your responsibility. In short, you simply need to be a human being prepared to help another human being. Hopefully, you have had sufficient practice being scared and vulnerable yourself.

If you join intensive care—and I do hope you’ll consider it—you will quickly learn that whoever euphemistically called them the “life sciences” was partly pulling our leg. We now face a situation where death is institutionalized, technologically controlled, and decidedly unglamorous. TV dramas will continue to perpetuate a convenient fantasy where sirens blare, squared jawed heros win the day, and patients are rapidly discharged ready to face the world. Reality includes far more silence and many more hands being held. It also includes lots of fear: the fear of being alone, rejected, and powerless. As such, there is no more important medical job than simply being there. Just as my lecturer did, might I suggest you (and I) park our overly confident answers, and instead go find a cup of tea and a box of tissues. And when that day is over, and before drifting into well-earned sleep, remember to offer your own family a big thank you. After all, they are so much of what truly matters in the end.

Peter Brindley, professor in the department of critical care medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. He is on Twitter @docpgb

Competing interests: None declared.