Too much rain loosens trees. In the hills giant oaks fall upon their knees. You can touch parts you have no right to—places only birds should fly to.
When I was 19, I went to Australia for several months as part of a 5-person field research team studying the Satin Bowerbird. The Satin Bowerbird is polygynous (unusual for birds) and a relative of the Birds of Paradise. Instead of extraordinary plumage, the Satin looks quite ordinary, but it exhibits extraordinary behavior. The males build bowers—a kind of avian “bachelor pad”—of twigs and sticks, arranged beautifully and adorned with blue and yellow flowers and scavenged objects. Every day, my teammates and I hiked for miles, sat in tents, watched birds, and listened to dingos howling and goanas dragging their tails as they lopsidedly walked along. We awakened each morning along Wallaby Creek to the richly layered songs of around 200 different species of birds.
Jenn was one of my teammates. In her late 30s and already a mother, she differed from me and the other members of the team. I liked birds well enough, but, really, I went to Australia for adventure: to spend my days with wallabies, koalas, and kookaburras, to live in nature, to cook over a campfire, to be a million miles from home, and to grow up. I did all that. Jenn went to the other side of the planet and lived in a hut with no running water or electricity for weeks on end and put up with the rest of us because she truly, truly loved birds.
Not long after we returned, I learned that Jenn had breast cancer. Radical mastectomy of her left breast, aggressive chemotherapy, repeated hospitalizations; after some months, she was skin and bones. A few months later, bereft, her son was without a mother and her mother was without a daughter.
A few weeks later, I walked into the anatomy lab as a first-year medical student. “My” cadaver was a woman in her forties, left breast removed, with metastatic cancer as cause of death. Not Jenn, but she might have been.
As a medical student encountering my cadaver, the sense of the sacred was profound for me, as it was for my classmates, who had reasons of their own. A grandfather who had recently passed away. The aunt who died years before. The older brother who had ended his life. Resemblances that made it possible to recall that the cadaver had been an animate person. Resemblances that broke through the safer feelings of distance and disbelief that helped when cutting through skin and bone, when gently and precisely performing the dissection of the brachial plexus, when entering the thorax and abdomen, when exploring the knee, when examining the genitalia, when opening the skull. When covering the body at the end of each afternoon and when uncovering, smelling, and exposing it again, more mutilated and somehow more naked, the next day. Sacred trespass.
Becoming a physician is just so very hard. I cannot see how it will be or ever could be different. And should it? Touching a cadaver, suctioning the meconium from the nostrils of a struggling newborn baby, holding the hand of a person laboring to breathe, sitting with a family stricken by grief, pressing down on an artery bleeding uncontrollably, realizing with dread that a child has been beaten by the person who should love and protect him most in the world—these are experiences that test and transform. They teach us in ways not possible in simulation laboratories or virtual experiments. Just as we did, our students come to understand doctoring as they meet the extremes of life, the ruin and desolation of disease, the unbearable and, at times, the unconscionable.
It is possible for an experience to be two things at once, thankfully. Our students also come to recognize the exquisite gift of good health, almost implausible in a world with genetic predispositions, overwhelming infections, environmental dangers, and threatened neighborhoods. Our students come to understand the extraordinary privilege of becoming a physician, being able to bring what one has had the chance to learn and one’s own self and strengths to help another person.
Becoming and being a physician inevitably pull deeply from us. In our work with learners and colleagues and our care for patients, we must not forget, Dear Reader, the realities of medicine and the challenges inherent to the work and role of a doctor.
We must try to remember the first times we encountered certain hard experiences and consider their importance in our own growth and identity. We must remember that such experiences do not inescapably produce cynicism, secondary trauma, emotional exhaustion, or objectification. When these hard lessons are recognized for their significance, shared, and intentionally addressed in our curricula and our clinical environments, they can become sources of resilience and purpose. They serve as reminders of the great honor we have, often going to places only birds should fly to.
Laura Weiss Roberts, MD, MA
1. Ryan K. Crown. In: Say Uncle. 2000New York, NY: Grove Press; [From SAY UNCLE, copyright © 1991 by Kay Ryan. Used by permission of Grove/Atlantic, Inc. Any third party use of this material, outside of this publication, is prohibited.]