It is ever the case that I learn from my children. One of the things I have learned from my son Elijah, a philosophy major, is the concept of virtue ethics.
To make a short and brutish explanation, virtue ethics emphasize the virtues of the mind and character. That is, there are things that are part of living the good life, as Aristotle said, and these are the behaviors and characteristics that make us good humans.
I think it's reasonable to connect this to our work in the emergency department. We do our work diligently because we are trained. We do it because we feel that it is the right thing to do. We generally pursue medical careers in the belief that healing the sick and comforting the wounded and dying are good things to do.
Some say this sense of good is natural law, ingrained in us from birth and passed down the eons. Some, myself included, say it is divinely revealed and guided. Others suggest this is evolution at work so we can cooperate and reproduce. Some believe these behaviors are choices, others that they are predetermined by our DNA.
Whatever you believe, let me suggest something wonderful: The work we do, when done well, is more than a job that helps other people live longer or pain-free. The work we do makes us virtuous. The struggles we endure lead us to a good life, a thing the ancient Greeks called eudaimonia, our flourishing.
EM as an End
Have you considered that the goal of your life is perhaps more than doing the job well? That it is more than knowing the science, following the guidelines, meeting the metrics? Of course, you have. But have you considered that the goal of your life is to be a better person? A higher kind of human being? In an age of evidence-based everything, when our job is increasingly to meet patient expectations and apply science, it's easy to forget that all our lives are a becoming.
Every kindness you show is good for the patient and staff, but it also makes you better. Every time you pursue the truth, tell the truth, and avoid deceit, you become better. Every time you are indignant against injustice or cruelty and act, you become better. Whenever you hold your tongue or control your anger, you are shaping yourself into a better future self.
All of the long nights spent patiently sorting through the crises of our patients, large and small, make us into better men and women. All of the study and dedication, all of the struggle and exhaustion are more than a race to the finish when we have accumulated enough cash to retire. Even in our retirement, we remain human beings who should strive to improve, to be wiser, calmer, more courageous, more just. The list goes on.
Many physicians are burned out or are suffering moral injury. Physician suicides continue apace. But maybe some of that is just because we have made this job an end defined by success or failure in caring for mortal humans, by rising or falling in our academies or corporations, by satisfaction scores and incomes.
And when we do not succeed, when it is difficult or near impossible or seems pointless, we fear that we are wasting our time and our lives. We also fear that our work comes to nothing because death and sickness go on. These are bitter pills.
If emergency medicine teaches us anything, it is memento mori, a reminder that we are mortal and have no idea when we will leave the world.
But it is a powerful thing to consider that the hard parts of our work, far from diminishing us, are making us brighter and better whether we attain the position we desire or the wealth we feel we deserve.
Our work, our troubles, our dedication and commitment make us humbler, more willing to endure the abuses and sorrows and wickedness we see in others. More loving. More dedicated to what is right and fair. They make us a better us.
On the day we ourselves lie in our death beds at home or on the ED gurney or who knows where, maybe we will remember that after all of the days and nights and years and patients and struggles that we did more than a job; we shaped ourselves into the best people we could be. And if we did that, then it would be hard to regret a single shift no matter how frustrating or long. In the end, at the end, we will know we tried to become more fully human and more fully good as we did good for others.
Maybe that will be some small solace in a world of too many wasted lives and too much wasted, empty time.
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Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available atwww.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter@edwinleap, and read his past columns athttp://bit.ly/EMN-Emergistan.