Updated: Feb 19, 2019
There is certainly a cookie-cutter answer to the question: Why emergency medicine? In many respects the answer is true about anyone going into the field. I love the pace, excitement, shift-work nature of the specialty, and the ability to quickly make a tangible difference. Although these are great reasons for choosing this field, they are not the reasons that actually set the foundation that my new passion would build on. I believe any structure built on a poor foundation is bound to topple over just like any career built on weak convictions is bound to lead to burnout, no matter what drew you us in the first place. This is especially true in a high-demand, low-control environment like the emergency room. I believe I only formed strong convictions about my career choice after life pushed me to redefine my what drove me.
Let me take us back to what initially drove me to medicine. In high school I was given the opportunity to interview at a few medical schools for admission into a combined BS/MD program. Fortunately, I happened to say the right things because I was eventually accepted. Even now during residency interview season I always get asked, “How did you know you wanted to be a doctor so young?” After a great deal of introspection, I realize now beneath every noble reason a high schooler like me could think of to become a doctor, it was all undergirded by a drive for greatness.
I believe we are all born to chase greatness. Have you ever felt that tension inside of you, that sense that you were born to do something extraordinary. In our youth we often live in this state of angst: who we imagine ourselves to become one day, and the person we are here and now. I don’t think anyone in medical field got to where they are today by telling themselves they are satisfied with mediocrity.
However, the crux of the matter comes down to how we define greatness. I honestly believe somewhere down the line we've gotten it wrong, and it has left us utterly unsatisfied. When we think about greatness we often paint a picture of wealth, respect, and influence. If you have power, money, and status, the world calls you great. I essentially chose medicine because being a physician was the highest paying job I knew, the two letters behind my name would earn me unquestioned respect, and the influence I would have on a person could mean life or death. I believed there was no “greater" job according to these standards.
You can imagine when I got to medical school, I didn't just want to be an average doctor. At the time I believed the the epitome of being a great physician was someone who was so well known and specialized in their field that patients from all over the world would come to them to seek care. And I confess, I didn’t strongly consider primary care specialties because I considered them “less great” to the more competitive specialties. Of course I told no one around me about this at the time, but my soul knew this attitude too well.
Although there is nothing wrong with wealth, respect, and influence in and of themselves, I realize now this distorted image of greatness would never actually satisfy me. I would always want more and the more I achieved, the emptier I would become. You don’t believe me? It doesn’t take much to see the increasing rates of physician suicide or hear about stories of those who had it all, ending it all. Of course there is no simple answer to such things, but one can only wonder, despite all their successes what drove them to a life without meaning?
The King Solomon was known to be Israel's richest and wisest king. He writes this,
“I became greater by far than anyone in Jerusalem before me. In all this my wisdom stayed with me. I denied myself nothing my eyes desired I refused my heart no pleasure. My heart took delight in all my labor, and this was the reward for all my toil. Yet when I surveyed all that my hands had done and what I had toiled to achieve, everything was meaningless, a chasing after the wind; nothing was gained under the sun.” Ecclesiastes 2: 9-11
This phrase “a chasing after the wind; nothing was gained under the sun” is the guiding principle of his book Ecclesiastes. But what does he really mean by "under the sun”? The intended meaning in Ecclesiastes for that which happens “under the sun” is a life separated from God— an earth-bound life. If there’s no transcendent perspective, if there’s no voice coming into this closed reality we live in, if our limited years on this earth is all we have to live and enjoy... It’s all a chasing after the win and nothing is ever gained.
Early during my 3rd year clinical rotations, I began to see this distorted image of greatness for what it really was. Just as Solomon says, “In all this my wisdom stayed with me,” I too held on to a transcendent perspective on life, but I couldn’t help seeing myself as a member in this rat race to get into the best residency possible. I couldn’t help defining myself by my board scores and the grades I would receive on my rotations. Despite knowing God, I began to see my own empathy begin to decline in the midst of jaded residents, ungrateful patients, and an inefficient health care system. During rotations I met attending physicians who depicted the greatness I sought after on paper, but in real life were visibly unhappy. With the reality before me, I had to ask myself, "what am I really chasing after, and is it even worth it?” If I continue what I’m doing, the way I’m doing it, would I only end up unhappy and burnt out?
I came across a portion of scripture that cut away at the image of greatness that was deeply invested in me. In Matthew’s gospel, the mother of two of Jesus’ disciples brought to him a request which tells us a lot about how humanity regards greatness.
She said to Jesus, "Grant that one of these two sons of mine may sit at your right and the other at your left in your kingdom.”... When the other ten disciples head about this, they were indignant with the brothers. Jesus then called them together and said, "whoever wants to become great among you must be your servant, and whoever wants to be first must be your slave— just as the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many.” Matthew 20: 20-28
Jesus redefined greatness! You see, he never said it was wrong to be great, or even wrong to seek it and chase after it. But the way he spoke about it was very upside-down to the way we view it in our culture. Greatness and power are not measured by the sheer number of followers we have, the money we have in our banks, or even the diplomas we frame in our offices. True greatness is the extent to which we will go to serve. This really hit home for me. I knew if there was anything I needed to do, I had to redefine my drive.
Yes, I chose emergency medicine for all the typical reasons, but my greatest drive toward the field became my ability to counsel my patient on what could be the worst day of their life. In the emergency room I'm challenged on a daily basis to let go of my pride and be ready to meet whoever comes through the department with compassion and respect. This level of servanthood is incredibly demanding, yet more fulfilling than anything else I can imagine.
Now am I saying that everyone who chooses a different specialty is driven by a distorted image of greatness? Absolutely not! I’m saying perhaps in someway we all are driven by this distorted image of greatness. The call to servanthood is what can give any career meaning. However, I can see how servanthood can be an upside-down concept to many. I think it comes down to how each of us view the world.
Your career is often a means to and end. I heard someone say once, “If being a means to an end is what gives life meaning, to what end do you want your life to be a means?” In the book of Ecclesiastes, Solomon doesn’t conclude that everything is meaningless after all. Instead he said, “the whole duty of man is to fear God and to keep his commandments”. Jesus positioned two commandments the greatest: to love God and to love neighbor.
In our world our careers can also give us a sense of duty. Duty always recognizes a cause greater than one’s self. No matter where you are in life consider what your end goal is. Consider the point of reference by which you measure why you do, what you do. Does that point of reference go just as far as the sun, is it simply earth-bound, does it end with you, or does it end with something greater?
I still believe I am destined for greatness and continue to chase after it, but it’s the image of servanthood I run towards, and my point of reference is God himself, whose service for me was death on a cross. This is what drives me and I believe it drives my career. As I start residency training, I'm confident I'm headed in the right direction.