By Suzanne Koven, M.D.
There’s an old black-and-white photograph I’ve always loved with the wonderfully unmelodious title: “Dr. Ernest Ceriani in a State of Exhaustion, Having a Cup of Coffee in the Hospital Kitchen at 2 AM.” The photograph, part of a 1948 LIFE magazine spread called “Country Doctor,” features a dark and handsome surgeon leaning heavily against a counter. He grips a cigarette in one hand and a cup of coffee in the other, presumably to stave off the fatigue that seems about to knock him down.
Twenty-one years ago, as I finished my chief residency in internal medicine, this image was much in my mind. It seemed to me to capture those essential qualities of the ideal physician—toughness, dedication, and self-denial—to which I aspired as I began my career. Never mind that I wasn’t a man, didn’t live in the country, had no desire to be a surgeon (or to smoke). I wanted to be him.
Two years later I was working full-time in a busy primary care practice. I had a couple of babies, a husband who worked full-time (with no option to cut back his hours) and a household that obstinately refused to run itself. I had two choices: I could work even harder in my practice and hire extra help at home, or work less and be home more. I chose the latter. But I still wanted to be a doctor—that doctor in the old photograph.
For the first couple of years working part-time I kept track not of my successes, but of my failures. Even as I accrued a panel of patients with whom I developed deep bonds, even as I made difficult diagnoses and navigated even more difficult conversations, I catalogued all I hadn’t done: hadn’t made myself available enough to be a sought-after consultant to my surgical colleagues, hadn’t joined the hospital committees that met early or late, hadn’t seen my inpatients every single day but, rather, had relied on my cross-covering partner (another part-time physician). Meanwhile, I kicked myself just as hard at home for missing school plays, lost teeth, and other milestones that happened to occur on my workdays.
The usual tedious handwringing of the over privileged working parent, you might say. Fair enough. But the point I want to make here has less do not with how I reconciled work and home (short answer: good help, a sense of humor, and all too soon the kids grow up) but, rather, with how I reconciled the doctor I was with my idea of what a doctor should be (see photograph, above).
That reconciliation occurred, oddly enough, during a single conversation. I’d been in practice about five years when I went to visit a hospitalized patient of mine who was recuperating from surgery. She was an older woman who’d started seeing me a few months earlier after her previous physician, Dr. W., retired. My covering partner had seen the woman the previous day, on my day at home, and now I arrived to discuss her follow up with me after discharge. “That won’t be necessary,” the woman informed me. She went on to say that she’d decided to switch doctors, to find an older man who was more accessible. “Someone more like Dr. W.,” she said.
I went back to my office visibly distressed. An older male colleague asked what was wrong and I told him the story. “Well,” he said, “she’s right.” This was not the consolation I sought. “You don’t offer what Dr. W. did,” he continued. “But, then again, you offer things Dr. W. didn’t.”
I thought about another patient I’d inherited from the retired doctor, an elderly woman who, I learned after many visits, had suffered abuse as a child. I’d referred her to a therapist and, in her eighties, she was finally coming to terms with decades of pent-up pain. She told me that she’d complained for years to Dr. W. about depression and anxiety and he’d merely told her to “keep busy.”
I realized that day that as a doctor I was neither the hero I thought I’d be nor the failure I imagined myself to be. In the years since, I’ve developed more appreciation for the things I do well, and more appreciation for the things other doctors do that I don’t. And I still admire those caffeine-infused, infinitely available physicians; those Dr. Cerianis. More than a few of them have been my patients. And one of them is my doctor.
Dr. Koven is on the faculty of Harvard Medical School and has practiced primary care internal medicine at Massachusetts General Hospital in Boston for over 20 years. Her essays, articles, blogs, and reviews have appeared in The Boston Globe, JAMA, Psychology Today, and other publications.