Monday, May 24, 2010

Earning the Name "Doctor"

At what point does a person earn the right to be called "Doctor?" So asked one of my classmates on Graduation night and as usual, when he casts a line into the water I can't help myself, I have to rise to the bait. It's self-evident that he, along with the rest of my classmates, received this right with their degrees and the swearing of their oaths. By the law, that's it. Black and white, no questions asked, you are or you're not.

But he knew that already. He wanted the big fish and sensed they were to be found in deep water. When did I earn this right is another question altogether. Starting with the obvious, he, I, and the rest of our classmates began earning it four years ago when we walked into medical school orientation, wet behind the ears and brimming with anticipation.

Personally, however, I believe it goes even deeper. Let me begin with an example that I honestly feel a bit self-conscious about sharing. On my last day of psychotherapy internship, a psychiatric resident and I were talking, as good friends will at times like this, about our experiences together and what the future might hold. As I got up to leave, he said, "Beggar, just remember, you are a doctor, no matter which degree dangles behind your name."

As much as his affirmation of my inner physician meant (and it meant a great deal, coming from him), I felt like any other degree would be a betrayal of the person I could have become. As it is, it still took two deaths and my father's terminal illness for me to get up the nerve to act. Yet, all of this was also part of my process. Earning the right to be called "Doctor" begins long before a senior classmate places our first white coat around our shoulders. And we do so in ways that may have nothing whatsoever to do with academic performance.

For some, it's like navigating the switchbacks on Utah's Green River (photo), while others follow a path straight from college, but it's difficult either way. What matters is being true to our vision of a life in medicine. That one is willing to make hard choices, sacrifice, work like a demon, and thereby develop maturity and character, is an essential part of rendering the person on the outside congruent with the one on the inside. To put it another way, the physician within must become visible, and not merely to those with eyes that can see.

It's a metamorphosis that doesn't happen overnight and doesn't become evident without effort. It must be earned -- by blood, sweat, and tears, and sometimes a lot of tears -- but you realize how worthwhile it has been the first time a patient looks you in the face and asks, "Are you my doctor?" And, after miles and miles of everything you've been through, at last you are free to respond, "Yes, I am."

Creative Commons image of the Green River Switchbacks in Southern Utah by BitHead via Flickr)

(Note to the reader: The Green River doesn't cut through the ground beneath it, forming the switchbacks you see in the photo. Instead, the ground beneath it rose upwards, forcing the river to deal with changes in its environment. This symbolizes the way in which life can interfere with our plans, changing our "course," and forcing us to adapt in order to arrive at our destination. For some, this process results in a different destination than one might have imagined. For my classmates, the uplift of the "soil," the stresses it produced, and their responses, have turned out a group of people who have clearly earned the title of "Doctor.")

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