The Doctor Mask

The Doctor Mask

Everyone has dreams.

Many are mere fantasies, transient wishes without substance. They never happen and don’t cost much – just the time spent wondering. Others dreams are more substantive. They may crystallize into true desires and definite life goals. I am here, and I want to be there. I want to live here, or I want that job. I want children. Can I do it? Is it worth it? Do I really want it? What will it cost?

Chasing a dream takes work and time and commitment. The journey is rarely as straight forward as one would wish. There are unknown barriers, distractions, financial pressures, family issues, health concerns, and many other speed bumps between here and there, that may shake your desire or drain your confidence or slow your progress. Maybe you don’t make the cut your first try. Do you try again?

Consider the dream of being a physician. It comes with a cost.

High university grades, good references and strong Medical College Admission Test (MCAT) scores, coupled with a resume of volunteerism and a successful application interview, all stand in the way of your entering medical school. There is a lot of competition for each and every training spot. To make it takes commitment, and sometimes a rejection or two before getting accepted. So, if you get in, be proud.

Acceptance into a training program, be it medicine or nursing, or coal mining, is like walking through an invisible barrier that will forever change you. Even in week one of your new life, after only a few shifts or lessons, you will begin to see hints of what your chosen career demands.

In medicine, you will receive a rigorous education. Each MD graduate has been tested academically and clinically to ensure readiness for the next choice - a medical residency. Is it t family medicine, plastic surgery, radiology, or one of the many other specialties and sub-specialties available? All of these choices lead to medical jobs with different skills and different tools, but they are filled with physicians who all share the same early training.

Getting into a program is an accomplishment, but that is really just the beginning. There is a lot to learn and many skills to master, in far too short a time. The clinical teachers, that you meet in offices or the hospitals, will impart to you the art and thoroughness of a proper medical history. They will teach you how to examine your patients in a competent professional manner. You will watch as they model their bedside manners and their caring, in addition to their medical acumen.

The intimate health experiences that you will be privy to in clinics and on hospital wards, give life to the medical words and diagnoses that you will read about and study. Illness will rapidly become the enemy, even though sick patients are probably your best teachers. It requires a toughness to look at the ills and injuries of the human population and recognize causes and solutions, if any are possible. You will be learning to communicate with people from every walk of life, in innumerable states of physical and emotional stress. You must learn to be the calm one and the decision maker in tense situations. In many different scenarios, you will need to put aside your own individual anxieties, secret biases or quirky dislikes.

Being in this responsible position will change you.

In your first week, you hear new words, make new friends, discuss new ideas, watch new role models, and accumulate new experiences, like anatomy class. Imagine a room with 12 expertly preserved recently deceased human bodies, all donated to science, and at present, all lying on stretchers covered with a white plastic sheet while they await dissection. Now, put 48 people wearing white lab coats, safety glasses and protective vinyl gloves in the room. An overhead ventilation noise hums in the background, but seemingly does little to dispel the formaldehyde smell.

Most of the students attending this anatomy lab are in their early 20’s, and despite the words of bravado spoken in the outside corridor, all are apprehensive about this first encounter with their designated cadaver, in a room filled with dead bodies.

Now, put yourself into that room:

“Everyone, looked here.”

You see a bald-headed older man, wearing a green lab coat. He is waving both hands, gloved, of course, above his head.

“The bodies that are lying before you, have been graciously donated to this school. They will assist in your education, and as such, they will be your teachers. You will learn to think anatomically, as you get to see and know the various systems and organs within these cadavers. Your experiences here, will stay with you for your entire career.”

He walks to the cadaver directly in front of his position and places a hand on its chest. “These bodies are your teachers,” he says. Then, “Fold down the sheets.”

You do as requested and uncover a young man’s unseeing face.

“Jesus,” says one of your three lab partners. “He’s younger than us.”

“It says here,” the female in your group reads, “that this… boy, died from widespread non-Hodgkin’s lymphoma.”

Perhaps you have seen dead bodies before, in open casket funerals, dressed in their finest with their faces expertly made to like their sleeping selves. Your cadaver looks very different. He was not prettied up with cosmetics, and does not look like he is sleeping peacefully. The skin is on his torso and face is mottled and yellow-purple bruises are evident on his arms. The deceased man looks uncomfortably young, probably within a year or two of most students in the room.

Life is not fair.

You look around the room at the 11 other donated bodies, all older than the boy your group was assigned. What were their stories? What kind of life did each of those people have, and why did they donate their bodies? How did they die?

Unanswerable questions flutter through your mind.

Thinking these types of caring inquisitive thoughts is a very natural response to what you are seeing, but in the career that you have chosen, too much empathy can be paralyzing. Not so good a thing in most emergencies, or for dissection. You will have to develop a type of controlled caring, to protect yourself from carrying around the worries and emotions of your patients. It is a balance, caring enough to do your job with compassion, but not deep enough to cloud judgement or prevent you from seeing the next patient. Every day will be different mixtures of mild, serious, funny, sad, and tiring. Yet satisfying. Most people will approach you with honesty, looking for advice or reassurance, but some will seek to use you looking for drugs, or try and convince you to sign some bogus insurance papers. You will see anxiety, anger, sadness and despair almost daily. It is not possible to sort through it all and not be affected.

Diseases and injuries are not very pretty. However, to work in medicine, the natural angst and repulsion that disease and dying evoke needs to be suppressed. You are there to help and to do so, you have to remain composed and keep your head clear. The smell of blood, or infected tissues, or human excrement may all be repulsive to you, but the person with that injury or illness needs a care giver that can stomach such sensory assaults, someone who will listen, someone that isn’t disgusted by their situation. They need to see you as a caring interested doctor that can and will help. Learning to quell personal feelings and biases can be difficult, but it is a necessary struggle.

These daily experiences with illness, injury, tragedy and other very emotional happenings, are better left at the metaphorical office. Mostly, and that’s not always easy. You learn to wear masks clinically and personally to hide your uncomfortable thoughts and emotions. One for the patients and another one for family and friends. These masks need to be carefully crafted to preserve caring and empathy while guarding against occupational burnout or compromised judgement. This is the doctor mask.

There are many others. All people wear masks, different ones for different jobs, or situations. We pretend to be interested, we ignore rude comments, we hide our hurt feelings, we follow orders that we don’t agree with. Masks are ubiquitous and necessary within our so very busy and demanding society.

So, mask up people. It’s a jungle out there.