by Kirsti A. Dyer, M.D., M.S.

As a child, I did not dream of becoming a physician, rather my dream was to become a teacher, following in the educator footsteps of my parents. By high school the goal had been refined—to become an English teacher, following in the footsteps of several influential teachers. However, after I became an Emergency Medicine Technician my senior year of high school the dream changed. I discovered the intriguing, usually rewarding and ever-challenging field of medicine, turned 180,° and headed down a very different road.

My early 20’s in the 1980’s were spent pursuing medical education goals, first an undergraduate degree at California State University, Sacramento and when the first medical school application attempt failed in 1983, a graduate degree from the University of California, Davis. With the master’s degree, I had the credentials I needed to be accepted in medical school. With a career in medicine ahead of me, I looked at the map for my life and decided I would have to choose a career in medicine or having a family. I didn’t believe that I could do both. There were few female physician role models in my circle of acquaintances, let alone ones raising families. The road to parenthood was one that I thought I could not take.

My late 20’s and early 30’s were spent in day-to-day survival during medical school and a residency training in internal medicine. I discovered that the medical education process was not what I had dreamed it would be. I entered medicine to connect with people, figure out what is ailing them, understand how the physical and mental impact of the disease, develop coping strategies and help them to heal. My goal during residency was to emerge with my heart intact, which for me has been having a compassionate ear and touch. Unfortunately, having the time to really listen to patients and determine what ails them is becoming scarcer in medicine of the new millennium. Today physicians are time-pressured to see more patients in fewer minutes, not miss any of the major medical problems and treat major depression in 10 minutes or less. Furthermore, I was dismayed by how little emphasis was placed on the health and well-being of those entrusted with the health of others and how the normal personal and professional stresses faced when practicing medicine were all but ignored. These experiences have lead me to focus on my own well-being, simplify my life, minimize material desires, adopt healthier life-style practices and to decrease my own profession-induced stress.

My strong English background and an interest in writing gave me a practical means of coping with many of the pressures of medical school and residency training. Over the years I published articles on a wide range of topics often not considered traditional medical areas, including: death education, hospice, sexual harassment, ‘toxic interns,’ residency abuse, work hour reform, burnout, and grief, loss and bereavement. (Some of these articles are available on the Internet, linked on our website, http://www.kirstimd.com/CV.htm) Writing allowed me to combine my medical training with the early goals of becoming an English teacher and turn intense experiences, or difficult topics into educational articles.

One of these articles, "The Road Not Taken," [1] was written during my final year of residency training, reflecting upon where I had arrived in medicine, as I rationalized my career choice and what I had given up to reach that point in my training. I wrote "I am grateful for the road I chose. I do believe, for the sake of my patients—those whom I have kept alive and those whose lives I have touched—that I made the right decision at the time to pursue a career in medicine and not to have a family. Parenthood was the road I could not take."

By my mid 30’s, during a time I should have been setting up a practice, I was questioning the road I had taken. The practice of medicine was very different than what I had dreamed it would be. I naively didn’t realize that so many of the decisions that I would be making about patients and their treatment would be overshadowed by an office manager, corporate office, or insurance company dictating how much time can be spent, what tests can be ordered and what medications can be prescribed. I discovered the actual "caring" about the patient must be done in a limited, expedient fashion; medicine left little time for connecting with patients, or really getting to the bottom of their health problems. I still believe the practice of medicine isn't about numbers, codes, papers and diagnoses; the practice of medicine is about people, individuals impacted by an illness. I have been accused at different times in my career of "caring too much" about the patient. I didn’t realize this was possible. "Caring" takes time to do it well; for me the practice of medicine became a demanding, life-consuming profession that when practiced full-time, left little time for anything or anyone else. For my own well-being and my way of dealing with the current uncertainty in the medical field, I chose not to follow the road to a traditional clinical practice. Instead I elected to practice part-time or locum tenens work.

Limiting my medical practice has afforded me time to pursue other interests: graduate school in medical informatics, medical writing, the medical Internet, and an overlooked area of grief and loss. Since medical school I have been drawn to issues of death, dying, and hospice. I have also been interested in grief and loss issues and the significant impact these emotions have on the health and well-being of patients. Based on the remarkable response to our non-profit website, devoted to these areas, I believe this area will eventually become a recognized part of medicine. One very important lesson I have been taught in being involved in the loss and grief field is an understanding and appreciation for how quickly things can change, how precious the time we have is. I have observed so many times too many friends, colleagues, and patients who put their life on hold for "later." Enough unexpected deaths occurred to make me realize life it too short to put your dreams on hold for a later time, because that later time may never come. Dr. Leo Buscaglia perhaps said it best:

Death teaches us--if we want to hear--that the time is now. The time is now to pick up a telephone and call the person that you love. Death teaches us the joy of the moment. It teaches us we don't have forever. If teaches us that nothing is permanent, It teaches us to let go, there's nothing you can hang on to. And it tells us to give up on expectations and let tomorrow tell its own story, because nobody knows if they'll get home tonight. To me that's a tremendous challenge. Death says, "Live now." [2]

Working in the area of grief and loss has helped me to focus on life, living and the here and now. Thankfully I learned the important lesson in my late 30’s after the deaths of several friends, colleagues and patients. I learned how important is is to appreciate the joy of the moment, because you don’t know how long it will last.

I spent eight years in medical school and residency training in pursuit of a medical dream, putting my life on hold and not really living. I always felt that something was missing; that was my own family. I met my husband, an army officer turned journalist turned computer engineer, soon after I finished training, providing me a spouse with a diverse background and who, thankfully, was outside the medical profession. We have focused on enjoying life by simplify our lives minimizing stress and material possession and maximizing exercise, traveling, and healthy eating. Weekends are often spent hiking on the many Northern California trails. Work schedules are arranged around medical conferences with interesting scenic locales or hiking potentials.

After ten years of putting my life "on-hold" in pursuit of a medical career, to be significantly in debt and looking at several more years of practicing medicine with my hands tied, I felt it was time to reassess my profession. I realized that the profession that I had devoted so much time and energy to had let me down. I was obviously unfulfilled in my chosen career. I felt that something was still missing. That something made her appearance in March of last year—our daughter.

A year since her birth, I have had time to reflect on my roles—as physician and as mother and prefer this new role. Being on-call 24/7 as the primary care giver for an infant is challenging and stressful, but I find it is nothing compared to the stress of clinical practice, and infinitely more rewarding. After years of treating demanding, irritable patients, and dealing with pestering office managers and managed care time constraints, I would choose a sometimes cranky baby over cranky patients, any day of the week. At least my daughter smiles every so often and can’t sue me for at least a few years.

" To laugh often and love much, to win the respect of intelligent persons and the affection of children… to leave the world a bit better whether by a healthy child…or a redeemed social condition; to have played and laughed with enthusiasm…to know even one life has breathed easier because you have lived—that is to have succeeded." [3]

Even more so, I am grateful at this point in my life, that I had the opportunity to change my original decision to not pursue career and family and can travel the role of parenthood on "The Road Now Taken." My choices will make all the difference.

References

1. Dyer KA. The Road not Taken. West J Med. 1996;164:369-70.

2. Buscaglia L. "Tomorrow's Children" from Living, Loving and Learning. New York: Random House: 1982, p. 152-153.

3. Cook J (Ed.) The Book of Positive Quotations. Fairview Press: 1997. Quotation also available at: www.motivationalquotes.com

Click here for Part Two - The Road Lightly Traveled: Part-time Medicine