Our two jobs

From Dr. Pauline Chen:

Over the course of the book tour, I have been asked quite a few times how doctors have reacted to Final Exam.

For the most part, my book has been well received by doctors, and that has been immensely gratifying. After all, I feel connected with other doctors. They are my family, the shared DNA being our education and training.

But I was asked more recently if I noticed a difference in how older doctors and younger doctors were responding to my book.

I answered no. My sense was that doctors young and old were responding in the same way.

I've thought a lot about that question in the last couple of weeks. I've gone so far as to ask other doctors I meet the same question.

Today if I were asked that same question, I think I might answer it a little differently.

There is a difference in the way older doctors – and I mean doctors who are at least a couple of generations ahead of me – have received my book. Like younger doctors, they have talked about how certain narratives resonated with their own experiences. And like younger doctors, they have talked about the need for improving how we educate and train doctors to care for the dying.

But what is different is the stories they tell me. In their reflections, there is a kind of quiet respect of mortality, an acceptance of our profession's limits.

I heard a story yesterday that really brought this home. I met a woman whose father had practiced surgery from the 1950's until his death from pancreatic cancer in the 1980's. He had a very busy practice and on top of his clinical duties was chairman of surgery at two of the local hospitals.

One day, this woman went to visit her father at the hospital. She found him in a patient's room, sitting at the bedside and reading the Bible aloud to his patient. When he later left the patient's room, his daughter asked him, "Why were you reading to that patient?"

"She asked me to read from the Bible to her," her father replied. "And because I could no longer do anything for her medically, I did what I could."

I grew up, professionally speaking, at a time when therapeutic failures were the exception, rather than the rule. It was hard not to ask oneself, "Isn't there some other procedure or medication we can use here to help this person?" when you wanted nothing more than to help your patients and in your mind helping meant curing. Liver transplantation, for example, was a "gold standard" of therapy for end-stage liver disease when I was training; easily 80% of liver transplant recipients could expect to live at least another five years.

But back in the 1970's, for example, only about a quarter of patients who underwent a liver transplant survived even one year. How could the physicians who grew up and practiced in that era not feel a little differently about mortality than my generation of doctors?

In an age when the number of our successful therapeutic options has exploded, it's difficult to see that sometimes the most therapeutic thing you can do has nothing to do with another drug or operation. Sometimes all we can – and should – do is simply be with our patients, make them comfortable. Sometimes the very best thing we can do as someone's doctor is to sit at their bedside, take their favorite book, and read aloud.

I think it's like Dr. Courtney M. Townsend, a legend in surgery and a personal hero, recently told me. "We have two jobs as doctors: to heal and to ease suffering. And if we can't do the former, my God we better be doing the latter."