By Anita Krishnan, PhD
In my late thirties, when most of my peers were settling into a consistent rhythm of life, I made a decision that prompted many to call my otherwise well-regarded sanity into question. And, indeed, I had already vetted my thinking with a psychiatrist because I, too, recognized the apparent absurdity of my intent.
I had a successful career in healthcare consulting, earning a few hundred thousand dollars per year and the next promotion in plain sight, when I left to enroll in freshman biology so that I can apply to medical school next year. At a time when many doubt whether medicine is worth the immense effort and expense (see Jauhar’s Doctored, for example), I was more convinced than ever that it is.
It’s not as though I hadn’t considered medicine before, it was impossible not to. I was instinctively drawn to the scientific complexity, and closely witnessed the tremendous impact a good doctor can have. Trained as a cardiothoracic surgeon in the early 70’s under the legendary Dr. Cowley at University of Maryland’s Shock Trauma, my father has been taking care of families within a small community in the Southeast for decades, where he saves lives and nurtures spirits daily. He has seen patients in their homes and visits his hospitalized patients when he’s not on-call. His very instinct is compassion and he perceives with a healer’s heart, which is why patients seek my father’s care even when they suffer non-surgical ailments. He extends his humanitarian agenda to provide sustainable, charitable access to healthcare – domestically and internationally – as well. As a child, I recognized his broad reach and unquestionable impact.
There was some obstinate rebellion, in part, that kept me from marching along the MD path that was being pursued by every good Indian child I knew. I followed curiosity in research instead, completing a PhD and post-doctoral fellowship. I sought to understand how we humans create our perceptions, how we think, and how we judge – essentially, how aspects of our cognitive development intersect with our mental health. The utility and wonder of medical knowledge enticed me strongly during graduate school and would continue to pull and prod for years to come, but it was too late, I thought, and I tried to focus on other good work.
For years, I did good work, ostensibly, on issues of healthcare efficiency, quality, and technology, all beautifully framed and tethered to the honorable mission of improving the lives of individuals. But I felt like I was cheating. I could convince myself on elements of the work that were objectively profound, and I could even close massive deals on the basis of that conviction, but I felt empty and distanced the further along I climbed. Sure, I gave my personal time and money to charitable causes and individuals in need, but there was an undeniable disconnect between the values I espoused and the actual guideposts of my days. I was in search of purpose.
I’ve struggled with meaning for the eternity of my consciousness — I would find it, grasp it and have it stolen repeatedly. Spiritual and philosophical inquiry provided elusive solace; staying emotionally connected to that perspective daily was tough. With age, I could more effectively distract myself from existential plights by focusing on some challenge to serve my obsessions, some achievement to cuff my competitiveness. But cut open with a 10 inch incision, lying in the hospital with significant blood loss, in pain and in fear, there was no escape.
Physically and emotionally vulnerable, my body behaved without my permission. I was dependent and disabled, even if only temporarily. I underwent several procedures and treatments for months prior to the risky surgery, in hopes of preserving my ability to have children with my husband. Interactions with my physicians were raw and intimate. I was meant to surrender control to their careful and nuanced clinical judgment. They let me in to the science because I craved the knowledge and desperately needed it for my piece of mind. One of my doctors sat with me for up to an hour on occasion explaining the intricate biochemical underpinnings of my affliction. The other explained the known, unknowns and potential implications of my surgery with the confidence that accompanies her experience as a surgeon, but with the concern that reflected my inexperience as a patient. They both somehow connected to me, so sincerely, in this condensed period of time.
My doctors were extraordinary, or maybe they were just doing their jobs; but, then, their jobs were extraordinary. Through the lens of a patient, I understood to my core why my father’s patients are humbled by his expertise, respectful gentleness, and intuitive awareness of their needs; and he, in turn, humbled by his role. Extreme vulnerability revealed my truths and put my actions in perspective – what am I doing and what have I done? That was my tipping point.
As a good physician, I can live in these raw, intimate moments – outside of myself and grounded in humanity. I can simultaneously cradle people’s fears, earn trust, provide hope, and solve difficult problems. I will have enduring and indisputably valuable knowledge. I will be challenged to take care of patients when deemed powerless in the face of unforgiving disease. And I will be challenged by the incongruities of our healthcare system, for which, I have another agenda. It’s through the lens of a healer that healthcare should be transformed – that’s what I want as a patient — from technology development through to payment transformation. I will be one of the physicians with the fortitude to innovate from the inside, to fight for the integrity of the mission.
Maybe I am searching for coherence of the soul, as David Brooks puts it (See Ted Talk, Should you live for your resume… or your eulogy?). Brooks contrasts the development of our “eulogy virtues” against our “resume virtues”, illuminating what he views as a core human conflict. Our eulogy virtues — our depth of character, our commitment, our integrity – are the virtues many of us value more, he suggests, though we disproportionately focus on our resume virtues — skills that lead us to success, professional status and differentiation. The rabbi Joseph Soloveitchik conceptualized this conflict, Brooks explains, as the battle between the two sides of human nature he called “Adam I” and “Adam II”. External and ambitious, “Adam I” is interested in conquering the world, whereas “Adam II” is motivated by serving the world, in understanding our larger purpose. Nourished by competing logics, our society prefers “Adam I” to the demise of “Adam II” according to Brooks; and, when we inevitably realize that we’ve lived for “Adam I” (in other words, that our desired self is not our actual self), we live miserably.
I can only covet the naiveté of a wide-eyed, pre-medical student. In spite of – or maybe because of – everything I know to be true and untrue about the realities of medicine, being a physician will inspire my mind, fuel my competitiveness with just cause, and comfort my heart. Medicine is my way to integrate ‘Adams’ which is well beyond a job and, instead, is my life’s work.