I recently sat by a man whose young wife was dying. Her cancer was taking her away from her husband and toddler. She was sleeping intermittently as the pain medication we administered did its work. Her husband’s eyes were red from crying and he could barely suppress a sob. He touched her and looked at me. I barely kept my own composure.

I wanted to avoid that room and that patient. A sick cancer patient was the very last thing I wanted to see. Of course, when I chose emergency medicine as a specialty over two decades ago, I didn’t realize that it was so much more than the excitement of trauma and toxins, cardiac arrest and assorted procedures. All those years ago the shiny thrill of lights and sirens and the delicious anticipation of drama filled my mind. Little did I know that I was entering a land of great suffering and pain, and that I would be party to, participant in, terrible losses.

I had no idea, as I looked forward to the rotor-wash of helicopters and the blood-stained scrubs that everything I wanted was associated with someone’s misery, someone’s worst nightmare. I certainly had no idea that I would care for so many people in times of pain that were less exciting, less titillating. That there would be old men saying goodbye to their old wives, or children and parents being separated. Or that I would have to learn to walk into rooms, like the one with the young man and dying wife, and have absolutely nothing to offer.

I also had no idea that ultimately, I would paradoxically have something to offer. What can I call it? Is it expertise? Is it knowledge? Neither of those describe it. Was it insight into suffering? Was it some pithy remark about loss? Hardly. When I sat by him, and put my hand on his arm, all I could say as his wife’s heart raced, as her leukemia triumphed, as her life waned, was ‘I’m so sorry.’

I’m quite certain I couldn’t have done it the same way years ago, when I was in medical school or even (to the same extent) when I was a resident. It wasn’t that I hadn’t been trained well enough, or didn’t know the right words. It was that I hadn’t lived enough, and hadn’t suffered enough, to understand how very much I meant the words ‘I’m sorry.’

Living teaches us about love if we choose to learn; and ultimately, love teaches us to live in fear of loss. Maybe fear is the wrong word. Love teaches us, I suppose, to expect loss. If we are wise, we all learn (physician or not) that pain, death, suffering and loss are things which have a prevalence of 100% in the human patient population. Some types are more common than others, and certain things strike at different ages, but none of us will avoid them in the end.

So the great gift of emergency medicine, indeed the great gift of medicine in general, is that it introduces us to loss early in life. It immerses us in the thing we fear. Like some great cosmic aversion therapy, we learn by living; or at least by living with the things that make life so difficult.

The terrible thing, the beautiful thing, is the way we can become better and more compassionate by our proximity to pain. It is, as in the title of the book by Sheldon Vanauken, A Severe Mercy. Our position as physicians leads us to places few now dare to go. Physician poet William Carlos Williams once said, ‘I was permitted by my medical badge to follow the poor, defeated body into those gulfs and grottos.’ I learned that line long ago, and it stuck with me.

Williams’ words are nowhere more manifest than in the trauma bays, the resuscitation rooms, the conference rooms or chapels we find in emergency departments. In those places we are called to give the great gift of compassion, of love, that is developed as we use our knowledge and skills, but is not predicated upon them. It is the kind of love that sometimes can offer nothing more than presence. Or at least, the willingness, the courage, to be present with loss. It is what Paul meant in Romans 12:15 meant when he said ‘Rejoice with those who rejoice, mourn with those who mourn.’ It is love, true love, to be there; just to be there.

We live in a world where many hold forth on issues, politics, philosophy and theology. But where precious few actually go into the places of suffering and meet the sufferers. But that is our job, that is our calling, that is our gift. Not the gift we give, brothers, sisters. It is the gift we receive.

This exposure, this opportunity to touch, hold, comfort, sometimes even to heal, it’s all our greatest benefit. It is our eternal salary, a great compensation we must never underestimate or devalue.

At the end of our own lives, as someone sits by us in some far distant hospital, we will probably have forgotten all of the money and vacations, benefit packages and retirement plans. Any power or influence we attained may well have evaporated.

But thanks to the way we touched others, God willing we will be able to approach our own passing with peace. Or at least, without surprise. And we will be able to look back knowing that, whatever else we did or didn’t do, we did all we could to comfort the hurting, the dying and the grieving. You can’t ask for much more than that in a career, can you?.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.

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