The following article is part satire and part imagination.

The classic poem “Casey at the Bat” delves into the dashed dreams of 5,000 frenzied fans who gathered to watch the “Mudville Nine” play baseball, pinning their hopes on their star player, Casey. Do they have unrealistic expectations of Casey, or is his prowess over-hyped? And what implications does this time-honored poem have for medical practice?

Parables – short stories that teach a moral or spiritual lesson – are powerful tools in medicine. “Casey at the Bat” is no exception. Although it is often considered a poem, “Casey” is actually a ballad (stories in rhyme) written by Ernest Lawrence Thayer, a San Francisco Examiner newspaper columnist. Thayer wrote the ballad in 2 hours and was paid five dollars for it. “Casey at the Bat: A Ballad of the Republic Sung in the Year 1888,” as it was officially designated, was published on June 3, 1988. The poem became famous similar to the way new prescription drugs and results of medical studies reach the public: through dissemination by the media.

“Casey at the Bat” is set against a backdrop of “deep despair” – fans who are desperate for Casey to get a whack at the ball, not unlike physicians who pray for miracles for their patients. Against all odds, with two outs in the final inning and two batters preceding him, Casey does, in fact, advance to home plate. The fans’ prayers have been answered; the two players preceding Casey have amazingly reached base. The crowd – the “stricken multitude” – are rewarded and uplifted “to the wonderment of all.”

Thayer writes: “There was ease in Casey’s manner as he stepped into his place … No stranger in the crowd could doubt ’twas Casey at the bat.” However, the team leader failed to deliver. Mighty Casey struck out. Casey’s failure may have been due to one of several factors described by Robert M. Peters, MD, MBA, in his book When Physicians Fail as Managers, such as inadequate talent, poor training, lack of desire to get the job done, and, most likely, impatience. Casey went down after only three pitches.

As a result of Casey’s misadventure, there was no joy in Mudville. The sun stopped shining. The band stopped playing. Men stopped laughing. Children stopped shouting. Health disparities increased, especially among those who attended the game “from benches, black with people.” Gloom and doom settled over the town so thick you could cut it with a knife.

Physicians who practiced in Mudville, many of them baseball fans, were deeply affected by the turn of events. In the game’s wake, over 40 percent of them reported they regretted their career choice. They looked for scapegoats rather than blame Casey and cited the umpire as crying “fraud.” The physicians discovered that the owners of the Mudville Nine were penny-pinching businessmen who also owned the local hospital and many others in their for-profit chain. The owners’ callous management was responsible for staffing shortages, incivility, and high levels of moral distress, leading to burnout and depression among the majority of physicians who practiced in town.

With professional fulfillment at an all-time low, there was no way to make a difference and improve joy and meaning in their work. Psychiatrists who recalled Freud saying “work and love” were necessary ingredients to personal fulfillment were charged with breaking the bad news to their colleagues that one condition – work – was missing from their repertoire, and the other condition – love – was absent in a quarter of them insofar as the divorce rate among physicians is approximately 25 percent.

Fortunately, the American Medical Association (AMA) stepped up to the plate. Long considered an ineffectual organization unable to unionize the medical profession like professional sports, the AMA informed the physicians of Mudville that they had a “recovery plan,” one intended to reduce physician burnout and provide resources that prioritize well-being and work conditions so physicians could focus on what really matters – patient care. The AMA even sponsored The Joy in Medicine™ Health System Recognition Program “designed to spark and guide organizations interested, committed or already engaged in improving physician satisfaction and reducing burnout.”

Additional officialdoms such as The National Academy of Medicine and the Department of Health and Human Services, including the office of the U.S. Surgeon General, instituted measures to address burnout and cultivate professional fulfillment. You would think that all these resources would have restored joy to the physicians of Mudville. However, researchers found that professional fulfillment scores continued to fall. Perhaps we shouldn’t blame Casey’s ill-timed blow; maybe we need more time to let all those prestigious organizations work their magic.

It’s a little-known fact that “Casey at the Bat” was not immediately a fan favorite. The poem gained additional notoriety when William DeWolf Hopper, a New York actor, and sports fan, enacted the ballad during his stage routine. The crowd went wild, as they say in baseball vernacular, and soon newspapers and magazines across the country reprinted “Casey.” Only after Casey’s tale was widely disseminated did the plight of the Mudville Nine and its townspeople become famous. In fact, two cities in the U.S. laid claim to the name “Mudville” as their own.

If that doesn’t bring a tear of joy to your eye, perhaps you should reconsider medicine as your calling.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.