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Finding integrity at the end of a career

Arthur Lazarus, MD, MBA
Physician
September 28, 2025
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An excerpt from Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock.

Dr. Raul Morales sat alone in Exam Room 3, now used for storage, staring out at the fading autumn light through a slit in the blinds. The clinic was quiet, eerily so. His last patient had left an hour ago. He was supposed to be packing up his things, but instead, he found himself frozen in place, nursing a cup of lukewarm coffee and an ache he couldn’t quite name. He should feel relief. Retirement loomed just a week away, long-awaited and hard-earned. Forty years old when he finished residency; he was a late starter. Now nearly seventy-five, he had logged over two decades as a community internist. And yet, all he could see were the cracks. He saw the patients he couldn’t help. The daughter he missed growing up. The colleagues he kept at arm’s length. The research path not taken. The preventive screenings he pushed that still didn’t stop the cancer. The words he should’ve said to a patient too scared to face the truth.

He didn’t expect to feel this.

When his former medical student, now a palliative care physician, dropped by to say goodbye, she found him in the empty room. “Raul?” she asked gently. “You seem glum.” He offered a tired smile. “You ever wonder if it mattered? All the years. All the nights. All the effort.” She paused, then pulled out a small book from her bag, one she always kept with her for patients who asked similar questions. “I want to read you something,” she said. “It’s a fable.” “Oh. Is this a new evidence-based intervention?” “Just let me read.” She opened to page one.

“A long time ago, there lived a farmer. The farmer owned two watering pots, and for many years the farmer would carry his pots from his big old farmhouse at the top of the hill, down the road to his fields below.” Raul listened, and something inside him softened. “One of the watering pots had a crack,” she said, closing the book and slipping into the story from memory. “The pot was ashamed of its flaw, convinced it was broken and worthless. But the farmer still carried it each day, alongside the perfect one. As he walked the same path again and again, water trickled from the crack, unnoticed by the pot, but not by the earth. Flowers began to bloom along that side of the road, fed by the steady leak. What the pot believed was failure had been quietly nurturing beauty, every step of the way.”

Raul’s arms were folded across his chest, his eyes glistening. “So,” she said. “You were the cracked pot.” “I still am,” he replied. “I just don’t know if it was enough.” “Do you remember Mrs. Davenport?” she asked. “The woman with metastatic colon cancer who outlived her prognosis by three years?” “She said it was because you treated her like a person, not a disease.” He smiled half-heartedly. “And Darryl,” she continued. “The kid you convinced not to drop out of school. He’s now an ICU nurse. His mom still talks about you.” Raul shook his head slightly. “I wasn’t trying to do anything grand.” “You walked the same path for decades, leaking little bits of yourself the whole way. And look what grew. You didn’t always see it. You weren’t supposed to.”

He chuckled, the sound tinged with disbelief. “I thought I was just losing water.” “Maybe,” she said. “But you were watering people. You didn’t just dispense meds or fill out charts; you showed up, even on the days it hurt. You listened when no one else did, made calls that weren’t your job, remembered birthdays, held hands when families couldn’t, and let your patients feel human again. Like that old James Taylor song, ‘Shower the people you love with love, show them the way that you feel,’ you did that, Raul. Not with grand gestures, but in steady, quiet ways. You may think it all leaked away, but love like that soaks in. And it stays.”

Raul turned back to the window. The sunset cast golden light across the parking lot, lighting up the row of shrubs someone had planted years ago (maybe him, maybe not). They were still growing.

He thought about Erik Erikson, the psychologist whose stages of life he’d memorized in college and again in med school and had forgotten soon after. The final stage had always sounded lofty: Integrity vs. Despair. He used to think it meant arriving at peace. Now he understood it was about perspective.

Despair was seductive. It clung to your regrets and whispered in your ear when the clinic got quiet.

But integrity wasn’t perfection. It was presence. It was showing up again and again, even when your pot was cracked.

He stood slowly and stretched. His knees ached. His back protested. But something else, something deeper, was just beginning to feel whole. Maybe he hadn’t wasted his water. Maybe he had created a path of green.

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. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.

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