Make the world a better place strobed through my mind as I trudged anxiously to my organic chemistry final exam after an all-night study session and a few NoDoz capsules. Unprepared and scared, I hoped for the best, as I took yet another exam on material which failed to come easily. Spanish Lit, Writing, and even Calculus clicked in my brain readily, but I had decided to mimic my mother’s path. Like her, I could help people, be respected, earn well, and find my calling. Medicine promised to fulfill all of my ambitions.
From a young age, I observed my mother pour her every cell into her small-town medical practice in the eighties and nineties. In fact, she still treats patients today. She was a mini-celebrity in my town; grocery store trips inevitably included a warm embrace or display of gratitude in the produce or freezer section. Every holiday season, our kitchen island vanished beneath a spread of homemade cookie trays, chocolate assortments, and fiery poinsettias. My mother loved her job and her patients loved her. My childhood served as the perfect foundation and perhaps fantasy for my perseverance.
Medical school admission felt formidable and, worse, Washington University in St. Louis, my alma mater, was a gauntlet designed to weed eager premedical students out. My pre-med counselor cautioned me to choose another path, but I was stubborn and steadfast. So I did, indeed, earn my spot in three U.S. allopathic schools.
Once in medical school, my success hinged mainly upon memorization and was therefore more attainable than undergrad. At Tulane, my classmates and I took full advantage of New Orleans’ celebratory essence and thoroughly enjoyed our time in school. I also found purpose while caring for patients from an under-resourced community during my third and fourth years. My path felt right.
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However, early on as a resident, when my hot pink Asics hit the cold gray marbled linoleum tile floor of the medical intensive care unit (ICU), the untenability of medicine as a career became clear. I witnessed several patients with minimal likelihood of recovery leave the ICU hooked to semi-permanent ventilators, also known as life support. The quality of these patients’ lives was so poor that I realized quite reluctantly that I wasn’t making the world a better place.
After residency, I joined a small private practice, unsure of my long-term career goals, but certain that medicine was temporary. I was efficient, skilled, and learned a lot. I held various leadership positions in this role and was earning more money than I would have imagined. Yet, the reality of modern-day medicine was a far cry from the image I had conjured as a child. While patients showered my mother with appreciation, a patient thanked me maybe once or twice in my clinical career.
Even worse, healing was a rare outcome of my work and instead, most of my practice was tantamount to a band-aid. I was essentially torturing patients by keeping them alive at all costs. Between the culture of medicine and the threat of malpractice, I was, against my will, harming people, and this was the absolute antithesis of the Hippocratic Oath doctors take in the beginning of medical school.
I also felt the need to dim myself and demurely dress when in reality, I like to wear bright colors with sparkles or flair. I would even try to look unattractive or wear glasses when I barely needed them so that people would take me seriously. Countless times, I would enter a room, and a family or staff member would think I was a nurse. Every time I would join a new facility, the nurses would haze me with their own version of sorority rush and then eventually, they might accept me. The nurses in management have tremendous power in hospitals and subacute nursing facilities; they function as physician shepherds, masquerading questions as commands. I like my freedom and find it soul-crushing when others attempt to control me, thus every day resembled a self-made prison.
Toward the end of my clinical career, I lacked autonomy. There was a septic patient at a nursing home and I placed an order to the nurse to send him to the hospital over the phone. Nursing homes are often reluctant to do this, as send-outs affect their metrics. I called his family, so that when the director of nursing inevitably fought me, I’d have reinforcement. And she did. “Tell me why you want to send him out,” she hissed.
In response to my specific data points, she retorted, “We shall see.” I documented in his chart that I wanted him sent out knowing she likely didn’t honor my order. About a week later, I learned she’d kept him at the facility and that he died the following day. I knew I couldn’t keep battling just to do what was right in my job.
The final straw arrived on an on-call weekend, at a hospital at which I’d rounded for roughly ten years. In my first few months there, the staff printed all my male colleagues’ names on the patient door signs and conveniently left my name off. They questioned my orders often in the beginning. However, over the years, I had built relationships with many of the nurses and managers and knew their family members by stories and names. Unfortunately, the more recently hired male nurse managers never quite warmed to me, least of all when I protested their habit of entering orders under my name without asking.
A few days prior to my resignation announcement, a male nurse manager decided to take issue with my patient progress notes. The offense? I’d used abbreviations in my notes and I had always used abbreviations. He reported this to my colleague instead of me. Meanwhile, my colleague, a former resident of mine with poor clinical knowledge and judgment, was popular with the hospital administration because he did exactly what they wanted, like a puppet. The puppet failed to mention this complaint to me and instead, informed my boss.
I wasn’t in trouble, but the practice planned to move me to a different facility to avoid future friction. However, when I found myself not only invisible for my clinical acumen, but picked on for something so minute, I knew I could not tolerate clinical medicine for one more day.
So I left.
And the wild thing is, I haven’t missed it for a millisecond.
This essay is cited in the KevinMD record on physician careers.
Prianca Naik is a physician and a model.
