Saturday, January 20, 2007

Why Pediatrics

About a month ago, a cousin's son, now in college, called me. He wants to go to medical school. The family, like mine years ago, is middle class . . . certainly not wealthy . . . and he is worried about how to pay for it. My long-retired debt is nothing compared to what he will likely face. He does not in any way want to burden his family. He wanted to know about "loan-repayment" for public service arrangements, and my cousin said, "Call Mary".

He's an incredibly bright kid . . . and he asked questions I did not even dream of asking when I was his age. I was brutally honest, telling him that I would not encourage anyone who was not absolutely certain about his/her calling to go into medicine right now. But if it was what he really wanted to do he should go for it. I also offered the following advice: 

You must remember that medicine eats its young - and the only one who is going to look out for you is you. Keep your eyes wide open. Get a lawyer to review any employment or partnership contract you sign out of residency. If a hospital administrator's lips are moving, he is lying. Anything that sounds too good to be true, is.

He is in the process of applying right now, and we talked about the strategy of all that. It's a game . . . and it's played very much like Survivor. He told me he was struggling with his personal statement (something that all of the schools request with an application). He wanted to stand out . . . to not appear like just another idealistic, "I wanna save the world" sap. He wondered what I wrote.

I told him that two rounds of medical school applications were a lifetime ago, and I had no idea what I had written. But he was in luck because I had saved the personal statement I had penned for my Pediatric residency application. I saved it because I'm proud of it . . . in fact, I was told it was passed out for a number of years to seniors at Bowman Gray as an example of fine writing . . . and a great statement of purpose. The statement was posted, for a while, on the original Asheboro Pediatrics website. Of course, it came down when the website was overhauled and greatly simplified for those with short attention spans . . . not to mention little or no interest in how a good doctor's life can be derailed.

Sometimes when I read the statement I want to weep.
I e-mailed my cousin's son the statement and (against my better judgment) some information links on federal loan-repayment programs (even though I'm suffering under no illusions that they've cleaned up their act). The following is the text from the web page.

Dr. Johnson authored the following “personal statement” in 1991, before she applied for her Pediatric Residency Program (at Brenner’s). While her experience in Asheboro has left her considerably more world-weary than she ever dreamed possible when she wrote this, the sentiment and hope still stand:

Three and one-half years ago, when I began medical school, the last medical specialty on my list of possibilities to consider was Pediatrics. As the daughter of a first grade teacher, catching brief, mostly after-hours glimpses of her life in the classroom, I had been witness to many of the pitfalls of that profession without experiencing any of its joys. I marveled at my mother’s tolerance and dedication, yet at the same time, it was crystal clear to me that dealing with children on a daily basis did not pay.

As I have a soft spot in my heart for the underdogs of this world, from mistreated animals to North Carolina State University basketball players, I focused my attention on Obstetrics. It was the fourth specialty on my list of fields catering to the “medically disadvantaged” - namely the mentally ill, children, the aged, and women. However, in the delivery room, the “miracle of birth” (the “procedure” for which I was so psyched-up) paled in comparison to its end result - the child - the reason for all the commotion in the first place.

Now while I am an idealist, I cannot sign on the humanist’s dotted line. The reason this world can be such a cruel place has much to do with the people in it, and life is not fair. Children, it seems to me, are the greatest social, medical and legal disadvantage in this or nearly any other society simply because they depend so totally on others to care and to speak for them. Being one of those people upon whom they can depend seems like a most worthwhile and challenging way to spend a life - my life.

The “mantle” of the M.D. degree carries with it much responsibility - not only to my patients (and their parents), but to the community as a whole. I hope to be an active voice in my little corner of the world (wherever that turns out to be), not only for children, but for any cause I believe in. Physicians are in a unique position to persuade and educate, and it is a position I intend to use. I cannot just sit back and watch the world go by. But in this role as a teacher, I shall never forget that I can learn just as much from my patients and students as they can from me. And balance is important, my professional and other responsibilities will not so engulf my private life that I neglect my family or personal interests and pursuits.

I learned a great deal last year. I discovered (to my delight) that babies in the Newborn and Special Care Nurseries were not so fragile that they would break when touched. I found that I could conceal my anger as I interviewed a parent who had almost certainly abused her little girl. I learned how to quietly absorb a father’s desperation and rage as he fought to come to terms with the fact that his son had failed a bone-marrow transplant and would die. I did my best to comfort a pair of nearly perfect parents after they delivered an anencephalic child. Meanwhile just down the hall two addicts who had just produced a perfect baby (when they’d probably have difficulty properly caring for a pet) taught me how to vent my frustration into constructive help for that baby and that family. Yet even after the most dreadful day, it was amazing how easily a child’s smile could make the world right again, if only for a little while.


Robert F. Kennedy was right twenty-four years ago when he said that the future is made by each of us working to change a small portion of events for the better. Pediatrics is about the future and the difference I can make - one child at a time.

Pediatrics does pay. It will pay. Mother’s aforementioned tolerance and dedication are not all at mysterious to me now. And although my procedure-oriented friends in Obstetrics and Surgery will no doubt reap several times the monetary reward than I, they can go tie square knots. Walking on water is not such a big deal when you can play in the pool with the kids. 


Inspired by Jerry Bledsoe, I am following this up tomorrow with a Rhino-like piece on my experience in Asheboro (only one installment as we don't want to bore those in the local blogosphere who don't care anyway).

Then I'm going to take a break for a little while.