I remember as a little girl, staring at the dark, walnut urn that held my father’s ashes, thinking, “I want to save lives too.” He was a fighter pilot in the Vietnam War—shot down on his last trip back to the base after flying all day through enemy fire to recover soldiers who had been wounded.

I opted for medical school instead of the military. I guess I didn’t think the hospital would be a combat zone. Only it is—or, more recently, it has become one.

Every day I go into battle… Like with the wife of a man who had complex ALS, who was grasping for air, after years of being mute and immobile, clearly scared, and unable to control his functions. I knew he’d never want to live like this, because he told me so before the disease took his voice. But because he had no Advance Directive and a spouse that insisted that longer life was better than its quality, I was hamstrung to relieve his suffering. I’ll never forget her standing over his contorted face, urging, “One more breath if you love me…come on, one more breath.”

Or with the children of a dying woman who threatened to sue if I failed to go against hospital regulations and an ethics committee’s verdict in order to keep their mother alive for as long as I could—or, as I learned, until some contentious issue of their inheritance was settled with the courts.

There was also the crushing defeat of our legal department in preventing a derelict father from exerting his sole parental rights in order to force his 13-year-old son to provide a bone marrow transplant for himself.

There was the war with the parents who thought their own ideas of “treatment” were better than mine and my team’s—to their child’s great suffering and eventual death; and the patient I watched die, because I couldn’t convince him to have one simple test. And how can I forget the ambush by my colleague, the hospital’s senior thoracic surgeon, who inflicted his own crushing defeat on my reputation and efficacy simply because I questioned his capacity to hold a scalpel steady anymore thanks to a clandestine diagnosis of Parkinson’s.

From the day I started med school, I had a clear vision of who I was. But after “death by a thousand cuts” from a system that makes me equivocate on “harm,” I no longer know who I am. I feel like part of my soul has been stolen—the part that holds me in relation to my Hippocratic oath.

You don’t go into medicine because you’re nice or sweet; you go into it because you care about doing good and not doing bad. But after twenty-years of being a physician, I’m struggling to tell the difference.

Next Vignette: Hollow

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