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facts & arguments

Neal Cresswell

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Why do you want to become a doctor?"

Money and status immediately sprang to mind, but I answered the medical-school application diplomatically. I wrote instead about how medicine was the perfect vehicle to make meaningful changes in the world, a powerful way to help others – the typical answers expected of an eager applicant.

I meant what I said; I really did want to have a job that helped people. If money and status were part of the picture, that would be the dream job.

Through the years, I have occasionally been very helpful, sometimes dramatically: once, a young man came into my office doubled over, sweating and feverish. I sent him to the ER with a note shrieking that he needed immediate surgery; he had developed testicular torsion that, if left a few hours longer, would have rendered him infertile for life – or dead. He got surgery that day. I was elated. Score one for the clever doctor!

Often, my therapeutic usefulness is just to validate a person's suffering; I tell them they have a condition that others share (depression, lupus, addiction) and that although treatments may be limited, they are not alone or "weird." Sometimes it is the best medicine I can give that day.

But most of the time, my interventions have not been helpful. Many times I've filled out a disability form even though the person was not disabled, because it meant they'd receive more money for rent. Many times I wrote prescriptions, which helped abate someone's anxiety or depression or pain only temporarily, because I could not do anything about their poverty. I was helpful initially – but not in the long run.

These interventions seemed to demotivate my patients. They felt better but did not make the changes necessary to sustain that improvement. They did not leave their stressful job or their toxic relationship. They continued to isolate themselves, to eat poorly, to live in housing that, though subsidized, kept them in neighbourhoods that triggered their addictions. They got hooked on pain pills. They couldn't sleep, even with their sedatives.

They came back wanting more. "I need something else, doc…" What was the latest medication or diet or technique?

I would scrape at the bottom of my toolkit. "Let's try this new med! Have you tried hypnosis, eye movement desensitization and reprocessing (EMDR), emotional freedom therapy?"

Or I would scan the disability form for a new box I could check off, maybe for transit tokens, so they could get $30 more a month. "Are you sure you aren't lactose intolerant?" I would say. I'd frown, wondering how I could justify this to the authorities. Who checked these forms, anyway?

The patient and I would have a few hopeful visits, and then the inevitable disappointment. "It's not enough …"

Over the long term, my efforts seemed to generate more frustration and dissatisfaction than help. Each patient encounter reminded me of how helpless I was, even in my cloak of competence. When I wasn't dealing with their complaints about me, I was furious with them, their ignorance and their weakness.

I became cynical. Bored. Resentful. Why were they asking for my help if they didn't listen? I ended up blaming patients for my misjudgments: Filling out a disability form consigned them to an aimless life of poverty; writing a prescription got them physically or psychologically hooked for years.

I burned out. I changed the focus of my family practice to addiction medicine, and when that did not work, I took sick leave. The desire to help turned sour like a romance. The money and status were never enough to soothe the hopelessness and anger I felt each morning when I looked at my day sheet of needy patients. I hated my perfect job.

I often saw other physicians in the same boat as me, trying to mill through the same treacherous darkness, crazy with the latest fad that promised redemption. We even joined peer support groups – where we could commiserate and try not to resent our patients and our own helplessness.

It was through such a group that I learned I couldn't help anyone unless they were willing to help themselves first. If I was working harder than the patient, my help usually made things worse.

I practice now in a short-term addiction centre. With my clinical knowledge and experience I can sometimes provide a diagnosis or treatment that is useful for a person. I might even aid in providing some temporary bridges or crutches (meds, short-term financial relief). But these are temporary aids.

There are limitations to what we each can do for another – regardless of what wizard's wand we are holding.

Over time, I have learned to sit back and let others trudge through their own version of the human muddle. I am most helpful if I haven't burned out before someone is finally able to accept the encouragement and direction I can give.

When someone dips down into their depths and then comes up for air, I want my hand to be there, waiting.

Vera Tarman lives in Toronto.