What was your “a-ha!” moment? In the first runner-up of this year’s Life Lessons essay contest, a voice from the past reminds Yasmine S. Ali, MD, why she chose the increasingly difficult path of being a doctor.
Mrs. Lewis* was in her early fifties when I first met her. I was 25. I had graduated from medical school just three months before she became one of my first clinic patients. As a medical intern at a tertiary care center, I had inherited this clinic roster from one of my predecessors, and I was as excited as I was scared. I had never had my own patients before, and now I would be responsible, under the supervision of my attending physicians, for all the individuals whom I would follow in this continuity clinic for the next three years of my internal medicine residency.
When I entered the exam room for the first time, Mrs. Lewis was already sitting on the examination table. She seemed curious, anxious, and hopeful all at the same time. We hit it off immediately, she and I, and soon we were both chatting and laughing about everything from the weather to the characters one can encounter at a university medical center. For most of the visit, she insisted that everything was just fine, that she was feeling just perfect and could not be better; and she stressed again and again how happy she was to have a female doctor “this time.”
Then came what physicians the world over know as the “hand-on-the-door-knob” moment. As I was getting ready to exit the room, having already said goodbye for that visit and advised her on when to schedule her next appointment with me, Mrs. Lewis piped up with, “Oh, just one more thing. Could you take a look at this?”
“This” turned out to be a rather large mass on her left breast that was so clearly visible and advanced that the skin in that area had a classic “peau d’orange” (literally, “skin of an orange”) appearance, meaning that, true to what I had seen in my medical textbooks, the skin around the nipple was dimpled, somewhat swollen, and looked like an orange peel. This was a textbook presentation of advanced breast cancer.
It was obvious to all who eventually became involved in Mrs. Lewis’ case that she must have known about this for quite some time. That sort of mass doesn’t appear overnight, and once it became visible on the skin, she would have known for sure. But also obvious was that she hadn’t felt comfortable telling or asking or showing any of her previous doctors, who had happened to be male—and excellent physicians, all.
She would often tell me, in the days and weeks and months that followed, that it was fate that had brought our lives together at that moment, in that exam room. I followed her through every step of her care: the surgery, the pathology, the radiation therapy, her decision not to undergo chemotherapy. Every hospitalization and every complication. And miracle of miracles, she survived.
Mrs. Lewis and I could not have been from more different backgrounds socioeconomically, educationally, or ethnically. But none of that ever, ever mattered. Rapport was immediate; the connection was effortless. I never faltered for words when speaking with Mrs. Lewis; everything just came naturally.
I even remembered her date of birth, which I am able to do for only a handful of my most special patients. But this, too, was simple—Mrs. Lewis had been born on New Year’s Eve, which is and always has been my favorite holiday.
When I graduated from my residency and the time came for me to move back home for my cardiology fellowship, the farewell was anything but easy, and we promised each other we would stay in touch. Over the years, she sent me lovely letters and cards, and I called her every year on her birthday—that favorite holiday of mine.
Fast forward 13 years, and there I was, in my late thirties now, feeling, like too many American physicians, as though I were banging my head repeatedly against a wall of paperwork, regulations, certification requirements, and the like, day after day after weary, mind-numbing day. It was becoming increasingly difficult to remember how and why I got into this mess in the first place.
The previous New Year’s Eve, when I made my annual birthday call to Mrs. Lewis, she had asked for my home phone number. I gave her my cell phone number, which is the best way to reach me, and never gave it a second thought. I honestly didn’t think she would ever need it or use it, but it seemed to please her to have it, and that was enough for me.
Then, at the end of a particularly dreary March day that had left me wondering how I could continue to practice medicine and stay sane in the current environment, how I might carve a niche that would allow me to continue to see patients and save my own health in the meantime, and how I might regain some hope in my chosen profession…my cell phone rang. The caller’s area code was one I had not seen in over a decade.
What could this be about on a Tuesday evening? I had been preparing for a particularly early bedtime, wishing to put that miserable day behind me as soon as possible. I answered the phone hesitantly and with my heart in my mouth.
At the other end of the line was that voice I knew so well. Mrs. Lewis was full of vim and vigor, enthusiastic and pleased with herself for surprising me. She gleefully and excitedly proclaimed, “See? I told you that when you least expected it, you would hear from me! I got a cell phone. This is my cell phone number. Dr. Ali, how are you doin’?”
I did not tell her how I was doing; rather, I told her, truthfully, how good it was to hear from her, and what a pleasant surprise this was indeed. And at some point during the conversation, Mrs. Lewis threw in, “Dr. Ali, you’re the best doctor I ever had. And probably ever will have. I miss you so much. You saved my life, you know.”
I saved my copious tears of gratitude for after I had wished Mrs. Lewis goodnight and ended the call. “This is why I do this,” I realized. This is why I must find a way to keep doing this. Because what I do matters to people.
I have always believed that being a physician is a calling, and I have found that most of the patients I have encountered over the years have believed that, too. But I had come to question that belief on the day when Mrs. Lewis called my old, beaten-up cell phone from her brand new one. She was still alive, and doing well, and maybe that is because fate brought us together on that pivotal day over a decade ago. What I have no doubt about now is that the same power was at work over the cellular airwaves in my moment of great need as well. As Mrs. Lewis herself undoubtedly knows, in her own wise way: doctors need saving sometimes, too.
*Name has been changed.
Read the essay from this year’s first place winner here.