The last two days were spent explaining what I’m doing and why I’m changing directions. The next natural step, I guess, is to explain why I’ve chosen to pursue medicine.

Of all the things I could possibly do at this point, medicine is arguably one of the most difficult and expensive. Law or business school would require minimal preparation and a relatively short time commitment, after which I could quickly realize the benefits of the education. Other paths that don’t require school would be even easier to follow. On the other hand, I have committed to roughly seven years during which I will either be a student or a menially-paid employee, followed by at least three years of modest income and very hard work. I will accrue a significant student loan burden and there will always be the risk that I will not complete my education, which would leave me with a huge bill and nothing to show for it. Why bother? What’s the point, especially if I truly believe that money is not the motivating factor?

I’ve previously mentioned my affinity for problem-solving and my interest in learning about complex systems. For example, when our washing machine broke earlier this year, my first reaction was to go online to learn how it was supposed to work. My eventual diagnosis and fix took more time and probably cost more money than if I’d hired a professional, due to an initial misstep; however, I walked away from the experience much more satisfied with myself and confident that I could fix it inexpensively the next time. I now see the machine as the sum of its individual components, rather than just a function of its controls. I am gratified every time I dig into a system with my own hands and gain insight into its inner workings. That deeper level of understanding is what allows experienced technicians to diagnose problems in ways that bystanders might find to be mystical; in fact, it’s just a result of the intuition gained from develping an intimate understanding of the system.

My engine rebuild project was a major undertaking, and while I committed to doing all of the teardown and assembly by myself, I was not sure that I could do it at first. Let’s face it: Even to an experienced hack mechanic like myself, car engines are complicated and rather intimidating. Most car enthusiasts, including those who modify their cars in one way or another, see their engines as black boxes. While anything that attaches to the engine or the car body is simple to diagnose or replace, anything that lies under the valve cover is often seen as foreign and dangerous territory. I wasn’t entirely sure of what I was doing as I put my car on jackstands and assembled the engine hoist. I still wasn’t really sure of myself as I tore down the engine, but by the time I got down to the crankshaft, I had built up enough confidence to know that I could rebuild the engine.

Taking apart the engine confirmed that it was indeed a complex system, but only because it was a system of many subsystems. These subsystems were all quite simple and easy to understand. Broken down into components, it was clear how they all worked and how they worked together to create forward motion. I was amazed and relieved at the same time. It was easy to see the evolution of the internal combustion engine from its roots to its modern state, and I could understand the rationale and implementation of each development. Modern engines may benefit from computer control and fuel injection, but at their hearts they are no different from engines built 20, 50, perhaps 100 years ago. As I assembled the engine, my understanding of this marvel of engineering changed significantly. Instead of a monolithic black box, I began to see through the iron and aluminum. The vague concepts of pistons, valves, and timing chains came into sharp focus and I saw them working in concert underneath the metal castings. Now I can encounter noises coming from the engine and make reasonable conjectures as to their source. The revelation was stunning, and my confidence and sense of satisfaction upon seeing the engine start for the first time was immeasurable. I’ll never forget that instant for as long as I live.

When I recount this experience to my friends, most of them ask why I don’t consider a career in the automotive industry. I’ve clearly shown interest and aptitude, and there are plenty of opportunities to earn a good living. While I do think about it from time to time, I don’t believe that I would ultimately be happy working on cars for a living. There are important differences between doing something as a hobby and doing it to put food on the table. My rebuild project took approximately ten months to complete, but the actual work involved would probably have filled no more than one to two weeks of 8-hour days. Because it was a third car, and because I was not depending on it for income, I had the luxury of choosing exactly when and how hard to work. When parts availability was an issue, I didn’t have a problem with letting the project idle for a few weeks. I had no issues with letting the machine shop take their time with their work, and I was able to pick one relatively far away from home because I was under no time pressure to complete the job. I therefore have nothing but positive, happy memories, and absolutely no stress…and I want to keep it that way. I want to work on cars to unwind and relax, not to make money. It simply isn’t likely that I’d find such enjoyment by working on cars to set deadlines or for purposes other than the purpose itself. More importantly, there are some key differences between cars and humans, differences that make the decision very clear to me.

Despite (or perhaps because of) my lackluster performance in introductory biology, I spent some time last year going through the exhibits at the nearby Smithsonian Museum of Natural History. With my hands often still greasy from the previous night’s work, I walked through the exhibit halls and began to notice some interesting parallels between the development of life on this planet and the mechanical development of the internal combustion engine. All living organisms are hugely complex systems of less complicated subsystems, which are frequently composed of many still smaller subsystems, and so on. Evolutionary theory traces life from an entropic mix of chemicals to the bounty of plants and animals that inhabit the world today. While we are infinitely more capable than our predecessors, the mechanics of our existence are strikingly similar to those of the bacteria that have been here for hundreds of millions of years.

While I subscribe to the modern theory of evolution, it totally blows my mind that it has happened at all. There’s an immense leap from a random pond of carbon, hydrogen, oxygen, and nitrogen molecules to single-celled organisms, never mind from there to humans. No one who perceives animals purely as their wholes could have any basis to believe that there was some sort of development from one to another; it takes a much deeper understanding, one that goes under the skin to look at structures, organs, and cells, before it suddenly becomes plausible that we are all related. Even then, there’s a big leap of faith until one explores the mechanics of DNA and DNA replication…and even then, there is so much left to discover and so much to understand. Nature is beautiful in ways that humans could never hope to imitate, and I wonder if we will ever answer the questions that have inspired scientists since the dawn of time.

Anyway, on a superficial and mechanical level, perhaps humans aren’t so different from engines — at least, not when it comes to the process of understanding the system, diagnosing a problem, and finding a way to resolve the problem. Gaining an intimate understanding of the human body’s physiology, combined with the physiology of disease, gives one the ability to understand what is going wrong and how to fix it. Being a physician will require that I use my problem solving skills on a daily basis in an environment where every decision and every success — or failure — affects someone in a very personal way. I relish the opportunity to be placed in that position.

For the most part, however, humans are not at all like machines. Machines are unfeeling and replaceable. Parts are easily acquired, relatively speaking, and there are no considerations beyond what is real and physically in front of one’s eyes. Humans have souls. We have feelings, and our emotions are just as important to our well-being as our physical selves. Sometimes the aggressive treatment of a symptom is not the best solution, and sometimes the best solution is simply not to fix what’s physically wrong at all. A physician’s attitude and compassion, or lack of either, is at least as important to the patient as the recommended course of action. I once read that patients are far less likely to sue a well-liked doctor for malpractice than one who did not gain their trust at all. In addition to providing the best physical care possible, it’s important for doctors to understand that humans are not machines.

I hear about uncaring doctors all the time, and I come across them in my own life. Several months before we were married, my wife went to an allergist to inquire about shots. We were planning to get a dog at the time, and she was concerned about the effects that might have on her breathing. The allergist ran the usual battery of tests, than scoffed at the notion that we would ever own a pet. In addition, he brusquely recommended that we rip out our carpets to install hardwood floors and encase our bedding materials in covers that prevent dust mites from causing problems. When Kim persisted, he insisted that shots would not be a viable option and all but pushed her out of his office. Needless to say, she returned home very frustrated. Even if the doctor’s opinion was valid, there was no reason to deliver it in such a manner.

We later brought home a puppy and Kim began to react to her after a few days. She went to a different allergist this time and was given a very different treatment. Rather than chew her out for owning a dog, she was put on allergy shots and given some suggestions for living as symptom-free as possible. The emphasis this time was not on turning around one’s life, but on making it as pleasant as possible. This allergist still suggested that we live with hardwood floors, plastic sheets, and no dog, but there was no sense of disdain and no insistence that the recommended course was the ONLY course to follow. We’ve had Taylor for almost two and a half years now, and it would simply be impossible to convince us that life would be better without a dog.

There are countless other examples of competent doctors who lack the ability to see a patient as a human rather than a soulless machine. I want to practice compassion as well as prescription. In addition to healing a physical ailment, I want to lift the spirits of those who come to me for help. I firmly believe that caring for a patient’s intangible needs play an important part in curing disease, and I can’t wait to see my first patient smile.

I’m no idealist. I’ve been out of school far too long to believe that any job is perfect, least of all medicine. Hospitals deal with their share of junkies looking for their next fix. Patients won’t always take their medication or change the bad habits that made them sick in the first place. When insurance companies are able to dictate what kind of treatment a patient may receive, there is no way that I could give the perfect treatment for everyone’s sickness…which makes it all the more important for doctors to be less cynical, less superficial in their patient interaction. I’m prepared for the realities of the working world, and I’m well-versed in the inner workings of a business.

Despite the inevitable mounds of BS, the actual work performed by a good physician is nothing short of magic in my opinion. It’s a balance of science and art, of medicine and compassion, and it’s something that I could never experience outside of the field. It’s more than being selfless; in fact, I quite selfishly will make myself happy by healing others. I can’t think of a single profession in the world that bears such responsibility, involves such direct interaction, and reaps such great rewards.

Quite simply, I want to be a doctor because there’s nothing else that I would rather do.

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