In medical school, O Best Beloved, there is a totem pole of who answers to whom. It begins with the medical students at the bottom. We check in with interns, in their first year of residency. Interns check in with senior residents. Senior residents check in with fellows, who have finished residency and are now doing specialty training. Fellows check in with the attendings, who are real doctors. At each stage, the plan is reviewed and revised based on new information or experience. Ultimately, the idea is that the attending can impart wisdom to the residents and medical students, and that potential harm and potential good will be properly balanced.
I read a lovely devotional once that referred to God as the great Attending. For some reason, at this stage in my life, I find that image unimaginably more comfortable than that of God as father. And if I am answering to the great Attending in the end, I know I had better have my lab results back, my note written and ready for co-signing, my physical exam details based on a real exam without assumptions. I know that my mistakes and my little cover-ups and my guesswork will all be picked through; I know that my triumphs and my research and my time spent will be rewarded. I know that I am accountable for what I did with the time and the freedom I was allotted. Attendings, you see, always know.
We get problem patients in the hospital, O Best Beloved. Problem patients and problem nurses and problem administrations. We have red tape and procedures and Cover-Your-Ass reflex tests and JCAHO guidelines and all the things we must do and should do and cannot do. And my attending expects that I will still do what is absolutely best for my patient, and that I will care and I will work and I will not be afraid to call consultants and labs and nurses and ask for answers. Because it doesn't matter what stands in my way - the how and the where may change, but the what never does.
I have a lifetime, approximately 78 years on the average by the last numbers I saw - fifty-three more to go. I have a lifetime in which every act I perform will be noted and scrutinized by that great Attending; in which I will encounter countless numbers of teachable moments - moments in which I will be taught wisdom and humility whether I had planned on learning them or not - I have a lifetime to do the things I have set out to do. And in the end, who benefits? My patients do. The people I interact with do.
I am not moving to Canada. I have been quite careful to neither say nor write any such implications, and I only once, quite jokingly, glanced at my Angel after the announcement of Mitch Daniels's gubernatorial victory and said "I can still interview outside Indiana." We both laughed. I am not sulking in the sunset of my party's defeat, O Best Beloved. I will, instead, carry on.
I have things to do.