Thread by @TheRealDoctorT

As much as it broke me down, it built me up.

As much as it disassembled me, it gave me form.

As much as it disoriented me, it gave me clarity.

As much as it took from me, it gave me back.

I look at the hospital from the subway station across the street

This beating heart. 1/

It’s the late 2000s, and it’s the last day of my residency.

I always feel reflective at transition points in my life. This moment is no different.

As I cross the street to enter the main lobby, my mind is far away.

Three years ago my heart was racing with anxiety. 2/

I remember walking into the hospital for the first time as an intern. I was an imposter, begging to be found out.

Wearing the white coat with the name-tag that had “M.D.” on it, credentials that felt unearned and undeserved.

A small pin on my lapel. “Be Kind.”

A reminder. 3/

I thought I was used to medicine, after doing so many sub-internships and rotations as a medical student.

I was wrong.

I learned very quickly to rely on and learn from the nurses, and my fellow house-staff.

You can’t do this alone.

That line still applies, by the way. 4/

Now here I am three years later, a senior resident at the end of this part of my journey.

As I think back on the path that led me here I realize that what I’m taking with me is an art form.

I am becoming the practitioner of an art that takes its shape in the form of stories. 5/

Stories whispered from the very walls of this hospital. Stories that have taught me what it means to practice medicine, what it means to be a human being.

As I get on the elevator, my hand hesitates for a moment before I push a button.

Each floor is an ocean of memories. 6/

They say it gets easier, the further along you go. That each year is a little less stressful than the one before.

I don’t think that’s always true.

The stress is woven into the system.

Some of it is toxicity, and some of it just comes with treating the sick. 7/

As I walk down a hallway, almost every patient room carries with it a memory, a story.

Ghosts linger in the doorways as I walk past, bearing witness, reminding me.

Some I remember for their maladies, some for their stories.

Each hospital room is its own world. 8/

I remember a young man with an accidental Tylenol overdose, and the growing horror of the realization.

I remember the vivid red of blood on white bedsheets as a tumor gnawed into a carotid artery.

And I remember the elation of a miraculous recovery from septic shock. 9/

I remember the hopes and dreams of a college athlete, derailed by a leukemia.

I remember the dry humor of a man with kidney failure.

“Doc, what do you get a lizard with chest pain?”

“Uh-“

“A geckocardiogram!”

I can’t help but smile to myself as I walk by his old room. 10/

I’m going to miss this place.

I learned in these rooms, these halls. Made lasting bonds.

I cried in the stairwell. I laughed in the resident’s lounge. I shared a coffee with friends in the cafeteria.

This is where I became a doctor.

I reach the office I’m headed to. 11/

It’s time to turn in my pager. I hand it over, and the woman behind the desk looks up at me.

“Congratulations doctor.”

I find myself hesitating, “That’s it?”

She smiles, “That’s it.”

I feel a massive burden lift, that I didn’t know I’d been carrying.

I am off the clock. 12/

As I leave the office I realize my role has already been taken up by someone else.

The new interns have arrived, and a junior resident has become a senior in my place.

I stop by the resident lounge one last time, to get the last of my things.

For a moment, I take a seat. 13/

I listen to the sign-out taking place, without any responsibilities.

I just listen to it, catching snippets.

“-okay so this is a really sick patient-“
“-follow up on that CT-“
“-call the fellow if she spikes a temp-“
“-DKA and the gap is closing-“

And I quietly leave. 14/

The hospital carries on without me, just like it always has.

I was never as irreplaceable as I felt myself to be.

None of us ever are.

Life goes on. That’s what it does.

I walk out of the hospital and onto the sidewalk outside, the sunlight feeling warm and welcoming. 15/

I’m going to miss this city, too.

Boston, the city that I made my home.

I start walking away from the hospital, down the street and into Chinatown.

Past the restaurants, the stores with their bright windows and flashing lights.

I’m not going anywhere in particular. 16/

I walk, just to walk.

Past the man selling the knockoff watches, and the corner cafe.

And I remember placing my first central line, my first patient, running my first code, pronouncing my first death.

I feel something I can’t describe.

This is what it feels like. 17/

Becoming a doctor doesn’t happen in one grand gesture.

It’s infinite small incomplete details that are forever falling into place.

It’s called the practice of medicine because that’s all you can do.

Practice it.

There’s no perfecting it.

Just go with it, grow with it. 18/

There’s a rising tide of dissatisfaction with medicine. People in all fields of healthcare telling trainees it isn’t worth it.

And there’s truth to that. There are deep-seated problems in medicine.

It may crush you. Break you. Deny you.

There are other paths to take. 19/

But medicine has always been the only path for me.

Painful as it is, problematic as it is, there is an undeniable beauty in it, a quiet majesty.

Medicine is still my honor, and my privilege.

Raw, and bloody, and messy, it is still the beating heart of me

This beating heart.