When My Job Was My Religion

When My Job Was My Religion

By

Leonard Zwelling

https://www.wsj.com/opinion/a-public-servant-faces-a-public-death-544c2c9e?mod=Searchresults&pos=1&page=1

It has been widely reported that many doctors are in love with the HBO Max series The Pitt. If you have not watched The Pitt, you are missing the most accurate glimpse into what it means to be a doctor that has ever been put on TV.

First, the series is based in a big city emergency room in Pittsburgh so the patients on screen represent the wide range of disease and trauma with which real emergency room doctors contend every day.

Second, the production design and special effects make the medicine look real. I have read that if the show runners cannot make it look exactly as it would be in real life according to their real ER doc consultants, they will not use it in the script.

Third, the actors do an unbelievable job of portraying the stresses that real physicians face on the front lines of medicine. They talk like real doctors and suffer psychologically from the carnage that often surrounds them. They also seem to be individually somewhat lonely in their private lives and work is their only social environment.

But perhaps most importantly, the scripts and the actors demonstrate why we doctors do it. This is our religion. We believe in medicine.

So, after watching the latest episode, I was discussing the different patients with the BW and she asked me, “do you miss it?”

This was an excellent question with many answers.

I do not regret my decision to alter my career from one of the provision of clinical care to one of laboratory investigation and then research administration. Science was very important to me and was very good to me. A lot of experiments I tried actually worked once I got situated in the right lab with the right mentor which was why I spent ten years leading the Cancer Track of the MD-PhD Program at the UT Medical School. I wanted to help develop the next generation of cancer physician-investigators. A few of my students are MD Anderson faculty now. One is a department chair.

I was indoctrinated early in my medical school career that real Duke internists are physician-investigators and needed to be both competent at the bedside and facile at the bench. I was competent as an internist, but found oncology fulfilled neither my fascination with diagnostics (as every patient I saw in my fellowship was already diagnosed when they got to me), nor my passion to make them better, to fix them, as my father, the engineer, fixed everything in our house. That was not the nature of oncology in 1975. It’s much better now.

Regardless, I never lost my belief in medicine, not because I missed caring for patients. I missed being part of the healing team. The Pitt does a great job of demonstrating what being part of such a team looks like, and feels like, especially with a flawed, but inspirational leader like Dr. Robby, as played by Noah Wylie. There was no one who led me on any team in medicine who was not somewhat flawed because every one of them was human. That’s the whole point of The Pitt. These doctors, these healers who sometimes pull off miracles are all human.

What I missed, that Dr. Kleinerman perceived as we talked, was being part of a team for I had been a member and a leader of medical teams in my career. I had chosen to give that up when I entered the laboratory (a truly self-centered activity) and I got it back a bit when I was a VP supporting the clinical investigators doing human subjects research.

Today, I am concerned that the younger docs don’t feel the way I did about the deeply held belief, almost a religion, of being part of the fraternity of medicine. I wonder if that belief is being widely taught to the medical students of today.

In the above interview in The Wall Street Journal on March 14, the ex-Senator from Nebraska, Ben Sasse, discusses his current battle with terminal pancreatic cancer for which he is being treated at MD Anderson.

Mr. Sasse has a very Christian approach to public service and a remarkably uplifting view of his disseminated disease. He also has some words of wisdom for both the current and next generation of American leaders, and, in my opinion, doctors.

He paraphrases Ronald Reagan when he says “in a republic, you’re always only one generation away from the extinction of freedom.” This is also true of the fraternity of medicine. We are always only one generation away from losing something that has been built over the centuries of man’s battle against suffering and disease.

When I entered medicine, I was choosing to go through a baptism of fire to become part of a guild with deep historical and spiritual roots.

I am pleased to say that to this day at my alma mater, Duke Medical School, a lot of effort is placed into paying it forward to preserve that historical bond with the doctors of the past. We see it twice a year when we go back to visit for Dr. Kleinerman’s service on the Medical Alumni Council. We saw it when we visited the Duke-NUS Medical School in Singapore. We support it with our donations. We give to two Jewish congregations in Houston and we give to Duke Medical School. We are called on to do this. All of it is what we believe in. It is why we are here.

It was also what we felt when we got to MD Anderson. We had been invited to be part of a cause greater than ourselves. Fighting Cancer, Now That’s A Job.  This cause has been seriously damaged over the past 25 years as the original belief system established by R. Lee Clark (a cancer center built around the patient) has been supplanted by an overwhelming addiction to money in MD Anderson’s C-suite led by its last three presidents who were all much richer personally when their terms were over or, in the case of the current $4 million man, not yet over.

We do not support MD Anderson any longer although we did in the past. Its leadership has departed from our belief system. The Board of Regents of the University of Texas has also departed from that belief system.

What do you believe in? When you go to work, is what you do resonant with your beliefs? If not, why not?

It often was for me and surely was for my first 20 years at Anderson. Then came Enron, ImClone, lawyers leading the institution, DePinho, and Pisters. I left that congregation. How about you?

I did not change religions. My place of worship left me.