醫者心聲：求醫先求己

“Why do you want to become a doctor？”

Money and status immediately sprang to mind， but I answered the medical-school application diplomatically. I wrote instead about how medicine was the perfect vehicle to make meaningful changes in the world， a powerful way to help others—the typical answers expected of an eager applicant.

I meant what I said； I really did want to have a job that helped people. If money and status were part of the picture， that would be the dream job.

Through the years， I have occasionally been very helpful， sometimes dramatically： once， a young man came into my office 1）doubled over， sweating and feverish. I sent him to the ER with a note 2）shrieking that he needed immediate surgery； he had developed testicular torsion that， if left a few hours longer， would have rendered him infertile for life—or dead. He got surgery that day. I was 3）elated. Score one for the clever doctor！

Often， my therapeutic usefulness is just to 4）validate a person’s suffering； I tell them they have a condition that others share（depression， 5）lupus， addiction） and that although treatments may be limited， they are not alone or “weird.” Sometimes it is the best medicine I can give that day.

But most of the time， my interventions have not been helpful. Many times I’ve filled out a disability form even though the person was not disabled， because it meant they’d receive more money for rent. Many times I wrote prescriptions， which helped6）abate someone’s anxiety or depression or pain only temporarily， because I could not do anything about their poverty. I was helpful initially—but not in the long run.

These interventions seemed to hinder my patients. They felt better but did not make the changes necessary to sustain that improvement. They did not leave their stressful jobs or their toxic relationship. They continued to isolate themselves， to eat poorly， to live in housing that， though 7）subsidized， kept them in neighbourhoods that triggered their addictions. They got hooked on pain pills. They couldn’t sleep， even with their 8）sedatives.

They came back wanting more. “I need something else， doc…” What was the latest medication or diet or technique？

I would scrape at the bottom of my toolkit.“Let’s try this new med！ Have you tried hypnosis， 9）eye movement desensitization and reprocessing（EMDR）， or emotional freedom therapy？”

Or I would scan the disability form for a new box I could check off， maybe for 10）transit tokens， so they could get $30 more a month. “Are you sure you aren’t 11）lactose intolerant？” I would say. I’d frown， wondering how I could justify this to the authorities. Who checked these forms， anyway？

The patient and I would have a few hopeful visits， and then the inevitable disappointment. “It’s not enough …”

Over the long term， my efforts seemed to generate more frustration and dissatisfaction than help. Each patient encounter reminded me of how helpless I was， even in my cloak of competence. When I wasn’t dealing with their complaints about me， I was furious with them， their ignorance and their weakness.

I became cynical， bored and resentful. Why were they asking for my help if they didn’t listen？ I ended up blaming patients for my misjudgments： Filling out a disability form 12）consigned them to an aimless life of poverty； writing a prescription got them physically or psychologically hooked for years.

I burned out. I changed the focus of my 13）family practice to addiction medicine， and when that didn’t work， I took 14）sick leave. The desire to help turned sour like a romance. The money and status were never enough to soothe the hopelessness and anger I felt each morning， when I looked at my day sheet of needy patients. I hated my perfect job.

I often saw other physicians in the same boat as me， trying to 15）mill through the same treacherous darkness， crazy with the latest fad that promised redemption. We even joined peer support groups—where we could 16）commiserate and try not to resent our patients and our own helplessness.

It was through such a group that I learned I couldn’t help anyone unless they were willing to help themselves first. If I was working harder than the patient， my help usually made things worse.

I practice now at a short-term addiction centre. With my clinical knowledge and experience， I can sometimes provide a diagnosis or treatment that is useful for a person. I might even aid in providing some temporary bridges or crutches （meds， shortterm financial relief）. But these are temporary aids.

There are limitations to what we each can do for another—regardless of what wizard’s wand we are holding.

Over time， I have learned to sit back and let others trudge through their own version of the human 17）muddle. I am most helpful if I haven’t burned out before someone is finally able to accept the encouragement and direction I can give.

When someone dips down into their depths and then 18）comes up for air， I want my hand to be there， waiting.

“為什么你想成為一名醫生？”

立刻浮現心頭的是金錢與地位，但是我在醫科大學申請表上的回答卻是一番“外交辭令”。我當時寫的是醫學如何作為完美的工具讓世界發生有意義的改變，如何作為有力的手段幫助他人——一名志在必得的申請人該說的標準答案。

其實我說的真就是我想的，我真的想從事一份能夠幫助他人的工作。如果鈔票與地位是其中一部分，那就真是夢寐以求的工作了。

這么多年來，偶爾我也顯得助人有功，有時候挺戲劇性的：有那么一次，一位年輕人來到我的辦公室，彎著身子、大汗淋漓，而且高燒不止。我把他送到急診室，并附上診斷書，驚呼他需要立刻動手術。他患上的是睪丸扭轉，要是延遲幾個小時，他很可能會終生不育，甚至死亡。他當天就接受了手術。我感到很得意。我這個明智的醫生得記上一功！

多數情況下，我的治療有效性只是用于確認病人的痛苦而已。我告訴他們，他們的癥狀（情緒低落、狼瘡還有癮癥）其他人也有，盡管醫療手段有限，但是他們不是唯一的患者，并非“異類”。有些時候，這便是我當天能開出的最好的藥方了。

但是大多時候，我的診斷介入并沒有幫助。很多時候，那個人還沒有到傷殘的地步，我開出的診斷單就已經將其判定為“殘疾”，因為這意味著他們可以獲得援助，得到更多的錢來支付房租。很多時候我寫下處方單，只能暫時地幫助緩解病人的焦慮、沮喪或者疼痛，因為我對他們身處的貧困境地無能為力。……