“We make a living by what we get, but we make a life by what we give.”       Winston Churchill

Churchill's words have great relevance for me as a physician. In this regard, I am not referring to uninformed altruism but, rather, a conscientious commitment to the welfare of others with full knowledge and free acceptance of the challenging adversity this entails. With full awareness of the vexations and difficulties we all face, I continue to make a conscious choice to persevere in the face of that adversity and draw strength from the unparalleled privilege I have enjoyed entering into the lives of others and affect those lives so very profoundly, often indelibly.  Yet, to me the greatest reward of medical practice has been my relationship with my patients.  I feel I have been given an incredible gift, the immediacy of close relationships.  I try to take the time to ask my patients to share their stories as well as their complaints. For this small effort, I have often been regaled with some incredible tales of heroism, pathos, love, and history. Many times I have been changed by this intimacy, by dying patients who have taught me much about living and more about dignity in the face of indignity, about courage to fight battles no one knows how to win, about the power of hope over despair, about grace and the strength of the human spirit.  I am reminded daily to appreciate the ephemeral nature of our existence.  This helps to focus my attention on all that is good and beautiful around us.  I consider my patients extended family and I hope they feel the same.  Practicing medicine well means caring deeply about the people for whom you are doing it.

The second greatest reward I glean from practicing medicine is the opportunity for continually learning something new. As Maimonides said, “Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained sufficient knowledge, but grant to me always the strength, zeal, leisure and ambition to ever extend my knowledge.” One great thing about this profession is that one is never bored. There are always new discoveries, so many advances each day that it’s hard to keep up. That's the reason I've been involved in teaching medical students and house staff for the past 30+ years. There is no better motivator to keep up than the stimulation that comes from teaching.  Helping the next generation understand the knowledge is rewarding, but helping them become enthusiastic and confident, PRICELESS. At the end of the day I always feel I learn the most from teaching.

We all have legitimate problems and sincere worry for our own futures. For me, though, when I step back from my immediate frustrations with practicing 21st-century medicine, the personal and professional memory of last week in my medical practice reminds me nearly every time just how fortunate I am. I have tried desperately never to lose sight of the fact that I must remain doggedly engaged, persistently constructive and consummately professional in my life and in the care of my patients.

When I fall short of my own expectations of myself as a physician, when I start to wonder why are things the way they are, a short reflection on my 30+ years of service helps me remember those times when I did rise to the occasion, and they inspire me to be mindful of my responsibility and thankful I have the privilege to be a physician. They remind me that I represent the entire profession, and I have an obligation to the profession to represent it well. Although the challenges I face are many and substantial, fostering the health and well-being of my fellow men and women is a worthwhile and noble cause.  A cause I have given the better part of my life to without regret.  I believe that attention to the humanism of my work has protected me from the bitterness and burnout many physicians feel and it remains the most important gift, I can give to others.

For millennia, physicians have freely accepted the awesome responsibilities associated with the healing profession. In turn, society has granted us uncommon trust, respect and security.  I have always felt that if I can preserve my moral compass and keep attention on the valued service I provide, all the other day-to-day worries will take care of themselves. In the pursuit of that noble cause, I remain confident I can and will continue to demonstrate that, we make our lives by what we give, not by what we get.

MAKE A LIFE               Marc J. Crupie, M.D.

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