Some kids go premed in preschool. Once they start playing doctor, they never break character. In kindergarten, they dress as physicians for Halloween. In second grade, they plate bacteria for the science fair. In fourth grade, they understand worm dissection as a practice session for gross anatomy. Not me. I finished college before I ever thought of becoming a physician.
My own preschool games occurred in my grandfather’s tire store. My sisters and I would clamber up a stack of belted radials, then leap into a pile of retreads, acting out the stories of our heroes and villains. Our games always returned to the one object in the shop that did not bear the logo of a tire manufacturer, a statue of a man rendered in rebar. He stood watch in the middle of the shop. His head was thrown back, his toothless mouth loosing a scream, his hands gripping his ribs as though he were prying open an escape hatch. From beneath his ribs, rusted cogs and wheels spilled out. We knew he was a sculpture, but we were afraid to touch him. His pain created a silence that separated him from us, a separation that I wondered how to resolve.
My journey from those wordless encounters with a body in pain to working as a physician was circuitous. I would never have arrived without assistance.
My four siblings, some of whom played with me in the tire shop, are my betters. Elisabeth is a better caregiver, Mary Margaret a better writer, Anna Cate a better thinker, and Andrew a better brother. I am grateful for their company and for their spouses and children who better our family.
Among my friends, I especially thank Andy Barton, who saved my life, and Tom Buller, who taught me what it means to go on after you lose a life.
My every step was guided by teachers, including Eva Aagaard, Neil Allman, Nadia Bolz-Weber, Andrew Ciferni, Karon Dawkins, Georgette Dent, Sue Estroff, Gary Gala, Stanley Hauerwas, Tess Jones, Nancy M. P. King, Michelle Kinney, Brett McCarty, David Moore, Jennifer Nelson, Laura and Roy Nichols, Lossie Ortiz, Don Spencer, Scott Stroup, and Joel Yager.
I have the opportunity to write this only because two other teachers, Farr Curlin and Daniel Sulmasy, offered me a University of Chicago Program on Medicine and Religion Faculty Scholars Award. Funded by the Templeton Foundation, the program introduced me to my remarkable fellow scholars Michael Balboni, Amy Debaets, Lydia Dugdale, John Hardt, Aasim Padela, and Elena Salmoirago-Blotcher. Finally, the program rekindled my friendship with Warren Kinghorn, who is a model of the good physician.
I work on becoming a good physician at my clinical home, Denver Health. Denver Health is a place where one can still practice medicine—we can see a patient irrespective of his or her ability to pay while teaching students and residents—and can learn from dedicated physicians like Vince Collins, Phil Fung (who reminded me about the case of Libby Zion), Gareen Hamalian, Rebecca Hanratty, Craig Holland, Jeff Johnson, Abby Lozano, Tom MacKenzie, Melanie Rylander, Allison Sabel, Jeffrey Sankoff, and Christian Thurstone. Robert House, the director of behavioral health at Denver Health, and Robert Freedman, my department chairman at the University of Colorado, have provided sustaining encouragement and transformative opportunities since I joined the faculty.
My local editor, Bridget Rector, improved every line of this book. My literary agent, Don Fehr, answered my query letter, gave my proposal a fitting shape, and found a home for this book at Yale University Press. At Yale, Senior Executive Editor Jean Thomson Black, manuscript editor Susan Laity, and the anonymous reviewers enriched the book with their careful attention.
My parents are attentive readers who piled every table and nightstand in our home with magazines and books. Our proudest possession was a shield-shaped plaque that named us the “Library Family of the Year” for checking out more books from the public library than any other family in town. It hung on the wall of our dining room.
That plaque hangs now on the wall of my own dining room. Though our own children are compulsive readers, I suspect the only thing Eamon, Mary Clare, and Helena Frances will appreciate about this book is its completion. As involuntary passengers on our family’s journey through the peculiar world of medicine, they have been subjected to call nights, post-call days, and too many dinner conversations about illness. I hope they remember us with mercy.
. . .
I distrust romances, but I could have told the story of the past fifteen years as a love story. I met my wife on the first day of orientation to medical school. I was sure we knew each other; she insisted we were strangers. I asked to sit next to her in lectures; she allowed it. We started eating lunch together on a narrow balcony overlooking the morgue. As we ate, we talked. She excelled at medical school; I struggled. She knew she wanted to be a physician; I thought of dropping out.
I would have left med school if I had not feared that it would mean never seeing Elin again. I desired to see her every day, but doubted desire. One night, when I should I have been reading biochemistry, I read Norman MacLean’s Young Men and Fire, his account of Montana smokejumpers. Like medical students, the smokejumpers were idealistic and young. MacLean observed that for most of the smokejumpers, there were girls they met at bars and drank with and girls at home that they married. He described a girl at home this way: “She was strong like him, and a great walker like him, and she could pack forty pounds all day. He thought of her as walking with him now and shyly showing her love by offering to pack one of his double-tools. He was thinking he was returning her love by shyly refusing to let her.” Reading that passage, I knew Elin was the girl you take on the long walk, the girl with whom you shyly share your burdens, and the woman you marry. We married as third year med students, and she gave birth to our first child when we were fourth year med students. It was a daring time to set out together, but twelve years and three children later, we are still walking together, and this book grew from the life we share.