Saturday, August 4, 2012

Take Home Exam

“What do you think a passing grade should be? Let’s call this earning a C on your own report card. What does it take to earn a C?”

“Well…that would be getting it right all the time. Every time. Never making a mistake, always knowing the answer, knowing the diagnosis….. saving every patient.”

“That? For a C?

What then would it take to get an A? To give yourself an A?”

“I have no idea.”

“Don’t you think that’s asking a lot of yourself?”

“Of course. It’s crazy. But that is what is expected of me. And that’s what I expect from myself.”

Now, thinking like this will put you on the couch in front of a shrink eventually. Usually sooner rather than later. And there I sat.

Years later, in my early 40’s I took up target shooting to help me relax. Every Saturday afternoon, after I closed the clinic at noon, I’d head over to the pistol range with my trusty 22 Ruger. And I’d burn up hundreds of rounds of ammunition seeking that quiet feeling in my head that came about with the zen like concentration that target shooting demands. I fired a gun, surrounded by dozens of like-minded citizens all firing their guns, seeking quiet in my head.

My target was glued to a bit of cardboard roughly 20X 30 inches hung 25 yards from where I stood. The black bull on paper in the center was 4 inches in diameter. My task, if I chose to accept it, was to place 50 bullets inside that 4 inch diameter black dot during one ten minute firing period. After each firing period, I’d walk down range during the ceasefire and replace the center of the target with a fresh black circle, and then cover my mistakes, those holes punched through the paper outside the black circle, with masking tape. And then I’d start all over again.

I counted only my mistakes. After all those Saturdays over all those years, I had one target saved, thumb tacked to the garage wall over my workbench, which had only three holes outside the black. They were in the first ring outside the black, mistakes by less than a quarter inch. In all those years of Saturday afternoons, this was the best I ever did.

Having spent all those hours at the range, standing next to guys who were happy when they consistently hit the larger cardboard backing, I was proud of that target.

Showed that target to my mother once. She grimaced a bit, and sliding her finger lightly, in turn, across those three holes that were my mistakes, as if she were moving something across a smart phone screen, she quietly mentioned that if I had simply moved those three shots into the black, that it would have been pretty good. No C that day.

Expectations. Set your expectations too high, and you are often disappointed. Set them too low, and you stand to underachieve and disappoint. And when your expectations don’t match exactly with others’ there may arrive conflict.

Picture the fresh doctor, finished with the 8 or 10 or 12 years of college, heading out to save the animals and help their people, and pumped full of expectations. She has built a tremendous knowledge base, reworked her brain to assemble thoughts like a doctor, practiced her fingers to hold strange tools and modify flesh for good, and she expects…

Our fresh doctor expects to communicate seamlessly with her clients, asking the right questions and receiving in turn vital information about their pet. She expects to examine her patient and gain much useful information, so she expects the pet to be well behaved. She expects to utilize all that wonderful technology available to her profession to yield even more important information, and then she will feed that into her computer of a brain and she will then know what is wrong with every one of her patients, and how to fix it.

And then she expects the client to encourage her to proceed to fix her pet just as good as new. She expects to be paid for all this effort, talent, skill, and investment at a level where she won’t have to take a second job to support herself and her family. She expect to face the mirror and praise herself for a job well done.

Inevitably, her expectations may run head on into a thing called reality. The doctor will not be able to meet all of her expectations, for not every case will have an easy answer, or any answer at all. Not every answer is a fixable problem. And not every patient, nor every client, will be a willing participant. (See rest of this blog)

The doctor is now susceptible to that corollary of expectation, disappointment. Which often transforms into disappointment in herself. Long nights staring at an uncaring ceiling, frustration while filling in that stack of medical charts at the end of the day, and putting the done ones in one small pile, and the un-done ones in the taller mound. Sense of failure and self-incrimination. That rising dump of fear in the gut when facing one more trip into an exam room filled with questions ya just caint answer.

It’s not possible to earn a C in this racket. And forget ever getting an A.

And when you sit in the chair in the dark, late on a lonely night, with nonsense on the tube and not ever enough bourbon in the glass, and you think of those times when you failed, and the grief that left with the clients who left, and the tears come and the shivers that wrack your body, and you cry out for forgiveness because you cannot be perfect, and none comes. Well, then you know why the young ones question why, and then chose another way to spend their lives that doesn’t involve the pain and the frustration and the sacrifice. For why would anyone chose to do this?


  1. This one really hit home with me. I'm constantly down on myself about how I could've done X or Y better; how I'm a mediocre doctor in my eyes, and how I'm always striving for perfection. My fantastic boyfriend likes to tell me when I have tears of frustration in my eyes: "Are you better now than you were years ago? Will you be better in 5 years than you are now?" I nor my head yes to both. "Then you're the best doctor you can be. I think you're amazing..."

  2. Thank you for posting this. Beautifully summarises how I often feel in this job. Add to that the days when perhaps you even go so far as to do that very human thing of making a mistake and the depth of feeling in the last paragraph can become almost too much.

  3. What a reality check. I feel this way so often. It helps to know its not just me. For some strange reason, I married a vet and it seems he just doesn't have these days. Which in turn makes me feel even more pathetic and worthless. I tip my glass of bourbon to you for writing such a heartfelt piece.

  4. 50 rounds in 4" circle at 25 yards in 10 minutes and only 3 barely outside it. Darned good shooting from where most folks would stand.

  5. Thank you...this is a good summary of why medicine is so tough, animal or human.

  6. Just wanted to say thank you for posting this, pretty much sums up the last month or so for me. And to top it off I made the mistake of reading some reviews online which only made me feel even worse. Of course there are plenty of good reviews but I only see the bad ones and they leave a deep mark. I haven't read the blog in a while and am so glad I decided to stop by tonight

    1. Just trying to do a good job, and payin' the price.