Because this is what haunts my dreams. Could be worse I suppose.

For many years, making medicine my life's career was decidedly not my aim. As a teenager I was convinced I would never want to be a doctor. I had good cause: my mom's life has been riddled with serious health problems, and her hospitalizations were characterized by difficult, unnecessary surgeries and false cancer diagnoses. To me, hospitals were cold, sterile, and garish places which I associated with fear and worry. The doctors were disappointing and distant figures dressed in white coats. When my mom moved to Annapolis, where I attended St. John's, I began to accompany her to her doctors' appointments. Over a period of four years I met a wide range of doctors and specialists. While some doctors showed devotion, warmth, and acuity, others did not. I remember one in particular who barely looked at her--instead he stared at his clipboard throughout the appointment. This lack of connection made them less attentive to my mom, prolonging her suffering by failing to answer questions and to address her concerns.

I have always been a naturally inquisitive student. In high school, though, my investigations were compartmentalized: my physics and biology teachers would argue over which was the better science, and English and math were different worlds. I needed a school that would allow me to explore my diverse interests, like literature, philosophy, science, and mathematics as part of an integrated world-view. I chose the Great Books program at St. John's College. Not only did we focus on the primary texts of monumental minds, but we wrote papers comparing the structure of an equation to the form of a poem; we recognized that careful observation in the lab can be useful in the study of music. Most importantly, I learned how to ask the best questions--both in and out of the classroom. The classical curriculum was rigid, but ideas were boundless. Our classes were conversations, not lectures or debates. A tutor would open each class with a question which students would then subject to careful analysis and discussion. The class usually resulted in another tantalizing question. I may have learned little about the practice of medicine at St. John's, but I learned to independently cultivate my mind. To master the art of asking good questions is to live well. Anyone can gather information, but acquiring knowledge and applying it correctly are ultimately more useful than hoarding facts. My mother's experiences had taught me that knowing how to ask the right question is crucial in the health care field. I began to wonder if my questions could help others live well, too.

During college I considered various careers: perhaps I would be a linguist, or an archaeologist. However, my work as a labratory assistant deepened my appreciation of science. It was exhilarating to reenact experiments and to trace the thoughts of brilliant innovators such as Willam Harvey, James Maxwell and Werner Heisenberg. Science is a wonder, but my personal experience has been the most influential. I saw a need for more doctors with stronger social skills and a greater ability to communicate. I was present to ask questions and remember explanations for my mom, but other patients were not so lucky. Though her doctors have not been incompetent, they have not made her life better. I realized an academic career was too passive. I saw medicine as a broad field where I could take action, a career in which question-asking could make a difference in people's lives.

After St. John's, I volunteered at the Hospice of the Chesapeake. I was inspired by a personal reading list I had developed, which consisted of works by doctors. I spent my free time exploring their stories, their struggles, and their joys. Many of these books, including Pauline Chen's Final Exam: A Surgeon's Reflections on Mortality, demonstrated how novices enter the medical world ready to cure, but are unprepared to face defeat and death. I chose hospice work because I wanted to be exposed to an environment where a cure is rarely an option, and palliative care and acceptance of death are primary. During my first few weeks I was in shock. I could comprehend the impotent rage and overt denial many of the patients expressed--how does anyone accept a death sentence? I found it difficult to understand young patients who seemed to accept their deaths with grace. In my training, Hospice was depicted as a way station for tired travelers: they are weary after a long journey, and they are unsure of where they are headed. Caregivers are there to give food, shelter, and human companionship, even if they, too, are ignorant of the path ahead. This analogy helped me as I wrestled with my questions. Some questions can be answered simply; but for others, the best response is honest conversation and compassion.

Intimate conversations with patients and families have been the best moments of my hospice experience. As I prepared their meals, I discovered their favorite foods and tried to brighten and to lighten their day. Even when patients were actively dying and there was a heavy weight upon the house, I continued to find the burden rewarding. I will never forget one of my first patients. He had proudly served in the Navy: when I shook his large hand, made slender by cancer, his grip was firm and welcoming. Looking at his thin frame, it was hard to believe that his alcoholism had once caused him to weigh over two hundred pounds. Even at the Hospice he was provided with a beer a day, before he was slowly weaned off it. He had no family. His wife had died in a plane crash at the age of 21. The other volunteers complained about him. They were bothered by his peculiar demands and temperamental nature. Yet, what other control was left to this man who could not move from his bed, who could not use a toilet? I was glad to speak with him and share my own stories. It was no trouble to make his sandwiches, even when I later found them stashed in a drawer. He died soon after I left to teach in France. He told me that he had accepted his death, but I still wonder if he really had; he never seemed at peace. To this day, when I visit the patients that occupy room 102, I think of him.

Riding my bike to the hospice, I contemplated the stark contrast between my present life working with horses and the declining health of my mom and those I cared for. I had spent the past four years asking questions in a classroom, and now it was time to explore those questions in the world. Reading books by doctors such as Danielle Ofri, Rita Charon, Abraham Verghese and Jerome Groopman confirmed what I had experienced: being a good doctor requires an ability to ask the right questions that will lead to the right diagnosis and treatment, but it also demands that health professionals remain to help their patients face their illnesses daily. The practice of medicine offers moments of intimacy and connection between doctor and patient. It is this interaction between beings--the communication--that allows our conversations to deepen and our questions to evolve. Through conversations at the Hospice, I have moved closer to understanding those who stoically accept death. In the hospice I had also confronted my own fear of death. I realize now, that we can only help others if we are first capable of honestly examining ourselves. Now, when I ask, "How can I best live?" My answer is to be a healer, a communicator and a good doctor.

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