Physicians are privileged to see patients at their most vulnerable, to reshape lives and continually revitalize the nation’s health system. In a challenging practice environment, physicians remain driven by the power of healing and the indelible connections they form with patients and families.
The AMA Wire® “When I Knew Medicine Was My Calling” series profiles a wide variety of doctors, offering a glimpse into the lives of the busy women and men navigating new courses in their careers and in American medicine. No matter their age, their specialty or their career stage, they were born to do this and they tell us why.
Share a moment with: Steven J. Stack, MD, an emergency physician residing in Lexington, Kentucky, and the AMA’s 170th president.
I was born to: Make a difference.
An experience from residency that confirmed my calling as a physician: I was working in the emergency department and treating a very sweet 92-year-old woman. During my history with her, she told me her doctor had advised her not to have more than a certain number of eggs per week because it could raise her cholesterol. I put my hand on her shoulder and told her that I disagreed. At 92, I continued, it was not likely that her cholesterol would seal her fate and, if eggs made her happy, she should eat a dozen every day. She smiled at me and replied, “I like you. And, I like your advice better.” This is clearly not an adrenaline story like one might expect from the “ER.” But it made it real for me that our advice and actions have impact on patients’ lives, that pragmatism sometimes matters more than science, and that our human connection with our patients is one of the great gifts of being a physician.
An experience from medical school that kept me going: In the first two years of medical school, most of us had limited exposure to patients and spent most of our time in labs, lectures and libraries. The TV show “ER” was in its earlier years and quite popular at the time. A group of my medical school friends used to get together weekly to watch the show, share stories and decompress. We had a lot of fun hanging out together over beer and snacks while watching the show. In addition to giving us material to critique or poke fun at, it was an important bonding experience that taught us the value of the brotherhood and sisterhood of medicine, and the value of physicians sharing stories and personal support with, and for, each other.
My source of inspiration: I’m an avid history buff. I particularly enjoy U.S. presidential history, and classical Greek and Roman history. I find that reading about the triumphs and defeats of those who have gone before me puts many of today’s events in a larger context, provides a stabilizing perspective, and helps me persist in my efforts to make things better even though the odds seem long and the toils take a toll.
My hope for the future of medicine: Despite the challenges that we and every generation face, in a relative blink of an eye, the science of medicine has warped forward from a relative stone age to a “Star Trek” level of amazement. Conditions that were debilitating or terminal, for essentially all of human history, have become curable or manageably chronic in just the past 100 years. So many things we could not even accurately describe in 1917 are now commonly, and uneventfully, treated as routine.
I eagerly look forward to the even more astounding advances that undoubtedly lie ahead. My hope for medicine, however, is that physicians redouble our commitment to, and defense of, the humanity of medicine. Our vocation is not simply, or even primarily, to diagnose and treat disease, but rather to serve as guides, aides, and companions to our patients in their journey through life as they face the uncertainties of the miraculous but imperfect bodies and minds they inhabit. This special, perhaps even sacred, bond between patient and physician is the past, the future and the true magic of medicine.
The hardest moment in medicine and how I got past it: I think I am living my hardest moments in medicine right now and I can’t say I’ve gotten past them. In emergency medicine, not a shift goes by in which I don’t intimately experience the vicissitudes and inconsistencies of life. There’s the young parent who dies unexpectedly, leaving behind small children without a mother or father. There’s self-righteous, demanding “VIP” who upends the department with their unwarranted sense of entitlement and exceptional demands. And there’s also the opioid overdose patient, revived after a near-death experience, whose struggle with addiction inspires in the clinicians a distressing blend of compassion, anger and despair.
I could go on for hours with different variations, but the never-ending crush of humanity’s sorrows and joys, affirmed and false stereotypes, outrageous intrusions by non-clinicians into clinical decisions, etc., routinely leads to a mental and emotional dissonance that is distressing and difficult to reconcile. As physicians, we need to do a better job addressing these strains, both helping each other to respond to them in a healthy and sustainable way and finding ways to mitigate them whenever possible.
My favorite experience working with the medical team: I love the teamwork of a well-oiled emergency department crew. I love it when a great nurse catches an error I made, or recognizes something I overlooked or would never have considered. I love witnessing the amazing mastery displayed by a skilled colleague performing an insanely intricate or terrifyingly dangerous procedure with a calm composure that defies belief. I love seeing the excitement of young learners who still find fascinating the journey of discovery and pursuit of knowledge. And, as I recall all these things I love, I love that my colleagues put up with me both because that’s not always easy and because I most certainly don’t thank them enough.
The most challenging aspects of caring for patients: Variation. Patients have private health insurance, government insurance, auto insurance, disability insurance, no insurance, etc. Also, some days at my hospital I have a neurologist or surgeon while other days I don’t. On top of this, some patients seemingly wander around the different hospitals in a nomadic fashion, thereby separating themselves from their medical records and doctors, complicating their care and escalating their costs. It’s both infuriating and demoralizing to try to do the right thing for patients—while having to reinvent the wheel, so to speak, for each patient—only to have governments, insurers and other groups accuse me of inconsistency and purportedly measure and grade me on “quality” when the entire system seems hopelessly chaotic and inconsistent.
The skills every physician should have but won’t be tested for on the board exam: Common sense and composure under stress are the first that come to mind. There’s science and then there’s the real world. We’ve all heard the saying, “Don’t let the perfect be the enemy of the good.” Well, it’s often far worse than this in the real world.
As an emergency physician, hardly a shift goes by when I don’t have to find a creative way to make a square peg fit in a round hole. This is hard enough. It becomes downright distressing when you are looking at a patient with an immediate risk of death, you don’t have the right medications or tools, and you have only a few minutes to invent a solution before the patient is permanently disabled or dead. I had that situation two weeks before Christmas last year when I had to intubate a 2-and-a-half-year-old child.
I stayed focused, improvised and got through it, but it was horribly stressful. I think the parents saw me as calm and composed, but the nurses who know me like family knew exactly how stressed I was. To get through that, I had to know some facts found on board exams, but I assert that’s not what saved that child (and me) that day. Instead, it was the hard-practiced self-discipline to maintain composure under pressure and to innovate while under strain that salvaged a fast-evolving crisis.
One question students should ask themselves before pursuing medicine: “Why am I doing this?” There’s no right answer, but there are many wrong ones. I’m not going to suggest any possible answers since they are unique for each of us. I’d urge any student considering the life of a physician, though, to reflect on this and be honest. There’s no amount of money, authority, recognition or other material trapping that will carry you through the hard times and provide you with a life of professional fulfillment. A life worth living is based on purpose and central to understanding one’s purpose is to answer the question, “Why am I doing this?”
Song to describe my life in medicine: “It’s Hard to Be Humble,” by Mac Davis. I have a lot of fun with my patients, nurses and other colleagues at work. When I’m in the emergency department, I’m known for my play with words, my candor, and my banter with patients and staff alike. I also take a good ribbing from colleagues and am quick to laugh at myself.
A few months ago, I was in the middle of a minor procedure with a patient and something about our conversation made this Mac Davis song come to mind and I started singing the refrain. The patient laughed so hard some equipment was dislodged (at no harm to anyone) and all of us had a good belly laugh from the moment. It was one of the “classic” Dr. Stack moments that have become an inseparable part of my identity as a physician.
In all sincerity, I appreciate the importance of humility more with each new year and I aspire to emulate it much better than I have so far. But, even more than that, the fun, folksy, self-deprecating sort of humor Mac Davis brought to life in this song is a cherished part of my life as a physician and my love for what I do.
