Julie has recently questioned her decision to teach students. She has been precepting medical students, internal medicine residents, and other learners in her clinic for over 20 years. She doesn’t do it for the small stipend she receives. She believes the back-and-forth questions and answers from students make her a better doctor. She also takes pride in training the next generation of clinicians.

Nine months ago, her corporate-owned hospital implemented a new electronic health record. They also increased requirements to see 18 established patients a day in 15-minute slots. Most of her patients are elderly and have multiple medical conditions. Julie does not believe in cutting corners with her patients or students. Conscientious to a fault, she works late into the evening to get her charts done.

The words of her husband on the phone today echo in her ears. “Something’s gotta give, Julie.” She feels powerless to change the system—or herself.

Julie’s nurse knocks on her office door. “Good morning, Julie. We have a student shadower working with us today. Her name is Anna. She is a junior at Maryland High School. Would you like me to bring her in?”

“Yes. Thank you, Donna.”

Julie sits at her desk. It’s early morning. She looks out the window through the blinds and watches the heavy snow come down. As soon as Donna leaves, she runs her hands through her gray hair and then pulls a chocolate bar from the bottom drawer. She gazes at her medical school diploma, board certifications, and the 3 teaching awards on the walls. She thinks about the long journey to get where she is today.

“Would I do it all over again?” she wonders.

She stares out the window again. Snow blankets the windshield of her Honda and the dogwood trees that line the parking lot. She momentarily feels as fragile as the snow-covered tree branches. She quietly recites the Serenity Prayer before Donna knocks on the door again.

“Anna, meet Dr Julie.”

Julie has a difficult last name to pronounce. Everyone calls her Julie or Dr Julie.

“Nice to meet you, Anna. Please sit down. Did you have any trouble driving in today? It looks nasty out there.”

“The roads are not too bad, thank goodness.”

Not wasting any more time with chitchat, Julie dives deeper.

“Please tell me why you want to shadow me today, Anna.”

Julie waits for the usual answers: My parents thought it was a good idea. My college counselor suggested it. I love math and science. I want to be a doctor.

Anna straightens up in her chair and says, “Dr Julie, both of my parents are internists. They have discouraged me from going into medicine. Early in their careers, they would talk to my sisters and me about the wonderful relationships they built with patients. Not anymore. They believe business has ruined medicine. They plan to retire before they turn 60. I tell them I love literature and medicine. I’m inspired by characters like Dr Rieux in The Plague. I want to see if there is still a place for the humanities in medicine. I want to prove my parents wrong. Friends tell me you are a great teacher, so that’s why I’m here. I know that’s a long answer. Thank you for the opportunity, Dr Julie.”

Julie leans forward in her chair. She herself was an English major in college. Julie sees a younger version of herself in Anna. Confident, mature, and idealistic. Even the oversized tortoise shell glasses and pigtails look familiar.

“You’ve given this a lot of thought. I’m impressed. Let’s go see some patients.”

Anna shadows Julie most of the morning. She also visits the clinic laboratory and radiology suite. In the afternoon, more patients. Ms C is the last patient of the day. “Anna, let me tell you, I love seeing the last patient of the day. I don’t care who it is. Knowing I can take as long as I like with the patient is so satisfying.”

“Ms C, this is Anna. Would it be okay if she joins us today?”

“Yes, of course.”

Anna sits against the wall and listens to Julie take a history. Her computer is in the room, but Julie ignores it until she completes the history. She sits within arm’s length of the patient. Anna watches Julie nod frequently as Ms C tells her story. Ms C has depression. Her diabetes and hypertension are under good control. She lost her husband 4 years ago, and the anniversary of his death is tomorrow. Donna calls Julie away to answer the phone.

“Ms C, would it be okay if Anna continues the conversation with you while I take this call?”

“Yes, that’s fine.”

Anna pulls her chair closer to the examination table where Ms C sits. Ms C is 76 years old. She tells Anna that she feels older than 76 and is ready to join her husband in heaven when God decides the time is right. Anna looks closely at her face and notices the numerous wrinkles, sunspots, and folds of skin around her neck.

“Thank you for the opportunity to talk with you, Ms C. I’m interested in becoming a doctor. I can tell you really like Dr Julie. What do you think makes her a good doctor?”

Ms C pauses, and then says, “Well, I can tell you right now I’ve never met a doctor who listens better than Dr Julie. When you’re in the room with her, you get the impression you are the only patient in the building. Did you see her head nodding while I was talking? Did you hear the ‘uh-huhs’ that prompted me to continue my story? And the way she looked at me with her empathetic eyes, then briefly turned them away when I became tearful? She gets me like no one else does. When you’re a bit older, you’ll understand what I mean. I’ve been her patient for over 15 years. She doesn’t pretend an antidepressant medicine will erase my grief and depression. She is my medicine, if that makes sense.”

Anna watches a few tears run down Ms C’s face and then looks away from her. Julie knocks and enters the examination room. She looks at Ms C and then quickly turns to Anna. “Is everything okay?” she asks.

“Ms C just told me you are her medicine,” says Anna.

Julie rushes over to Ms C and wraps her arms around her, and says, “You are my medicine.”

Julie finishes her examination and steps outside the room with Anna. “I know you need to leave by 5 Pm today, so run along. Drive carefully, and I’ll see you tomorrow.”

Julie carries her computer back to her office to place orders for Ms C’s refills. She looks out the window and smiles as Anna walks across the parking lot. She raises the blinds and gazes at the dogwoods, bending from the weight of the snow but standing strong. The snow has stopped, and the late afternoon sun fills the room with light.

2024