Kokomo...

Late at night, lying in a single bed and listening to frogs chirping outside your window, you might start to relax. You can feel your sunburn radiating into the cool cotton sheets. Aching muscles remind you that you chased a pack, or flock, or rumble?... of goslings around the lake in the canoe. You stretch out, settling into a deep and untroubled sleep. Big picture happiness.

Medicine is a permanent hierarchy. Regardless of how far you've come, you will always be looking up to someone, looking down on someone else.

Friends of mine have mocked my choices; Australia, family medicine, the non-academic path. These same friends come to me now with sunken eyes and pale complexions. They need to know that their sacrifice is worth it, so they try to convince me they're having more fun than me. They talk about the work they're doing; seeing interesting cases, learning interesting medicine.

Their girlfriends ask me, "How can I get him to do what you're doing? I never see him". The answer is easy, but very hard for those who need the hierarchy to maintain their sense of self.

In family medicine, the work is not glamorous. You see the same patients. You say the same things over and over again.
- It's a virus, you don't need antibiotics.
- It's gonorrhea, you need antibiotics.
- You have got to start eating right and exercising.
- You have got to lose some weight.

Your patients will tell you you're stupid. They will counter your every suggestion with WebMD printouts. They will book an appointment to have you fill out their tax exemption forms, then shout at you when their application is denied. They will threaten to sue you whenever they're unhappy, and ignore you when you do things right. You have to be able to let go of your ego and try to see the big picture.

My big picture involves working reasonable hours for reasonable money. I need to feel that I've made a positive difference in at least one person's life every day. I need time to exercise, to cook (a political action now, according to Michael Pollan) and to wrap myself around my giant man. I need time to read for pleasure. I need time for Pender.

Family Medicine gives you big picture happiness. Emergency medicine will be icing (or gravy) on top. I used to feel defensive when I talked to my Internal Medicine colleagues. Now I look at them with sympathy and say, "When you're ready to let go, come find me".