I cried in the dark auditoriumas Dr. Fauci described how all of his patientsused to die.And now, less than a generation of medicinelater,I prescribe medicines he could only dream of.My patients?We talk about the weather,our weekends, our families.I shake their hands.I’ll see them again soon.

Dear Student,I can show you the way, even holdyour hand at first.I am, however, eventually going to let go. We came together because of my class.But look beyond that topic, learn to be curious, learn to teach yourself, learn to think clearly, and learn to write so others canfollow you.

Beep… boop… continuous…Patient life in ICU…Hope for improvement. Beep.. boop… continuous…Doctor life in ICU…Doing my job… check. Boop.. booop… boooop…. booooop…..beeeeeeeeeep……….Patient death in ICU…Your suffering gone. Boop.. booop… boooop…. booooop…..beeeeeeeeeep……….Patient death in ICU…My despair begins. Within my control?Feeling burned out… hopelessness?My ICU life? …

Room by room, they ask, “How am I doin’doc?” They mean, “Please, don’t let me goblind.” I reply, “Everything looks good.” I mean,“I’ll do my best.” Room by room, they gift metrust. Room by room, that gift transforms intoweight in a reverse metamorphosis – butterflyback to caterpillar, hope into burden.

The baby had sparkling eyes and a captivating smile, even around his endotracheal tube. He traded one tube for another (tracheotomy), but would not let go of his ventilator. Not for 15 years. He taught so many those 15 years, without ever speaking a word. He is still teaching, in the book we wrote together.

My sister calls two days before Christmas,“Our brother is gone… he died by suicide.” Twenty-four years old,A graduate student.He had missed the deadline to submit his thesis. First day of class,I look into the eyes of the graduate students I teach,Twenty-four years old. And I pray they know their worth.

When I was seven, I saw a genetic code table in a reference book. Must be a magic spell, I thought, as I looked at the columns of the mysterious “Phe,” “Leu,” “TTT,” and “TCT.” I whispered it, line by line, waiting for some powerful magic to manifest. And it did. It filled my world.

Late at clinic stilltyping, typingI am struck with hunger pangsmy lunch long goneI search the breakroom fridge.So much salad dressing, coffee creamers,not much sustenance,I push those other containers aside.At the back,luminescent in its green saline solution1 solitary pickle.Alien like,long past expired,all mine.

A phone call came to the clerkship director.A student wasn’t meeting expectations. The director met with a surprised student.The student asked:Why wasn’t I given the feedback directly?How can I improve without constructivefeedback? The director did not have these answers,But the attending did. Have courage to give honest, constructivefeedback.

She loved her unborn daughter so deeply that they chose to forego NICU admission and spare her the pain caused by “intensive care” which would not necessarily save her life. She was in labor. Unknown to all, her uterus ruptured… her daughter died, she arrested, CPR, ECMO. She survived, changed. She loved her children most.

Mother comes in with son. 27 years old, his brief prior dalliance with temptation became life-consuming addiction. Mothers never quit on children. They still see the gleaming vessel of hope that is no longer visible to others. Long ago, she sweated the same parenting decisions I do now. Selfishly, makes me scared for my own.

It is dark out now and it will probably be darkwhen we are done. Many days I won’t see anynatural light this winter. There are usually nowindows in the operating room. Despite this, Iwill come back again every day to keep watch,so that tomorrow you can see the sun again.

“You mean to tell me,” she shouts through the video monitor, “that after only two visits, you have diagnosed ADHD as the cause of my struggles, when I’ve spent years in therapy and doctors’ appointments, without relief?”The delay, explained by treatment of significant depression and anxiety, offers little solace for her years of suffering.

Halfway through a busy clinic day, illness overtook me. Apologizing, I rescheduled patients and sought care, feeling I had failed as a doctor and teacher. The next day, my medical student emailed: “You taught me doctors are human. You modeled self-care.” Her words transformed guilt into grace. In my weakness, I had given her strength.

My oath to first, do no harm,Was slipping away.Political rhetoric and expediencyCrept into more of what I did.Within arms’ length of patients imprisoned,My professional identity was reborn.Life lost too soon from a kidney stone,A leg and an eye ravaged by diabetes,A hug after talking about end-of-life wishes.

In my dreams again:the cachectic boy amongst menwith his copy of Catch-22His wife had taped an errant flagto his drip-stand, over the TPN baga newspaper photograph of moules marinières“Eat, drink, and make merry…” I said.Then blushed at my stupidity: the nearly dead.He smiled again: “Yes… exactly that.”

Anxious patient. Slow.Long case flows.Difficult tumor–What is too much? Too morbid?“We trust you” … to go slow.Decisions made. No going back.The mind is done. It rushes. Repeating, reflecting, replaying.Home again. Be present. Go slow.Sudden thoughts of tomorrow. Mind rushes.Sleep—the battle won between ebb and flow.

Pancreatectomy. Splenectomy.Cholecystectomy. Bowel resections. Her post-surgery support group has slowly shrunk from twelve to three over the years. She needs another surgery due to adhesions from her prior surgery. Is she next? Snow falls over the construction outside. We can hardly see the mud. “I just wish I could start all over,” she cries.

You were kind and direct, so you looked shocked when I stepped quickly to the bedside, took my father’s hand, and told you, “NO.” I could hear what you could not: he was only agreeing politely, not understanding that his “yes” meant consent. This is collaboration, not correction. You know how, but I know him.

Bruises, everywhere.On his legs, petechiae splatter like tiny red droplets.Below ribs, we palpate edges of liver and spleen.In his mouth, gums peel ever so slightly away from teeth—pooled blood glistens, reflecting our light. You glance at me.There is no teacher. No student.Only a shared understanding of what comes next.

Jeff sat in his office, charting on his “patients seen.” As he clicked, a fear gnawed at him: Could AI replace me? He remembered the spark in her students’ eyes when they learned. Teaching was about connection, not just content. Determined, he resolved to embrace technology as a tool, not a threat. – Written with …

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