Doctor By Default
Some physicians can’t imagine doing anything else.
I’m the other kind.


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By Richard Donze | “What kind of doctor are you?”

I hear this occasionally, at parties or on the sidelines of kids’ sporting events, after meeting someone who learns I am Dr. Someone. The questioner ostensibly wants to distinguish those who probe body orifices from those who probe atoms, Bible verses, or sonnets—after which the question defaults to, “What’s your specialty?”

At a recent neighborhood get-together someone asked and I answered, “Occupational medicine and hospital executive,” then further specified, “80/20 administration/clinical.”

But lately I’ve come to realize that this sort of pigeonholing glosses over a more basic, even existential, distinction. Some people go into medicine because they simply can’t not be doctors—like the house-calling general practitioner that surgeon Sherwin Nuland later wrote about as his inspiration in How We Die: a larger-than-life healer in a long overcoat and fedora who kindled a palpable sense of calm whenever he carried his magic black bag over the family threshold. Nuland knew he wanted to be able to affect people that way, and people who catch that spirit seem unable to imagine pursuing any other vocation, as though medicine were destiny, no more opposable than falling head-over-heels in love. Even an initial rejection from medical school cannot bend their resolve; in my 30-odd years in the profession I have watched many such men and women apply and reapply, again and again, until some program grants them a chance.

Then there are those who don’t possess the aura that seems to surround those for whom medicine is the one and only path. I know this type even better, because I am one of them—a doctor who backed into the profession, a person who went into medicine thinking, well, why not?

My first life-direction lightning strike came courtesy of the singer-songwriters who started making figurative house calls as I was departing calmer pre-teen waters for the hormonal rapids of adolescence. Sometime between John F. Kennedy’s assassination and the Beatles’ third appearance on The Ed Sullivan Show I lost both my innocence and high voice. I was 12 on that awful Dallas day, and afterwards sensed I wasn’t a kid anymore. Seeing John and Paul seemed to illuminate a path away from childhood.

Decades before me, Nuland had charted a workmanlike course from college to medical school, post-graduate training, and practice. I had a different, less defined, plan: form a band, get a record contract, and then start running away from screaming females. Soon I was repurposing my rudimentary knowledge of chord structure, gained from mostly uninspiring piano lessons, to teach myself guitar. Next, I tossed aside the Schaum series of music-instruction books in favor of figuring out songs by ear in front of the swing-out speakers of a fold-down turntable. Finally, I joined three other school chums (“mates” in Liverpudlian) in a Beatles-wannabe band—as did about 30 other kids in our suburban Philadelphia elementary school, and numberless others around the world.

We performed at fire hall dances and private parties, including our eighth-grade graduation celebration, where the church-basement audience included my recent, current, and future non-screaming girlfriends. When other rockers traded music for high school athletics, dramatics, or forensics, we rocked on at mixers and proms. By the time I got to Penn, in September 1970, complex lyricists and softer sounds were dominating in the singer-songwriter universe, and my concert logbook included James Taylor, Jackson Browne, Joni Mitchell, Stephen Stills, Neil Young, Tim Buckley, and Cat Stevens (the latter two at Irvine Auditorium). Thus inspired, we morphed into a folk-rock college coffeehouse band that drew on our evolving musical chops and undergrad-poetry-class sensibilities to write original material and play at venues such as the Catacombs, in the Christian Association basement at 36th and Locust Walk. Fancying our stuff good, we pooled our teeny gig payouts to rent some studio time and recorded a demo with six ostensibly “original” songs (today mine sound more like deconstructed and reassembled Taylor and Buckley).  

We arranged to meet with a distant cousin who had a recording-industry connection. He was a cellist who didn’t appreciate our product, or the fact that we didn’t rehearse eight hours a day like “serious” classical musicians. Since he was obviously out of his genre, I wanted to hurl Dylan’s lyric back at him—“Don’t criticize what you can’t understand”—but ultimately discouragement trumped anger. We kept writing and playing, but when no contract-toting record company executive materialized, we gradually relegated our musical lives to the peripheral province of hobby-land as college and serious career contemplation occupied the center.

When one dream is fading without a ready replacement, a 20-year-old may grasp anywhere in search of a stabilizing rope. Cue my parents’ subtle lobbying to consider a medical career. Ivy-worthy academic performance predicted capability, and it was inconceivable to them that anyone capable would desire anything else. As American-born children of immigrants who had come through the Great Depression and the War and not been able to attend college themselves, they saw medicine as a vocational pinnacle that leveraged intelligence and altruism into gratification, respectability, and a comfortable living. Whenever a doctor walks into a room, my mother never tired of telling me, “All heads turn.” She wanted me to be a head-turning, can’t-not doctor.

Having a steady girlfriend forced my hand, as I acknowledged that someday marriage would fit better with school and training than cross-country concert touring. I finally chose English as my major but committed to take the medical-school science prerequisites. My adviser, the Milton scholar Jason Rosenblatt (who had recently taught me Paradise Lost), lauded my desire “to do good,” but I got a little dizzy bouncing between Joyce’s epiphanies in one class and Watson and Crick’s double helix in the next. It was physically tiring, too, hustling those five or six blocks from Bennett Hall to Leidy Labs. But I was determined to at least see how far it went. Why not?

Then 39 years passed.

In the can’t-not physician, desire marries ability: the heart drives and the head and body follow, and the marriage between person and profession lasts until death. When a can’t-not doc grudgingly recognizes a physical or mental inability to play the game with the same skill or intensity, he or she will often stay close out of pure affection—as an administrator, free-clinic volunteer, hospital-chart reviewer, or continuing-education-seminar attendee long after licensure mandates compel it.

A why-not physician kind of just falls into doctoring, perhaps pushed by vague intellectual curiosity, or the notion that doing good might feel good, or, as with me, the need to fill the vacuum created when another option evaporates. Ability often marries circumstance, not desire. At some point a path to medicine opens just when the traveler needs to move, so … why not? The head drives and hopes the heart will follow. A long clinical career may derive less from affection than inertia, and a why-not doesn’t typically get dragged kicking and screaming from the clinic. Indeed, he might move to administration or research even when he can still hear through a stethoscope or suture with a steady hand, sticking with medicine as a natural, logical, energy-saving choice.

Desire still exists in a why-not, but it’s less like falling in love with a soul mate than an arranged marriage—a union of convenience built on respect and necessity that, with luck, also leads to love.

This sounds a little dreary, but the good news is that I never really abandoned my dreams. They accompanied me, just transformed in an unexpected way, like secret agents working undercover with the mission to preserve my soul—or those persistent shoots of Queen Anne’s Lace that find or create a crack in the pavement and push, push, push up until a white flower crown unfurls and amazes. What is soul-driven can only be suppressed for so long.

It’s less my literal performances with a fundraiser-circuit medical-staff blues band, and more what happens with patients—those little audiences of one sitting gowned and goose-fleshed on cold exam tables. Effective doctoring requires consistently hitting certain notes. Knowledge. Imagination. Compassion. Humor. Stringing these together into a melody, adding narrative glue and energetic improvisation, I still sing original songs every day.

I can’t not.

Richard Donze C’74 is a hospital administrator and practicing physician in West Chester, PA.

©2011 The Pennsylvania Gazette
Last modified 6/24/11