I don’t know why I worry so much about things that haven’t happened yet, and aren’t going to happen any time soon. It’s not like I can do anything now to mitigate whatever will happen.

The interesting thing about medical training is the emphasis on the teaching aspect. I mean, most of medicine (at least if you’re not a surgeon) is about teaching—educating people about their diagnoses, about possible treatment plans, about the natural course of their condition, about what things to expect, what things to be concerned about, what things they need to call about, or head to the emergency department for. In peds most of all, a lot of the teaching is about what is normal, what not to worry about. This is no surprise. After all, the word “doctor” is simply Latin for “teacher.”

The more immediate aspect is the fact that I will have my first real supervisory month in a little more than a week. I’m not worried about not knowing my medical knowledge, about looking like an idiot in front of my interns and medical students. I’m humble enough to know that the sum of my ignorance far exceeds the sum of my knowledge. What I worry about is that I don’t want to infect them with my pervasive sense of cynicism. It’s one thing if they’re already cynical (which would not be all that surprising since it is the end of the academic year), but as much as I sometimes detest optimists and their naivete, I don’t want to be the one to tear their world down. If they’re still bright-eyed and bushy-tailed, who am I to put a monkey-wrench in their universe?

Still, I suppose it is much like dealing with patients. Especially when the diagnosis is something awful like metastatic cancer, or anoxic brain injury, where the prognosis is hopeless. Sometimes you have the unenviable role of forcing them (or their loved ones) to face reality.

I have been perhaps lucky in that all my patients and their loved ones in such dire straits thus far have been extraordinarily brave. As the end comes closer, I’ve found that people become more sober and realistic. I have never sensed any opposition when the question finally came down to actually pulling the plug. There is always wailing and gnashing of teeth, but, as has been said, not all tears are an evil.

So if I’m cynical, then so be it. Seeing death too many times forces one to adapt extreme forms of coping, and ultimately, you’ve got to protect yourself. Because if you can’t take care of yourself, how can you take care of other people?

In retrospect, I think of one of my favorite residents, who is also one of my heroes, and she is equal parts hardened cynicism and daring hope. If she were simply just cynical, there is no way she would want to perform the extraordinary life-saving measures that she excels at. But if she were just naievely hopeful, there is no way she could survive the onslaught of tragedy that is part and parcel of dealing with the very sick. I’m really glad that I got to work with her. She taught me a lot about being a good doctor, and hopefully I can manage to be at least a tenth as good as she is.

Times like this, I’m tempted to echo Charles Barkley and say that I’m no role model. But these things are rarely choices. For the most part, they get foisted on you. Now that I think about it, I’ve been a role model from the start, as unwitting as I was. This is the plain consequence of being the eldest child. I like to hope that I’ve been a decent older brother to my sibs. And I know that for better or for worse, at least during their childhood, they’ve used me as some kind of measuring stick (undoubtedly leading to all sorts of psychological trauma.) I hope that I’ve been more forgiving than my mother, who is a woman who is impossible to please and who needs to always be in control, even of things that no sane human being could be in control of. I hope that I’ve been more engaged than my father, who has such a devil-may-care attitude to life, and who often comes across very convincingly as someone who doesn’t gives a rat’s ass.

Despite my rather unflattering portrayal of my parents, from wisdom obtained from distance and from trying to carve my own niche in this world, I have grown to truly love them for who they are, in a manner more closely approximating parity (I say approximating, because they will always and forever be my parents.) I’m not saying that I’m a successfully independent human being, but what I do know is that it’s been a long time since they’ve been able to successfully protect me from the trials and tribulations of the world, and well into my childhood, they would actually sometimes look to me to make important decisions and to provide needed knowledge to situations. Maybe it’s just the archetypal role of the eldest child of immigrant parents. I even wrote this in my personal statement when I was applying for medical school: in many ways, I’ve felt like I’ve been a conduit, a bridge, a mediator, forever translating different weltanschaungs to try to get people into agreement. That’s frequently the role of the primary care physician as well: to get the patients to understand all the medical gobbledygook handed to them by specialists, and to get the specialists to understand the idiosyncracies of your patients, because you will the one who knows them best. I am but a messenger, a mountebank. So be it.

But I ramble endlessly on and on.