The Level One Commitment

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I’m writing this article inside a tent. Lying on my thinning mattress pad, I can occasionally feel a refreshingly cool and crisp mountain breeze seep in through my partially unzipped front door. From here I can just see the top of the mountain that is tomorrow’s goal. It’s quiet out; I feel content and at home. Times like this one make me wonder why I chose to spend eight to 10 years beyond a college degree, education consuming all of my time, while chasing a somewhat distant and intangible goal. I could have chosen to do anything with that time — anything that brings me contentment.

I have many friends who chose to complete their education with college or high school. Most of them are relatively successful in their fields, living respectable lives, and have considerably more time off than I do. It’s easy to feel envious, as I seem to nearly always find myself not lost among the immensity of a picturesque outdoor scene, but as just another scrub-clad dot quadrated within the four square blocks or so that make up our medical campus. The walls are usually some tinge of off-white, and they will never compare to a clear blue sky and the peaceful feeling of being immersed in the great outdoors. And yet, we all chose the walls, we all come back to them… because we love it.

Some things are more important than ourselves and our own pleasures. Ask just about any new parent, and they can expound on the unexpected joys they find in their children, despite the persistent demands on their time. There is indeed a special bond created between us and those who depend upon us.

Recently I found myself wandering the streets of Denver on foot, biding my time before catching a redeye flight back home. I was appreciating the experience that is the Mile High City, and I semi-intentionally found myself at the main entrance to the well-known Denver Health medical facility. I watched as an indigent man crossed the street, bandages trailing from his hand as he strolled towards the bus stop. A woman with one crutch hobbled in toward the clinics, a large bag slung over her shoulder. A sign out front read, “Denver Health, Level One Care for All.”

That phrase struck me, reaffirming a sometimes forgotten tenet of medicine. It was more than a reference to a trauma center designation. It was a realization why we forgo many of our other goals and aspirations. We give up personal goals, the time at home, and small pleasures because we are called to something much more than serving ourselves: serving others. That fact may be perhaps even truer in our field than in just about any other.

Long gone are the days of the old-fashioned country doctor. The weathered black bags have been traded in for computer processors and the Internet. No longer do we go to the sick, but let the suffering come to us – we don’t make house calls, we work shifts. Despite the good that has come from modern advances in practice, there is still a special spirit that accompanies the Norman Rockwell style of physician. They represent a certain purity of action and a unified medical community driven by compassion. In the name of practicality, these days we sit in large comfortable chairs and await the next patient who comes to us. Doctors are now better recognized for their TV shows, news appearances, or worse, their practice missteps and ethical controversies. That old-time sense of caring can easily become diluted and disappear. Within our  departments it happens all the time. Sometimes veiled under the guise of efficiency, it can be easy to brush aside what are perceived as undesirable complaints. It becomes so important to remind ourselves of what our calling is. We need to remember this mandate of “Level One Care for All.” It is our duty, right, and privilege to give our all as often as we can to help our neighbor.

And that’s what our profession is all about – that’s why we give up our personal interests. Our specialty, indeed all of medicine, is devoted to providing the best level of care to all, whether that be here in the resource-rich United States, or globally in the most austere and remote villages. We as physicians stand together for those in need. We’re here to give of ourselves and to put our personal lives on the back burner for their benefit. There is an old-time doctor inside every one of us, and that’s how it always should be.

Nathaniel Mann, MD

Nathaniel Mann, MD

Nathaniel Mann, MD is a resident at the University of Cincinnati and was elected to the EMRA Board of Directors in 2013 to serve as Editor-in-Chief of EM Resident Magazine.
Nathaniel Mann, MD

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