To my Impending Successors,

I am writing this to inform to you of the scope of your duties after you earn your doctorates—but not of the standard duties of pain and procedures that you have heard a million times by now; there is no use in reciting those again. However, I have worked in this profession for twenty-seven years, and I can tell you that there is a deeper layer of complexity to this job that you simply will not learn in a classroom. It is my job to pass this knowledge down to you, so that I may live the rest of my life in peace after I retire today.

A year from now, when you walk into your little offices where your first patients are waiting for you, if you must remember anything, and if I have to teach you one aspect about this profession, it is this: you are the patient. You are the only patient that matters. A doctor is nothing more than a title given by those certified to award it. A year from now, when you yank out your fancy stethoscopes and check little Jimmy’s heart rate, it is not him who is under diagnosis; it is you. You are not doctors, though out of dear respect, I will call you that. The doctorate is merely an illusion.
In my years of service, I have heard the same assertion claimed by my various patients, every day. “Doctor, I seem to have a mysterious lump growing on my back.” “Doctor, my sides have been terribly achy for the past few weeks.” “Doctor, I think something is wrong with me.” Now, the fluentness and diction with which this message is delivered may adjust appropriately with the patient. Be that as it may, the message never changes. And consequently, my answer never varies. “Well, Mr. Sampson, I’ll have to take a look at that lump.” “Do your sides hurt only when you stand, or do they always hurt?” “I can assign a prescription, Mr. Johnson, but I’ll have to direct you to a surgeon if you want to resolve this problem for good.” Either way, the look of despair among their faces never vanishes.
The sick and ill will look to you and they will ask you if you can help them, if you can fix them, if you even know what the problem is. And you will say no, I’m sorry, I can’t make that determination; I don’t have the qualifications. And you will be truthful, as truthful as any innocent man can be, but it won’t matter, because they won’t believe you, and you won’t feel innocent. And they will ask you, in a different, less insistent manner, the same question. But what they are really saying is this: “Please lie to me.” Now tell me you have learned this in a classroom.
You may lie to them. You may not. You might say something along the lines of, “Well, my guess is that your condition isn’t fatal,” or, “Just stick with the prescription for a couple months, and your rash should disappear,” and they will retain their looks of doubt either way. But you will feel sedated, at least until the next patient arrives, and then the process shall repeat itself. I must reiterate it, dear friends: you are the patients.
It is a widespread epidemic, undoubtedly, one in which a cure simply does not exist. But we can dull the senses and numb the mind. Up until now, it has seemed as if I have nothing but relatively bad news to share with you. But I can now lighten the mood. When your patients ask you for your help, simply do the opposite of what your instinct might suggest. Say, “it might be cancerous, Mrs. Sanders.” “This could be more serious than strep throat.” Articulate it however you want. But always remember to fit in the most essential assertion: “Unfortunately, Mr. Adams, your medical plan will not cover the type of treatment you need.” Follow of course with, “However, I can recommend…” and the rest doesn’t matter. You see, in my years of service, I have picked up on a number of patterns that exist in this profession. Three, in particular, stand out.
The first one is this: the poor folks are always the people who need the most help. And this makes sense: perhaps they don’t have the greatest hygiene available, or they live in an unnaturally unhealthy environment. My favorite people are the ones who can barely scrape by on house rent, yet have the extra cash to smoke cigarettes and destroy their lungs.
The second pattern is this: as a condition worsens, the more reluctant a person becomes to visit a doctor. Nobody likes bad news, after all. And you may think this will cause people who are relatively healthy to visit the doctor more often; but actually the opposite takes place. If people believe they aren’t in need of a checkup, they won’t get one, but if they believe their condition is serious, they will wait until it develops and becomes lethal before they visit a doctor. The system is quite backwards, really.
The final pattern I have noticed is this: most people have medical plans which won’t cover the most urgent treatment they need. This, of course, is a direct result of the other two patterns. Those in the lower class cannot afford great medical plans, and thus will become more hesitant about seeking treatment for their illnesses.
This is more of a profession of the human mind than it is of human health. Think of it as a giant cobra, squeezing its prey lifeless until the last possible second, as the prey finally gains the nerve to fight back, only to realize that it is too late. You see, every life is a death sentence, for you, for me, for the cobra and the prey. There is nothing left to say, then. The truth should not be hidden, even if we must lie to show it. If we tell people that their time is coming to an end, in the midst of the moment it may be a lie, but one day it will be truth. Everyone dies. This is the one diagnosis that matters, and the only one that needs to be stated. All else is a variation. All else is false.
In the years ahead, you will understand me more completely than you do now, but I hope today I have opened your eyes to the world of doctors—a world of false identities and false promises. Only two entities exist here: the message and the patient. If you don’t believe me, you may write to me, but do it quickly. Tomorrow I may be dead.
Best of luck,
Doctor Lennie Ingram Erwin