"Meaning is an antecedent of commitment, and the original meaning of our work is service. Service is not a relationship between an expert and a problem; it is a human relationship, a work of the heart and the soul. Restoring a sense of service to the practice of medicine will lead us to re-examine the process by which we become physicians. Our current training furthers our expertise but not our wholeness. We are trained to value objectivity. We are taught to view a genuine human connection as unprofessional. But we cannot serve or find meaning at a distance. Learning to serve requires education, not training. The root word of education, educari, means to lead forth the innate wholeness of each student. Medical training often wounds and diminishes us. Restoring a sense of service in our students will require a fundamental educational reform.
"As professionals, we may not be fully connected to our lives. Distance may become a daily habit. In reality, most physicians lead far more meaningful lives that they realize. Proust said, 'The voyage of discovery lies not in seeking new vistas, but in having new eyes.' Finding meaning will require us to see the familiar in new ways.
"Harry, an emergency physician, tells the story about a woman who was brought into his emergency department about to give birth. As soon as he examined her, he realized that unless her obstetrician was already on the way, he was going to get to deliver this baby himself. He had barely finished his examination when the head crowned, and, with nurses on either side of him holding the mother's legs on their shoulders, Harry delivered the little girl.
"She was breathing spontaneously, and he felt a familiar sense of satisfaction at his own competence. He laid her along his left forearm with the back of her head in his left hand and began to suction her nose and mouth. Suddenly, the infant opened her eyes and looked directly at him. In that instant, Harry realized that he was the first human being this baby girl had ever seen. Deeply moved, he felt his heart go out to her in welcome from all people everywhere, and for a moment he had tears in his eyes.
"All this surprised him. Harry has delivered many babies and has always enjoyed the excitement of making rapid decisions and testing his skills. But he had never before let himself experience the meaning of what he was doing or let himself know what he was serving with his expertise. He feels changed by this moment. In that flash of recognition, he felt years of cynicism and fatigue fall away and remembered why he had chosen this work in the first place. As he put it, 'It all suddenly seemed worth it.'
"Meaning is a human need. It strengthens us, not by numbing our pain or distracting us from our problems or even by comforting us. It heals us by reminding us of our integrity, who we are, and what we stand for. It offers us a place from which to meet the challenges of life. Part of our responsibility as professionals is to fight for our sense of meaning — against fatigue and numbness, overwork, and unreasonable expectations — to find ways to strengthen it in ourselves and in each other. We will need to rebuild the medicine system, not just on sound science or sound economics but on the integrity of our commitment. It has become vital to remember the essential nature of this work and renew our sense of calling to preserve the meaning of the work for ourselves and for those who will follow."
