I have called for a meeting with my manager and the head of the hospital to resign from the top of my academic perch.  It’s set to begin in ten minutes.  I can feel my heart racing and I take a moment to pause.  I wonder if my deceased mother would argue, “You’re throwing it all away?”  I wonder if I’m directionless.  I’ve spent months dissecting and years rehearsing this very moment.  I tilt my head back and reflect on the journey that brought me here.

I parrot him:  lifting the knee to make contact with the jangling metal sensor, warm water spouting from the tap, flowing over my unsure hands.  A renowned surgeon in his mid 50’s, Dr. Kapps is roughly my same height, but it feels like he towers over me.  He oozes confidence.  His surgical cap is crisply folded above his forehead, tightly fitted above clear, plastic framed glasses.  He nods at me, his surgical mask covering a prominent nose and dark brown stubble.  “Zo, open the Povidone Iodine and let’s get moving,” he matter-of-factly charges.  I watch him tear open the cleansing solution package, squeezing the scrub sponge, as the dark brown liquid flows over his busy hands.  In a rhythmic motion—almost ritual in cadence and familiarity to him—he squeezes and releases the brush as he firmly sweeps up and down his sinewy forearms, back down to his hands, around his fingers, an ephemeral dark brown coating quickly rinsed away.  I clumsily adopt the ritual, trying not to be obvious in watching him.  He pushes the Regional hospital operating room #17 doors open with his back, his hands appearing to be locked in prayer—palms facing his chest—avoiding touching anything as he enters the bright room.  Mechanical beeps and pings fade as the door automatically shuts behind him.  I focus on rinsing off the iodine residue, a slight guilt upon noticing portions of my forearms that were never discolored.  I clumsily knock the metal sensor a couple of times until the water turns off and copy Dr. Kapps’s entrance into the operating room.

The operating room theater is bright, loud, and has a distinctive septic scent.  I flatten my hands against one another, invoking their status as “sterile.”  Dr. Kapps stares at the 5-year-old boy’s abdomen, a mosaic of pink and hot white lights from two overhead surgical lamps.  The anesthesiologist placidly reclines on a thick black-cushioned medical stool checkered with small regions of orange foam peaking through the cracks.  I note, “This is, after all, the Regional hospital,” and wonder why this esteemed surgeon does not perform pediatric surgery at the main University hospital.  I’ve certainly read and heard enough about him.  He begins the operation and, as if in answer to my silent inquiry—his eyes never lifting from the incision and following his mechanical hands—my private session has begun.  “Urachal cyst,” he gently intones to the opened pelvis.  “You’ll have time to learn about that.  But, seeing as this is your first day in the surgical theater, I’m going to give a more important lesson.  Jennifer, please turn on my music.”  The operating room attendant hurriedly presses play on the worn CD player and the slow, soft rhythm of a strummed guitar awakens memories of a callback story song.  “On a warm summer’s evening, on a train bound for nowhere,” the crepe paper voice intones, “I met up with the gambler.  We were both too tired to sleep.”  The soft melody and light timbre carries me to the emergency room six years earlier where my grandfather is dying.  I squeeze his once-powerful–and now virtually lifeless–hand so hard that it becomes paler in mine as I listen to his breath fluctuate, layered sounds of hurried voices, medical devices, and cries.  I ineptly pray that some of my life energy can transfer into him.  Shortly before he passes I secretly promise to become a physician and start the pre-medical curriculum when I return to college.

Dr. Kapps gently bobs his head as the multiple instruments make their entry.  “He said, ‘Son, I’ve made a life out of readin’ people’s faces,’” the song picks up as the assured crooning voice becomes the creak of an old mattress.  I’m sitting in Jenn’s white Ford Explorer with the beige cloth seats one year prior to applying to medical school.  Mentally tracing through the window the peeling yellow and green paint on the old fraternity house, I casually share with her my nonchalance about applying to medical school.  Alarmed, she asks if I’ve carefully thought it through.  “Zo, this isn’t another award or achievement.  We’re talking about your professional career.”  The surgery is going well, and Dr. Kapps drains the infected cyst followed by a second excision.  He nostalgically whispers along, “And the night got deathly quiet, and his face lost all expression,” and for the first time lifts his head to stare at me.  “This is the part to never forget.  In medicine.  In life.  Never forget these lyrics,” he quietly and casually laughs, and I remember my first night in Nashville, the evening before medical school.  I just turned 24 years old.  Lonely, I lie down on the floor and cry, staring up at the off-white popcorn ceiling, the chemical smell of new paint along the walls filling my lungs.  In time, I will tape pictures of friends and artists to those walls, quotes, and expressions.  I’ll tape excerpts from the 2002 commencement address from my alma mater, a notable scientist charging the graduates to follow their hearts.

“You’ve got to know when to hold ’em, know when to fold ’em.” 

After five years of making friends, I am so very desperate to return home.  I’ve spent so much time alone in libraries.  Eating at large dining halls just to use silverware somebody else had touched; attending movies alone so I could join in others’ laughter.  I graduate from business school and remark how much more “at ease” I feel than in medical school.  I also feel out of place.  Like I don’t truly belong in either.  However, I’m coming home which is all that matters.  I work so hard during internship and love the camaraderie and challenge of taking care of others.  But I barely see my family or friends.  They’re all getting older and I feel like I’m missing out.  A year later, at my graduation, the program director publicly calls me Superman and asks me to reconsider leaving internal medicine for my specialty.  During residency, I meet wonderful people but, early on, realize I want to do so much more.  I’m stuck memorizing minutiae for boards exams that will consume much of my time.  Studying, alone again, in private study rooms, full texts marked with yellow and pink highlighter, ripped-out papers, and colored pencils spread across the long, shiny black table.  Does it ever end?

“Know when to walk away, and know when to run.”

My first academic job involves working hard and “playing the game.”  To care for others.  To attend to their needs.  To pour myself into trying as hard as possible to better their odds of cure, comfort, and health means everything to me.  The heartache wears on me.  The moments of frustration and sadness sometimes loom larger than the solitary moments of savoring a miraculous outcome.  I try to befriend my patients and make myself more human, and more approachable.  I try to peel away time for myself- for my family and friends.  It becomes so difficult.  My mind is always in the clinic.  My second full-time job fills me with passion.  And, at times, with loneliness.  Should I be doing something else?  Where has this path taken me?  How can I find other outlets for creative expression?  During COVID, my mother is put on a ventilator—my last words to her sharing my deep love and appreciation for her—and, shortly thereafter, I interview for a position, my mind wandering to an intensive care unit I will never see, a machine breathing for her as I meekly answer the interviewers’ questions.  Before I hear back, she passes and my father becomes critically ill.  I walk to work so I won’t get sick.  I must take care of those I love and of myself before I truly can care for others.  But where is the time?

“You never count your money, When you’re sittin’ at the table”

And then it happens.  I ascend to the highest spot in an academic hospital environment.  A coveted Chair position at the age of 42.  And, with it, the full extent of frustrations with hospital bureaucracy, and middle management.  I lament that I am “cursed to have such ambition.”  But it is not for naught.  I form close friendships and working relationships.  I truly love my patients.  They text me to let me know how much I mean in their lives.  I conduct research and start peering at a world outside of pure clinical care.  I reflect on Dr. Kapps’ charge over twenty years prior.  Time goes by so quickly.  I write myself notes to have courage; to find the heart to make a big jump.  To look around.  When students look to me for advice, I remind them that they must be happy and ask them to think over their choices in the near and long-term.  I must remind them of that eccentric southern surgeon.  I apply for a job in industry and am elated that there appears to be a good match.  Before resigning my academic hospital job, I take a moment to reflect on the moment.  “The jump” feels less perilous with perspective guiding me.  I can hear the song get louder with a quicker beat progression as the chorus concludes, “There’ll be time enough for countin’ when the dealin’s done.”  Standing, I sing the entire chorus aloud in my office as a short, middle-aged soft-faced hospital employee walks by, and I hear her rhetorically chuckle, “I love that song!  I used to listen to it in college.”  It’s time to resign and take a big new step.