If we were to try to establish the ultimate, pie-in-the-sky goal of medicine as a profession, it would have to be to drive itself out of business, to become unnecessary. Ideally, people should not get sick, should not have accidents, and should not need any of the interventions that doctors provide. Recorded human history, and undoubtedly human history before that, says otherwise. We get sick, we get hurt, and some of us don’t like the way we look. We have genetic accidents, acts of nature, acts of human violence, environmental assaults on our person, the ravages of time, and, even today, global pandemics. It is a wonder that any of us make it to middle age and beyond largely unscathed. Even so, in the end we all die, so our reprieve is temporary.

I had nothing to do with today’s patient’s medical history. His family history of diabetes. His poor control. His kidney’s failure due to the ravages of the disease. His terrible circulation, which has already cost him multiple digits. I am, however, in a unique position to help him.

Once I decided to become a doctor, a decision that was not the least based on future financial remuneration, but, rather, on my lifelong interest in biology and people, further incentivized by my mother’s stories of my maternal grandfather, a physician in Brazil, this put me on a path. The path involved years of intense study, first to secure a place in medical school and then to graduate four years later. From there, I spent five long years learning the art and science of surgery from multiple older surgeons until, finally, settling on plastic surgery. This cost me an additional  two years of the most intense and stressful training I have ever undertaken. I sometimes look back in wonder that I made it through. All of this was for the privilege of being competent to go in this morning and help out a stranger by removing his painful, infected, gangrenous finger.

Will I charge for the privilege? Sure. I will bill the insurance company and accept what they pay. If he had no money or insurance, this would not change a thing, however. I would still do the surgery and expect to eventually write off the bill, as I and most of my colleagues do on an almost daily basis. I know I will not starve and that my wife and family will not go without. The satisfaction of the surgery is not in the reimbursement; it is in knowing that I can uniquely offer something that most others cannot. I did not find surgery until I was near the end of the third year of medical school. I was almost in despair because I did not like any of the medical areas where I had rotated earlier, not internal medicine, pediatrics, anesthesia, orthopedics, psychiatry, radiology, emergency medicine, or obstetrics/gynecology. Then I was exposed to surgery and discovered my life’s calling. It was an “ah ha!” moment to be sure.

Yes, I am happy doing this. I am happy that I am able to do this. I am a plastic surgeon. It is what I do. I know I will regret when I am no longer physically able to operate. So, for now, I must enjoy it, weird as that may be.