Training is crucial in medicine, as in boxing, to ensure you can absorb the body block, and go back out again.
I done wrestled with an alligator, I done tussled with a whale. Only last week I murdered a rock, injured a stone, hospitalized a brick. I’m so mean I make medicine sick.
–Muhammad Ali, 1974
Doctors are like boxers. Training is crucial. You must learn everything there is to know about Sonny Liston, renal insufficiency, George Foreman, hepatocellular carcinoma. Learn how they strike, study their vulnerabilities, try and knock them out. But you must also understand that when you finally put on your gloves-red or latex-a jab is coming that you just didn’t anticipate, and you’re going to get punched right in the gut, and your eyes are going to tear.
In 1974, in the African country then known as Zaire, Muhammad Ali was set to box George Foreman in the fight called the “rumble in the jungle.” The odds were in Foreman’s favor-he was the world heavyweight champion, younger than Ali, physically menacing, and known for his powerhouse punch. Through 7 rounds, Foreman wailed on Ali. He pinned Ali into the ropes and ceaselessly punched his body. It was only the occasional quick jab to the face that Ali could throw, until in rolled the 8th round. By this point, puffy faced Foreman was so drained from his constant powerhouse punching that Ali saw his opportunity, stepped in, and rapidly knocked Foreman to the ground to finish the fight and regain the heavyweight title. This strategy of Ali’s became known as the “rope-a-dope” and has been emulated more than once in the boxing world, and its scope extends beyond the world of boxing. As a third year medical student during my first clinical rotation, I adopted this tactic quickly.
I started counting-one, two, three. The patient’s wife speaks only Mandarin, but none of us do. As she waits in anguish for her son to translate our words regarding the critical condition of her husband, all she can do is interpret our expressions. This makes masking emotions harder. I cannot let tears fog my clarity. We firmly believe what is being said. Her husband is going to die, and there is no longer anything we can offer him other than comfort as he passes.
He was a kind man, a gentle father and husband, and a young victim of liver cancer. When we transition to morphine, we do not know how long he will survive, but it will not be long.
Four, five, six. I feel as though I’ve been socked in the stomach and it has welled up in my throat, and I recall the medical term globus hystericus. It is said a medical student learns 10,000 new words during his or her first year of training. I’m in my third year now, but my collection of medical jargon does not help me here. Instead, by counting, I resort to some of the first words I ever learned.
Counting keeps me calm, keeps me focused, keeps me supportive. Our role is as health practitioners to this family. They look to us for the reasoning behind an unimaginably difficult decision. If I waver, they waver. As much as I wish to hold their hands and squeeze in understanding of their agony, I know I do not understand. I have not been around when their husband and father was healthy. I do not know the man they know. I must balance stoic certainty with sympathy.
Seven, eight, nine. When asked how many push-ups he can do, Muhammad Ali replied that he doesn’t know because he only starts counting once it starts hurting. Ten, eleven, twelve . . .
The patient died within an hour. I stood by as about 10 members of his family sobbed for their loved one. His widowed wife sat slumped in a chair, lost in shock and tears and disbelief. Nothing prepares a medical student for a moment like this. A patient’s death is an inevitable part of medicine, and an experience we anticipate with dread. The most I could do for the family was provide my sincerest condolences and retreat before I lost my composure. When you step through the ropes and into the hospital ring, you have to take those punches and keep standing, trying to dodge the next one.
In medicine as in boxing, you get to take a few swings of your own. Physicians observe humanity displayed with a candor and intimacy granted to only a few. While moments are at times heart-wrenching, and at times uplifting, together they represent the human condition in its most unadulterated form. Doctors have the opportunity to discover what we as mankind are capable of, and what we as individuals treasure. We watch our patients struggle with news of death and triumph with regained hope. Throughout these bouts, we learn what to value in life and what cannot be taken for granted. Although at times we may need to wipe away blood and tears, through the process we become better physicians and ultimately, better people. These are the victories that we can attain in our ring.
In fact, more often than not, doctors are the ones throwing the knockout punches. All it requires is stepping into the ring each day and being prepared for anything. Take the punches and keep on swinging, trying to make it through one more set of rounds. Medicine is not an easy career-it is physically and emotionally draining. But, in the midst of our rumble in the jungle, the 8th round is always waiting-it just requires a little perseverance.