The Ugly Side of Being a Doctor


I said something last week to a blogger friend. I was quick and brief and thought it was helpful. Well a caring friend of hers felt I was too harsh. She says:

I went over to visit Dr. Cason’s site and while I see a ton of information informing parents how to be a good, normal parent, I fail to see the part where she addresses anything that even comes close to what so many of us live with everyday.


It’s true. I try to be light. Life a bummer and sick kids are tough. I don’t dwell. But here’s the thing. I never forget. It might seem like I do, so I’ll let you know what I ruminate over in the quiet of the night.

Here’s the ugly side of being a doctor. The side I don’t talk about.

Warning some not so positive stuff about to unfold.

  1. I never wanted to be a doctor.
  2. I wanted to be a writer.
  3. But here I am.
  4. The buck stops with me.
  5. I’m in a war zone here.
  6. I’m not in the war.
  7. I just watch it.
  8. And try to stop it.
  9. There too many dead children on my mind and in my heart.
  10. You can delude yourself into thinking you are helping someone.
  11. That what you do actually matters.
  12. But the truth is.
  13. People live and die and life goes on.
  14. I was baptized in Medical School.
  15. I pray because it’s the only way I can stop crying.
  16. I go for runs and pray.
  17. I pray for the two month old dropped on her head.
  18. She herniated before my eyes.
  19. I pray for the  two year old who drowned in a neighbors pool.
  20. He came in on the same shift as the baby.
  21. We celebrated his 3rd birthday.
  22. And then disconnected his ventilator.
  23. His mother thanked me for crying. She said it was nice to see someone who cared.
  24. I pray for the baby found dead next to his sleeping mother.
  25. I stood poised with ET Tube as the ambulance approached.
  26. He was gone too long.
  27. I pray for the abandoned comatose girl in the PICU.
  28. I  gave her a sponge bath, combed her hair and put in little braids.
  29. The nurses wrote me up.
  30. It seems doctors aren’t usually that nice.
  31. I’ve cath’d babies, tapped them, intubated them and helped harvest their organs.
  32. I’ve watched a quivering heart be placed in a cooler and flown away.
  33. To help another life.
  34. I’ve called codes, ran codes and run to codes.
  35. All holding my pregnant belly as Gabby jostled around.
  36. I pray for the seven year that died within minutes of my exam.
  37. She was talking.
  38. I got her a glass of water.
  39. She was stable.
  40. She smiled.
  41. “I see colors” were her last words.
  42. I pray for the baby with the gray tummy.
  43. Perfect little peanut until I rolled him over.
  44. I pray for the 22 week old preemie.
  45. The parents begged me to save her.
  46. But I’m not God and I can’t grow lungs.
  47. I’ve struggled with my team to save a newborn
  48. When it was apparent that I COULD NOT DO ANYTHING
  49. I turned and RAN. Down the hall.
  50. That baby needed his mommy to hold him as he died.
  51. That Mommy needed to hold her baby as she said goodbye.
  52. I pray he found peace.
  53. And she too.
  54. I pray for the four year old I diagnosed with cancer.
  55. As his father clung to me he cried
  56. Please help us.
  57. I pray for the 5 year old immigrant who was rescued by his grandmother in TJ.
  58. Left alone for days then stolen by drug lords. Repetitively.
  59. He cried when I examined him.
  60. Afterwards I held him.
  61. Shhh Shhh Shhh I cooed . He felt like my sweet kids.
  62. He wouldn’t let me go.
  63. So I carried him from room to room.
  64. I pray for the 14 year old boy who cried in my office just last week.
  65. I knelt down and said I understood.
  66. But watching the war is not the same as being in the war.
  67. I’m in the war with my son.
  68. I pray for him repeatedly.
  69. I prayed when they scoped him, poked him, prodded and took his blood.
  70. I prayed when I heard those words- Immunodeficiency.
  71. Hmmm how interesting I might say any other time. But not this time.
  72. It’s not a book or a case
  73. It’s my son.
  74. I feel the desperation.
  75. He’s coughing now.
  76. I am a doctor.
  77. I owe a quarter of a million dollars in medical school loans.
  78. I fear my debt will outlive me.

So maybe I can’t come close to what other feel but I try. I know that as a doctor, I’m on the better end. I can’t even imagine the pain of those parents. But it doesn’t mean I don’t care or can’t relate. This is not a “job” for me. It’s my life. I’ve resuscitated babies in a Walmart and a pizza joint. I’ve run to  multiple car accidents and performed the Heimlich in restaurants. I answer  questions daily for readers, friends, neighbors and strangers. I keep a otoscope charged in my kitchen. I make house calls and advise friends. I have two websites. I make no money but dream of funding humanitarian missions. Because I have time and medical knowledge, I hope to use it well.

The ugly side of medicine it what it is. I didn’t even come close to all the other terrible crushing memories. Some are fading some not.  Don’t worry. I’m not crying right now.

  1. I’m happy.
  2. I like what I do.
  3. I can sleep at night.
  4. I took an oath and
  5. This is my calling.


129 thoughts on “The Ugly Side of Being a Doctor

  1. Dr. Cason, thank you for your beautiful words. What you wrote above is very much like poetry. The image I had in my head was of words, emotions, encounters all falling together down the page to merge at the end like the pool at the bottom of a waterfall. Would you ever consider submitting this to a journal for publication?

    I’m a former med student who is searching my heart to figure out whether I should go back and continue my studies to become a doctor. Most of what I gather from the writing of other physicians, through their essays and in talking with them, is a great amount of frustration with the state of the profession these days. My question to you (if you don’t mind my asking it), is the reward there, is there satisfaction and joy in your job? If everything you do is so hard and time-consuming and sometimes even gut wrenching to experience, what drives you to continue as a doc? What is the incentive to battle through tough years of schooling, long hours of training and work (not financially speaking)?


  2. Shammaz- Don’t let the pain or potential distress deter you. If you feel compelled that that means it’s the right way for you. I remember someone discouraging me and I brushed them right off. I’ve never been in it for the financial rewards and as the years go on the reimbursements are down. It’s the people and the privilege to help them that makes it worthwhile.

    Josh- Thank you for the kind words. It’s now a push to get me thinking again to why I do this. In my heart in know why but my head says a lot of different things. I’ll follow up soon. 🙂

  3. SHEILA – I hope you see this post under this older blog.

    Such a beautiful and caring heart you have. You may not have had plans on being a doctor, but I can tell that God (yes God, Dr Atheist) hand-picked you for this task – and He also put you right there in Guam to touch all of these hearts and souls you have touched.

    Your tenderness shines so sweetly:

    “I pray for the abandoned comatose girl in the PICU.
    I gave her a sponge bath, combed her hair and put in little braids.
    The nurses wrote me up.”

    Don’t EVER let others stop this tenderness. It is so needed in the medical profession. Yes, doctors are smart – but no one ever needs to forget God created us and gave us the incredible body and brains we have.

    I have to tell you a story about my very special friend, my rheumatologist. When both of my sons were very young, I was suddenly struck with rheumatoid arthritis and osteoarthritis. The pain was unbearable, and I went through months of this pain under the care of my very special rheumatologist, Dr. Lowell Robison, until he found a treatment my body could tolerate.

    When I would go in, he would do everything possible to ease my pain. But what he gave me was so important – HOPE. When I would ask him with tears in my eyes if I was going to be able to continue working and raise my two sons, he always gave me this HOPE. Disability was a very present fear of mine. I was divorced, I was all they had to raise them. He would always assure me we would find a treatment, we would get it under control, I would raise my sons, and his kindness and hope kept me going.

    Well we have both celebrated I am still working, my sons are raised and have their own families now, and I am a grandmother times 4 with another on the way.

    Yesterday, I had to say goodbye to Dr. Robison at my appointment. He is retiring. Before I knew it, I reached up and gave him a big hug goodbye and we were both crying. He was not just my doctor, he was my best friend too. He also shared with me I had been one of his most difficult patients to treat at the beginning, but he praised I had fought to stay on my feet – and we had won the battle together.

    This is the type of doctor I know you are also. Bless you and those you touch always. Someday one of your patients will give you a big hug when you retire too…..

  4. That made me cry and cry. Thank goodness there are people like you in the medical profession.

    On a more personal level, do you know of any forum that links up death and end of life care? I am watching my boyfriend die right now and its both humbling and gut wrenching.

  5. Kathleen- And I’ll sob just as much as the patients. Thank you for the kind words and wonderful story.

    Santosh- We have our ups and downs don’t we?

    Kitty- Oh no- How hard that must be. No I haven’t heard of anything on the net but have you tried a local hospice? There are wonderful at tying in the emotional needs of the patient and their family!

  6. Oh my….

    This is something else.

    Probably the most moving thing I’ve read in 3 years of blogging.

    I need to wait for my eyes to stop watering before I move on.

    You are a beautiful writer.

    May I submit this to “Grand Rounds” on your behalf?

    Kims last blog post..BlogWorldExpo 09 – We Can DO This!!

  7. Kim-

    Thank you so much for your incredibly kind words. I have received so many nice comments from people all over that I am continuously amazed and grateful that people take the time to comment.

    Yes you may submit it. Thank you so much for the offer.

    I think maybe in some way this piece brings up all the individual cases that we all have experienced. I never wanted to talk about it but now that I have, I think of all the beautiful aspects as well!

  8. Beautiful. Know you are not alone with these experiences and thoughts. As a former ICU/CCU nurse I too have been in the same place. You do these acts of kindness and goodness because it is the right thing to do. You know that life is just a crap shoot, but more precious than all the riches of the world. Be kind, the world can be so cold.

  9. I’m a doctor myself, I can see what you feel. I had the same thing to face here. We’re a doctor. Our duty is to understand people out, but has no right to ask to be understood. We’re healer,we’re no god, we only have to do what we can do and we must do. Not what others want us to do.
    last post: “do’s and don’ts to save your backbone”

  10. The compassion for your patients that you describe is absolutely inspiring. I have a lot of respect for you and your work.

  11. Molly- Absolutely. Everyone does this. And not just in medicine. It’s everywhere. We do things because it’s the right thing to do. 🙂

    Dextro- We just owe it to ourselves to grieve and process that though tough at times what we do is good and we mean well. That’s all we can expect.

    Vera- Thank you. But it’s a small part of this world that is inspiring. My patients inspire me. Just to keep going and smiling all the way.

  12. Dr. Cason, thank you for showing a doctor with a heart. I stumbled across your website and this blog made me cry. I do not know you but I felt your love for your young patients. I would definitely feel comfortable leaving my sick child with you because I would feel that you would treat them as if they were your own.

    No, you are not God. Yes, you are a doctor and you can’t bring back the dead but it seems you are doing the best you can to keep children healthy. May God bless you.

  13. There is nothing self absorbed in this at all! I know as a nurse I frequently run into things that upset me and I have difficulty with some things. I find that alot of the negative things that I have experienced I keep to myself. We build our own coping mechanisms for the stresses and heartbreak that we feel. Who want to hear of all the things that we have seen or heard?
    It takes a strong person to be a doctor! God Bless you! The world need more ppl like you- caring and passionate about what you do.

  14. As a med student considering a pediatric specialty, I am touched by your writing. Every day I fight the battle of the soul between taking care of my own needs and giving all to my patients. God bless you and keep plugging.

  15. Here I am with five more office days before I wind up and become a full time medical administrator, and this post resonates with me. We become paediatricians for a large number of complex reasons, many of which I’m sure are hidden to us. Yes there are awful moments, but because of what we do there are so many wonderful ones as well. More birthdays, more graduations, more dreams reached.

    And yet, we remember each and every child who didn’t do well. We play it over, wondering if we could have done better. That makes us human.

    The sorrow in our own lives makes us more human. We don’t know how the other person feels when they have a child with a serious illness, but we have learned through bitter personal experience how they want to be treated. Hopefully, that makes us better physicians.

    Thank you for your blog, both the medical insights and the photography.

  16. Sunny- So sweet to say and I hope to carry a passion for kids forever. I always feel so honored when parents come and request me- word of mouth has spread. It’s a little report card on how I’m doing.

    Tara- Thank you for the words. Self absorbed at times but now realizing that this is necessary. If we cont to squash it all down, we burn out. The tears help heal.

    Amy- And you will continue that struggle always. It’s better to realize it now though and create ways to cope. Talking helps me the most. Sometimes it’s complaining other times, it’s just talking.

    Jannie- Oh Jannie. Crying just means your human and you feel the pain just like anyone else. As for me, I sob with pets too.

    Jon- Wow! 5 more days…And will they be double booked or will you linger with each patient? For some reason, I think that I am unique and hold on to the memories more. With this post I realize that I’m not unique. That we all care and hope to do right by our patients and ourselves. BTW- Nice photos on your site as well! I will go back and look some more but clinic is about to jump off. 🙂

  17. Thank you for that. We need more doctors like that. I’ll be starting med school next year and hope to later in life be able to say something like this. I’ve been a patient all my life and can’t wait to give back.

  18. Off to med school- Oh my goodness you are on for a ride! But it really is fun and hard at the same time. Don’t get wraped around the grades. Just do your best and leave medical school still loving medicine and the patients!

  19. Happy New Year Dr. Cason
    I have been a follower of your blog for a couple months when i started my blog. I loved it sooo much that as a future pediatrician I really look up to you. Even though medical school was difficult, I think that it made all the difference in my life as it was a huge personal learning experience. I grew as a person and began to learn things about myself I never knew until medical school pushed me out of my comfort zone. How do you do it all??? taking care of your kids, practicing pediatrics, doing photography, and taking care of chores around the house. I can’t keep up with my dog and my house alone…

    Anna Esparhams last blog post..A prayer

  20. Wow, that was incredibly touching. We are so lucky to have you in the medical profession.

    I really wanted to be a doctor. I have wanted it ever since I was a little kid. I went to college and got pretty good grades. I graduated with a 3.5 GPA. I still look back and wish I had tried harder. Sometimes I think if I had gone to a smaller private school instead of our huge state university it would have been better. I got good MCAT scores, I had tons of experience. I worked in a medical clinic as a medical assistant/EMT for 5 years. I didn’t get in the first year I applied. I decided to go on and get my masters degree in public health at the same school where I hoped to attend medical school. I still didn’t get in.

    I did get in to one school in Grenada. It was the hardest decision of my life, but I decided not to go. I twas just too much to ask my husband to give up. We would have had to sell our house and he be out of work for at least 2 years. I worried other doctors would look down on me for attending med school outside of the US.

    It was definitely one of the hardest periods of my life. I have found peace with my decision now, but I still love medicine and like being able to live vicariously through others who are doctors.

    Thanks for sharing a piece of your life with us.

    Kerrys last blog post..Welcome little one!

  21. You and me are a lot alike…was supposed to be a writer too…and medicine is not a job it is my life and will always be….couldn’t imagine it any other way…..thanks for sharing….at least I know now that I am not the only one who thinks this way. Actually takes it all in…hard even though I am too sensitive to be doing so….just can’t help it. I gave up my life for this field and it has been hard, so hard, and so expensive….I WILL die before I pay back my debt.
    Not that I am negative….but I stopped praying.

  22. just read a few other posts…..
    very interesting how people have responded about themselves based on your writing.
    ever thought about psych…it is all peds you know…in the end.
    Medicine for me is in the Bronx….supposedly the worst of the worst places in NYC….and although Peds in the Bronx is something I am not strong enough to be able to do…..medicine here….
    defines PTSD…and no I am not in psych
    no way
    but it is raw
    rough and
    unlike yourself
    with beautiful children and a husband
    I am going to burn out
    very soon
    b/c I gave up my life…
    that means all of it….
    and I was thinking about whether I would make the same choice again
    is it a cliche
    no accent “aaaguuu”
    perhaps it is the ultimate cliche
    but yes
    I would do it all again
    is it only b/c I know nothing else
    or is it b/c I do not have the inclination
    to know everything else
    going abroad as soon as I can
    to work in the field
    where I will feel like I am doing something to better things
    even though
    maybe I am not
    at least it will seem more like what I do makes any difference in this world
    I wish I was a stay at home mom sometimes
    as my college fiance has five kids
    and we broke up b/c of medicine
    31 yrs old
    no it is OLD
    for all of that stuff
    maybe not chronologically
    but I am old
    I don’t want to be
    but I am
    thanks again for your inspiration

  23. Scutmonkey, I was at a hospital in the Bronx a few months ago and God bless you- it was hell for me. And more because of staff than pts!
    I am now doing psych at a big psych hospital and it’s funny, I was just thinking it’s really just peds.
    Hang in there.

  24. Anna- I can’t do it all. I don’t even try anymore. But I like to write and take photos. I like to run and play with the kids. I like movies/books and chocolate chip cookies.

    Teiy- Puhleeze! 🙂

    Kerry- Funny I dream of being a photographer and you dreamt of being a doctor. We find our way eventually and it all settles out huh?

    Scutmonkey- Don’t burn out. Take a few naps and keep writing. It helps to talk it out. We’re human and not meant to not feel. Those who say otherwise are deluding themselves. I used to be upset when it hurt so bad then as I rested and came to terms with the real “difficulty” of medicine, it helped.

    Verena- It’s true some of the stories that linger are from the people who work with all those patients. I suspect that they too are burned out. Psych, peds and geriatric medicine- Same Same.

  25. The doctors I have are so amazing. They really care and as a patient, that means to most to me. They’ve become some of my closest friends over the years. They care enough about me to do the best they can and they’ve saved my life on multiple occasions.
    It’s because of doctors like you and the doctors I have that have inspired me to get into the medical field myself and try to be what they were and still are to me. Thank you so much for writing this.
    Know that the patients you’ve comforted remember you just as much as you remember them.


  26. it’s funny how i stumbled upon your site. i googled something like “on being a doctor” and found your site (yes, strange i googled that =) i am a doctor and i am becoming more and more disillusioned. i think i’m burning out, so instead of enjoying what i thought would be my “dream” job, i am becoming more resentful of my patients. there is a danger in caring too much. i felt that bits and pieces of me were slowly taken away by each of my pt. i think that’s how i started to lose myself… i’m looking very hard for the reason/thing/etc that inspired me to become a doc in the first place. anyway, i love what you wrote here. lots of food for thought!

    karleens last blog post..(Untitled)

  27. I don’t usually reply to all the blogs I read but this one has really touched my heart. If ti wasn’t for brave, wonderful and caring doctors like yourself I would be laying down typing this without my leg ) or worse, I wouldn’t be here to type it at all) instead of sitting here being thankful for the doctor that was willing to take a chance on saving me.

    Thank you for all that you do and all that you feel.

  28. you might not have been crying at the end of that; but i was.

  29. I am one year away from getting into univeristy
    all i need is to know which course to take,
    or biomedical science.
    and if i want to become doctor or teacher. or both.
    i looked at your other artical too, 10 questions to answer.
    one thing is for sure, i want to be someone who can help another.
    what i fear, is not making the cut.
    i looked here to see the hardship of doctor’s life, and i appreciate what you helped me learn.
    tell me, if i am afraid i will not be good enough, if i am afraid i wont absorb what they teach, if i wont remember everything i should know to be a good doctor… what should i do?
    i am not afraid of failure as long as i know im doing what a good doctor would do. im afraid i wont do exactly that.

  30. Mashal-

    You said-

    “tell me, if i am afraid i will not be good enough, if i am afraid i wont absorb what they teach, if i wont remember everything i should know to be a good doctor… what should i do?
    i am not afraid of failure as long as i know i’m doing what a good doctor would do. im afraid i wont do exactly that.”

    Already I can tell you that you will be a good doctor.

    Do what makes you happy. If that’s teaching, then teach. If it’s being a doctor, then go for it. Don’t let fear stand in your way just let it help you become better and better. As for the question about which class to take, ask your pre-med counselor. In some schools it doesn’t matter but others are looking for a specific class you may be missing. I really couldn’t advise you which one that may be.

    Good Luck! 🙂

  31. i am also a doctor. i am an emergency room cardiologist. and i have lost many people and i have told one of my patients who is about to die that i also am terrified of death. but if my supervisors or manger finds out he’ll kick my ass. and everyday that i go home from work i can still see the faces of the people that i lost. still alive in my heart. and everytime someone is lost i get goose bumps. buts thats just life. people come and go.

    so if you are a lucky person, born healthy-keep yourself healthy try to avoid going to the hospital and having someone tell you that you are going to die. it is painful for me or any doctor to spread the bad news, i don’t want to tell them they are going to die or be paralyzed. i see then crying and many of them say “can i have a minute?” and then i come back and they are dead. i call for help and try to bring you back to life- CPR-Defibrillators-etc.

    if you have some thing to say please email me on

  32. Thank you for creating this website. I am a 25 year old who graduated from Georgetown (I saw the GW med school!) and am struggling right now because I’m considering going back to med school. I have pursued my passion for sailing and teaching with the company I currently work for. I have been very successful and have inspired and found inspiration from my students (all teenagers who I live aboard with), but now I’m thinking more grandly about the time that we have and medicine keeps call me back.

    None of that matters, but when I googled (which I do in my most desperately confused moments) “the best thing about being a doctor” – your site came up pretty high on this list. So, kudos to you for being open and for sharing, it’s very helpful for someone on the other side of that void and debating whether to cross it.

  33. i just want it to thank you for expose your thoughts like it.. i am a med student and sometimes its hard for me to believe that many doctors are so cold and they seem that they dont care about the patient feelings.. but i think is a way to protect yourself… if you dont care you dont suffer
    is just that i am a very emotional person and to read your post is really inspiring for me because i know that by the end of the day if you helped one person then its worth it… so thank you for sharing this with us

  34. I nearly cried… I hope someday I can be as good a doctor as you 🙂

  35. I read something the other day that reminds of this. “For in much wisdom is much grief, And he who increases knowledge increases sorrow.” Ecclesiastes 1:18. (NKJ version)

  36. Dr. Cason,
    I read this with tears rolling down my cheeks. As a mother, I put myself in every one of those mothers shoes and my heart breaks As a mother of a child who is going through medical testing for something unknown lurking in his little body, your words re assure me and soothe my heart that your not lip service, that he is not a number to you. That he is real and you are real. That you are on our side.
    When called about the first results of his tests, it was all I could do not to cry on the phone. Especially when the word tumor is used…. So, I just ignored that possibility. He is going to be fine. I am going to be fine. God will get us through this dark valley. And in faith and by grace, I smile and continue to hold my little man and sing “Mr. Alligator” as he is getting poked.
    I happened upon this blog by accident surprisingly enough. It was attached to another friends blog. So you’ll understand how surprised I was to read your heart felt words, and hopefully understand my need to thank you for being real and thank you for helping us.
    Philippians 1:3

  37. Wow. Amazing. Sad, but amazing. I failed high school because i did not care. I care very much so now. I want to help people. I want to help like you. This makes me want to help even more. This inspires me. Thank you for writing this and thank you for helping kids and family’s!

  38. Dr. Cason,

    Your words are beautiful and extremely powerful in their honesty. Thank you for sharing. I am a recent graduate of art school and have always wanted to be a doctor. I am thinking of applying to medical school here in Canada, but will have to start from scratch (obtain a Bsc, MD and then a residency) which will push me into my late 30’s by the time im done. I keep reading really negative things about medical school, residency and life as a doctor (horrendous hours, lack of any personal or family time, abuse from senior staff, and absolutely no work/life balance). Medical students post feelings of absolute sorrow and depression consistently feeling they have lost their youth and have no joy on student blogs and it makes me feel completely overwhelmed. When I read your post it reminded me of why I want to do this. However I am scared to jump in given the risk and all of the negatives I have been reading. Thank you again for sharing your stories and for your lovely website and amazing photographs. I think what you are doing touches peoples lives more than they are able to articulate.

  39. I am a young teen and i would like to be a doctor. I found this very inspirational. It may scare some but it just encourages me to try harder because there may be many bad things to being a doctor but there are many good things as well. Even though some die they still live on in our hearts and its always worth it in the end. trying to help people. I will be a doctor some day and i will always remember this The Ugly Side of Being a Doctor. Thank you

  40. You made me cry!!! This is one of the most beautiful and raw things I have ever read. I LOVE your blog.


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