Dean Gianakos
Lynchburg, Virginia, United States

It is February in Boston, and the snow is coming down hard. From his office window, Tom shakes his head and watches a car spin its wheels in the middle of the road. Next week, he will be in southern California for a medical meeting.

“I’m so done with this,” he thinks to himself.

Tom grew up in the South, lives in New England, and has practiced internal medicine for twenty years. Driving in the snow still challenges him, but in the last year, he has been trying to weather something new.

He has lost interest in practicing medicine.

Many of his colleagues feel the same way. Some have retired. Others have become chief medical officers, pharmaceutical executives, or insurance doctors. Tom believes electronic health records and moral distress are to blame.

Medicine is not what it used to be.

When Tom arrives in California, he steps out into the bright sun, slips on his sunglasses, and rolls up his sleeves. In the elegant lobby of the hotel, men dressed in linen shirts are on their phones and computers. Attractive couples wait in line for the concierge. Tom imagines what it would be like to fly around the country as a healthcare executive and stay in nice hotels like this one. A Beach Boys song plays overhead, capturing his longing for a different life.

“Yes, wouldn’t it be nice,” he says to himself.

The next day, Tom attends a lecture on alternative careers for physicians. During a conference break, he wanders through the exhibition center and stops by a display advertising an MBA degree from State University. The sales rep gives him an enthusiastic handshake.

“How about an espresso, Doc? Right this way. Let me know if you have any questions.”

“Thank you.”

Cappuccino in hand, Tom picks up a brochure and moves on.

On his way back to the main conference hall, he bumps into a former colleague. Tom and Barry practiced internal medicine together for ten years before Barry left to become the chief medical officer at a hospital in Colorado.

“Barry, it’s been forever! How are you, man? It’s great to see you.”

Barry wears a tailored khaki suit and a red tie. Polished brown cordovans. He carries a matching leather briefcase strapped to his shoulder. The tag on his jacket reads “Speaker.”

“It’s great to see you too, Tom! Sorry to run, I’m on my way to give a talk on performance excellence. Do you have plans for dinner? I’d love to catch up with you.”

“Sounds great.”

“Okay, meet me in the lobby at 7 pm. I’ll make dinner reservations. Italian okay?”

“Perfect.”

Tom returns to his hotel room. Looking out the window, he admires the lush golf course and decides to skip the afternoon seminars. He changes into his running clothes and heads to the nature trail that surrounds the hotel. The lawns are freshly cut and very green. Palm trees and flowers are everywhere. After a leisurely two-mile run, he showers and gets ready for the evening.

Barry greets him in the lobby.

“Let’s go! The concierge says this restaurant is great and you can’t go wrong with any of the pasta dishes.”

The maître de shows them to their table. The table is set with white tablecloths, short ivory candles, and a dim lamp. A waiter places a basket of warm bread and a dish of olive oil on the table. Laughter rings out from the bar.

The two of them talk about the conference, basketball, and kids before the conversation turns more serious.

“Barry, I’m thinking about leaving medicine. I know you made the jump to administration around ten years ago. Any regrets?”

Barry pauses before saying, “No, not really. Instead of worrying about patients, I now worry about meeting budgets and holding doctors accountable for bad behavior. The stories I could tell! I certainly don’t miss the clinic grind and taking night call. Do I miss my patients? Of course. It’s a tradeoff, Tom.”

“Yeah, I’m sure. I’m struggling with the monotony of practice and business pressures. I don’t know, maybe I’m in a middle-aged slump. I turn fifty next month.”

“I get it. Waiter!”

Barry orders an Italian Cabernet. They raise their glasses.

“Cheers, Tom. To old friends!”

Tom excuses himself from the table and heads to the restroom. Barry sips on wine and dips his bread in a pool of olive oil. As he pulls out his glasses to read the menu, he hears a crash in the back of the restaurant. Barry turns around and sees a man lying on the floor. He rushes over to help.

Barry shakes the man’s shoulder and asks, “Are you okay?”

“I think so, just a little dizzy. Woozy in the head.”

Barry waits anxiously for Tom. After ten years away from clinical medicine, he feels out of practice. He waves to Tom as he leaves the restroom.

“What’s going on, Barry?”

“I’m not sure. He says he feels dizzy. No chest pain. I can barely feel a pulse. Take over here, Tom.”

The man attempts to sit up. Tom firmly grabs his arm and tells him to lie flat on the floor. He then goes into clinical mode, asking questions and performing a focused examination. The man is seventy and has a history of heart disease. He had two gin and tonics an hour ago and a glass of wine with dinner. Now he is pale and his pulse is weak, rapid, and irregular.

“Is he going to be okay?” his wife asks.

 “Yes ma’am, I believe so. We’ll know more after they evaluate him at the hospital. The rescue squad is on its way.”

“Thank you.”

Two paramedics arrive with a stretcher as customers look on. Tom returns to their table to find Barry texting on his phone.

Without looking up, Barry asks, “What happened to him, Tom?”

“He likely has atrial fibrillation with rapid ventricular response, maybe triggered by alcohol. Need to rule out coronary ischemia. He flew in from Charlotte last night, so pulmonary embolus is also in my differential.”

“Well, thanks for jumping in. It was another reminder of how far away I am from clinical medicine. Sad to say, I’m not much of a doctor anymore, Tom. Well, not a real doctor, anyway. So, where were we? I believe we were talking about regrets. Like I was saying, there are tradeoffs, Tom.”

“Yes, I can see what you’re saying.”

I saw what you are saying, Tom thinks to himself.

Tom changes the subject and asks Barry about life in Colorado. They both order lasagna and finish the bottle of wine. Barry insists on picking up the check.

Back in his hotel room, Tom reviews the conference agenda again. He makes a mental note to attend the cardiology session on atrial fibrillation in the morning.

Almost asleep, he hears a familiar song rising from the lobby. The Beach Boys again.

Tom rolls briskly on his side and wraps a pillow extra hard over his head and ears.