I
t is not a natural act, taking account of
things you never intend to revisit or re-
claim. Unlike a beautiful memory that I
could savor or relive a thousand times, a
sacrifice implies a loss that perhaps bears
not repeating. With each sacrifice I made to
become a doctor, I daresay I tried to put it
behind me, hoping it was the last of its kind
or modest in its impact. Nowhere along this highly rewarding path
had I stopped to catalog the sacrifices being made. I suspect few
doctors have.
What would those catalogs look like had we each created one?
Would they be thick or thin? What entries are common to each
physician’s edition? What sacrifices are unique to our individual
cultures, genders or station in life? Could we have persisted despite
the mounting evidence of what it was costing us? These were my
first thoughts about creating a narrative of sacrifices I made to
become a doctor. Yet, in reflection, it has been a powerful exercise.
The first obvious sacrifice that came to mind was not even my
own. In pursuing this career, I chose a lifetime of sacrifices for the
people I love. When I strive to give 110 percent of myself, that’s
all that I have, and 10 percent of what someone else has. I had not
thought of my sacrifices in this way before this writing to honor
Dr. Spear. Like him, I chose a surgical career. In surgery, there is no
place for less than 100 percent effort. I would not want a surgery like
that nor would I offer one like that. Giving everything you have is a
sacrifice I imagine would appear in many of our editions. But where
does the extra effort come from when we see one more patient in
the emergency department or add a late case to the board? I see
now that it comes from the people who love us. It is sometimes why
these relationships are strained, or don’t exist at all. I noticed Dr.
Spear’s obituary did not reference a wife or children who survived
or preceded him in death. I saw that he served in our nation’s armed
forces. Moreover, I saw in these few details, great sacrifice. I am
grateful for the loyalty, love and selflessness of the people who are
making sacrifices with me and because of me. Every diagnosis, cure
or ounce of hope that I provide in my work comes through me from
those who love me well. Their sacrifice is the source of my ability.
Naturally, the abilities of a physician require cultivation, practice
and refinement. Those abilities, without exception, require work and
sacrifice. The abilities we develop as physicians are earned. They are
the dramatic substrate of television, the plot twist in movies, the
powerful influence behind health-related marketing. If four out of
five of us agree on something, it is immediately validated for public
consumption. Through this essay, I discovered some abilities I sac-
rificed becoming a physician. I sacrificed the ability to ignore our
differences. While we are undoubtedly more similar than different,
SPEAR ESSAY
health disparities grow out of our differences. Not recognizing
meaningful differences is the auger that nurtures disparity. Failure
to see when a patient, a colleague or a trainee is being impacted
by a difference is to allow them to continue to exist in the margin,
with the inequities that exist there. Ignoring our differences so we
can ignore their impact and value is not what I promised to do as
a physician. Ignoring meaningful differences is not what we do in
Louisville. I am honored to be among hundreds of physicians in
this city who work to make health accessible, equitable and of the
highest quality for all. In the wake of one sacrificed ability, I found
advocacy work. It takes cultivation, practice and refinement. The
Center for Health Equity, a division of the Louisville Department
of Public Health and Wellness, states it well in its 2017 Health
Equity Report.
“In Louisville, health equity means that everyone
has a fair and just opportunity to be healthy and
reach their full human potential. A person’s iden-
tities, whatever they may be, should not predict
how long or how well one will live.”
Ultimately, I sacrificed the convenience of helplessness to join
the work being done here against health disparities. I have a lot to
learn. I grow some every day. I could not have been planted in a
better place for this work.
I choose not to measure my sacrifices in missed hours of sleep,
dollars of earnings potential lost or miles I have relocated. I am
humbled by the sacrifices and contributions of my colleagues who
have persisted despite great adversity, as immigrants, pioneers in
discovery, early advocates. Simply, I wanted to avoid a list of losses,
balanced out by altruistic justification, so as not to dampen anyone’s
spirit for health care work, including my own. I am proud to say I am
part of a profession in which great sacrifice is the rule rather than
the exception. My initial uncertainty surrounded what a narrative
about sacrifice could accomplish. It is more than a catalog of loss.
It is a professional thumbprint - a story with recognizable features,
as unique as the bearer.
Dr. Erica Sutton is a practicing general surgeon and founder of Surgery
on Sunday Louisville.
This article was an entry in the 2018 Richard Spear, MD, Memorial
Essay Contest.
FEBRUARY 2019
11