Third drawer down, to the right of my chair in my office, in an unmarked file but within reach at all times, is where I keep my “Q word” anecdotes—notes and cards that I quietly slip into my lab coat pockets. I’ve been collecting these notes since residency, and although the file is still thin, it is full of meaning.

I have considered quitting at several stages of my career. I left medical school still believing the fiction that if I worked hard enough, I could save everyone. Residency quickly shattered that illusion; my first call night as an intern, I conscientiously thought about, and then purposely did not reorder, pro re nata medication for a floor patient. Four hours later she died, and I was asking my senior resident if I had killed her. My flirtations with the Q word began that night, but every time I thought I was done with surgery, someone came along and shooed me back on the path. Here are a few examples.

  • “Thank you for fixing me, doc”: The patient who was shot by two men while he was minding his own business
  • “Thank you for trying to make my pain go away”: The electrical injury patient with chronic neuropathy
  • “Thank you for helping me clean my patient when everyone else was busy”: One of my intensive care unit nurses
  • “Thank you for crying with me”: Family, nurses, and other colleagues
  • “Thank you for helping me review this article”: One of my best friends
  • “Thank you for teaching me how to do a focused assessment with sonography in trauma exam”: My residents
  • “Thank you for getting Mother to hospice. It was the right decision. She was at peace”: From both daughters of a woman who had fallen and was done with the pain of her non-healing fractures, and my own mother, a year after her mother moved into hospice

It never ceases to surprise me how invigorating “thank you” can be. In this era of frugality, Joint Commission regulations, and mountains of paperwork, it seems easy to forget there is a human being (one specially trained, but still human) struggling to do his or her best for strangers. My mother was right—it always pays to be polite. Much as we rarely expect gratitude for doing our jobs, sometimes we forget how many people around us are also interacting with our patients—a silo is a lonely place. A simple “thanks” goes a long way toward reestablishing the connection that I think drives the best people to be health care professionals.

Eight years after that first death, I made a promise to one of my patients in the trauma bay. He was badly burned but still lucid, and after I put him on the phone with his family, before I intubated him, I told him it would be a long haul but that I would see him when he woke up. He died four days later while I was out of the hospital. I came back to work the next day, unclear of my purpose and furious with the world. I walked into the unit, and before I said anything, the nurses thanked me for letting him speak with his family, who cherished the opportunity. The Q word vanquished yet again.

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