Commentary on “Apologia pro Vita Sua”

I am human; I think nothing human is alien to me.1 Every day, critical care clinicians bear witness to human experiences that are at once universal and exceptional. As they attend to individual patients, they actively participate in the cycles of grief, joy, sickness, and recovery that all humans encounter between the boundaries of birth and death. Critical care clinicians occupy privileged positions in the lives of others, and thereby develop a unique understanding of the complex factors informing how the paths of their patients and fellow practitioners unfold. This collection is grounded in the theme of examining formative experiences in each of the author’s professional path to clinician. “Profession” stems from the Latin professio, “I profess,” or to make a significant public declaration. Choosing to pursue clinical work is itself a formative public declaration for and about one’s identity, and from this starting line of personal choice, diverse professional journeys take shape within the ecosystem of medicine. All 5 of the works are excerpts from larger self-reflections, which were, in turn, sculpted from stories, light- and heavyhearted, shared by the writers over the course of several evening discussions as part of a medical humanities elective. The writers address the challenge, but also the meaning, fulfillment, and recompense, of their profession. This body of work thus becomes an Apologia Pro Vita Sua, a written defense for their belief in their vocations, an explanation for having chosen their arduous courses. At a time when burnout is a pressing systemic issue among health care professionals,2 prescient related topics such as handling difficult emotions, overcoming imposter syndrome, and reaching professional fulfillment continually rise to the surface. Here, clinician–authors comment on the wide spectrum of emotional situations they must be prepared to deal with at work, experiences echoed by their colleagues.3 In “Dear Me” and in “The Threshold,” Andrea Leal Barcelo and Laura Buckley investigate the steep emotional demands of their labor and arrive at wise, encouraging conclusions: Barcelo acknowledges medicine’s abundant emotional rewards, and Buckley accepts the perennial presence of difficult emotions. Difficult emotions can also emerge from clinicians’ tendency to ask difficult questions about others and about themselves. Self-questioning is a valuable asset in the pursuit of self-improvement, but taken too far, it can also manifest in the phenomenon of imposter syndrome, to which health professionals are uniquely vulnerable because of their public roles as experts tasked with significant responsibilities in safeguarding the lives of others.4 Though insecurities can persist even in later stages of a clinician’s career, contemporary initiatives encourage sharing feelings of imposter syndrome in order to safely explore and understand them. As an alternative to focusing solely on gaps in their ability, clinicians can benefit from recognizing improvement and mastery over things they previously found challenging.5 “Questions” by Cory Anderson captures the experience of weighing the delicate balance of uncertainty and confidence in one’s abilities; the speaker in the poem continues to ask questions but also learns to appreciate his skills has acquired. Loved ones, too, may ask tough questions about a physician’s professional choices. These questions can motivate self-reflection, which can strengthen the responder’s resolve by reminding them of the goals and ideals that drew them at the outset of their career; however, such questions can cause self-doubt and reinforce the disconnect between those in the field and those outside of it. “Prisms of View” by Prashant Aravind recollects a peer’s naive assumptions about the protagonist’s values based on his chosen vocation. In continuing to pursue a career as an “intensivist,” the protagonist clearly chooses to hold onto his own assessment of the ideals that have guided him on his professional trajectory; still, the protagonist leaves the conversation troubled, illustrating how painful misunderstandings between loved ones can remain unresolved. Finally, in my (B.M.’s) short story, “Ventilators and My Dad,” the narrator and her father have a conversation that not only sparks a profound teaching moment between a specialist and a nonspecialist but also gives voice to the demanding yet vital task of communicating clearly to promote understanding of health and health care. Ultimately, the writers all demonstrate how professional fulfillment can be a potent antidote to burnout and a meaningful answer to the question of why medical professionals continue to work in such a stressful field. In fact, fulfillment may be a more sustained state than burnout for critical care clinicians.6 When clinicians understand why they chose to become medical professionals and how their work contributes to the lives of others, they are more likely to find professional and personal fulfillment, which can pull them through the rigor of providing contemporary health care.2 Sometimes, a pause is necessary for physicians to reflect and write about their experiences, a pause helps remind them how far they have come and how much they have learned in their high-stakes, emotionally and physically demanding workplace where their actions can irrevocably change their lives and the lives of others. These works, the challenges and successes of an increasingly demanding profession, and the rewards of forging connections across fields and between people honor this group of writer–clinicians. The authors express gratitude to the University of Toronto’s Faculty of Medicine for their support.

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