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The fundamental act of medical care is assumption of responsibility. -Francis D. Moore, MD

The Captain’s call came at 30,000 feet,

a flight attendant’s hand pressing

an oxygen mask to a woman’s mouth, her eyes

rolled back, chin on chest, every crisis

I’ve seen flashing through my mind—

hemorrhagic shock, cardiac arrest,

as if thirty years had not flown by

and I was back in training, not yet a

psychiatrist who read “Management

of In-Flight Medical Emergencies”

a few weeks earlier and thought: No way

will I ever volunteer to deal with that!

But there I was, on automatic pilot,

asking for a blood pressure cuff, IV

lines, a defibrillator, connected

by air-phone to an ER doc in Pittsburgh,

my finger on an irregular carotid

pulse working to reach forty beats.

The details of treatment were simple–

believe me, you could have done it yourself,

yet all the passengers filed out saying, “Thank you!

We didn’t know a doctor would still help

in an emergency.” But I was like the heroes

on the evening news declaring, “No big deal.

Just doing my job,” and meaning it,

even if we can’t let ourselves believe

their modesty. By mid-life and mid-career,

there have been countless times I’ve worked hard

without thanks from anyone, practiced

with dishonor, knowing I didn’t know

enough, because to be a doctor means

a life of shame— for every complication,

missed diagnosis, treatment failure, or death,

that airsick, empty, sour, sinking sense,

we feel when responsibility gnaws

and we struggle against our helplessness

clothed only in white coats that have no wings.

Dr Berlin has been writing a poem about his experience of being a doctor every month for the past 26 years in Psychiatric Times in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is Tender Fences.