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“Why do you want to become a doctor？”
Money and status immediately sprang to mind， but I answered the medical-school application diplomatically. I wrote instead about how medicine was the perfect vehicle to make meaningful changes in the world， a powerful way to help others—the typical answers expected of an eager applicant.
I meant what I said； I really did want to have a job that helped people. If money and status were part of the picture， that would be the dream job.
Through the years， I have occasionally been very helpful， sometimes dramatically： once， a young man came into my office 1）doubled over， sweating and feverish. I sent him to the ER with a note 2）shrieking that he needed immediate surgery； he had developed testicular torsion that， if left a few hours longer， would have rendered him infertile for life—or dead. He got surgery that day. I was 3）elated. Score one for the clever doctor！
Often， my therapeutic usefulness is just to 4）validate a person’s suffering； I tell them they have a condition that others share（depression， 5）lupus， addiction） and that although treatments may be limited， they are not alone or “weird.” Sometimes it is the best medicine I can give that day.
But most of the time， my interventions have not been helpful. Many times I’ve filled out a disability form even though the person was not disabled， because it meant they’d receive more money for rent. Many times I wrote prescriptions， which helped6）abate someone’s anxiety or depression or pain only temporarily， because I could not do anything about their poverty. I was helpful initially—but not in the long run.
These interventions seemed to hinder my patients. They felt better but did not make the changes necessary to sustain that improvement. They did not leave their stressful jobs or their toxic relationship. They continued to isolate themselves， to eat poorly， to live in housing that， though 7）subsidized， kept them in neighbourhoods that triggered their addictions. They got hooked on pain pills. They couldn’t sleep， even with their 8）sedatives.
They came back wanting more. “I need something else， doc…” What was the latest medication or diet or technique？
I would scrape at the bottom of my toolkit.“Let’s try this new med！ Have you tried hypnosis， 9）eye movement desensitization and reprocessing（EMDR）， or emotional freedom therapy？”
Or I would scan the disability form for a new box I could check off， maybe for 10）transit tokens， so they could get $30 more a month. “Are you sure you aren’t 11）lactose intolerant？” I would say. I’d frown， wondering how I could justify this to the authorities. Who checked these forms， anyway？ The patient and I would have a few hopeful visits， and then the inevitable disappointment. “It’s not enough …”
Over the long term， my efforts seemed to generate more frustration and dissatisfaction than help. Each patient encounter reminded me of how helpless I was， even in my cloak of competence. When I wasn’t dealing with their complaints about me， I was furious with them， their ignorance and their weakness.
I became cynical， bored and resentful. Why were they asking for my help if they didn’t listen？ I ended up blaming patients for my misjudgments： Filling out a disability form 12）consigned them to an aimless life of poverty； writing a prescription got them physically or psychologically hooked for years.
I burned out. I changed the focus of my 13）family practice to addiction medicine， and when that didn’t work， I took 14）sick leave. The desire to help turned sour like a romance. The money and status were never enough to soothe the hopelessness and anger I felt each morning， when I looked at my day sheet of needy patients. I hated my perfect job.
I often saw other physicians in the same boat as me， trying to 15）mill through the same treacherous darkness， crazy with the latest fad that promised redemption. We even joined peer support groups—where we could 16）commiserate and try not to resent our patients and our own helplessness.
It was through such a group that I learned I couldn’t help anyone unless they were willing to help themselves first. If I was working harder than the patient， my help usually made things worse.
I practice now at a short-term addiction centre. With my clinical knowledge and experience， I can sometimes provide a diagnosis or treatment that is useful for a person. I might even aid in providing some temporary bridges or crutches （meds， shortterm financial relief）. But these are temporary aids.
There are limitations to what we each can do for another—regardless of what wizard’s wand we are holding.
Over time， I have learned to sit back and let others trudge through their own version of the human 17）muddle. I am most helpful if I haven’t burned out before someone is finally able to accept the encouragement and direction I can give.
When someone dips down into their depths and then 18）comes up for air， I want my hand to be there， waiting.
“为什么你想成为一名医生？”
立刻浮现心头的是金钱与地位，但是我在医科大学申请表上的回答却是一番“外交辞令”。我当时写的是医学如何作为完美的工具让世界发生有意义的改变，如何作为有力的手段帮助他人——一名志在必得的申请人该说的标准答案。
其实我说的真就是我想的，我真的想从事一份能够帮助他人的工作。如果钞票与地位是其中一部分，那就真是梦寐以求的工作了。
这么多年来，偶尔我也显得助人有功，有时候挺戏剧性的：有那么一次，一位年轻人来到我的办公室，弯着身子、大汗淋漓，而且高烧不止。我把他送到急诊室，并附上诊断书，惊呼他需要立刻动手术。他患上的是睾丸扭转，要是延迟几个小时，他很可能会终生不育，甚至死亡。他当天就接受了手术。我感到很得意。我这个明智的医生得记上一功！
多数情况下，我的治疗有效性只是用于确认病人的痛苦而已。我告诉他们，他们的症状（情绪低落、狼疮还有瘾症）其他人也有，尽管医疗手段有限，但是他们不是唯一的患者，并非“异类”。有些时候，这便是我当天能开出的最好的药方了。
但是大多时候，我的诊断介入并没有帮助。很多时候，那个人还没有到伤残的地步，我开出的诊断单就已经将其判定为“残疾”，因为这意味着他们可以获得援助，得到更多的钱来支付房租。很多时候我写下处方单，只能暂时地帮助缓解病人的焦虑、沮丧或者疼痛，因为我对他们身处的贫困境地无能为力。起初我还是能帮助解决问题的，但是不能长久持续。
这些诊断似乎为我的病人的生活前景设置了障碍。他们感觉好点了，但却没能作出必要的改变来让事情继续往好的方向发展。他们还是从事原来高压的工作，或是持续着那段荼毒心灵的恋爱关系。他们继续离群索居，饮食不佳，住在尽管有政府房屋补贴但却要与瘾君子为邻的区域里。他们对止痛药上瘾，就算服了镇静剂也还是无法入眠。
他们回来找我提出更多的要求。“我需要一些其他的东西，医生……”最新的处方、食谱或技术是什么？
我会绞尽脑汁，“让我们试试这款新药！你尝试过催眠、眼动脱敏和再加工治疗，还有情感释放治疗法吗？”
或者我会审视他们的残疾鉴定表，看看在哪个病症选项上能再打个勾——或许只是为了多得车费，这样他们每个月可以多拿30美元。“你确定你不是乳糖不耐症？”我会这样说。我还会皱眉，思考怎样对政府官员作出合理解释。不过，谁会检查这些表格呢？
我和病人会满带希望去申请，然后难免失望而归。“这还不够……”
在很长的一段时间里，比起帮助，我的努力似乎带来更多的挫折和不满。每一次会诊，病人都提醒着我自己是多么的无能，甚至在我能力范围之内亦如此。当我不是在处理他们对我的投诉，我就在对他们、对他们的无知和软弱感到生气。
我变得冷漠愤世、厌倦恼怒。如果他们不听我的建议，为什么还要向我求助呢？最后我把自己的错误判断怪在病人的头上：填一张残疾鉴定表，将他们推向毫无目标的贫苦生活当中；给他们开一张处方单，让他们年复一年在身体上或者精神上无法摆脱依赖。
我感到精疲力竭。我从普通医疗转向专注成瘾性药物这一专科，当那样还不能解决我的问题，我就请病假。就像爱情故事激情不再一样，我助人的欲望日渐变味。当我看着那张记录当天我要会诊的贫困病人名单时，名利不足以抚平每天早上感到的绝望与愤怒。我痛恨我这份完美的工作。
我经常看到其他内科医生陷入与我相似的境地，试图挺过这种自欺欺人的黑暗煎熬，对最新流行风潮痴迷不已，满怀希望从中求解脱。我们甚至参加同僚互助小组——在那里我们可以互相同情，并试着不去厌恶我们的病人和自身的无助感。
正是通过这种互组小组，我明白到，除非病人首先愿意帮助自己，不然我帮不了任何人。病人不努力，光靠医生用劲的话，那我提供的帮助通常只会让事情变得更糟。
我现在在短期瘾症中心工作。我的医学理论和临床经验让我在一些时候能够为病人提供有用的诊断或治疗。我还能够提供临时性的桥接器和支架（起到药物的作用，或是缓解短期的财政紧张）。但这一切都只是暂时性的援助。
我们能为别人做的事情毕竟有限——无论我们手上拿着什么样的魔杖。
这么多年来，我明白到要放手让人们从自己的生活泥潭中走出来。如果我在变得暴躁不堪之前最终能让人接受我给出的鼓励和指引，我就最能帮上忙了。
当一个深陷困境的人能探出头来挣扎喘息，我希望我会伸手在那儿，等着，拉他们一把。
Money and status immediately sprang to mind， but I answered the medical-school application diplomatically. I wrote instead about how medicine was the perfect vehicle to make meaningful changes in the world， a powerful way to help others—the typical answers expected of an eager applicant.
I meant what I said； I really did want to have a job that helped people. If money and status were part of the picture， that would be the dream job.
Through the years， I have occasionally been very helpful， sometimes dramatically： once， a young man came into my office 1）doubled over， sweating and feverish. I sent him to the ER with a note 2）shrieking that he needed immediate surgery； he had developed testicular torsion that， if left a few hours longer， would have rendered him infertile for life—or dead. He got surgery that day. I was 3）elated. Score one for the clever doctor！
Often， my therapeutic usefulness is just to 4）validate a person’s suffering； I tell them they have a condition that others share（depression， 5）lupus， addiction） and that although treatments may be limited， they are not alone or “weird.” Sometimes it is the best medicine I can give that day.
But most of the time， my interventions have not been helpful. Many times I’ve filled out a disability form even though the person was not disabled， because it meant they’d receive more money for rent. Many times I wrote prescriptions， which helped6）abate someone’s anxiety or depression or pain only temporarily， because I could not do anything about their poverty. I was helpful initially—but not in the long run.
These interventions seemed to hinder my patients. They felt better but did not make the changes necessary to sustain that improvement. They did not leave their stressful jobs or their toxic relationship. They continued to isolate themselves， to eat poorly， to live in housing that， though 7）subsidized， kept them in neighbourhoods that triggered their addictions. They got hooked on pain pills. They couldn’t sleep， even with their 8）sedatives.
They came back wanting more. “I need something else， doc…” What was the latest medication or diet or technique？
I would scrape at the bottom of my toolkit.“Let’s try this new med！ Have you tried hypnosis， 9）eye movement desensitization and reprocessing（EMDR）， or emotional freedom therapy？”
Or I would scan the disability form for a new box I could check off， maybe for 10）transit tokens， so they could get $30 more a month. “Are you sure you aren’t 11）lactose intolerant？” I would say. I’d frown， wondering how I could justify this to the authorities. Who checked these forms， anyway？ The patient and I would have a few hopeful visits， and then the inevitable disappointment. “It’s not enough …”
Over the long term， my efforts seemed to generate more frustration and dissatisfaction than help. Each patient encounter reminded me of how helpless I was， even in my cloak of competence. When I wasn’t dealing with their complaints about me， I was furious with them， their ignorance and their weakness.
I became cynical， bored and resentful. Why were they asking for my help if they didn’t listen？ I ended up blaming patients for my misjudgments： Filling out a disability form 12）consigned them to an aimless life of poverty； writing a prescription got them physically or psychologically hooked for years.
I burned out. I changed the focus of my 13）family practice to addiction medicine， and when that didn’t work， I took 14）sick leave. The desire to help turned sour like a romance. The money and status were never enough to soothe the hopelessness and anger I felt each morning， when I looked at my day sheet of needy patients. I hated my perfect job.
I often saw other physicians in the same boat as me， trying to 15）mill through the same treacherous darkness， crazy with the latest fad that promised redemption. We even joined peer support groups—where we could 16）commiserate and try not to resent our patients and our own helplessness.
It was through such a group that I learned I couldn’t help anyone unless they were willing to help themselves first. If I was working harder than the patient， my help usually made things worse.
I practice now at a short-term addiction centre. With my clinical knowledge and experience， I can sometimes provide a diagnosis or treatment that is useful for a person. I might even aid in providing some temporary bridges or crutches （meds， shortterm financial relief）. But these are temporary aids.
There are limitations to what we each can do for another—regardless of what wizard’s wand we are holding.
Over time， I have learned to sit back and let others trudge through their own version of the human 17）muddle. I am most helpful if I haven’t burned out before someone is finally able to accept the encouragement and direction I can give.
When someone dips down into their depths and then 18）comes up for air， I want my hand to be there， waiting.
“为什么你想成为一名医生？”
立刻浮现心头的是金钱与地位，但是我在医科大学申请表上的回答却是一番“外交辞令”。我当时写的是医学如何作为完美的工具让世界发生有意义的改变，如何作为有力的手段帮助他人——一名志在必得的申请人该说的标准答案。
其实我说的真就是我想的，我真的想从事一份能够帮助他人的工作。如果钞票与地位是其中一部分，那就真是梦寐以求的工作了。
这么多年来，偶尔我也显得助人有功，有时候挺戏剧性的：有那么一次，一位年轻人来到我的办公室，弯着身子、大汗淋漓，而且高烧不止。我把他送到急诊室，并附上诊断书，惊呼他需要立刻动手术。他患上的是睾丸扭转，要是延迟几个小时，他很可能会终生不育，甚至死亡。他当天就接受了手术。我感到很得意。我这个明智的医生得记上一功！
多数情况下，我的治疗有效性只是用于确认病人的痛苦而已。我告诉他们，他们的症状（情绪低落、狼疮还有瘾症）其他人也有，尽管医疗手段有限，但是他们不是唯一的患者，并非“异类”。有些时候，这便是我当天能开出的最好的药方了。
但是大多时候，我的诊断介入并没有帮助。很多时候，那个人还没有到伤残的地步，我开出的诊断单就已经将其判定为“残疾”，因为这意味着他们可以获得援助，得到更多的钱来支付房租。很多时候我写下处方单，只能暂时地帮助缓解病人的焦虑、沮丧或者疼痛，因为我对他们身处的贫困境地无能为力。起初我还是能帮助解决问题的，但是不能长久持续。
这些诊断似乎为我的病人的生活前景设置了障碍。他们感觉好点了，但却没能作出必要的改变来让事情继续往好的方向发展。他们还是从事原来高压的工作，或是持续着那段荼毒心灵的恋爱关系。他们继续离群索居，饮食不佳，住在尽管有政府房屋补贴但却要与瘾君子为邻的区域里。他们对止痛药上瘾，就算服了镇静剂也还是无法入眠。
他们回来找我提出更多的要求。“我需要一些其他的东西，医生……”最新的处方、食谱或技术是什么？
我会绞尽脑汁，“让我们试试这款新药！你尝试过催眠、眼动脱敏和再加工治疗，还有情感释放治疗法吗？”
或者我会审视他们的残疾鉴定表，看看在哪个病症选项上能再打个勾——或许只是为了多得车费，这样他们每个月可以多拿30美元。“你确定你不是乳糖不耐症？”我会这样说。我还会皱眉，思考怎样对政府官员作出合理解释。不过，谁会检查这些表格呢？
我和病人会满带希望去申请，然后难免失望而归。“这还不够……”
在很长的一段时间里，比起帮助，我的努力似乎带来更多的挫折和不满。每一次会诊，病人都提醒着我自己是多么的无能，甚至在我能力范围之内亦如此。当我不是在处理他们对我的投诉，我就在对他们、对他们的无知和软弱感到生气。
我变得冷漠愤世、厌倦恼怒。如果他们不听我的建议，为什么还要向我求助呢？最后我把自己的错误判断怪在病人的头上：填一张残疾鉴定表，将他们推向毫无目标的贫苦生活当中；给他们开一张处方单，让他们年复一年在身体上或者精神上无法摆脱依赖。
我感到精疲力竭。我从普通医疗转向专注成瘾性药物这一专科，当那样还不能解决我的问题，我就请病假。就像爱情故事激情不再一样，我助人的欲望日渐变味。当我看着那张记录当天我要会诊的贫困病人名单时，名利不足以抚平每天早上感到的绝望与愤怒。我痛恨我这份完美的工作。
我经常看到其他内科医生陷入与我相似的境地，试图挺过这种自欺欺人的黑暗煎熬，对最新流行风潮痴迷不已，满怀希望从中求解脱。我们甚至参加同僚互助小组——在那里我们可以互相同情，并试着不去厌恶我们的病人和自身的无助感。
正是通过这种互组小组，我明白到，除非病人首先愿意帮助自己，不然我帮不了任何人。病人不努力，光靠医生用劲的话，那我提供的帮助通常只会让事情变得更糟。
我现在在短期瘾症中心工作。我的医学理论和临床经验让我在一些时候能够为病人提供有用的诊断或治疗。我还能够提供临时性的桥接器和支架（起到药物的作用，或是缓解短期的财政紧张）。但这一切都只是暂时性的援助。
我们能为别人做的事情毕竟有限——无论我们手上拿着什么样的魔杖。
这么多年来，我明白到要放手让人们从自己的生活泥潭中走出来。如果我在变得暴躁不堪之前最终能让人接受我给出的鼓励和指引，我就最能帮上忙了。
当一个深陷困境的人能探出头来挣扎喘息，我希望我会伸手在那儿，等着，拉他们一把。