A man, middle aged, sat in the dark lobby. I ushered him in to the interview room. Words came slowly for both of us. A cursory hand-shake and hellos exchanged, introductions traded. A tentative start to long discussion began with the words, “I just need to get something off of my chest.”

The minutes that followed will stay with me for the rest of my life. Here this tattered soul laid bare his most horrific moments to a complete stranger. He shared with me the details of events that loomed over him even at his happiest times; secrets he had often dared not even repeat to himself as if in acknowledging them he would make them true. In recounting the experience, I am even more certain it was nothing I said or did but simply the fact that I was there in a white coat, listening and nodding. With a quiet “thank you” Pandora's Box was shut but the seal forever broken.

Appointments were made, prescriptions written, goodbyes exchanged. I called the attending, as required, to check out the patient. On paper, it's all pretty unremarkable. But sometimes paper doesn't tell the whole story.

Scary though it is to be there, raw and new, walking the tightrope with a distant net, the visceral impact of these kinds of interactions are a strong reminder of why any of us bothered to do this in the first place. It would be a comfort to have someone there with me, but it's a comfort that waters down the satisfaction of being that patient's physician.

I'd like to tell you that my next call night I slept like a baby, but it's not true now and I'm not sure it ever will be. I can tell you, though, that the next time my pager went off it was a bit more confidence that I made my pilgrimage to the Emergency Department. The unfiltered call experience, as deceptively solo as it appears, develops those skills much more rapidly than one of stifling oversight. It also allows for nights like this one, which remind me that if there's anything in the world worth doing then this is it.

Andrew G. Nanton, M.D.