When you hear the same comment from two very different places/people in a short space of time, you need to take it seriously.

First, a friend/colleague at Brown said she loved the book, couldn’t put it down, but felt it didn’t paint a very optimistic portrait of medicine since “so many of the characters left medicine or were on the verge of leaving”  and while many seemed very happy in their careers, it was the leavers who lingered in her thoughts.

Then last weekend, Howard Carter, PhD, a medical humanities scholar whom I’ve never met but whose work I’ve admired for years, posted a review of A History of the Present Illness on the remarkable NYU Literature, Arts and Medicine database.

In the review, Dr. Carter notes that the reader surmises that Robert in “Giving Good Death” leaves San Francisco “and, we surmise, medicine. In three other stories, doctors also leave the profession.”

I have a different read on this. I would say one character leaves without question (Perla) and another is forced out (hint: she holds a lot of professional degrees…). That means two left, and only one intentionally.

But what a writer intends isn’t necessarily what appears on the page. Moreover, one of the joys of literature generally and so-called ‘modern’ literature in particular is that its ambiguity mirrors the uncertainties of real life.

So I did an informal survey, using what we call in medicine a ‘convenience sample’ i.e. the first ten people I encountered who had read the book.

The results were interesting. One other person thought a few characters had left the profession. Several noted the two I mentioned above and weren’t sure about a couple of others. All the geriatricians shared my interpretation: two left, the others remained committed but took breaks to achieve better work-life balance or recover from burnout, two very common challenges for practicing physicians today.

This doesn’t surprise me. Geriatricians must be experts in coping with ambiguity. Rarely in our work are things – medical, social, ethical – simple and straightforward. That’s part of what makes geriatrics so interesting and part of the reason we can be helpful to colleagues in helping patients and families through challenging situations without easy answers.

Burnout is a stress-related condition associated with emotional exhaustion, depression, sleep disturbance and suicide. The condition is more common among physicians than others in the U.S. population. Curiously, it appears related to why people are in medicine; the more personal the motivation, the higher the risk of burnout.

Work-life balance, of course, is a challenge for all of us, perhaps all the more so in this digital age where we have access to others and they to us 24/7.

That’s why those issues are in the book: because they are common and they matter, and we can’t decrease their incidence and help people avoid burnout and achieve a pleasing balance in their lives if we don’t look carefully at the many causes, personal and professional of these problems.

Call me naive or overly optimistic, but I believe the other characters who took breaks or changed their lives or jobs ended up happier people and better clinicians for having confronted issues that challenge us all.