My first memories are of being taught. I was raised by the kind of reader who installed tilting shelves in her living room to keep past issues of magazines behind the current issues. She married my father, a man whose only woodworking projects in their fifty years of marriage are a set of floor-to-ceiling bookshelves and a crib.

He built the crib in the Dartmouth woodshop when he realized he would be leaving business school at the end of his first semester without a degree. He took my mother and the crib home to Amarillo, where I was born four months later and became the first of five children to sleep in, teethe on, and be read to in the crib he built.

My mother read to me constantly: while I was in the crib, in her lap, and by the side of my siblings. We read so many books that the local public library created a wooden plaque whose engraving declared us Library Family of the Year.

My mother read me to the kind of college where the only breaks from reading were writing assignments. Every week, we wrote single-spaced, ten-page seminar papers, then tacked them to the doors of each other’s dorm rooms. The next day, we spent the afternoon debating each other’s works as if we knew what we thought or how to think. I imagined I would spend the rest of my life doing the same.

Over spring break, I road-tripped up I-95 with classmates to visit graduate programs. I loved the reading lists which scrolled on and the libraries which towered over quads, but when I sat in on classes, I was disappointed to find my mother’s way of reading—her encouraging tones, her smiling gaze, her omnivorous appetite—was discouraged.

I delayed graduate school for what I thought would be a single year of service, accompanying medically ill and injured homeless people to and from hospitals. I saw how they swallowed cornstarch to stay full and alcohol to stave off seizures. I smelled how poverty alienated them from the doctors and nurses who were supposed to care for them.

Confused by the experience, I did as my mother taught me and found books about what ails medicine. I wrote one of the authors a letter. He wrote back with an invitation. I moved halfway across the country to become his research assistant. He kept an office crowded, floor to ceiling, with books. I told him I hoped to follow his path by earning a doctorate in the humanities and becoming a teacher. He told me to consider medicine saying, after all, the root word for doctor means teacher.

• • •

For academic physicians like me, seeing patients with medical students and resident physicians is root work. I rarely see a patient alone, so when I examine, say, a patient experiencing an adverse effect of their medication, I am doing so with a trainee at the patient’s bedside. I teach the trainee to hold the patient’s forearm, move the elbow, reassure the patient, and dose a new medication which induces no shaking.

I doctor, so I teach.

My own teachers did the same for me. They spent hours correcting my movements, my speech, and my thinking with direct feedback and dashing lines of red ink. When I see them, across campus or across the country, I thank them for making me a doctor. As I walk away, I feel again the joy of medical training is entering a series of relationships which make you capable of attending the sick.

When I thanked one of those doctors, his eyes twinkled as he recalled a favorite Simone Weil quote from memory. “The joy of learning is as indispensable in study as breathing is in running. Where it is lacking there are no real students, but only poor caricatures of apprentices who, at the end of their apprenticeship, will not even have a trade.”¹

• • •

Every June, I welcome new resident doctors to our hospital. We badge, vaccinate, drug test, and orient them. They log onto the electronic health record for the first time and learn how to write a note and place orders. It’s a logistical challenge for the doctors—they have only three hours—and for my team—we have two days to welcome two hundred and fifty doctors—so we batch the new doctors by their future specialties.

Seeing them in batches, I realize the residents have already sorted themselves out by learning to dress the part of their specialty. I can guess an intern’s future specialty from across the room. Emergency medicine interns are the only ones still wearing cargo pants, future pediatricians wear cartoon animals around their stethoscopes, orthopedic trainees wear extra muscle, and psychiatry interns wear stylized eyeglasses.

I sometimes ask interns if they were instructed to dress in a specialty-specific uniform. They look puzzled. The answer is formally no, but I know the informal answer is yes. American resident physicians are selected and trained for efficiency; they are people who receive messages without waiting for them to be spoken and alter their behavior accordingly. Fitted to the system in clothes that match, they move through the various orientation stations as quickly as they can, on their way to accrue another merit.

Every year, I add one more stop than necessary: a conversation with Mary, an interpreter at a public hospital in Denver where the patients speak two hundred different languages. Even though she is a doctor three times over, the people Mary meets as patients never call her doctor. Mary speaks their two most common languages—English and Spanish—fluently. The root word for interpreter means to understand between, and Mary understands between two languages but also between worlds: doctor and patient, America and Mexico. She completed medical school in Puebla, then a residency, then two fellowships, and entered practice. She saw patients. She took up the root work of doctoring and taught students.

Life intervened. She met an American at her sister’s wedding. They danced. He asked to see her again, again. Soon, they married. Mary split her time between her medical practice and her new husband’s home in Denver, flying to her practice and then flying home to her husband. She was a doctor in one part of her world but not yet in the other.

One year, Mary motioned me over to her orientation station. She asked, “I am a doctor too. My joy is being a doctor. I want to practice again. What can I do to practice here?”

• • •

For the past century, American medicine has tied medical learning to research universities, which are less focused on fostering the joy of learning than they are on sorting candidates. Every year, approximately 140,000 students begin college as premeds, but only half will accumulate the necessary requirements of four years of the research sciences and completion of the MCAT. While 50,000 students apply annually, less than half will enroll. After four years of medical school, about 20,000 of them will apply for residency training, which lasts between three and a dozen years in one of our nation’s 182 specialties and subspecialties. Along the way to joining our country’s roughly one million licensed physicians, trainees secure standardized exam scores, letters of recommendation, transcripts, and diplomas, each of which functions as a gate guarding entrance to the most technically advanced and financially rewarding version of medicine in the world.²

When internationally trained physicians like Mary try to translate their skills into American medicine, they are typically stopped at the first gate and asked to verify their medical education is equivalent to American medical training through an expensive and complicated process, which becomes nigh impossible if their home country is riven by conflict or their medical school is shuttered. If their education cannot be verified, their best recourse is to start over by enrolling in an American medical school. Some do so, but most are discouraged by the prospect of paying for another decade of school at the prices of American research universities and take other employment as clerks, drivers, and teachers. Or interpreters.

• • •

I know the pathway to becoming an American doctor. I followed it myself, my wife followed it, and we both experience the indispensable joy of learning with and from our trainees. The joy of teaching is, to paraphrase Walker Percy, the opportunity to know someone and help them a little bit along their journey for good and selfish reasons, just as you were helped.³

When Mary asked her question, I received it as an opportunity to chase joy and agreed to help her apply for the next year’s residency match. I knew internationally trained physicians found a match only two-thirds of the time, but Mary embodied the joy of true learning.4 She asked questions and never settled for easy answers when we met. She wrote a winning personal statement, assembled letters from current faculty, and prepped for interviews. I called programs on her behalf. Friends read her application, admitted she had the love of medicine, but politely declined to interview her because she lacked clinical experience as a physician in the United States.
Given how poorly medical care in our country is regarded by many of our citizens, I thought it might be a benefit for her to have brought a different set of experiences, for her to be someone who could teach and understand between. Residency program directors regarded her differences as a liability, fearing she would be unable to translate her skills into an American setting. Like many internationally trained physicians, Mary would never be known as a doctor here.

• • •

Even after she failed to match as a resident physician, Mary’s question
nagged at me. She asked only for an oppor­tunity.

The opportunity came six months after Mary failed to match. A local nonprofit which specializes in intercultural learning and refugee education reached out. They were interested in helping international immigrant physicians enter our state’s primary care workforce. We looked at national models. We drafted legislation. Three years later, we secured grant funding to open the program we call Colorado Works for International Physicians, or CO-WIP for short.

• • •

My first call was to tell Mary about the new program. We would offer trainees a nine-month clinical learning experience in an American teaching hospital so trainees could have translatable experience. We would offer weekly didactics so trainees could learn together from faculty in small groups. We would offer individualized coaching mentorship so trainees could earn detailed letters of reference from American physicians. We would secure trainee licenses from our state’s medical board so trainees could participate fully in clinical care. We would take down as many gates as we could to help an international immigrant physician eventually secure a full license to practice in America. We would even pay a living wage with full benefits.

Mary surprised me again. She said, “I will think about it.”

When we talked again, she cried. She raised her hands and counted out the years she spent applying and the years I spent building the program, all while her children grew older. Mary wanted to train, but in the intervening years, she had directed her joy into her children. She still loved her time with patients, but realized she spent more time with patients as an interpreter than most American doctors. She would channel her joy into her family and her work as an interpreter. Mary told me to offer her opportunity to others.

• • •

We opened the program later that year, with four local middle-aged women. Hind, Islam, Suhaila, and Sulafa knew each other as members of the local Sudanese refugee community and agreed, together, to entrust their deferred dreams with us.
Every time I saw them, they celebrated something new. The skill of American doctors. The efficacy of American medicines. The availability of imaging and labs. As their hopes grew of being called doctor again, so did the joy on their faces, even as they encountered challenges. They spoke accented English which others struggled to understand. They dressed in ways which did not map onto cultural expectations, wearing hijabs in a town where doctors more commonly wear ski-wear than religious garments. They were unaccustomed to spending so much time documenting in electronic health records. They did not know how to narrate their personal experiences into personal statements and residency interviews.

American trainees are taught to narrate their experiences as struggles surmount. I often have to nudge an American trainee to write admission essays about something other than their own journey, to sound some note of how they will help patients on journeys of their own. When I practice interviews with immigrant physicians, I find them so self-effacing they offer no account of the remarkable distance they have travelled in pursuit of their dreams. Many have endured personal violence, fled war, and suffered heart-wrenching losses, yet they find speaking of their struggles too personal or beside the point. They are formed to write about patients instead of themselves.

As the hopes of Hind, Islam, Suhaila, and Sulafa grew, they brought in food. For a staff meeting, they filled a conference room with cumin and garlic-infused dishes. For the first time, I ate asida and ful medames, sopped spiced okra with kisra bread, and mullah, a hearty stew of lamb in a spiced broth.

Now, whenever I grow frustrated enough to quit teaching, I remember how Mary asked me one question and how my only way to answer was by teaching for mullah.

• • •

Around the time I was learning to eat mullah, a group of American medical students approached me and asked me to be their faculty sponsor for a human flourishing club at the medical school. Doing so meant going through an online training designed to ensure compliance with university policies. One item surprised me: neither I nor a student were allowed to share any homemade food. I thought it some kind of typo and called the university. I was informed homemade food was a liability.

I have a friend who is a dean at another medical school. He has studied what it means to be a wise physician by interviewing physicians across the country. They taught him medical practice is so complex and dynamic that it requires more than technical knowledge. Becoming a physician necessitates practical wisdom. Wise physicians also need the ability to adapt to their circumstances while following a moral compass. And yet my friend found American medical education is too often reduced to a technical practice which turns medical students, trainees, and faculty into Weil’s joyless caricatures.⁵

What he never gets to in the paper is how flavorless it can be. We need to taste the new flavors of mullah, to smell cumin and garlic when we doctors undertake our root work as teachers.

• • •

The library plaque from my childhood still hangs on the wall, but now in my own living room, surrounded by stacks and stacks of books that I have taught my own children to read. I still teach American medical students, but now I also teach international physicians. With all three, I seek the joy of learning, of forming close relationships, of taking care of each other while doing so, of building out the capacity to adapt and the virtue to practice courageously, which needs to accompany the transmission of technical knowledge and skills. I try to teach like my mother, like the professor who inspired me to attend medical school, and like the wise older physician who quoted Weil. With the scent of joy.

Inside the bookshelf I also keep a series of small gifts the first group of CO-WIP learners gave me after they realized their dreams. They matched in American residencies. I have a leather belt, a hand-tooled wallet, and a spice jar from a group of women who are now called, for the first time in a long time, doctors.

They taught me the joy of teaching is to be entrusted with someone’s dream enough to share a homemade meal. When I teach now, I do so for Mary and for mullah.