Don't you want to be a sommelier?

Lessons for those of us who love medicine

Recently while traveling in Europe, I met a oncology department chief in charge of hiring. Of course, unlike the United States, you can't easily open a new position in Europe. Often, you need a senior faculty member to retire to make room for a new doctor. But they, inevitably, don't always want to.

The chief expressed frustration with docs unwilling to retire, even though they reached the age of pension.

“I just love what I'm doing; I don’t want to stop.” they tell him

“But don't you want to be a sommelier?” He asks pointedly.

Why did he have to pick sommelier? I thought to myself. Of course, he picked it because it was his passion. He loved wine. He wanted to explore the limits of his senses. Could he train to recognize wine the way humans can tell faces apart, with a million shades of gray? With practice could he delineate the subtleties, the flavors, the aromas?

The French have a word called terroir, which means that merely by drinking, one can describe the very plot of land from which the wine came. You can the taste of the dirt, the sun, the rain.

Some describe terroir as minerality; yet, it's much more. It's tasting the craft at such a deep level that you can close your eyes and be in the field where the grapes are grown.

Why did he have to say sommelier? I thought to myself. He could have said anything. It bothered me because, of course, I too was in love with wine. I was in love with the idea that one could devote oneself to the craft and be able to sense the subtle differences of that living, breathing drink.

Winemaking is like medicine. It goes back thousands of years. It has a tradition that will exceed us, and yes I am as curious about it as I am about medicine. I spent 20 years of my life thinking and breathing medicine, and all it's intricacies. I would love to spend some years discovering the intricacies of wine before I die.

“ Do you know what it takes to be a sommelier?” He asked me.

“ Obviously one has to be an expert tasting the differences…” I began

“—-No, much more”, he interjected, “It takes a minimum of 3 years of devoted study. It's what you do. You cannot do anything else.”

It was consuming, just as medicine is.

And so he asked the senior faculty, did they want to be a sommelier? Was there something in their life that they wanted to pursue, doggedly, in that brief time before we die?

Who knows that better than an oncologist. Who knows how cruel and tempestuous life can be then a cancer doctor. Each year we bury many, who lived pristine lives and were struck by the randomness of it. Many who worked until the moment they began treatment.

“ I never want to be like that.” He said. “If you gave me a pension today, I would become a sommelier. Yes, I love what I do, but there are other things I love too.”

When I started in medicine, I found it all consuming. I was in love with every detail and nuance. I didn't just want to be a cancer doctor; I wanted to understand every aspect of it. Why we made every decision, and the history behind those decisions. And so I poured myself into it. I wrote a book about it (Malignant). Each year I still learn more, but I do see it with a million shades of distinction. I know I'm not perfect, but I feel that each year I'm better.

How do we reconcile wanting to be experts in one thing, but keeping open the part of us that could become an expert in something else? How do you pour yourself into medicine, but not lose yourself in the process?

I worry that the pendulum has swung too far the other direction. Now, it is all work life balance from the moment you begin in the field. It's mental health days off, and pass fail curricula. The very best students are the same. They are internally driven. But for so many medicine is just a thing they do alongside skiing and biking and traveling.

Yes, I want to be a doctor; but I also want someday to be a sommelier. Both are people who pour themselves into a craft and art. Something that is rooted in science but branches beyond.

If you gave me a pension tomorrow, I don't think I would retire, but I also hope I can become a sommelier before it is too late.

When does that moment come?