I look 12 (flattery will get you everywhere)

I made it through a long Hurricane Irene call shift with two nights of minimal sleep on a call-room bed that is more metal springs than fluffy mattress. When I returned [to my thankfully unscathed!] home, my elderly neighbor greeted me in the driveway for a little neighborly small talk.

Mrs. Cataract: So, you gonna start back at college soon?
PGYx: (in scrub pants & t-shirt) [laughing] I'm a doctor!
Mrs. C: Oh! Where you work?

In related news, not one but several patients and family members have commented specifically that I "look 12!" Not 14 or 16 or like a teenager, but that I specifically look 12 years old.

Now let me tell you, I don't think I look that young. I wish I looked younger. I've aged a lot since my early 20s, including gaining a few horribly wiry white hairs worthy of Alfalfa's cowlick.

I wear modest business-casual clothing -- not purchased from the children's section -- to work with sensible flats or Sanita clogs. I top off the ensemble with a long white coat.

I wear a little bit of natural-looking makeup and have eye creases from smiling and laughing a lot. I'm starting to get two vertical lines between my eyebrows from chronically furrowing my brow every time I think, have a question, or feel amazed (i.e., ~16 hours per day). I'm told I have a very expressive face, so more wrinkles can't be far behind.

I never really had a growth spurt, it's true, but have no clue how anyone could mistake me for a day under 26. I don't act young and from a very early age have frequently been told I am "mature for my age."

Plenty of patients ask me questions like, "So, doc, in your experience, how often do you see [insert adverse effect]?" And I always have to toe the line between inspiring confidence in my clinical judgment and acknowledging that I'm a new physician-in-training supervised by much more experienced attending physicians. So it's not as though people are questioning my competence when they muse about my age.

One particularly lovely and loving family surprised me when they shared their curiosity about my age. We spent a long night together in the intensive care unit as I directed care for their loved one, unexpectedly gravely ill with sepsis.

We had a frank goals of care discussion during which they opted against cardiac resuscitation for an arrhythmia I told them they could reasonably expect. They understood that compressions and defibrillation would not meaningfully prolong her life. They seemed satisfied by my explanations and no one asked for a second opinion from someone with greater expertise.

The next day, the arrhythmia came. My attending indicated that we could cardiovert her. It was both an academic statement and a chance for her family to feel as though they tried "everything." Her husband, clearly upset, motioned for me to come over. He questioned whether his decision to withhold aggressive care was mistaken. "Would it change anything?" he asked, his pain palpable. "No, it won't change anything. It won't save her," I told him as kindly as I could.

"Is he the big doctor?" he asked, referencing both my attending's expertise and alluding to his small stature. "Yes," I replied, "He knows what he's talking about, but only you know what your wife would want for herself."

"How about you, how old are you?" "Yeah, we've been wondering all night!" his daughter chimed in with a smile. I paused a fraction of a second before answering, but felt he deserved an answer: "Thirty-three." "You look twelve!" he exclaimed without skipping a beat.

To this day, he remains the only family member with whom I have exchanged goodbye kisses in my role as physican. I will never forget him, his wife of more than 50 years, their children & grandchildren, or the fact that I apparently look 12 came up in this most unlikely of circumstances. I hope they're doing ok now. And selfishly, I hope I get to look 12 for at least a little while longer.