In the fifteenth chapter of Middlemarch, George Eliot gives her young doctor his vocation in a single scene. Tertius Lydgate is ten years old, home from school, and bored. A wet day sends him to the small home library to hunt for a book with some freshness in it, and finding none, he climbs on a chair to take down a dusty row of volumes from the highest shelf, “the volumes of an old Cyclopaedia which he had never disturbed.” He opens the first one where he stands, in what Eliot calls a makeshift attitude, and it falls open at Anatomy. The first passage that catches his eye is on the valves of the heart. He knows nothing about valves, but he knows that valvae were folding-doors, and through that crevice, Eliot writes, “came a sudden light startling him with his first vivid notion of finely adjusted mechanism in the human frame.” Then the sentence that every reader remembers: “But the moment of vocation had come, and before he got down from his chair, the world was made new to him.”
It may be the most famous first day in the literature of medicine, and Eliot plainly loves it. She also, in the same paragraph, quietly undermines it. A few lines earlier she has generalised the scene into something nearly universal: “Most of us who turn to any subject with love remember some morning or evening hour when we got on a high stool to reach down an untried volume, or sat with parted lips listening to a new talker, or for very lack of books began to listen to the voices within, as the first traceable beginning of our love.” The phrase to notice is first traceable beginning. Not the first beginning; the first one that can be traced. Eliot knew that love, of a person or of a subject, rarely begins where its story says it begins, and that the hour on the high stool is remembered because it is the earliest point to which the thread can be followed back, not because nothing came before it.
This essay borrows its title from that kind of story, and it should say plainly, once, what it will not do. It does not reconstruct a particular day, a particular conversation or a particular revelation in the author’s life; the subject is how vocations begin, and how they are told afterwards. The public record of my own beginning is a list of dates and institutions: Khalsa College, Amritsar, for the pre-medical sciences, 1994 to 1996; then five years, 1997 to 2002, for the MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research; then residency in Little Rock and Fresno; then practice in California since 2010. Those dates record when the training began. They do not record when the idea began, and the idea is what this essay is about: medicine before the white coat, when it was still something one thought rather than something one did.
The First Traceable Beginning #
Eliot’s scene repays a slow reading, because almost every detail in it is double-edged. Lydgate is not seeking anything; he is bored, and he reads “in a makeshift attitude, just where it might seem inconvenient to do so.” The vocation arrives sideways, through an accident of which volume came off the shelf first. It enters through a word rather than an observation: he knows next to nothing about valves of any kind, but he knows the Latin for folding-doors, and the doors open in his mind before any door of the body is opened to his eyes. And Eliot is merciless about the education that preceded the moment. A liberal schooling had left Lydgate free to read the indecent passages in the classics, she remarks, but so ignorant of his own body that “for anything he knew his brains lay in small bags at his temples.” The sudden light is sudden partly because the darkness before it was so complete.
Then, having granted the vocation its moment, Eliot turns at once to its fate in the world. We are never weary, she complains, of telling how a man comes to fall in love with a woman, and comparatively uninterested in the other kind of love, the love of a subject, “which must be wooed with industrious thought and patient renunciation of small desires.” Among the many middle-aged men who go about their vocations in a daily course determined for them as much as the tie of their cravats, there are always some “who once meant to shape their own deeds and alter the world a little.” Their ardour cools imperceptibly, “till one day their earlier self walked like a ghost in its old home and made the new furniture ghastly.” The paragraph that begins with the high stool ends with the ghost.
The novel then makes good on that warning. Lydgate carries to his studies in London, Edinburgh and Paris the conviction that “the medical profession as it might be was the finest in the world,” and the conditional clause, as it might be, is where the tragedy hides. He marries badly, falls into debt, compromises, and leaves the town where he meant to reform medicine. In the Finale, Eliot gives him an excellent practice, divided by season between London and a Continental spa, and a treatise on gout, “a disease which has a good deal of wealth on its side.” He dies at fifty. “His skill was relied on by many paying patients, but he always regarded himself as a failure: he had not done what he once meant to do.”
So the great scene of medical vocation in English fiction belongs to a man whose vocation, by his own reckoning, failed. Eliot leaves the moment its truth and denies it any power of guarantee: a beginning, however bright, decides very little. The day on the chair was real within the novel. What it could not do was guarantee the days that followed, and the novel spends hundreds of pages on those.
Medicine as an Idea #
Before anyone becomes a doctor, medicine exists for him as an idea, and the idea is necessarily made from the outside. A child or a young student sees what the occupation looks like to those it serves: a person who is sent for when something is wrong, who is listened to when others are anxious, who can do something when everyone else can only wait. The idea has authority in it, and usefulness, and a kind of competence that seems, from outside, to be calm. It has very little else, because very little else is visible from where the young person stands.
Punjabi has a word that holds this stage of a vocation exactly. ਖ਼ਿਆਲ (khiāl) means a thought, a notion, an idea, a fancy; it is what one has in mind. But the same word, in the everyday phrase ਖ਼ਿਆਲ ਰੱਖਣਾ (khiāl rakhṇā), means to look after someone, to take care of them, and one of the commonest leave-takings in Punjabi is an instruction to look after oneself in exactly those words: ਆਪਣਾ ਖ਼ਿਆਲ ਰੱਖੀਂ (āpṇā khiāl rakhīṃ), take care of yourself. The word spans the distance between having an idea of something and taking care of someone. A vocation in medicine is, among other things, the long passage from the first sense to the second: from the doctor one has in mind to the patients one has in one’s keeping. The first sense can be acquired in an afternoon. The second takes years, and is never finished.
The idea also contains a self, and honesty requires admitting what kind. A young person who imagines becoming a doctor imagines the work, but he also imagines himself doing it: respected, useful, perhaps admired, a person whose arrival in a room changes the mood of the room. Service and vanity are mixed in that picture from the start, and there is no point pretending otherwise. Eliot, who never let a character keep a flattering self-image for long, said exactly this about Lydgate. His intellectual ardour was real and his intentions noble, but his “spots of commonness,” she wrote, “lay in the complexion of his prejudices,” which were half of them the prejudices of ordinary men of the world: the distinction of his mind “did not penetrate his feeling and judgment about furniture, or women,” or the wish to have it known that he was better born than other country surgeons. The vocation was pure in one compartment of the man and common in the others, and the novel shows that it was the common compartments, not the pure one, that decided his fate.
I find that a useful corrective to every origin story, including the ones that physicians tell about themselves. The first idea of medicine is rarely made only of compassion and curiosity. It has ambition in it, and a wish for standing, and sometimes a wish to please people whose approval matters. None of this disqualifies it. A vocation is not required to begin pure; it is required to become, over time, more faithful to the patients than to the self-image. The idea’s mixed motives are simply where everyone starts.
What the idea leaves out is almost everything that fills the working day. It leaves out uncertainty, which is the physician’s daily element and which the idea, built from the outside, replaces with calm. It leaves out paperwork, in all its modern electronic abundance. It leaves out the patients who do not get better, and the ones who never return, so that one never learns how their stories ended. It leaves out the nights spent thinking about a single conversation, a subject another essay on this site describes better than I can here. None of this makes the idea worthless. An idea of an occupation formed from outside is how nearly every vocation starts, because there is nowhere else to stand at the start. The question is only what happens when the idea meets the work.
Whose Idea It Was #
Ideas of vocation are seldom entirely one’s own. They are suggested, encouraged, overheard, borrowed from admired people, absorbed from the general esteem in which certain occupations are held. In many Indian households of the last century the esteem of medicine was strong enough to become a joke about itself, the parental wish that a child become a doctor or, failing that, an engineer, repeated so often in comedy and conversation that it now functions as a cliché. Like most clichés it contained a truth about social aspiration, and like most it flattened the variety of real families into one.
Nearly every idea comes from others at first, so the line worth drawing runs elsewhere, between encouragement and pressure. Encouragement adds an option and leaves the others standing; pressure removes the others. The difference is visible less in what is said than in what happens when the young person hesitates. A borrowed idea can become one’s own, the way a first language, which no child chooses, becomes the language in which he thinks most intimately. It becomes one’s own through use, through the slow accumulation of reasons that were not there when the idea first arrived. Whether a vocation began as one’s own thought is a less important question than whether it became one’s own, and the second question can only be answered later.
That is also why other futures belong to the story even when they were never pursued. Every vocation is chosen against a background of alternatives, some considered, many simply unknown to a young person whose acquaintance with the range of possible lives is limited by the lives he can see. A student in a particular city, in a particular decade, with particular examinations ahead of him, chooses among the futures that are visible from there, and the ones that are not visible are not rejected; they are absent. It is easy, looking back, to describe that limited field as a free choice among all possibilities, and easy, in the opposite mood, to describe it as no choice at all. Neither description is honest. The truth is narrower: a choice was made among the options that could be seen, and some of those options would have been good lives too.
Calling, Profession, Career #
English has three words for the thing this essay is about, and each carries a different theory of how it begins.
Vocation comes from the Latin for a calling, and for most of its history it meant a religious calling: the summons of a person to the priesthood or the cloister. The Reformation widened it. Luther, translating scripture, used the German Beruf, a calling, for ordinary worldly occupations, and the idea that a cobbler or a merchant might be called to his work as surely as a monk to his became, as Max Weber argued in his study of the Protestant ethic, one of the quiet foundations of the modern attitude to work. The word assumes a caller and a moment of address. To have a vocation is to have heard something, and a story of vocation naturally takes the form of a day on which one heard it.
Profession comes from the Latin for a public declaration, and its oldest English sense is the vow made on entering a religious order. A profession is not heard; it is professed. Its natural story is a ceremony: an oath, a robing, a degree conferred, a name entered on a register. The White Coat Ceremony and the oaths that medical students recite belong to this word. They mark the beginning by an act performed before witnesses.
Career has the humblest origin. It comes through French from words for a road or a racecourse, the track along which a vehicle runs, and in English it long meant a gallop or a course before it meant a working life. A career is not heard or professed. It is run. Its natural story has no single first day at all, only a long course that can be described as a whole once enough of it has been covered.
Medicine is spoken of in all three words, often in the same sentence, and the mixture is revealing. The young person with an idea of becoming a doctor is told he has a vocation; the student at the ceremony enters a profession; the older physician looks back on a career. Each word asks for a different beginning, and the first day of the essay’s title belongs to the first word only. A truthful account of a medical life probably needs all three: something heard, something declared, something run. The difficulty is that the hearing, which comes first, is the part least likely to have been witnessed, recorded or even noticed at the time.
Vows Made for Me #
The finest account in English poetry of a vocation recognised rather than chosen is a passage in the fourth book of Wordsworth’s Prelude, and it is remarkable mainly for its grammar. In the summer vacation after his first year at Cambridge, the poet has spent a night at a country dance, with music, shuffling feet, “slight shocks of young love-liking,” and he walks home at dawn. The morning rises “in memorable pomp”; the sea lies laughing in the distance; the mountains shine; labourers are going out to the fields. And then:
Ah! need I say, dear Friend! that to the brim My heart was full; I made no vows, but vows Were then made for me; bond unknown to me Was given, that I should be, else sinning greatly, A dedicated Spirit.
I made no vows, but vows were then made for me. Wordsworth refuses the active voice. He does not decide to become a poet on that walk. A bond is given, unknown to him, and he finds himself bound. It is an honest description of how vocations often feel from the inside: less like choosing a road than like discovering that one has been on it for some time. And it is honest in another way, because the passage is openly retrospective. Wordsworth began the poem that became The Prelude at the end of the 1790s, completed one version in 1805, and kept revising it for the rest of his life; it was published only in 1850, after his death. The dawn walk of a young man was written down, and rewritten, by a much older one who knew what the young man had become. The bond was “unknown to me” at the time. It was known, and named, only afterwards.
There is a footnote to this passage that I find almost as moving as the passage itself. William Knight, editing Wordsworth late in the nineteenth century, tried to work out where the walk took place: which farmhouse the dance was held in, which ridge the path crossed, from which point the sea could have been seen at sunrise. He and his correspondents weighed two or three routes, and concluded that the landscape could support more than one, and that a note by another scholar summed up all that could “be safely said.” The vow is precise to the word. The ground on which it was made cannot be located. That is very often the condition of first days: exact in the telling, uncertain on the map.
Elsewhere in the poem, in its twelfth book, Wordsworth describes what he calls spots of time, moments in a life that “with distinct pre-eminence retain / A renovating virtue,” to which the mind returns for repair when it is depressed by false opinion or the round of ordinary intercourse. The idea is beautiful and also revealing. The spots are not chosen at the time they occur. They are chosen by later need, by the mind going back to find what will nourish it. A first day of vocation may be one of these: not the cause of what followed, but the place to which the person returns when he needs to remember why.
Desire Meets Prerequisites #
An idea of becoming a doctor is cheap. The prerequisites are not. Between the idea and the white coat lies a long sequence of requirements that have nothing to do with vocation and everything to do with whether the vocation will be permitted: subjects that must be studied, examinations that must be passed, marks that must be high enough, places that are limited in number. In India in the years I am thinking of, admission to medical college turned on competitive examinations and ranks after the pre-medical sciences of physics, chemistry and biology. The examinations asked what a candidate knew. They did not ask why he wanted to be a doctor. Whatever the idea of medicine was, it had to survive the syllabus, the timetable and the arithmetic of seats, and many ideas did not, for reasons that had nothing to do with their sincerity.
What carries an idea through that sequence? Not, usually, the idea in its first form. Educational psychologists who study how interest develops describe it as passing through phases. In an influential model published in 2006, Suzanne Hidi and K. Ann Renninger distinguished an interest first triggered by something in the situation, a striking fact, a vivid demonstration, a page that falls open at the right place, from an interest maintained by the situation over time, and both of these from the individual interest that emerges later and eventually becomes well developed, a lasting disposition to return to a subject and to pursue it for its own sake. The early phases are fragile. They depend on the environment to sustain them, on teachers, tasks and companions, and they can easily die out. The later phases depend increasingly on what the person has come to know, because knowledge is what makes further engagement possible and rewarding.
The model describes Lydgate’s chair with uncomfortable accuracy. What happened on it was a triggered interest. Eliot’s genius is to show the trigger as though it were the whole of the vocation, and then to spend the novel showing that it was not. For a real student, the passage from a triggered interest in medicine to an individual one runs through exactly the prerequisites that seem most remote from vocation: the chemistry, the physics, the long hours with the biology textbook. Competence, far from being the enemy of the idea, is the medium in which the idea either grows into something durable or quietly dies. A student who survives the syllabus with his interest intact has not merely kept an early idea alive. He has replaced it, piece by piece, with a better-informed one.
That arrangement has an odd consequence for the story of first days. American medical schools ask applicants for a personal essay, and the question underneath the genre, as every guide to writing one makes clear, is why medicine. An applicant who must answer that question in a page is under strong pressure to produce a beginning: a scene, a moment, a person, a day. The admissions system does not invent the vocation story, but it rewards the story with a clear origin, and over time it trains a whole profession to narrate itself that way. A system that admits by examination asks for no such narrative, and so leaves the beginning, for better or worse, untold.
Then there is the coat itself. The White Coat Ceremony, now widespread in American medical schools, in which entering students are formally robed at the start of their training, took its now-familiar form in 1993 at Columbia University, where Arnold P. Gold and the foundation that bears his name introduced it as a way of emphasising humanism in medicine from the first day of school; the University of Chicago’s Pritzker School of Medicine had held an earlier version in 1989. It is a recent ritual, younger than many of the physicians now practising, and it does something worth noticing: it manufactures a first day. It takes a beginning that is in reality diffuse, spread across years of interest, application and preparation, and gives it a date, an audience and a garment. There is nothing wrong with that; rituals exist to give shape to transitions that would otherwise have none. But it is a reminder that the first day of a vocation is often a social construction placed on top of a process, and that before the coat there was only the idea, which no ceremony records.
Memory After the Outcome #
Once a vocation has been followed for decades, it reorganises the memory of its own beginning. The fault, if it is one, lies less in particular people than in the way life stories work, and linguists and psychologists have described the mechanism with some precision.
The linguist Charlotte Linde, in Life Stories: The Creation of Coherence (1993), studied how people tell the story of their lives in conversation, and took as a central case the account of a choice of profession. A life story, as she defined it, is told over many occasions, altered to fit each occasion and each listener, and revised as the speaker’s situation and values change. Its tellers work hard to establish what she called adequate causality: a reason for the professional choice that will strike a listener as sufficient. Accident is a problem for such stories, because a career that happened by chance seems to say something unflattering about the person who drifted into it, and so accident has to be managed, explained, or converted into destiny. Continuity is the other demand. A person who has changed professions must show how the second grew from the first. A first day, with its revelation and its clear cause, is an almost perfect device for satisfying both demands at once.
The psychologist Michael Ross, in a 1989 paper in Psychological Review titled “Relation of implicit theories to the construction of personal histories,” described the process from another side. People do not simply retrieve their past attitudes. They reconstruct them, using their present state and their beliefs about whether people like them stay the same or change. Someone who believes he has always been the same tends to recall his earlier self as more like his present self than it was. A physician who believes that his vocation is deep and constant will find it easy to remember an early version of it, and to date that version earlier and earlier, because his implicit theory of himself requires it.
Families take part in this reconstruction, often lovingly. Once a person has become a doctor, the household’s memory begins to find the signs: the toy stethoscope, the interest in a relative’s illness, the bandaged doll, the question asked at a dinner years ago and now retold as prophecy. Such stories are a form of affection and a form of authorship at once. They give the grown child a past that fits his present, and the fit is satisfying to everyone. But children play at many things. The signs that pointed elsewhere, toward a profession not taken or a life not lived, are not retold, because nothing came of them, and so the record of childhood that survives into adulthood is a record selected by the outcome. Every memorable early sign of a vocation is accompanied by a crowd of forgotten signs of other vocations, and it is only the career that decides which of them was the omen.
None of this means first days are inventions. William James, in the lectures he gave at Edinburgh in 1901 and 1902 and published as The Varieties of Religious Experience, devoted two chapters to conversion, and his treatment remains the most balanced account I know of sudden and gradual change. Drawing on the psychologist Edwin Starbuck, he distinguished a volitional type of conversion, in which the change is “usually gradual” and consists in building up, piece by piece, a new set of habits, from a type by self-surrender, in which it comes suddenly. Even in the gradual type, he noted, there are critical points at which the movement forward seems much more rapid; “our education in any practical accomplishment proceeds apparently by jerks and starts, just as the growth of our physical bodies does.” He quoted Starbuck’s comparison with an athlete who keeps at his sport until “there may come a day when all at once the game plays itself through him.” And he recorded, with a dry relish that I share, the case of a graduate of Oxford converted at three in the afternoon.
James’s point is that suddenness and gradualness are not rival theories of the same event. A gradual growth contains sudden moments, and the moments are real, and they feel, from the inside, like the whole of the change. The mistake lies in giving them sole credit, as though the jerk forward had no long preparation and no long sequel. A first day may well have happened, as a point of acceleration in a slow process, and still not have been the beginning.
The Pose of Modesty #
Refusing the heroic origin invites an objection of its own: the refusal can become a pose. The narrator who says, with a thoughtful air, that his vocation grew gradually and that he distrusts tidy beginnings is also telling a story, and a flattering one: the story of a person too honest for myths. Linde’s coherence systems are not available only to those who tell dramatic tales. The gradual narrative is a coherence device too, and its appeal to sophisticated listeners is precisely what should make a sophisticated teller suspicious of it. And if a genuine moment did occur, a real hour on a real chair, then to deny it in the name of modesty would be its own falsification.
I accept the objection, and I think it leads somewhere useful. The answer is not to choose the gradual story over the sudden one, as though the choice of genre settled the facts. It is to hold both to the same standard. A sudden beginning should be told only when it can be confirmed, and with no more detail than memory can bear: no invented dialogue, no certainty of feeling that a young person could not have had, no causal weight that the moment could not carry. A gradual beginning should be told without the self-congratulation that makes modesty a performance. Either can be honest. Either can be a costume.
James supplies the deeper answer, in his first lecture, where he argued against what he called the notion that the worth of a thing can be decided by its origin. Religious states, he said, should be judged by their “fruits for life,” not by whether they arose from a miracle or from natural psychology. The same holds for vocations. A medical life is not made more valuable by a radiant beginning, or less valuable by a muddled one. Its worth lies in what it did for the people it served, and in how faithfully it kept the care that the idea of it once promised. Lydgate’s beginning was as radiant as any in fiction. Eliot judged his vocation by its fruits, and so, at the end, did he.
An Honest Beginning #
What, then, is the most precise statement that can be made about the day in this essay’s title?
That medicine was an idea before it was a training, and that the idea, like Eliot’s love of a subject, has a first traceable beginning that need not be its first. That the training has dates, which the public record holds, and the idea does not. That if there was a day, its importance was assigned afterwards, by a person who already knew how the story continued, and that this is not a reason to distrust it but a reason to hold it lightly. That a vocation which grew through many small moments, some of them sudden, most of them unremarkable, has as much dignity as one that arrived in a single flash, and probably more claim to be called a vocation, since it had to be chosen again each time it might have been abandoned.
If a young person reads an essay like this while wondering whether he or she ought to become a doctor, I would want one thing from it to be clear. The absence of a revelation is not a disqualification. Many people who will make fine physicians have no hour on a chair to report, only an accumulation of interests, encouragements, aptitudes and accidents that point, more and more insistently, in one direction. The interview question that asks when you first knew can be answered truthfully with a process rather than a scene, and an examiner worth impressing will hear the difference between a story that has been polished and an account that has been examined. What matters is whether the idea, however it arrived, has been tested against the actual work, so far as a young person can see it, and has survived the testing in a better-informed form.
Before the white coat, then, there was a khiāl, an idea held in the mind. The work of the years since has been to turn it, imperfectly and incompletely, into the other khiāl, the care that is kept for someone else. The first can begin on any afternoon, on a chair, at a shelf, in a conversation, at a dawn after a dance. The second has no first day. It begins each time someone is in one’s keeping, and it is the only beginning in a medical life that really matters, because it is the only one that has to be made again tomorrow.
Evidence and Editorial Note #
Documented findings. The essay relies on the author’s public biography: pre-medical studies at Khalsa College, Amritsar, 1994–1996; MBBS, Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002; PGY-1 at UAMS, Little Rock, and PGY-2/3 with UCSF Fresno; practice in California since 2010; Punjabi as first language. George Eliot, Middlemarch (1871–72), chapter 15 (the cyclopaedia scene, “first traceable beginning,” valvae, “small bags at his temples,” the passage on the love of a subject and the ghost of the earlier self, “the medical profession as it might be”) and the Finale (Lydgate’s practice, treatise on gout, death at fifty, “always regarded himself as a failure”): Project Gutenberg text; Lydgate’s “spots of commonness” from the same chapter. William Wordsworth, The Prelude, Book IV (“Summer Vacation,” the dawn walk and dedication) and Book XII (“spots of time”), with William Knight’s note on the Hawkshead morning walk: The Poetical Works of William Wordsworth, vol. 3, ed. Knight (Project Gutenberg); the poem’s composition history and posthumous publication in 1850 are standard reference knowledge. William James, The Varieties of Religious Experience (1902), Lecture I on judging by “fruits for life” rather than origin, and Lectures IX–X on conversion, Starbuck’s volitional and self-surrender types, “jerks and starts,” the athlete, and the Oxford graduate converted at three in the afternoon: Project Gutenberg text. Charlotte Linde, Life Stories: The Creation of Coherence (Oxford University Press, 1993): chapter abstracts (Crossref) (the life story told over many occasions and revised; adequate causality for a professional choice; the management of accident; continuity across professions; coherence systems). M. Ross, “Relation of implicit theories to the construction of personal histories,” Psychological Review 96 (1989): 341–357: bibliographic record (Crossref); the summary of its argument is standard reference knowledge. S. Hidi and K. A. Renninger, “The Four-Phase Model of Interest Development,” Educational Psychologist 41 (2006): 111–127: bibliographic record (Crossref); the summary of the four phases is standard reference knowledge. The etymologies of vocation, profession and career, Luther’s use of Beruf, and Weber’s argument in The Protestant Ethic and the Spirit of Capitalism: standard reference knowledge. The White Coat Ceremony in its 1993 Columbia form, introduced by Arnold P. Gold and the Arnold P. Gold Foundation: Gold Foundation website; the earlier 1989 ceremony at the University of Chicago’s Pritzker School of Medicine: Wikipedia, “White coat ceremony.” Personal essays in American medical school applications and admission by entrance examination in India in the 1990s: standard reference knowledge, stated generally. Punjabi ਖ਼ਿਆਲ and ਖ਼ਿਆਲ ਰੱਖਣਾ: standard usage. Vendor representations. None.
Recollection and tradition. The dates of the author’s education and training are part of his published biography. The essay does not assert or reconstruct any particular day, conversation, person, book or experience in which the author first thought of becoming a doctor, and it makes no claim about who encouraged him or what alternatives he considered. Remarks on Indian households, the doctor-or-engineer cliché, and the way families retell early signs of a vocation are general observations, not claims about any family. Another essay on this site, on patients who stay in a physician’s mind, is mentioned without detail.
Analysis and forecast. The readings of Eliot, Wordsworth and James, the account of how admissions systems and rituals shape first-day narratives, and the view that vocations should be judged by their fruits rather than their origins are the author’s interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.