All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts,
His acts being seven ages. At first, the infant,
Mewling and puking in the nurse’s arms.
Then the whining schoolboy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths and bearded like the pard,
Jealous in honor, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into the lean and slippered pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well saved, a world too wide
For his shrunk shank, and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
William Shakespeare: As You Like It, spoken by Jacques in Act II Scene VII
In Shakespeare’s As You Like It, the melancholy Jacques delivers the soliloquy quoted above relating 7 stages of a person’s life. During my undergraduate years at Yale, one of the best classes that I was fortunate enough to take was Professor Maynard Mack’s year-long Shakespeare course, which left me with an abiding love for the works of the bard from Stratford-on-Avon. It occurred to me recently that this famous soliloquy by Jacques could easily reflect the life of a physician.
Thus, the first stage is the infant “mewing and puking.” This initial phase would represent the future physician’s first inkling that a career in medicine would be something desirable, probably occurring sometime during childhood or adolescence. At this point in life, the individual lacks a full understanding of the implications of future life choices, but many habits are established that will be important if medicine is eventually the career choice, for example, attention to detail. The schoolboy years represent high school and early college years when the student decides to follow a premed course. This is a life phase that is often filled with anxiety: “Will I be accepted to medical school?” and “Can I really survive the challenging educational demands imposed?” Next comes the lover phase, filled with hopes and sighs as she/he waits for the special letter of admission to medical school. This would probably occur during the final 2 years of college or perhaps during an additional year of study to satisfy premed requirements. Once the letter arrives, there is usually jubilation accompanied by pangs of anxiety that carry over from the schoolboy years.
The medical school years belong to the phase of the soldier, bravely facing the trials of pre- and postgraduate medical education. It is during this phase that the pre- and postgraduate develops the skills that will be the cornerstone of their professional career. The justice with fair round belly represents the successful career years in practice, industry, or academia, “full of saws and modern instances.” I see the “saws” as the clinical “pearls” that each of us employs in our daily clinical activities and the modern instances as continuing medical education, that is, keeping up with the new developments in medicine during the years of practice. With the sixth stage, “the lean and slippered pantaloon,” the physician retires and enjoys a quiet life, the fruits of many years of successful labor. And then one reaches the final stage that awaits us all, “second childishness,” when the physician’s efforts of a lifetime are forgotten by the young, upcoming generation.
It delights me to think that these words written more than 400 years ago might still have meaning for those of us who chose a career in medicine.
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-Joseph S. Alpert, MD (Editor-in-Chief, The American Journal of Medicine)
This article originally appeared in the January 2018 issue of The American Journal of Medicine.
