Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

A Glass of Milk


When I was working with my grandpa as a dairy farmer, he said what made it all worth it was knowing how many children needed the milk. As a doctor, I find meaning by reminding myself how many people need care. 

“I just never thought I could have worked that hard,” my patient quipped when we were having some small talk at the start of his physical. He knew I’d been raised on a dairy farm and always wanted to chat about how much respect he had for that way of life.  “You’d be married to them cows–and the hours would be as bad as being a doctor!” I laughed and shared with him I decided long ago I couldn’t work that hard either, choosing an “inside job” instead of alternating freezing in northern Iowa winters working with the cattle and sweltering under the sun working hay in the summer. 


My grandfather was a dairyman. So was my father, my uncle, cousin, and brother.  It was truly a family operation, one that required a level of dedication that many in medicine can relate to. There were cows and calves to feed, barns to clean, corn to chop, hay to bale, tractors and equipment to fix and maintain.   


And of course, the milking. Every day, and twice at that, 365 days a year. Bring the cows into the barn. Wash the udders. Place the milking units. Remove and rinse the units. Release the group of cows. Bring the next group into the barn. Repeat, repeat, repeat. Every day, and twice at that.   


I remember someone once asked my grandfather how he stayed dedicated to the dairy, getting up at 4:30 AM day after day, year after year. I was quite young then and I don’t remember who they were or why they wanted to know, but I was old enough to understand that they just couldn’t fathom why someone would work so hard for seemingly so little reward. Grandpa smiled and said, “Every time I get in that barn, a whole bunch of kids can have a glass of milk to enjoy.” He really felt that he was working hard for the benefit of others. Dairy was his vocation, how he served the world’s needs. 


One of my mentors in medicine was an internist, a fantastic rural physician. He built a practice on the principles of strong clinical knowledge, focused attention to detail, and careful diagnostic reasoning. I remember being impressed with his calm demeanor and thoughtful care and wanted to emulate that myself someday.   


I remember a patient asked him close to his retirement how he stayed dedicated to his craft, patient after patient, day after day, year after year. They were genuinely interested in how he seemed to stay so sharp, collected, and caring over his career. He said, “My job is to help you feel a little better if I can, and to not miss anything big.” It seemed a simple thing at the time but the emphasis on the intent of healing with careful reflection on that care is quite profound. Thoughtful care was his vocation, how he served the world’s need. 


Neither time did I know how important these small conversations would be to me.  Years later when I’ve had to make big decisions, I’ve tried to stop and wonder, “How will this help me serve even just one child a glass of milk to enjoy?” While I’m no longer in dairy farming, I still try to think in terms of service to others through my work–and try to be sure that care is intentional, thoughtful, and complete. 


Think of how you can serve others even just a glass of milk and do it well. You’ll look back on the joys of this calling when you do so.  




The author and his grandpa working together on the farm.


Their hardworking dairy cows resting in the barn.






This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.