By the end of the second week the stream
of patients had been so vast, varied and extensive that I could hardly place a
name to the diagnosis. It’s making me
wonder how I will ever keep up with all the patients once I am more than just
an observer. That’s a lot of medicines,
lab results, allergies, and social histories to keep straight.
Rounds have been
by far the most interesting time of the day.
We go as a team to meet new patients or give progress reports on
others. It’s not really that interesting
to go stand in a room to listen to other people talk, but it is interesting to
watch the interaction between the families and doctors, and doctors and
patients. Most often the room is dark
and we wake our patients and families up with a mass movement of yellow-gowned
people of indiscernible origin crowding around a sick bed. These moments have
taught me lessons that classrooms cannot.
How to deal with pained patients and frustrated parents. How to communicate with people in the midst
of language and social barriers, and mostly to put all of the pieces of the
puzzle together to see the patient, disease, and cure all in the same
place.
As a student, it
is sometimes difficult to see past the disease itself. That is something that I need to work
on. You see the situation more as a case
study and less like you trying to end some pain and worry. I think about the right questions to ask and
the meaning behind the labs, and not about the effect these have on the
patient. From observing the attendees
and residents, it seems like this comes with time, but I still have a long time
until I become comfortable enough in my role to see more than just the means of
health care. Now, don’t think me
callous. I walk into the rooms and, as
an observer, hear the stories with compassion and empathy. Not every case is interesting, I can’t help
but admit, but every case is of utter importance to the people involved, and that
has to be the one thing I remember, no matter my role in the case.
When the time
comes, however, for me to play doctor, I begin to see the task at hand and not
so much the patient. I enter the room
and play a film strip in my head of all the chores that have to be checked off
the list. Introduce myself. Ask question A and question B. And don’t forget question C. Keep eye contact, and allow the patient or
the family to talk, but don’t let them talk too much. You do have other things to do and people to
see. And then comes the physical
exam. Is the patient breathing?
Check. Can you hear a heartbeat? Is the
stethoscope on correctly? Lung sounds? Is that sound my shirt or a lung
crackle? Pupils? Reflexes? There’s a lot
to remember and even now I can’t recall all the components. Then there are the labs. A lot of numbers that can tell me so much
about a patient. The blood
cultures. The stool samples. The myriad of facts that tell me everything I
need to know about a patients true health form a mask in front of the true face
of the patient. And as these numbers
increase and these histories and physical findings become more extensive, the
faces behind the sickness begin to blend together and I can hardly find the
patient in the hospital, let alone remember why they came.
But how can I
forget the people that have been so formative in the beginnings of my medical
education? The boy with salmonella
meningitis whose family could not take him home for fear of reinfection has
taught me that every family has its own cross to bear. The 4-year-old
girl with diGeorge’s syndrome who taught me to recognize the different degrees
of heart murmurs (6 degrees, who knew?).
And I’ll never forget the weary faces of mothers who were wishing that
they could ease their children’s pain or simply find a way to take their babies
home. They remind me of the reasons to keep on learning, so that one day I
could be a source of comfort. Not that I
will not have the answers all the time, but I will know enough that the faces
will begin to reemerge from the facts and I will be able to play the small and
vital role in giving some sort of ease and comfort.
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