When I enter the examining room, Mr. Jones is visibly distressed. His chest heaves as he struggles to catch his breath. I glance at his charts and make note of his chief complaint: chest pain. After a brief introduction, I fire off a barrage of well-rehearsed questions: When did the chest pain first begin? Does it radiate outwards or stay localized in one spot? Is there anything that makes the pain better or worse?
Delirium is a bread-and-butter presentation. The differential writes itself — stroke, infection, intoxication, electrolyte imbalances, shock, organ failure. The intellectual exercise this invites was practically invented for medical students, even if the final diagnosis (dehydration secondary to gastroenteritis) and its treatment (fluids) were relatively mundane.
It was early in third year and Ms. G was my only patient. I visited her every morning and evening and sometimes in-between. While our discussions had little to do with receptors and pumps, Ms. G taught me some of the most enduring lessons of that year.
On the first day of my psychiatry rotation I was anxious, and like most students I worried. I worried I would not have anything to say and I worried I would say too much. I worried I would say the wrong thing at the wrong time and I worried that my words would be more consequential than I ever intended them to be. I worried about my worry.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous.
As physicians, it is our responsibility to understand these serious implications and to help these patients live as fully as possible. A patient is not just his or her numbers — their vitals or their lab values. A patient is not just an MRI reading or a CT scan finding. Every individual has a mind, and we must take into account mental health when treating these patients because if left untreated, they can have dire consequences. More importantly as people — as humans of society — we must not stigmatize these illnesses.
Everyone has heard of startups. For many of us, the term “startup” is a reference to technology companies in Silicon Valley. Companies like Google and Apple for example. These companies are so well-known to us because their products and services have and continue to significantly shape and define the world we live in today, from how we purchase almost everything we buy to how we communicate with almost everyone we know. But startups seem to have become more than just providers of goods and services — they’ve become lore of our capitalistic society: a standard for what it means to be truly successful.
Have you ever had a sinking feeling in your stomach when you are about to tell something to a patient or family member that might change their life forever? I had that feeling before speaking to the wife of my patient, Mr. Smith. It had only been one day since Mr. Smith was first admitted to the inpatient unit but regardless of how long the interaction is with a patient and their loved ones, some news is always difficult to deliver.
Patients don’t always have to let us into their rooms. As medical students, I think we don’t give enough acknowledgement or praise to the vulnerable individuals that allow flocks of medical students to bumble around their bedside. But our perceived ineptness is the last thing on the patient’s mind; a friendly face that is willing to listen to their story is just as important.
In this column, I hope to explore various qualities of a physician that we learn through medical school experiences — whether it be through class, shadowing, research, or even interacting with peers — but also to introduce a patient’s perspective in each case. Midway through my junior year of college, I was diagnosed with Cushing’s disease, a rare endocrine disorder that affected every aspect of my life. Throughout the next year and a half, I lived as a patient of my disease, while simultaneously trying to hold onto my plans and aspirations of becoming a physician.
I knew you were a champion, / though I never saw you win, / by the precision in your choices / and your knowing, tired grin.
“Great, six weeks of crazy people!” This is the sort of attitude with which I went into my psychiatry rotation. Couple this with the fact that while most schools only have four required weeks of psychiatry, my school has six weeks. Of course, I would have more free time compared to other rotations — it is called “psychation” for a reason — but at what cost? Mental illness was something that made me uncomfortable.