“From now on,” our deans told us at orientation, “society will see you as a doctor. Sometimes you may not feel like one, but that is what you are becoming. This week marks the beginning of that transition, which will continue in the months and years to come.”
Dear medical students, I’m sorry. You had just finished two years of didactic learning and couldn’t wait to feel like a “real” doctor. You were finally starting your clerkships, that is, finally working with patients and getting deep in the trenches.
During the team huddle I was assigned to Room 403, Bed 1. “There is a lot you can learn from this patient. You should see him.” I got the one liner and was off.
“Where are you from?” A question that I am asked many times during the course of my day. But the answer has never been clear nor concise.
First year of medical school: / Don’t remember much. / MD/PhD students, you know what I mean. / Learned how to use a stethoscope.
“There must be a better way to make a living than this!” / Slam. / Silence, except for the persistent heartbeat. / The beat of the ticking time bomb, the dying heart.
Sunrise on the psych unit. A tentative, yawning flicker, a wash of tired fluorescence, and the hallway shudders to life—or something approximating life anyway.
I spent the first week of my outpatient experience in internal medicine working with the nurses at Hospice of the Red River Valley in Fargo, ND. Besides being incredibly nervous to begin my third year of medical school, I was anxious about what I might encounter on my week at hospice.
“Be a duck,” became my mantra throughout medical school, so much so that my mother had it printed onto a canvas and has it hanging on a wall at home in my honor. As a medical student you might think I would be more interested in having the prowess of a lioness, the elegance of an eagle, the speed of a cheetah or the energy of a dolphin. A duck, as most envision it, does not have much appeal; except, however, when swimming. The quote that led me to emulate the duck is Michael Caine’s, “Be a duck, remain calm on the surface and paddle like the dickens underneath.”
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.
For the smaller challenges of medicine, like fitting an entire person’s pertinent medical status in the half-inch gap between names on the patient list.
There was an elderly man suffering from late-stage Parkinson’s dementia. There was a patient with schizophrenia experiencing a COPD exacerbation. Then, there was Mrs. G, who was admitted for immune thrombocytopenia. She was a retired teacher who spent her time volunteering at her church and caring for family members.