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Review of Systems

With my Fisher-Price stethoscope drooping to my knees, I opened up my first practice as a young boy, working out of my family’s kitchen, my hours fluctuating with my nap schedule. I was a dragon-seeker bent on improbable rescues, and as I would fiddle with my tools, I would imagine a future where patients returned to my office full of life and gratitude. What I did not count on as a five-year-old—or even as a first- or second-year medical student—was how quickly I would lose sight of my purpose as a future physician.

I began my clinical rotations three months ago, beginning with two months of inpatient internal medicine. Before I could even figure out the right place to stand during morning rounds, I found myself in a chronic disease alphabet soup. Intern after resident after attending rattled off terms like DMII, HTN, COPD, CAD and LDL levels, presenting each patient as a neatly organized pathologic package before our unholy procession of white coats entered the room to evaluate the patient’s clinical status. As any eager and competitive third-year medical student would do, I quickly embraced my medical team’s habits, wanting to impress my attendings with my clinical reasoning skills.

Over the course of two months, I became efficient at categorizing my patients into packages, beginning with a chief complaint and moving methodically through diagnostic algorithms that I had spent countless hours studying: a 55-year-old male patient with past medical history of HTN and OSA presents with chest pain on exertion and bilateral lower extremity edema. Almost reflexively, I was immersed in a congestive heart failure work-up, examining the height of the patient’s neck veins, using the “jewelry around my neck” (as our chairman referred to the stethoscope) to auscultate extra heart sounds and to palpate the patient’s ankles to see if my fingers would leave imprints. If a patient presents with productive cough, fever and rigors, my mind was already racing with antibiotic classes and which bug was causing the patient’s pneumonia.

In a short period, I had transitioned to a new side of myself: curious, yet detached, actively suppressing any emotional response to a patient to learn as much science from each case that I could. I examined each part of the body in small segments, areas defined by the nerves that innervated a specific space and the arteries that looped through particular muscles and bones. This is the way it had to be.How else was I going to work my way through seemingly chaotic problem lists? Operating with this mentality is where I found myself with one hour left in my entire inpatient medicine rotation. I had just successfully tracked down an elusive diagnosis for my patient and I was immensely proud of how far I had come from day one of the rotation, becoming a more thorough thinker with a disciplined process of evaluating my patients. As I was finishing my presentation to one of the interns, a woman who I had never seen before introduced herself.

“Are you Karan Desai?” she asked, as I nodded my head a little startled. “I thought it was you. I could never forget that name. I remember you from the memorial service last year,” she said with a slight stutter, as tears were developing in her eyes. Nearly a year to the date, I had spoken at our school’s anatomy memorial service where my class gathered to express our appreciation to those who donated their bodies for our education. I had spoken about how as future physicians we must learn every disease process not only with pathophysiology in mind but also within the context of each patient’s life story. “My father donated his body, and I was there that day when you spoke. My father’s brother, my uncle, was so angry that my father had done this. Until you and your classmates spoke that day, we didn’t realize how important his gift was. We didn’t realize how much thought you all put into his life. My uncle left that day and decided that he was going to donate his body too. You may not know it, but you have impacted my family’s life in more ways than I can describe,” she said, gently tapping my shoulder in gratitude as she walked away.

Here I was, one hour from completing my inpatient month, and my first patient had shown up full of life and gratitude “at my door” like I had imagined as a kid. And I had not lifted a finger. I had not auscultated a difficult murmur. I had not percussed out a diseased liver. I had not labored through a challenging diagnostic work-up.  I didn’t need to organize a patient into a pathologic package as I had done for the past few months. All I had done that day a year ago was acknowledge that learning medicine was more than understanding a disease.

In that moment, I reflected on what I had implored my classmates and myself to do a year ago—learn medicine in the context of humanity—and how quickly I had forgotten my own words. Over the past few months, I had become efficient, almost mechanical, in asking whether a patient had experienced “any fever, chills, night sweats, or rigors?” But how often had I asked the question, “do you have any concerns or worries?” I had almost left the hospital after two months of internal medicine trapped in a mentality that treated patients as puzzles that needed to be pieced together with deft history-taking and advanced physical examination skills. This is certainly a part of medicine. But as the woman reminded me, healing is so much more. She may have said that I changed her family’s life but she returned the favor to me; with just a few words and grateful pat on the shoulder, she redirected me towards focusing on becoming a complete physician. I may never get to show up at that woman’s door like she did for me, but from the bottom of my heart, thank you.

Karan Desai Karan Desai (1 Posts)

Contributing Writer Emeritus

Albany Medical College

Hi all. My name is Karan Desai, and I am a Class of 2015 student at Albany Medical College. When I was born, my dad lifted me to the skies at our local community hospital (Simba style from Lion King), and proclaimed "This son will be a doctor." So, I am currently working towards fulfilling that prophecy. I love medicine, and the opportunities I get to help people in their most vulnerable moments. Outside of the hospital, I am also a health policy wonk, with positions within the AMA, NBME and AAMC. My other loves in life include the Philadelphia Eagles, the Northwestern Wildcats, goat cheese and tailgating.