Contributing Writer
Yale School of Medicine
Tehreem Rehman is an MD/MPH candidate at Yale/Johns Hopkins. She is invested in addressing the impact of adversity and trauma on psychopathology, clinical and community interventions for violence, and the relationship between healthcare provider biases and health inequity. Tehreem blogs at www.tehreemrehman.wordpress.com and can be reached on Twitter @tehreem_rehman.
“You need to come in to the E.D. ASAP.” A new patient was admitted at 2 a.m. and requested for a crisis counselor. Back in 2009 when I was volunteering in New York City, unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help.
She was a petite, otherwise well-appearing woman, apprehensively sitting at the edge of the examination table. Hoping to mask my nervousness about this first, intimate patient encounter, I inquired about the reason for her visit. She told me that she was here to discuss a hysterectomy. She shakily explained her two-year history of heavy, painful menstrual bleeding. She hoped that the hysterectomy would be her saving grace. The insistence on this procedure made me suspicious of stirring waters beneath calm surfaces, so I probed further.
My dad taught me how to swing a golf club at an early age. No, not with the overbearing exactitude of an Earl Dennison Woods. Robert Mooney Jr., a brilliant emergency physician with a respectable high school swimming career, never wished to live vicariously through my future sporting exploits. Perhaps having personally authored the genetics of scrawny paleness into my genetic constitution, he knew a losing battle when he saw one.
It is one thing to be a doctor and another to be a patient. It is a radically different thing to be a medical student paired by your medical school to a physician who is your “patient-partner.” Sounds like a word salad, but that is where I found myself as a first-year medical student at The Geisel School of Medicine of Dartmouth a few weeks after moving to New Hampshire, weeks before I would receive my white coat, months before I would have any clear idea of what the medical world is really like.
On the first day of my surgery clerkship, our chief resident gave us a few instructions for our next two months together. We had to carry certain types of gauze and tape in our soon-to-be overflowing white coat pockets, create a clear and confident daily plan for each patient we followed, and be ready for rounds at 6 a.m. the next morning.
A volunteer coordinator once told me that philanthropy is about “giving a voice to the voiceless.” I want, more than anything, to be worthy of that statement. As a premedical student, I had — and still have — grand visions of uncovering the hopes and dreams of the disenfranchised and trumpeting them to the world. I have used my voice to give encouragement to struggling children, frightened women and the demented elderly. I have held hands and written to members of Congress.
Inpatient neurology at UAB is a busy service, accepting a variety of calls every day from the ED, inpatient consults, and transfer patients throughout the state. On a particularly hectic Wednesday afternoon during my second week of rotation, our team received a page from the psychiatric ward that one of their patients, Mr. S, was being transferred to our floor after a possible seizure. The residents were busy checking out patients to the night team, so I was sent to see the patient first.
“Look, you’re not out on a four-year picnic at that medical school, so stop talking like a disappointed lover. You signed up for a spell of training and they’re dishing it out to you, and all you can do is take everything they’ve got, everything they hand to you, and tell yourself how lucky you are to be on the receiving end — so you can be a doctor, and that’s no bad price to pay for the worry, the exhaustion.”
How can doctors-in-training practice not just patient-centered, but family-centered medicine? Carissa, a graduating fourth-year medical student in Indianapolis intending to pursue an obstetrics and gynecology residency, shares the lessons she learned as a medical student when her mother was diagnosed with breast cancer.
It was Friday of the seventh week of my family medicine clerkship. I was tired. Tired from the day and, honestly, tired from the clerkship. I was ready for a change of pace. The next patient was Mr. S., a 30-year-old male, here for an establish care visit. I did not recognize the name. I reviewed his chart before the encounter, two visits in the system, both to the ER for cocaine-induced angina. I stereotyped him immediately. Not that this was right, but I did. I think everyone does.
The traditional structure of medical education begins with teaching normal anatomy and physiology followed by the various pathologies and treatments. Once students reach the clinical years, we are taught to think in the form of a SOAP note. First, perform a history and physical; then, order the necessary diagnostic tests to obtain your subjective and objective information. Next, form your assessment and plan — what is the problem, and how do you fix it?
The circumstances under which Jane and I met were less than ideal. That day, I had already seen a family of maggots making a happy living in someone’s foot and been chastised by my attending for failing to recognize the imprecision of my visual acuity in assessing a patient’s ascites — how else could I do so without a measuring tape in my pocket and daily charts of his abdominal circumference?
Contributing Writer Emeritus
University of Florida College of Medicine
Sean is a member of the University of Florida College of Medicine Class of 2016 and graduated from New York University with a major in philosophy and a minor in chemistry. When not contemplating medical ethics, culture in medicine, and sustainable approaches in global health, he can be found on the nearest hammock jamming to the tunes of the Caribbean and West Indies.
