From the Wards
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The Most Important Thing: First Day on Wards

The day had finally come for me to begin clinical rotations. As I arrived at the hospital, my mind nervously reviewed the format for presentations and the mnemonics for obtaining a history from a patient. As the doors to the hospital opened, advice from older students for my first day bounced around my head. I thought about the etiquette of introducing myself in the right way to the team I would be following that morning. I thought about how to make the right impression. I thought about what impression I even wanted to make. I thought about all the clinical knowledge I had yet to learn in order to properly take care of a patient. I thought of everything I had studied for in the past year-and-a-half and prayed that I would remember my training. I worried about being in the right place at the right time. I worried about saying the right thing and, even more so, about saying the wrong thing.

Most of all though, I tried to calm my racing mind and remind myself to just learn. And with that, I wondered, “What is the most important thing I can do today?”

I didn’t have too much time to wonder, though, because soon I was briskly walking down hallways, checking door numbers along the way and nervously trying to smile at everyone I saw. After an eternity of wandering, someone pointed me to the right room where I found the hematology team to which I was assigned. The small workroom was filled with the familiar sound of typing I knew from lectures, but this time there was only a fellow, my attending and me. As the team began talking about our list of patients we would be seeing that day, the realization quickly hit me that my hours of studying and hard-earned learning over the past two years were woefully insufficient for the swirling jumble of acronyms dancing around the room as they chatted.

“Mr. So-and-so needs an ESR and CRP for the MRCP before TIA and HIT testing,” and it just kept going. Despite being familiar with foreign languages, I have never felt as confused and lost as I did in that moment. The team bounced between chief complaints, plans of care, lab results and consult notes faster than I could even register that we were talking about a new patient. Madly, I scribbled down any phrases I could pick out from the cacophony to look up later for the purpose of hopefully beginning to decipher this uncharted territory.

My team was gracious in looking over to see how I was doing, occasionally stopping to clarify their train of thought. Those moments of respite gave me the chance to breathe before feeling like I was in deep water again, trying to stay afloat. Somehow, between frantically scribbling notes and desperately trying not to look confused, we had apparently discussed all of our patients. Before I could even close the notebook, the team was off to the races. My stethoscope thumped against my chest as I ran after my team members zooming through the hallways.

Out of breath and unsure as to which floor we were even on, I found myself standing inside the first room on our list. My attending kindly welcomed the family members present and explained the plan of care. As he did, familiar words began to flow forth. Some of the acronyms I recognized from the cramped windowless workroom, though now they were carefully and patiently explained in detail compared to our earlier discussions. The most noticeable difference, however, was the presence of the person lying in a bed in front of us. Here was the focus of our detailed discussions, medical terms and planning. He was the esoteric idea I had been trying to formulate back in the room. The diagnosis, the plan of care, the differential, the consults, the looks of concern on the face of my attending physician all fell out of mind as I took in the man before me.

I wish I could say that I paid closer attention to my attending during my very first patient encounter in the hospital. However, my mind and focus were fixated on the man in the bed. He was resting, hooked up to beeping monitors and machines, seemingly unaware of his surroundings or the strangers in his room. Family members listened intently to the two doctors in their crisp white coats … a nurse was in the corner printing labels … another person was picking up the patient’s untouched breakfast tray and then there was me awkwardly staring at him. Even so, he didn’t stir.

As the team turned our attention to the physical examination, we gently moved his limbs and unwrapped bandages in order to examine his healing body — hands, abdomen, legs and toes. We began our examination, with my attending smiling as he taught both the family and me what we were checking for. In the process of rewrapping his legs again, I noticed the man was clearly in discomfort and pain from the movement. With several people in the room, many with decades more experience than me, I was unsure of what to do as the man grimaced again. Before I could register what I was doing, I placed my hand gently on his shoulder in an attempt to comfort him. In a foreign world of medicine, I knew the only language I felt comfortable enough to speak was love and compassion.

As we turned to leave, his daughter stopped me. She had seen my hand on his shoulder and thanked me for that little gesture. She explained that with everything going on and the anxiety of watching her dad in such grave condition, it was nice to remember that we, as his medical team, care about him.

Once again that morning, I was speechless. This time not from lack of understanding, but from a lack of adequate words. I wanted to convey to her how much each member of the team cared about her father. I wanted to tell her about my own family members who had been cared for by health professionals. I wanted to tell her about the surgeon who had placed a hand on my own shoulder years ago as he explained the procedure that would save my life. I wanted to tell her that she and her father were the reason why thousands of medical students across the country were studying for all hours of the night and sacrificing so much. I wanted her to know that I would do it all again even if it meant that her father would be the only person I helped. I wanted her to know how much each patient meant to me individually. I saw myself, my family members and all the people I loved in their eyes. I just wanted her to feel how much I cared.

Instead, I smiled and I nodded.

My attending was already halfway down the hall in what seemed like a full sprint to the next patient, so in the half-second that I had with the daughter of the man in the bed, all I knew how to do was smile and nod. I silently hoped it was enough to get across even a fraction of what I could not put into words.

As I ran after the rest of my team to go see the next patient, the jargon and chaos of the morning seemed to melt away after the moment I had just experienced. Acronyms and hospital layouts would come with time; soon enough I would be presenting patients like my residents and slowly I would gain confidence in being the doctor I want to be. However, for today, a thought came as an answer to my own question from that morning: “That moment was the most important thing I could do today.”

Isaac Myres Isaac Myres (2 Posts)

Contributing Writer

UT Southwestern Medical School

Isaac Myres is a fourth-year medical student at UT Southwestern Medical School in Dallas, TX. After growing up in San Diego, CA, he earned a BS in Biophysics at Brigham Young University. He will be applying into Otolaryngology this year. In what free time exists, he plays volleyball and pickleball, reviews donut stores, and competes in local trivia nights with friends.