Every life is full of firsts. First steps. First words. First kiss. First love. First (and ideally only) marriage. For physicians in training, there is one other first that quite possibly ranks ahead of those other life milestones: the first real patient. Sure we’ve practiced on each other, on paid actors, and even on lifelike robot mannequins along the way, but at some point every medical student starts rotations. Rotations equal the first taste of actual real life patients. Patients whose presentations and disease processes don’t always match what you have read in your textbook.
For those who don’t know, the general medical school setup consists of two years of didactic classroom based lectures followed by two years of hospital and clinic based experience. The saying goes that those last two years make all the work of the first two years worth it. Each year, eager medical students across the country transition from sitting in classrooms and study rooms for hours on end to standing in hospitals and clinics excited to transition from paper medicine to actual medicine. The process is exhilarating, fascinating, and absolutely terrifying and everything else in-between on the emotional spectrum.
I recently began my transition from paper medicine to actual medicine along with my classmates and I’m sure countless other medical students across the country. I didn’t think I would be nervous on my first day (I was). I even laid out my clothes the night before to cut down on my morning routine to make sure I was not late for orientation. It was a level of planning that went well beyond the usual for me. I showed up for orientation about thirty minutes early (added insurance for not being late I suppose), and to my surprise I wasn’t alone. Several of my classmates also showed up very early. It was good to know I wasn’t the only one who remembered the “if you’re not early then you’re late” lesson that had been drilled into our heads for two years. After orientation we all reported to our first rotation. I introduced myself to my preceptor and made some small talk for a bit. Then I heard it. “Okay go see the patient in room 15 and then come back and tell me what you think.”
“Whoa what?! By myself? On my own?” I thought. Right into the fire I see. I think my blood pressure just jumped twenty points. I entered the room with a knock as I’d been so thoughtfully instructed for two years and introduced myself, trying desperately not to show that I was nervous beyond belief, yet sure it was certainly visually obvious. I started my history without a hitch, asking all the questions I thought would be important for the case “Do you smoke? Does anything make your cough more intense? Is it there all the time?” After I had gathered enough history, I began my physical exam. I promptly dropped two otoscope tips on the floor before I figured out how to lock them in the place on the otoscope used by the clinic, which in my defense, was different than my otoscope. I immediately thought “well this patient is going to think I’m clueless.” Luckily the rest of the exam proceeded more smoothly. I even remembered to place my stethoscope in my ears. After I’d elicited all the physical exam data I needed, I left the room and reported back to my attending.
“I think it’s a case of bronchitis,” I said.
“Okay, what labs would you want to do?”
“A CBC and a CXR just to rule out pneumonia or anything else that might be going on.”
“Okay, well let’s go back in and see how you did.”
Uh oh. Here’s where we learn how clueless I am. My attending reviewed my questions with the patient and then did his physical exam. In case you’re wondering, he did not drop the otoscope tips on the floor. He told the patient he wanted to do a couple of quick labs and then we’d be back in the room.
“I think you’re right. We’ll do a CXR and a CBC just to be sure and then give her something for her cough and an inhaler to help her breathe a little easier. Good work.” Good work. Those words were strangely reassuring for me. The rest of the day went on as you would expect a day in a clinic to go. I saw many more patients and got better and better (I think) as the day went on. I even fixed my otoscope tip dropping habit. I can’t remember every face from my first day. I can’t even remember every case from my first day. I do remember everything about that first patient though. As time goes on and I see more and more patients, I suspect I will always remember my first, for it was so much more than just my first patient. It was an unforgettable rite of passage.