This is Medicine by Jason Faber

The voice of the resident in the far corner begins to fade out.  His white coat begins to blur along with everything else in my visual field.  As this happens, I explain it to myself in medical terms; the blur is the result of my eyes converging due to the movement of my ocular muscles, which I’m losing control over due to my fatigue. At this point I’m only catching little phrases from the presentation.

“55 year old male…” “History of CAD and hypertension..” “Sodium 135, Potassium 2.0…” “Chest X-ray shows bilateral…”

Then, like two stage curtains, my eyelids begin to droop and I can feel my head falling forward.  Suddenly, the fail-safe alarm in my subconscious comes on, rattling me back into consciousness.  My head pitches back, my eyes fly open, and my hand comes up to my mouth to make me look like I’m deep in thought about what exactly is ailing this 55-year old man.  It’s the second week after my first-year finals, and I’m sitting in morning report at seven in the morning.  I look around to make sure no one saw my descent into REM.  Everyone’s eyes are fixed on the overhead projection of the chest X-ray.  My eyes dart toward the X-ray.  I look at it sternly, but I am thinking in the back of my head, “Are the lungs normal…I think so…is this pneumonia….I’m not sure…wait, is this Situs Inversus…no the X-ray is backwards.”  I strain my mind to remember my anatomy class and the radiographs I studied intensely.  Then the X-ray begins to blur.

I wouldn’t be tired if it wasn’t for the fact that I have been staying up late reading my pathology book to get a head start on second year in med school.  In the first class we get three weeks to read 600 plus pages from the pathology book and a pharmacology book.  This then, culminated with the fact that I have to drive to Miami Valley Hospital in Dayton from Cincinnati every morning, results in one fatigued student.  Sitting in morning report, I know this, but I keep telling myself the same thing I’ve been telling myself all year, “This is medicine…this is medicine.”

As morning report draws to a close, I team up with a resident and we begin to see patients.  After spending four years in the hectic pace of an ER, I expected family practice to be more lax and slower paced.  I was wrong.  The residents darted from room to room as patients remembered more complaints.  The residents swiftly scan through test results and old medical records.  They write prescriptions and medical notes quickly, with the penmanship paying the price for speed.  As time goes on, I’m amazed with how much I remember about patients I’ve seen from a few days ago or even last week.  The names of patients I’ve seen previously don’t ring a bell, but give me a chief complaint or a medical history and I can tell you what that patient ate for breakfast on the day I saw them.

Despite the fatigue, I listen closely with each patient, desperately trying to recognize a constellation of symptoms that I can categorize or thinking about what would be in my differential diagnosis.  Here is a five-year-old with diarrhea for the past two days.  So I think, “What could it be…probably Rotavirus…or could be Vibrio Cholera…no, no this isn’t a third world country…but could it be?  Is it Salmonella….no no…there’s no blood in the stool…wait, was there blood in the stool?

Lunch comes and goes, and although they are nice enough to provide me and other students with a free lunch, it comes with a side of a Conference on Obstetrics, and the dessert is Medical Journal Club.  The afternoon is filled with the same, but this time more patients.  Then, the resident and I go in with a patient who is scheduled for a fifteen-minute appointment, but unloads on the resident a multitude of complaints, some of which are personal and emotional.  We leave the room forty minutes later, far behind the schedule.  Despite the surprises and new complaints, somehow we’re done just about when we should be. 

I drive off toward Cincinnati and back home where I can relax for a few minutes before moving back to the books.  I’m tired but awake.  I treasure this long drive because I feel good about myself and about what little I’ve done to help these people, these patients.  I arrive home feeling rejuvenated and hungry for more.  As midnight rolls around, I realize I’ve been reading the same page for the past fifteen minutes.  It’s about edema due to lymphatic obstruction.  I read over and over again but it doesn’t quite stick.  The pages begin to blur and the stage curtain begins to drop.  My head pitches forward and I keep telling myself, “This is medicine...”