Notes from a Medical Student:

Summer Sun and Morning Rounds

The radiance of the summer sun is quite a spectacle in mid-morning rounds. The light shines brightly into the hospital room of the upper floors, bathing the patient, medical staff, and myself in its glow. I squint my eyes out at the outside world. Try as I might, my eyes don't adjust to the glow, a consequence of walling myself in this citadel of the sick for so many hours. I move my gaze back to the patient, a kindly looking elderly gentleman, all smiles despite the odds. He is staring directly at me while I was looking out the window, and in a reflex response I smile back at him. He smiles and turns back to my attending physician who is talking softly and with compassion as the plan is put forth in simple terms. The patient nods his approval and looks back out the window, perhaps trying to see what I was looking at. We move back into the hallway…I field a couple of questions from the residents and the attending physician. Some I get, some I don't...and we move on down the hall to the next beam of light shining.

The crux and keystone of the practice, art, or science of medicine is the basics of Internal Medicine. A vast library of knowledge supplants this specialty and gives credence to Hippocrates' description, "The life so short, the craft so long to learn." So as my third year of medical school draws to a close, I finish on the specialty which allows me to use all that I've learned to this point. It is by far the biggest world of medicine I've come into contact with. The differentials are long and the possibilities endless.

So I start where I began so many years ago, with some simple reason to derive a common theme or two from this ocean of knowledge and practice. Up to this point, I've derived three qualities I find I cannot do without if I hope to be worth my weight in salt as doctor.

Of course, the most obvious is a love of knowledge. The curiosity has to be there or this long course of learning can't continue. Now the verve for this learning can wax and wane, with the circadian rhythms of the day or the trials and tribulations of any life, but eventually the deep entrenched curiosity of what is wrong and how to effect change must come flooding back. When the possibility of an uncommon ailment or the hoof beats sound more like a zebra than a horse, I detect the eyes of the physicians around me shining a little brighter with interest and intrigue. After all, part of being human is being humbled by not only that which we do not understand, but that which we do not commonly see. This leads to the second quality.

Einstein himself related "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." Without humility, curiosity would never be strong enough to be considerate of every patient. So humility is indispensable, because without it you can run the risk of diagnosing the patient before seeing them. I've walked out of a patient's room and believed that I had the diagnosis nailed down, only to discover I was so far off as to be embarrassing. Those times in particular, I saw what I wanted to see instead of seeing what is simply there. So instead I've tried to walk into a room as Tabula Rosa, allowing the patient to paint the entire picture while I'll simply add the framing.

However, humility and a love of knowledge cannot exist without simple compassion. It's a quality that is simply human but not the simplest of emotions for humans to control. Without simple compassion I am already categorizing them without humility and often without sufficient curiosity. After four years in an inner city ER, compassion isn't the easiest of emotions to turn on or off. Nor should it be so pliable, but with anything takes practice and I haven't mastered it yet.

The patient in the next bright room is doing well, or at least much better than last night. When I saw him at admission the night before he was severely hypotensive without tachycardia. Fluids were started and antibiotics as well. As I laid in the on-call room, I tossed and turned over it. Finally, I got up and made my way to his room and sat there for some time. I don't know if he was aware of my presence--he didn't have to be. As time passed, he became normotensive, and I made my way back to the resident lounge. Today, the light is reflecting off the monitor in his room, and his lucidity has improved. The attending physician is doing his examination and his vitals are looking good. I look back out the window. An elderly woman is walking up the path to the hospital, a large green lawn stretches out into the distance, and I swear I can smell fresh cut grass.