My classmates and I have been desperately trying to ignore the great weather to study for our last exam of our third year. It’s hard to believe we’ve gone through twelve months of clinical rotations! They somehow managed to be intense but fun, frustrating yet inspiring all at the same time. Lately I’ve found myself looking back at this past year and reflecting on some of the patients and experiences that have made a lasting impression on me.
During my internal medicine rotation at St. Vincent’s, we had a woman on our service with cirrhosis of her liver due to alcoholism. She had many of the “textbook” physical exam findings that come with liver failure, which as students we don’t often see. Our resident physician talked to the patient and asked her if she would be willing to allow us to examine her, and she agreed. The resident brought us into the room, and we spent half an hour practicing abdominal exam techniques and discussing the unique findings seen in a patient with liver failure. The patient was very kind and understanding as we took turns palpating and percussing. I was amazed that this woman was willing to let us spend so much time learning from her body. As students, our education wasn’t going to cure her disease, nor would her course in the hospital be any different. Yet I suspect she hoped to teach us a little about her disease so that we could better help the next patient we see down the road. So much of medical education is based on the concept of paying it forward.
On my psychiatry rotation, the first patient I was assigned to follow was a man who was just admitted to the hospital after attempting suicide with a drug overdose. It was 9 AM and I was sitting across from a man who I knew only through the few scribbled paragraphs I read from his chart. I was truly at a loss for words. What do you say to a patient who is suicidal? You can’t possibly say you know what he is going through. How do you try to understand his perspective without coming across as judgmental? From this patient I quickly realized the role that silence can play in an interview. When talking to someone you occasionally reach an awkward pause, and the natural thing to do is push the conversation forward or change the topic. However, it’s in those silent moments that patients process their thoughts and can really say what’s on their minds. Sometimes the key to gathering information is to listen, not ask.
For my family medicine rotation I was in Sandusky. One day I met a man who had urgently requested an appointment. He told us that his father recently had a heart attack which required bypass surgery to repair the clogged arteries around his heart. The man was obviously scared to see his father go through this ordeal. Also he admitted to neglecting his own health lately, and was afraid that he might suffer the same fate as his father. We talked to him about ways he could improve his health, including controlling his cholesterol and blood sugars. This man actively sought out guidance and education, though that isn’t the case with all patients. On this rotation I learned the importance of taking advantage of teaching movements to help motivate patients to make positive health choices. For example, my physician talked to teens during their sports physicals about the dangers of smoking, especially how it could be detrimental to their athletic performance.
As part of my internal medicine rotation I went on a medical mission trip to Guatemala. We were in a village near San Lucas Toliman, where I met a teen who came to the clinic feeling short of breath. Upon talking to her further, we discovered her symptoms were related to anxiety. We asked about her home life and what things in particular were troubling her. She was worried for her father. Her family was incredibly poor and lived in a small shack. Her father felt the only way to support his family was to go find work in the United States. The family had yet to hear from him since he left the month before, and they had no idea if he was all right. This patient was one example of the human stories that sometimes get masked by political drama. I was reminded that often in medicine the political and social realities of the world can be seen in your own waiting room.
I did my pediatrics rotation at Toledo Children’s Hospital. Now, I was already leaning heavily towards pediatrics as my career choice before my rotation, though there was one experience that confirmed things for me. I was on-call, and late that night I met an 18 month-old little girl and her very anxious (and very tired) parents. Earlier that evening she had a large episode of rectal bleeding, and was in a lot of pain. We were worried that she might have intussusception, a condition where a portion of the intestine telescopes into another part. I donned a lead vest so I could help hold the child in place as she got x-rays taken, and then went through her films with the radiologist. The attending physician and I spent a great deal of time talking to the parents about our evaluation and what the next steps would be. Even though it was 3 AM I was wide awake and incredibly interested in evaluating this pint-size patient. I thought to myself “I could really be happy doing this the rest of my life,” and so I decided I would. Right then and there I officially decided I was going to be a pediatrician.
And finally, one of the many small reminders that there is always so much to learn. One day on my cardiology rotation at UTMC I was walking down the hall towards my patient’s room, a man admitted for an abnormal heart rhythm. All of a sudden I heard the fast beeps of his heart monitor. They quickly slowed to an ominous beep…beep…beep….and then came to a stop. I ran in the room, my own heart racing as I feared the worst. It turns out I wasn’t hearing his heart monitor, but rather his TV. I was listening to a contestant on the Price is Right who was spinning the giant wheel, competing for a spot in the showcase showdown. The patient gave me a strange look as I burst in and then quickly retreated.
The biggest things I learned this year were never published in a textbook (such as deciphering the cacophonous soundtrack of a hospital ward). Rather they were learned through experience, example, and sometimes an embarrassing game show moment.
