Brought to you by the students of the University of Cincinnati College of Medicine
By Khanant Desai
I enjoy listening to doctors tell stories. Especially ones with punch lines that involve the patient exclaiming something like, “I have no idea how that got in there!” Sometimes, these doctors will tell a story, and they will become very somber. Their eyes become fixed and their memory becomes sharp, and they will recount the exact time, place, weather, and ambience in which this story takes place. They will give you the patient’s age, vitals, social history, and even the clothes they were wearing on that day. All these stories reach the same climax – something goes wrong, sometimes in a terribly quick instant. Whether through fault of the physician or paucity of luck, the patient experiences an adverse event. The storyteller pauses for a second as they relive this moment, and one can almost see on their face that they are burdened with a heavy boulder, living with the reality of another human being having been profoundly impacted under their watch.
After eons of high school AP classes, undergraduate graduation requirements, pre-med prerequisites, and learning such vagaries as how much potential energy a free-falling elephant holds, I believe there comes a time for all of us when the realm of our education finally collides with the realm of the living, breathing world. We realize at some point that the work to which we are dedicating ourselves will directly alter the course of another person’s – our patient’s – life. This transition, this comprehension, was precipitated for me by a jolt of an event.
Early 2012, Mumbai, India. After an uncharacteristically frigid Indian winter, an elderly gentleman presents to the local mega-hospital ICU with stroke-like symptoms. He is taking medication for hypertension at the time of admittance. A diagnosis of meningitis is made after extensive work-up, and antibiotic therapy is initiated. While recovering in the hospital, sharp pain arises in the patient’s knee, leading the attending physician to prescribe medication for suspected gout. The pain does not improve, and blood cultures finally come back positive for antibiotic-resistant P. aeruginosa. The patient is treated with a drug of the penicillin family. Shortly thereafter, the patient has a seizure. The attending physician is paged, and he exclaims something about a drug interaction. The patient’s condition rapidly deteriorates - disseminated intravascular coagulation, followed by multiple organ failure. This is how my grandfather passed away.
Medicine was a very small part of my grandfather’s life, yet he was very proud to see me in medical school. It is odd talking about my grandfather as a patient, using medical terminology. This is not, of course, how I think of him; I remember his deep patience, timely wisdom, and unshakable religiosity. He enjoyed watching cricket and reading the newspaper with his black-rimmed glasses every single morning. More engagingly than any book I could ever read, he told me the parables of Hinduism in a way that made them come alive in my mind. He had lived a full and healthy life into his ninth decade, so when his health abruptly took a turn for the worse, we never had a chance to contemplate the siege of pathology that had beset him.
It was only a few weeks after he passed away, deep in the thick of an all-nighter as I studied for the Infection & Immunity final, that the world of medicine forcibly infused itself into my memory of my grandfather. As I flipped through endless practice pharmacology questions, I suddenly came across one describing exactly what triggered the drug-induced seizure that led to his decline – something to do with penicillins interacting with gout treatments. I would have blown through it without a second thought, happy to have gotten it correct and ready to tackle the next one. It looked so innocuous on paper, and yet, it may as well have been an obituary.
My mind wandered, and I found myself in the shoes of his attending physician, just after he had realized that his prescription for treatment had led to an adverse event. Did he try practice questions such as these when he was a medical student? At our age, he probably was not cognizant of the humanity behind each question, and viewed them as we all do – stepping stones to help him achieve a higher grade. Maybe he had lost the ability to see patients as they truly were, and only saw numbers and charts everywhere he looked.
I was given a glimpse into my future life as a physician that night; I was able to see past the veneer of quizzes and tests and recognize that each practice question, each clinical vignette, was just the masquerade of a patient, a real human being, somewhere out there in the world. We only read about them now, but in the near future, we will actually meet these people. The study of academic medicine is necessarily nameless because pathologies have no face, feelings, or grandchildren. I am thankful, however, of being reminded that the practice of medicine is not, and should never be, anonymous.
I would wager that every healthcare worker owns a similar story. Living through the consequences of our field is a crucial final (or perhaps first) step in the transformation of layman to physician, and it is an intensely personal experience. This story may mean nothing to you, and it might not make you care any more deeply about your work. But I believe as medical students, we will each have a transformative experience to possess and integrate into our fabric. When it does happen, we can only hope to capture it, to remember it, and to use it as fuel for the work that is to come.
An experience reflecting the true value of our education
Copyright © 2012 Mentis
About the Author:
Khanant Desai is a second-year medical student