So simple it all seemed: if you suspect that a patient has a small bowel obstruction, you first try to relieve it by placing a tube down the patient’s nose and sucking out the gastrointestinal contents to relieve the pressure instead of being trigger happy with a scalpel (hmm…I’ve never encountered a triggered scalpel -- what a tragically mangled metaphor).
Anyhow, this was the gist of the chapter in my surgery textbook. It was my first day on the surgery service and I was attempting to put a large volume of information into my tragically and chronically undersized cranium before I reported for duty. As it happened, I did encounter a young patient with the textbook complaint and the textbook solution. I walked into the room, having read her chart, expecting nothing unexpected—I had read the chapter after all and was the master of the anatomy, physiology, pathology, and the treatment modalities for the patient’s problems (temporarily, before it all leaked out of my head).
The third year of medical school is all about being surprised.
I had gone in expecting someone in, what medical students label, NAD—“no apparent distress.” This young girl’s condition was in stark contrast to that oft- misused acronym. I have become more adept at handling awkward interpersonal situations in the past two years of med school, but I admit I still feel pretty powerless when confronted by a crying girl. This one was particularly inconsolable. She had had to live with the tube for a couple of weeks by the time I met her and it had wrecked her ability to sleep peacefully. This was only one of her myriad complaints that day. I won’t reveal any more details for fear of violating patient privacy. However, I did all I could to try and calm her down and did my best to explain the necessity of her uncomfortable treatment, but her continued distress made me realize I was out of my depth.
As I rubbed my hands with alcohol while exiting her room, I felt betrayed by my textbook. It did not speak of the discomfort, disturbance, and despair that our patients were subjected to as a side effect of our treatments. But I suppose they can be excused: we don’t want the global obesity epidemic infecting our textbooks. On a serious note, though: it became apparent to me that clinical medicine is staggeringly less perfect than our books and scholarly articles lead us to believe. The veracity of this impression has been reaffirmed repeatedly during my hitherto short career in clinical medicine. Therefore, in addition to our knowledge about the pathology and pharmacology, we need to possess the knowledge that being in the hospital is really insalubrious and the cognizance that it is our job to be there for our patients on what is possibly the worst day of their lives. We must do so with patience and empathy.
This idea is approximately as novel as sliced bread in 2012 and is written, spoken, and communicated through morse code and smoke signals ad nauseum but it has become very real to me very recently and I feel compelled to document that, albeit rather inarticulately.
Update: While chatting with a friend about this uncharacteristically touchy feely blogpost, I managed to verbalize this clichéd concept in, what I hope is, a novel way. I think you have to wear two hats in medicine: Sherlock’s deerstalker and one of Stephen Fry’s ridiculous hats from QI (British reference, don’t worry if you don’t get it). While formulating an assessment and plan for the patient, you have to display a Sherlockian scrutiny of all facts and healthy amounts of skepticism. However, once that part’s over, Fry’s gentleness and empathy become desideratum while interacting with the patient and realizing that the treatment isn’t as cut and dry as it appears in the sterile pages of your textbook. This idea sounded better in my head than it does on the page, but there you go.