Friday, August 24, 2012

Trial By Fire

I could feel her holding her breath as I continued the phone conversation with the oncologist. She sat in the floral upholstered chair next to the desk in my office.  Her short white coat was a touch to clean to belong to a student entrenched in hospital warfare.  A second year medical student with little clinical experience, she asked to shadow me a few days earlier. 

Half way through my morning, we had only encountered the simple bread and butter issues: upper respiratory infections, blood pressure follow ups, etc. She followed dutifully from room to to room, writing notes in a small pad that she slipped gently into her front pocket from time to time before retrieving again as need be.

She was young.  Inexperienced.  Her exuberance was evident in her overly self conscious nature and her precise preoccupation with detail.  I tried to be patient and kind.  Remembering my own student days, I knew that a young persons field of study was often determined by the quality of their experiences and not the day to day content.

As I hung up the phone, I paused for the comment that I sensed waiting to burst forth from her lips.  She spoke with surprising conviction.

That's why I want to be an Internist.  Oncologists have to deal with death all the time!

Almost falling off my chair, I bit my lip so hard, I drew blood.  I stood like a statue trying to mentally compose myself.  There were so many things I wanted to say.

My dear child.  Today you will walk in my shoes.  You will wake at 4:30 AM and drive to the nursing home and pronounce the old man dead right in front of his wife and daughter.  You will express your condolences and sorrow before you excuse yourself to round at the hospital.  Your first patient will be a seventy year old with widely metastatic lung cancer who has finally agreed to hospice.  Her time is limited.  But so is yours, so you will rush to see the other patients and then return to your office for a few minutes of paperwork.  The message on your desk to greet you will be a notice that a middle aged man you once took care of collapsed unexpectedly on vacation.  The funeral will be over the weekend.  It's is 7:30 AM and your first office visit will be arriving soon. 

In the few short hours you've been awake, death has already consumed you.

But instead, I leave the soliloquy in the realm of my thoughts where it belongs.  I look down at the computer screen and search for the next patient: a thirty five year old who is losing his battle with leukemia. I beckon her to follow.  I needn't say a word.

Experience will be a far better teacher than I.


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