An Awakening

Ben Ferguson -- Sometimes in medical school, especially during first year, you really feel like you’re back in undergrad again, learning about seemingly mundane details that don’t appear to be applicable to the practice of medicine. I got this feeling a lot during my first year and even at points well into my second year.

The first time I really, truly felt like I was a medical student was when I interviewed Mrs. D, a teacher from Chicago. We had just finished the heme/onc section of CPP that day and I felt like I was still really solid on most of the material. Anemias, leukemias, lymphomas, signs and symptoms -- all fresh in my head. (CPP stands for Clinical Pathophysiology and Therapeutics and is the best class at my school by far, the one that makes you realize there actually was a valid reason that you learned all that biochemistry and physiology and neurology and anatomy during first year that, at the time, seemed entirely detached from the practice of medicine.)

After a brief meeting with our resident who took us around to a few patients to expose us to some clinical findings like jugular venous distention indicating congestive heart failure, displaced point of maximal impulse indicating left ventricular hypertrophy, and spider hemorrhages from cirrhosis, I was introduced to Mrs. D and began to run through my lengthy list of questions just like with every other patient: absolutely robotically and without a clue as to the reasoning behind my questions.

After finishing up her history of present illness, I started to realize that I knew what was wrong with her. She had some of the same signs and symptoms that actual, real-life doctors had just told me should be present in situations like these. Fatigue, dyspnea on exertion, cachexia, lightheadedness, dark urine, hepatomegaly, severe jaundice, scleral icterus -- it was like she had memorized a textbook for the purpose of reciting it back to me. She couldn’t have been more spot-on had she been a standardized patient trained to present with these findings. And I felt so empowered. I felt resonation with the questions I had been asking all these patients over the past year instead of just reading them off a list. I at once knew their value like I hadn’t realized before, and I was able to direct my questioning according to her specific complaints. And it was great.

At the same time, it wasn’t great. I realized she had acute myelogenous leukemia, a nasty adult leukemia that is relatively aggressive and has a relatively poor prognosis. And I realized that I learned about this disease in a classroom, free from emotion and patients and crying and fear of one’s outcome, secure in my own worry-free environment.

Meeting Mrs. D there and coming to the abrupt realization that she was in dire straits was a very difficult situation to be thrust into. On the one hand, she introduced me to the true value in knowledge about diseases and their management; on the other, she showed me that we should always remember what we are learning. We are not merely learning scientific facts. We are learning about human diseases that affect patients’ lives -- not just their bodies -- in ways that we can’t always comprehend as hard as we may try. We should never forget that.