The longer I practice medicine, the more I feel that time is circular as well as linear.
We see orbits within orbits, everywhere we look.
Cycles of life, and death.
Cycles of growth, and stasis.
Cycles of mistakes made, and lessons learned.
The past is never far. 1/
We see orbits within orbits, everywhere we look.
Cycles of life, and death.
Cycles of growth, and stasis.
Cycles of mistakes made, and lessons learned.
The past is never far. 1/
It’s the early 2000s.
I am a medical student, inhabiting that eternally stressful space of self-doubt, and lack of clarity.
I am taking a clinical skills class.
The standardized patient sits before me, and I watch as my classmate presses his stethoscope to their chest. 2/
I am a medical student, inhabiting that eternally stressful space of self-doubt, and lack of clarity.
I am taking a clinical skills class.
The standardized patient sits before me, and I watch as my classmate presses his stethoscope to their chest. 2/
As I observe, for a moment I think of a child listening through a door, their ear pressed to it.
We press our ears to the human body, listening for the secrets it might whisper back in murmurs, gallops, rubs.
“2/6 systolic murmur and an S3 gallop,” he announces confidently. 3/
We press our ears to the human body, listening for the secrets it might whisper back in murmurs, gallops, rubs.
“2/6 systolic murmur and an S3 gallop,” he announces confidently. 3/
The preceptor says nothing, their features impassive.
It’s my turn to take a listen, and so I do.
I press my stethoscope to the patient’s chest at the different locations we have learned.
And I close my eyes, and listen.
To orbits within orbits.
And the cycle of flow. 4/
It’s my turn to take a listen, and so I do.
I press my stethoscope to the patient’s chest at the different locations we have learned.
And I close my eyes, and listen.
To orbits within orbits.
And the cycle of flow. 4/
It sounds harmonious to me. Normal. Everything as it should be. Rhythmic. Strong.
I don’t hear any murmurs. I don’t hear a gallop.
Biting my lip, I listen harder.
My self-doubt blossoms like the lethal flower it is, petals unfurling and thorns sharp.
I must be wrong. 5/
I don’t hear any murmurs. I don’t hear a gallop.
Biting my lip, I listen harder.
My self-doubt blossoms like the lethal flower it is, petals unfurling and thorns sharp.
I must be wrong. 5/
The student who listened before me, he’s brilliant. He went to a better undergraduate school than I did. He gets better grades. He is a member of the AOA honor society.
He has a nicer stethoscope. More expensive at least.
It can’t be normal.
I open my eyes.
“I hear…” 6/
He has a nicer stethoscope. More expensive at least.
It can’t be normal.
I open my eyes.
“I hear…” 6/
The preceptor looks to me, “Yes?”
“Ah… I hear a murmur. And… I think a gallop.”
“You think?”
“Yeah, I think so...”
I don’t know why I’m saying the words I’m saying. I just know I don’t trust myself.
A look of disappointment flickers across the preceptor’s face. 7/
“Ah… I hear a murmur. And… I think a gallop.”
“You think?”
“Yeah, I think so...”
I don’t know why I’m saying the words I’m saying. I just know I don’t trust myself.
A look of disappointment flickers across the preceptor’s face. 7/
“It’s a normal cardiac exam. You should know what this sounds like. Listen to these sounds over and over. Eventually you’ll be able to pick up on when something sounds a little off.”
The student with me grins and nods. He is unfazed by his mistake.
I am crestfallen. 8/
The student with me grins and nods. He is unfazed by his mistake.
I am crestfallen. 8/
A year later, during a clinical rotation, I am paired up with the same brilliant student once again.
We are evaluating a patient with hypercalcemia.
I have studied this topic intensely. My burgeoning interest in nephrology has led to a fascination with electrolytes. 9/
We are evaluating a patient with hypercalcemia.
I have studied this topic intensely. My burgeoning interest in nephrology has led to a fascination with electrolytes. 9/
He gives his analysis and says what he thinks is going on.
The resident on the team listens and nods sagely, then turns to me.
I give my differential, and my final diagnosis.
This time I pay no attention to what was said before me.
I have learned. 10/
The resident on the team listens and nods sagely, then turns to me.
I give my differential, and my final diagnosis.
This time I pay no attention to what was said before me.
I have learned. 10/
It turns out I am correct. Elated, I grin widely.
Since the patient has been followed by me during their admission, I get to discuss the diagnosis with her.
The reason for her high calcium levels had been a mystery, but a bone scan and blood tests suggest a kind of cancer. 11/
Since the patient has been followed by me during their admission, I get to discuss the diagnosis with her.
The reason for her high calcium levels had been a mystery, but a bone scan and blood tests suggest a kind of cancer. 11/
As I talk to her, I am upbeat, still riding the high of having synthesized the data and arriving at the right answer.
I’m not paying attention to her body language, the drawing up of the blankets, the widening of the eyes, the gritted teeth. 12/
I’m not paying attention to her body language, the drawing up of the blankets, the widening of the eyes, the gritted teeth. 12/
The resident who is standing beside me takes over at this point. He sits down beside the patient and leans in close towards her.
His voice is quiet and reassuring as he carefully explains what I’ve just said, without the jargon.
The patient starts to tear up. 13/
His voice is quiet and reassuring as he carefully explains what I’ve just said, without the jargon.
The patient starts to tear up. 13/
After we leave the patient’s room, the resident turns to me. He is angry, and I deserve it.
His voice is quivering with a quiet fury.
“Don’t ever speak to a patient like that again. This isn’t a multiple choice test, or a flash card you got right. It’s a person.” 14/
His voice is quivering with a quiet fury.
“Don’t ever speak to a patient like that again. This isn’t a multiple choice test, or a flash card you got right. It’s a person.” 14/
I am humbled. He’s absolutely right, and I was absolutely wrong.
I feel sick, in the pit of my stomach.
Later that same day I return to the patient’s room and apologize for my demeanor, and for being inconsiderate.
The patient says something I’ve never forgotten. 15/
I feel sick, in the pit of my stomach.
Later that same day I return to the patient’s room and apologize for my demeanor, and for being inconsiderate.
The patient says something I’ve never forgotten. 15/
“You get to walk out of this room every day, but I’m still here, every day. Still here.”
I nod, my mouth turning dry.
“I’m so sorry.”
She says it’s okay. She says she forgives me. She even smiles.
But I don’t forgive myself. Not now. Not for years to come. 16/
I nod, my mouth turning dry.
“I’m so sorry.”
She says it’s okay. She says she forgives me. She even smiles.
But I don’t forgive myself. Not now. Not for years to come. 16/
Why do I remember these moments so strongly?
Where are they locked in my memory, these crystalline images frozen in time?
My self-doubt, my arrogance, and my lack of empathy.
Because if I forget them, perhaps I forget their lessons.
We orbit the mistakes that made us. 17/
Where are they locked in my memory, these crystalline images frozen in time?
My self-doubt, my arrogance, and my lack of empathy.
Because if I forget them, perhaps I forget their lessons.
We orbit the mistakes that made us. 17/
The longer I practice medicine, the more I feel that time is circular as well as linear.
We see orbits within orbits, everywhere we look.
Cycles of life, and death.
Cycles of growth, and stasis.
Cycles of mistakes made, and lessons learned.
The past is never far.
We see orbits within orbits, everywhere we look.
Cycles of life, and death.
Cycles of growth, and stasis.
Cycles of mistakes made, and lessons learned.
The past is never far.
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