Thread by @TheRealDoctorT

“How many letters in the alphabet?”

I had been expecting a question, just not this one. Damn.

Uhh. Twenty-six. Right?

… Right? Argh, this is so simple, but why is it so difficult?

“Twenty-six,” I say.

The cardiology fellow who asked me the question grins, “Perhaps.” 1/

Perhaps? What does that mean? I glance at the other house staff, and there are a few nervous shrugs.

The fellow continues, “It might be 26, or it might not. Depends on the language.”

Oh, right.

Medical training tends to create a singularly stressful environment. 2/

You’re trying to learn an art and a science, immersed in an entirely new highly technical jargon with thousands of words.

You’re trying to figure out what you want to do with your life within this vast world.

And you’re trying to make a good impression while doing it. 3/

Every time you’re asked a question, it may be an opportunity for learning, but it also feels like an opportunity to prove yourself.

A missed question on rounds can hang over your head in ways few things can.

A missed opportunity to shine. 4/

I’m an intern on the Cardiac Electrophysiology (“EP”) rotation. My fellow for the rotation is a tall gentleman with a rumbling baritone and a mind like a steel trap.

He’s kind. The quiet sort.

And willing to teach.

I sit before him and his EKGs spread out on the table. 5/

It’s later in the day, after the morning rounds.

EKGs are the heart and soul of this rotation. If you can’t read them, you’re like a sailor who can’t navigate, a scholar who can’t read.

I stare at the line tracings. Electrical signals rippling through fibers, and muscle. 6/

He describes the EKGs to me. I’ve read books on them. Studied them already. But I don’t see them, not like he does.

“To be honest, I don’t really see the lines anymore. Not like that. I see …” He scratches his brow, “the heart. Visualize it, how it’s beating.” 7/

I shake my head, “I can’t read them like you can.”

He nods, “Well, of course. It’s experience, isn’t it? I’ve just read several thousand more of these than you. Give it time.”

I nod, exhaling deeply.

And we return to studying the EKGs, and the secrets between the lines. 8/

I know that I don’t want to go into cardiology, at least not EP. It feels too detached from the human experience. At least to me.

For me, the EKGs are windows to circuitry, not people.

But I study hard, like with every rotation. To add skills, and perhaps understanding. 9/

But I will never see the EKGs the way the fellow does. The more he explains them, the more I realize we are seeing two completely different ways.

I’m reminded of the story of a chess prodigy, who didn’t see the pieces.

Instead he saw vivid colors on the board. 10/

He would choose the best moves based on the color combinations, and the patterns they created.

He saw truth, but through the lens of beauty.

I will never see these EKGs the way the cardiology fellow sees them.

I will always search for the truth that he finds in the beauty. 11/

At the end of our impromptu teaching session, I have one last question.

“This morning, why did you ask me about the letters in the alphabet?”

He thinks for a moment, “Because perspective is important. With EKGs. With life.”

Finally, I understand.

He smiles, and gets up. 12/

Before he leaves, he turns to ask me one more thing, “How many bones in the body?”

I think for a bit, “Depends on the body?”

He grins, “Good man. Oh, and if the attendings ask you any questions about arrhythmias, the answer is “re-entry” about 99% of the time.”

I laugh. 13/

The next day the EP attendings are having their morning rounds, with the house-staff clustered around the table in a reverent hush.

Suddenly one of the attendings points to a tiny squiggle on an EKG and then points to me. “You. What does this mean?”

A chance to shine. 14/

Before I speak, I glance at the fellow. He gives the smallest of nods, and I smile.

“Re-entry,” I say.

“Excellent. This is what triggers the aberrant conduction and leads to…”

As the attending carries on, I smile, feeling the endorphin rush of an answered question. 15/

How many letters are in the alphabet?

How many bones are in the body?

I remember a story about a chess prodigy who saw colors instead of pieces.

I knew a cardiology fellow who saw a beating heart instead of EKGs.

We see not only what we can.

We see what we choose to.