Wednesday, August 12, 2009

Trilogy: On becoming a Physician. Part One: Student

It is that mysterious wide-eyed look. It corrals the expectant father look, the deer in head light gaze and the wonderment of an adventure to come. Medical students are not really anymore studious then the rest. They just are constantly at it. A lapse in the knowledge of an appendix is forgettable but not the heart. Yet all things intertwined by the sinews of life are inter-dependent. Well not the appendix you say. To the contrary my dear Watson in disease those two are related. I can see someone opening the book to figure out that connection.


Jack was a beanstalk climber, trying to unravel the mysteries of the human body. His curiosity was exceeded only by his fear of a lack of knowledge. He would wander into the library at all odd hours of the day and night opening books and journals whose spines had not been tested or paper not yet dog-eared by human hands. He was on a mission to understand the mechanism of life before he knew how to decipher the afflictions of disease. But there was a problem with Jack. Things and differential diagnoses would roll off his tongue in class, to the amazement of his peers and sometimes even to his professors. Yet given the simplest of cases he would wind himself around the bark of this metaphorical tree of bookish knowledge tracing the ridges and failing to see the obvious.


In his final year Joe befriended him. Now Joe was street smart and could see with clarity the whole picture in a single piece of puzzle. He had the common sense built into his collected knowledge. His problem was that he could never look nor find the doors to the library. "Why spend time shuffling papers when you can get the info from others. When stumped he would prod Jack to come up with the litany of what it could be and Joe would arrive at the right answer of what it was. That’s how the two got together as good friends. Little by little they arrived at an understanding best suited for each. It happened on a bedside conference with the professor.


The patient was jaundiced and lay supine in bed unable to answer any of the questions. After each student had had a chance to interview and examine the patient the professor, a fifty-something with a graying goatee assembled the gang in the conference room.

“Alright then,” he proclaimed, “Jack let’s hear your answer?” The professor would always ask him after the rest of the class and before Joe had his say.


And Jack as usual started with his laundry list of possibilities, not quite committing. But when it came to Joe, he simply answered, “My friend Jack has the answer. We can take his number three possibility and add number seven to it which will give us cirrhosis of the liver with hepatic encephalitis as the diagnosis.”  He was correct.


“You know Jack if you and Joe got together half and half will make a great whole.” The professor counseled them. 

 They became best of friends and through that friendship of collaboration, they graduated first and second on top of the class. Each learning from the other and each prodding the other for more. Knowledge, they realized is to be shared with give and take and each old and new paradigm polished and shifted to a newer orbit of understanding. That is what takes knowledge to a new frontier.

Physicians who become good at their art share their knowledge, keep an open mind, limit the one sided arguments in their heads and collate information for a healthier patient. 

The rigors of these four years as students were barely contained within a week's worth of the interns’ life that was yet to come for Jack and Joe.

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