Tuesday, March 2, 2010


One year ago tomorrow, we were assigned to flaunt our brand new White Coats and prance around the cardiology floor of the hospital and impose ourselves onto some unsuspecting patient. Our task was to go through the motions of interacting with a human being whilst wearing said new coat, to experience how the symbol translates into real life. The problem was that we didn't have any useful clinical purpose. The assignment wasn't "go and see Mr. Smith, take a history and do a physical." Rather, it was "go and see Mr. Smith and practice talking to him." See also: "Go wake Mr. Smith up, disrupt his restorative post-surgical sleep and ask him to tell you his life story (for the umpteenth time) for no reason other than for your practice interacting with a real person, despite your complete inability to contribute in any way to his life."

I couldn't make his heart pump stronger. I couldn't get him out of the hospital and back to his real world any faster. He didn't have an overwhelming desire to unburden himself of his innermost concerns. He wasn't looking for anyone to listen to him and support him. He just wanted to go home, and I could do absolutely nothing to further that end.

I didn't belong in that hospital. I didn't belong in that coat. I was an imposter, completely disconnected from any of the privileges of existing under those conditions. I knew it before I walked into Mr. Smith's room that I would feel awkward and guilty for draining his resources without serving any purpose of any kind. It was an experience of profound uselessness that scarred me, inspiring a borderline-pathological, obsessive sensor to evaluate my contributions to any patient who has allowed me to learn from him or her ever since.

Exactly one year later, imagine the irony of beginning my third-year clerkship. Yesterday, I drove and moved myself to Portland, ME (a feat in and of itself: my car was so packed that I couldn't see out the back OR side windows... that I made it here alive without rendering irreparable harm to myself or others is pretty mind-blowing) to start my new life. And this morning, I strutted into the hospital - garbed in White Coat, of course - with a confidence that I could not even have imagined a year ago.

Day 1 of orientation was pretty chaotic. Lots of info, lots of hallways, lots of disorganization. But as I walked those hallways, I felt something completely foreign to my inpatient experiences to date (see also: my "Operation: Own Your Discomfort" trips with my preceptor this Fall). I felt like I kind-of, sort-of, just-a-little-bit... belonged there.

The first day was concluded with my first patient interview as a third-year student.

Assignment: "Go see Mr. Jones. Don't take a history or perform a physical exam. Just talk with him about what it's like to be in the hospital." The same exact assignment from a year ago.

"I heard a little bit about your experience from Dr. X. What has it been like for you?"

Twenty thoughtful minutes later, I found myself discussing this man's use of narrative to construct a meaningful experience of his frightful events (cardiac arrest, followed by an induced coma). With each rendition of his story, he recounted, he felt more and more appreciative for his life and the people around him. He selected his details, framed their context and consequence -- all of it shaped exactly as he needed it to be. His story was his coping mechanism, his structure. His way of establishing control in the face of chaos.

As his words fell upon my eager ears, I was surprised at how natural it felt -- it felt just like interviewing a patient at clinic, as I'd done so many times before this year. Granted, he was not in acute distress. I don't think clearly or feel comfortable/confident/anything remotely positive whilst in the presence of someone in acute distress: this is definitely going to be a challenge, and one that simply did not present itself today. But for now, in the moment, I felt like I truly did belong.

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