Brrring!
The landline in my call room trills, jolting me awake. I have a consult. I’m a third-year medical student on my internal-medicine rotation. This is my second overnight call and second week of clerkship.
“Hi, Keith!” the caffeinated resident chirps. “I have a consult for you!”
The patient is Ms. Carrera: a young woman with a history of diabetes, renal disease and a recent heart attack. She’s here because her legs hurt. Cardiology and nephrology have no explanation, so they called internal medicine—and by extension, me. My shoulders slump.
Actual doctors already saw this patient, I think. What can a third-year medical student possibly contribute?
The resident notices my pause.
“Sorry, I know this is a bad consult for you,” she sighs. “Just try your best!”
I take a deep breath, bracing myself with the sharp smell of disinfectant that clings to my scrubs.
The resident expects me to think of a treatment plan, but so far, most of my plans have been slightly off. Last week, I learned that a patient who was retaining urine didn’t need a medication I’d suggested; they needed a catheter. Another patient with a cough didn’t need the antibiotics I’d ordered; they needed a chest X-ray. I know that mistakes are necessary for learning, but I feel like I’m failing to care for patients if my plans miss the mark.
Meanwhile, a fourth-year student on my team seems to be an expert in patient care. He can see through someone’s hazy symptoms and target the right tests. He can line up potential medications to treat an illness, then knock each one down until the best option remains. Once, I saw him return a textbook about electrolytes to our supervising physician.
“This was so good!” he gushed, and the doctor agreed emphatically, praising his commitment to patients. I gazed in wonder, thinking, Maybe if I had more medical knowledge, I too could care for patients well.
I enter Ms. Carrera’s dark room and peer at a snoring mound of blankets.
“Hello,” I say timidly. No response. I try again, a bit louder. She startles awake with a shout. After giving us both a moment to recover, I introduce myself.
When I say that I’m a medical student, her eyes narrow.
“I don’t mean to be rude,” she says, stifling a yawn. “But what’re you hoping to get out of this discussion? I’ve already repeated myself so many times. Isn’t everything in my chart?”
“I was hoping to, um, clarify the timeline of your illness,” I stammer. When in doubt, a preceptor once told me, start with the onset of illness.
She sighs. “I’ll talk for five minutes only. Everything has gone downhill since my heart attack last week…”
My questions soon peter out. I try to listen to her answers, but my mind is scrambling to recall everything I know about heart attacks. I bite the inside of my cheek—the clock is ticking.
I’ve never felt pressure like this. Before clerkship, I didn’t stress about memorizing every detail of diseases. Preceptors often asserted that knowing minutiae won’t make me a good doctor. So instead of reading textbooks, I devoured Pachinko, Braiding Sweetgrass and dozens of other books, continuing the literary adventures I’d loved since childhood.
As clerkship approached, I wondered if I should be cramming my brain with medical knowledge instead. I signed up for a flashcard website that claimed to help clerks “stand out on rotations.” I subscribed to a podcast on how to approach common presentations. I flipped through hundreds of pages of notes that older students passed down like heirlooms.
And yet, all I can offer Ms. Carrera is silence. I start retracing our conversation. Suddenly, I recall her comment about her life spiraling since her recent heart attack. This story sounds familiar.
“Can you tell me more about your heart attack?” I ask. “That must have been terrifying.” I can only imagine how her life changed instantly. Any perceived control over her health must have vanished.
The wrinkles in her forehead unfurl slightly.
“Yes,” she sighs. “It was awful.” Her aging mother, whom she used to care for, must now care for her. She’s also become more dependent on her friends, and she worries about burdening them. None of this was in her chart.
Her words pull on ideas in my mind, drawing them into place like an arrow poised on a bowstring.
“How else did it affect you?” I ask.
“Well…” she gazes at the wall behind me. “It made me think about death, which is totally wrong for my age.” There, a target. I let my words fly.
“You’re very young,” I agree. “It seems like your heart attack divided your life into before and after.”
She sits up, suddenly alert. “Yes, that’s it!”
A few weeks ago, I read Between Two Kingdoms: A Memoir of a Life Interrupted by Suleika Jaouad. Its hundreds of pages guided me through a journey that I’d never seen on a flashcard: an experience of suffering and recovering from cancer that mirrors Ms. Carrera’s story.
Conversation flows as Ms. Carrera and I explore the undercurrents of fear and uncertainty in her life. Five minutes pass, then ten, then more. Afterwards, she thanks me for listening and drifts back to sleep.
Our conversation swirls in my mind as I consider what to tell the resident. The medical treatments that Ms. Carrera needs probably won’t relieve her emotional concerns.
I meet with the resident and stammer through a summary. But my thoughts straighten when I arrive at the treatment plan. “Honestly, I don’t know what to do for Ms. Carrera’s leg pain,” I confess. “But I think we should offer spiritual care. The therapists on the team can help Ms. Carrera process her experience with illness.”
The resident stops typing and looks at me.
“That’s a good idea,” she says slowly. “I didn’t even think of that. Great work! For her pain, we should…”
As she continues, a memory drifts to my mind’s surface. I recall my grade-four teacher drawing a triangle on a piece of paper. Her marker squeaked as she wrote the connections that people make when reading a story: text to text, text to self and text to world. I was half listening to her, half daydreaming about Percy Jackson, a series about teenagers who are descended from Greek gods. I loved the books, and I often fantasized about inheriting a deity’s powers. Apollo—the god of healing, music and archery—was my favorite. But I knew I could never be like his children: they stitch wounds, strum lyres and shoot arrows effortlessly.
Back in my call room, I picture Apollo’s children speaking to patients, aiming their words carefully to strike the right chord. These demigods probably love reading cardiology textbooks, and if I’d studied like them, perhaps I could’ve decoded Ms. Carrera’s symptoms. But a large portion of my medical knowledge will come from experience. Meanwhile, I should remind myself that medicine encompasses more than just fixing a disease. I still helped Ms. Carrera by exploring the impact of illness on her life, listening to her story and connecting it to books I’ve read. Although I didn’t cure her, I did care for her.
The following Tuesday. Another week, another overnight shift. I’m reading Dracula in my call room, trying to tune out the blare of ambulance sirens. A landline sits nearby, threatening to ring. I’m ready: I might not be able to solve a patient’s medical problems yet, but I can help untangle their knotted emotions.
The phone trills, and I pick it up immediately. I have a consult.
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