Probably the most striking difference I have realized between the two years of basic science and the two years of clinical rotations (of which I’m about a third of the way though) is how I have come to understand things. Up until my first board exam, I was driven to quickly and judiciously answer multiple choice questions. Now, in the real world, I am realizing more and more that medicine is, happily, more than that. Medicine, for me, as a third-year medical student, is about stories.
Stories come from a constellation of sources; the extensive computerized charting system, the patient, the nurses, and the other caregivers on the patient’s service. There are a number of storytellers who tell me their tale, and, in turn, I tell them the plot I have understood and surmised. As a narrator, once I have that consensus of information in me, my interpretation of the subsequent events quickly and easily follows. The story straight, I can give a terse and bloodless summary of the patient and their current status. This rapid turnover of information is the daily routine of medicine, and I suspect it is not unique to medicine alone. The process I outlined above can apply to law, a business client, etc.
Regardless, during my internal medicine I asked my resident if he was willing to allow me to help on a case report of any interesting patients he may have had the pleasure of treating. He graciously obliged, and, as this was essentially my first case report, I began to read everything I could on this patient. The story of this particular patient was tragic, complex, and compelling. I sat after-hours in the student lounge for days, pouring over her charts and the notes in the system. Being thorough, I started at the first notes dating back years ago. As I read what acutely brought this patient to the hospital and the trials and travails she faced, my interest grew. After a week and a half of summarizing, I was near the end of the story, and close to reaching present day in terms of the progress notes I read in the computer. I was glued to the edge of my seat, and as I read the final outcome, I was thrilled. The patient had survived her major surgery, and was being seen in follow-up clinic as an outpatient.
Having finished that report, I was able reminisce about the whole process and was reminded of two fictional examples of what I did. In the past, during my high school English class, my teacher had assigned for us to write a paper on a specific short story from The Best American Short Stories of the Century; 100 Years of The Best American Short Stories edited by John Updike (of the ‘Rabbit’ series); my short story was The Rotifer my Mary Ladd Gavell. That story is divided into three parts, each unrelated to the next. The overall theme of the piece is about inevitability and frustration to change outcomes in situations. The first is about a lab student who sees the titular rotifer under her scope and is frustrated when she attempts to alter the slide and the whole world under the scope is changed. The last story is about a woman whose relative is getting married and is observed to be cheating; there’s a good line from that one that I’ve quoted on this blog in the past. The middle story is the one I was reminded about, which, to be honest, was the one at the time that least interested me. It was about a period where the narrator was engrossed in the past – more specifically, the distant past. The narrator reviewed an extensive story though the form of letters and posts from a century ago – a series of correspondences that the narrator traced through the latest one, just as I did with my patient.
The other piece of fiction I was reminded of was All the King’s Men by Robert Penn Warren – one the best books I’ve listened to. The narrator in that book, Jack Burden, goes through a few epiphanies as he accompanies Willie Stark, a messianic fictional political whirlwind, through the muddy waters of early 1900s populist politics in Louisiana. One of those epiphanies came from his thesis, in which he crawled through letters of the past like the narrator of The Rotifer. Jack was driven but ultimately distraught by his degree, to the point where he left his manuscript unattended and unfinished. This disappointment drove him later in the book to thoroughly investigate on his boss’ behalf about the past of another major character so as not to repeat his past mistake. There is particularly poignant line he delivers when he succeeds: “And all times are one time, and all those dead in the past never lived before our definition gives them life, and out of the shadow their eyes implore us. That is what all of us historical researchers believe. And we love truth.”
At any rate, medicine – people – are stories. There is always more upon inquiry, and I feel entwined in the story of my patient I read about. There are a million threads behind each person, and it is always a pleasure to be drawn into that tapestry as a student.