Friday, December 30, 2011



I wake from a dead sleep to the words, “hey, could I get some help our here?”  Everything is dark in my dorm room, and it takes me a minute to realize the voice was not part of a dream.

I clamber out of bed and find my glasses, snap on the light, scoot my illegal hotplate out of the way so I can open the door.

Out in the black and white tiled hallway, my friend and hall-mate David is on the floor in his African safari print pajama pants, limbs sprawling.  His hair looks like he may have been electrocuted, but this is normal for David, and he doesn’t seem to be near an outlet.

I squat by his head, “what happened?”

“Not sure,” he says into the floor, “I just kind of…passed out.”

I rock back on my heels.  I’m a premedical student.  I can explain mitosis and I can run a mean chromatography lab.  I can dissect fetal pigs with precision.  I can explain how color vision works and I can diagram the circulatory system.  But I still don’t really know anything about human bodies overall or how they work or what to do when they don’t work. 

With the hall lights on, David looks pretty green.  I call 911 on my cell phone.  The EMTs come and check him out.  Flashlights in the eyes, blood pressure cuff squeezing his arm.  They decide to strap him to a backboard and carry him down the three flights of stairs to the ambulance waiting on the sidewalk.  They have to stay in shape somehow, I guess.

I will meet them at the ER.  As they carry David off, I duck back into my room.  I put on jeans and shoes and grab two books – Rumi and Organic Chemistry.  We could be there a while.

We aren’t there too long, it turns out.  I beat the ambulance to the ER.  All six beds are quiet.  The nurses are kind.  David looks embarrassed when they stick the EKG leads to his chest. 

As we wait for the doctor, I try to maintain an attitude of concerned curiosity.  David looks more himself now, sitting up in the bed and chatting.  I’m less worried about him than I was half an hour ago, squatting in the hallway in my PJs. 

The anxiety rising within me now is about the doctor.  I feel preemptively defensive and protective of my patient.  Will the doctor assume David is on drugs?  Will he scoff at me for being a lowly premedical student?  Will fail to introduce himself or not ask before he touches David’s body or ignore me entirely or not answer questions?  Will he do any of the multitudes of seemingly inconsequential things that doctors don’t realize are hurtful and dehumanizing?

I’ve been seeing enough doctors for my own health issues lately that I have learned to set the bar very low.
My fears in this case are not realized.  When the doctor comes to see us, he is not in a hurry.  He sits down, speaks slowly.  He introduces himself to both of us. He asks permission before examining David.  He explains vasovagal syncope, writes it down for me, winks at my Organic Chemistry book.  He talks about the vagus nerve wandering and makes theatrical motions with his hands.  He treats us like whole people, and for me this is so rare and special in my encounters with physicians that I want to bottle it.

And the thing is, this whole night still sucks.  This thing has not even happened to me, but still the idea that the human body would just short out like this…it feels like a betrayal.  How dare you, vagus nerve?  I have learned about the ion channels and the nodes of Ranvier and I assume that when I recite these things like mantras, they will keep us safe.

They don’t, though.  Knowing is not enough.  Acing a human physiology course is not enough to ensure that your own physiology doesn’t fail you. 

Years later, David will write that his physiology failing him temporarily highlighted the miracle of how well it works the rest of the time.  That it is a miracle that we are here, that we get to walk around in these bodies and live our lives at all.

And it is a miracle.  My understanding of the human body has grown dizzyingly complex over the past several years, and every new molecule or gene or process I understand is a miracle.  (Both that it exists and that I understand it.)

But the lesson I take from this night is slightly different.  We are all subject to our own human fragility; we each have weaknesses in our very DNA.  No knowledge or power or faith is enough to make anyone exempt.  And so, by all means, we should celebrate the miracle of what is working. 

But what isn’t working is sometimes just going to suck.  And sometimes the best I can do as a doctor is to just not make it suck any more than it has to.    So my new mantra is less about ion channels and more about shaking hands, introducing myself, being mindful of my patients as whole people.  Remembering that every patient I see in the ER or in the clinic comes from someplace as real and textured as that dorm room is to me.  Most of my life now is here in this hospital, but most of my patients’ lives are elsewhere, in the real world, where they may wear silly pajama pants.

It seems like these things should be easy to remember.  That most people have this basic sense that other people are real and intrinsically valuable.  But the process of medical education is not the process of fostering this understanding.  Instead, it is the process of deluding ourselves into thinking that we are special enough to warrant exemptions from our own human fragility.  And by extension, our patients who are sick, were obviously not special enough to warrant an exemption from their own biology.  Patients must be unlike and inferior to ourselves if we are to remain psychologically isolated from the horrors of bodies simply failing.

Some doctors have obviously been able to retain this ability to see their patients as whole people, and I have seen from the patient’s perspective how healing it is to be treated in this way.  So I will fight the good fight that is being mindful of each person’s humanity.  It’s all I can manage right now. 

In college, David and I had a problem with clubs.  As soon as we joined a club, we would be nominated to lead that club.  As soon as we saw a problem, we were suddenly in charge of solving that problem.  This is how we ended up co-leading a faltering campus living wage campaign.

So I hesitate to mention this, but while being mindful of each person’s humanity is the good fight, it’s clear to me that the better fight is finding a way to train physicians that doesn’t rob them of this intrinsic sense in the first place.  Surely there is a way to educate physicians without training them to be aloof assholes.  But guys, I don’t have time to reform medical education, so please don’t nominate me.  (At least not till after residency? Please?)

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