We like to say good things; we try to make normative to our profession to do the things that should be done. Many of us are saying that physicians should be advocates for their patients and communities outside of the clinic. Sounds good right? Unfortunately, what sounds good is not always a reality on the ground. I think most physicians agree that some from of advocacy for patients outside the clinic ...

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Watching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation. In the operating room, the ...

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Mrs. C was used to my quiet knock every morning at 6 a.m. She smiled as I turned on the overhead lights, but began to grimace when she realized that today was dressing-change day. The rustling packages of bandages in my overstuffed coat pockets had given it away. Mrs. C had stage four metastatic endometrial cancer; a malignancy of her uterus that was not responding well to chemotherapy and had ...

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I didn't think much of it at the time. Most physicians can trace back and recall their first patient.  For some, it is a clinical encounter the third or fourth year of medical school.  The more creative may point to their cadaver during first year anatomy and nod knowingly.  My first patient was a mouse.   Or shall I say a group of them? My freshman year of college, I volunteered in ...

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Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, ...

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The most valuable lesson about teaching that I ever learned occurred in high school. I took my first algebra test. The questions were easy, and I wrote down the answers. All my answers were correct, but I got a B. After each answer, she wrote “show your work.” She explained that while algebra questions start out easy, they become more complex over time. Only through careful understanding of ones thought ...

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Money has always been and will always be a big part of medicine Medicine is not about money, except when it is. When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor's offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the ...

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Pamela sits on the examining-room stool, looking at me expectantly. I am in my first year of medical school. I do as I've been told to do in medical skills class: I observe my patient -- without judgment or assumptions -- and try to figure out what questions to ask, based on the information I am given. Pamela has curly, strawberry-blonde hair and looks to be thirty, just a few years older ...

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Life is full of choices and each choice has the potential to open certain doors and close others. I choose medicine. It is a demanding career, but even as a 7th grader, I knew what I was signing up for. What I didn't know was how much this profession could influence the trajectory of my personal life and the types of relationships I’m able to maintain. I grew up genuinely thinking ...

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In the midst of a lumbar puncture: Thinking of Stevie Nicks Like most second-year medical students, I have the MP3 files of Goljan’s high yield pathology review lectures on my phone. Unlike most medical students, I rarely bring myself to listen to them, always opting for their Motown or punk counterparts instead. I often feel guilty about this -- listening to them would make for more efficient car rides and walks home -- ...

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