A medical student is forced to step beyond the things he knows

There comes a moment when you’re forced to step beyond the things you know. It’s a split second — an instant adjustment from the safety of recollection to the insecurity of the unknown. Day after day we head into the library, hunching over twice-reviewed notes and hidden behind piles of books yet to be read. We push ourselves to work harder, study longer. We toil knowing that each page holds a secret that might allay suffering or change a life. But at some point, the physiology and pharmacology don’t matter. Organ systems and microbiology give way to something different, something more.

Mr. Thomas has Parkinson’s disease. Once a constant fixture at his family restaurant, the aging man now spends his days confined to a twin-sized bed, a protective railing keeping him securely in place. His son, a local police officer, stops in when the visiting nurse leaves for the day. For the most part, they get by. Mr. Thomas watches television while his nurse ensures the machines are tended to. When his son gets home, they sit together as the night falls. Tonight, though, Mr. Thomas needed help.

I was confident on my way to the scene.  Having just finished the first neuroscience block, I assumed knowledge of neurons and dopamine would help me treat Mr. Thomas. At the very least, I felt that familiarity with the standard medications and textbook presentations would make the problem clearer. When we pulled up to the house, I hurried through the rain and past the door that the still-uniformed police officer was holding open. We’d met on countless other scenes, and he thanked us for coming as I pulled the heavy oxygen bag off my shoulder.

Mr. Thomas was struggling to breathe. Despite the oxygen flowing from the bedside, each gasp was harder than the one before. Reacting to the slowing beeps of the monitor, I tore open my kit, determined to place the needed airways and help the man breathe. Additional rescuers arrived as we hurried to move our patient to the stretcher, by now breathing entirely for him. Mr. Thomas’ heart continued beating only because of the oxygen we were forcing into his lungs.

“It’s not what he wanted,” the tearing son spoke from the corner. I looked up as he pulled the distinctive papers from a bedside folder. My heart fell as I recognized the bold letters and I held my hand up to halt the team, so intent on their task. Mr. Thomas’ son had been reluctant to acknowledge his father’s wishes, but now accepted the end.

I knew the rules, had read the law. I knew the process behind the disease, and I knew how to keep Mr. Thomas alive longer. But I’d never been where I then stood, kneeling alongside while a beating heart slowed for want of a breath. I wanted to ignore the official scroll and force life back into this man who could still live. I wanted to bark orders to ensure efficiency and sail into the night with lights and sirens leading the way. I wanted to do the things I knew how to do.

But it’s only at the threshold that we learn, adapt, and grow. I stood as son took his father’s hand and held it tightly, tears streaming down his face while a tired heart took its final beats. There was no physiology or pathology here. No dopaminergic rescue or endotracheal salvation, only a shoulder to lean on and an extra pair of hands. I watched as courage and respect trumped justifiable prejudice.

As I hunched over my desk, filling out the obligatory reports and summaries, it struck me how the odds are I’ll never be the one to prescribe the Sinemet for patients like Mr. Thomas. I’ll never really need to know about Mr. Davis’ enzyme mutations or Mrs. Smith’s DNA repair mechanisms in order to help them feel better. But, maybe that’s not why we learn. Perhaps the hours under fluorescent lighting and weary eyes are so that we don’t have to think about chromosome translocations or histocompatability — maybe it’s only when we know the disease that we can learn the medicine.

Rick Pescatore is a medical student who blogs at Little White Coats.

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