In medical school, everything is a zebra


As a medical student, I have big shoes to fill. I feel that void in my foot-space at all times. These shoes are expensive, and they are monstrously huge. We’re talking circus-clown, Shaquille O’Neal, Andre the Giant shoes. I feel awkward in these size 24s. I’m stumbling and scuffing them, but I’m not even close to calling it quits. These shoes are staying on. I am trying as hard as I can to grow my feet with sheer concentration and willpower, millimeter by millimeter. This process takes years, and probably decades. But one day I’m going to fill these scuffed-up shoes with my big-ass feet. And they’re going to look good on me.

The standing advice is “fake-it-til-you-make-it.” I’ve readily adopted this tactic. I aggressively apply my limited medical knowledge to every scenario I encounter. I’m trying to view the world as a physician. I boil everything down to some physiological process or another. I assume everything has an explanation, even if I’m not sure what it is. It’s hard to be an authority in an esoteric field like medicine with only a single semester under your belt. Oh, but do I try.

Doctors love to tell the same medical adages over and over. One of them is this: “When you hear hoofbeats, think of horses not zebras.” The common diagnosis is more likely than the exotic diagnosis. It’s probably a common rash and not necrotizing fasciitis. The newbie’s plight is that every diagnosis is exotic when you are a novice. We learn the spectacular hand-in-hand with the mundane. Everything is a zebra.

If my pregnant wife remarks on how her belly is bigger than she expected: “maybe it’s polyhydramnios.” When my dad tells me about his heartburn: “maybe you have a hiatal hernia.” I’ll order a Chipotle burrito from a young woman with a slightly yellow tint in her skin and think “Type II Crigler-Najjar Syndrome.”

These are heavy terms to throw around. When I loudly, arrogantly, assert a half-baked theory to friends and family on a medical topic I know I’m not pulling from a wealth of knowledge. Generally speaking, so do they. But these are the tools I have. I need to start using them. I need to get my gears turning. One day my toolbox will contain everything I need to make a confident diagnosis. Right now it has tinker toys, a handful of mismatched screws, and a long-forgotten, rotten banana.

“As wide as the ocean, as deep as a puddle.” That’s how I would describe my understanding of medicine. I know a little bit about everything, but I don’t know everything about anything. I stamp the end of every medical opinion by saying “… but I’m just a student. I’m not a real doctor yet.” That little footnote brings me great comfort. It lets people know to not take me too seriously. But I want them to take me seriously. I hope I rely on that disclaimer less and less over time, so that by the time I lose the ability to use it, I’ll have no need for it anymore. That day I will feel like Neil Armstrong stepping onto the moon.

I hope my feet have grown by then.

Jake Eggett is a medical student and can be reached on Twitter @jakeeggett.

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