I knew it was the end of the world. I was about ten years old and returning home just as it was becoming dark. The sky began to be shot full of incredible colors coming from one direction. They became larger and brighter. Having been raised in a strict Catholic household, I had been well prepared for the end of the world – it was here! I raced home at a speed my synaptic junctions did not know they could achieve. I got my mother and pulled her outside and pointed in greater fear than I had ever experienced. She calmly looked up and said that it was really beautiful and was called the aurora borealis – the northern lights.
That same household propelled me to become a physician. I was the child most likely to become a priest, and that was the ultimate achievement in a family such as ours. I was sure that would not be my path and soon realized that becoming a doctor would erase that disappointment quickly for my parents. These past forty years have proven I took the right path.
Recently a first and second-year medical student presented a case to me. I teach in a student-run free clinic in a challenged city. It is the perfect role for me as I get to give back, to see patients who really need care, and to teach. The first-year student, having recently learned how to do an organized medical interview, proceeded to tell me of this seventy-one-year-old lady from South America who recently moved here to be cared for by her daughter. She had fallen a few years ago and hurt her back. She was seen by a physician there and was told she had bad arthritis that was worsened by her fall. She slowly worsened and now could not get out of a chair by herself. The pain was now minimal. She did not speak English, and the story came from her daughter and an interpreter. She was not on any medications. The story given me was clear and organized. Nice job.
The role of the second year was to do and report the physical exam. He went through the vital signs, the appearance, the heart, and lung exam, etc. He did not do the neurologic exam as that had not been taught yet in the curriculum. Normally there is a third-year who presents the assessment and plan, but there was none today. The second-year did a wonderful job in stating that this lady likely had spinal stenosis from arthritis from the fall, and was now very depressed due to her profound disability and reliance on others. He noted that she was emotionless and appeared sad throughout the evaluation.
We went to see this new patient together. I opened the door, and in seconds I knew what she had. Medicine is seeing the aurora borealis for the second time. Once you see it and learn what it is, you will recognize it quickly. I now had the opportunity of allowing these two students to recognize a disease the next time they see it. This nice lady had advanced Parkinson’s. I knew it from the look on her face – it was “masked”- expressionless. I asked her questions through her daughter that should have made her smile, and her eyes opened, and her answers were funny, but her face did not move. The students stood in awe. I moved her arms and found the classic cogwheel rigidity and immediately had them do the same. This continued, and I was able to teach them why this nice lady could not stand from a chair and why her gait was as it was. I was saddened that this was not picked up earlier but able to hold out some hope to her that treatments will likely help now that we have a diagnosis. The students were amazed. This baton had been passed.
I told the patient what she had and outlined the plan of care. Our hospital does an amazing job of supporting those in our community who do not have insurance. Medicines were begun, a neurology consultation was set up, and physical therapy was begun. All of this was done free, as the costs were absorbed by the charity care of our institution. I told her that she might dance again and that I wanted the first dance! Months went by, and one day she came in and specifically asked for me to be the attending physician. There are others who work as I do, and we rotate who we see to allow optimal education by giving students different views and approaches. I walked in the room with a big smile; her daughter took out her cell phone and began to play music. Her mother rose from the chair without assistance and held out her arms to me. We danced! It was a moment I will always treasure.
Each patient I have seen over these four decades has made me a better doctor. Books do not impact long term memory the way a real patient can. I once heard the chair of medicine at a teaching hospital say that the worst thing about being on call every other night as an intern is missing half the patients. I now know he was right. Each patient becomes a colored light in our sky.
John F. McGeehan is an internal medicine physician.
Image credit: Shutterstock.com