Saturday, October 8, 2011

Lessons from my first patient

I was doing a little light reading this morning in The American Journal of Medicine ,
Vol 24 ,October 2011 and 4 articles got my attention.

The first article, Lessons from my first patient, was written by Lt. Brent W. Casey, MD. He was freshman in medical school at the time and was just starting his anatomy lab. He was looking at the body of a red haired women whose brain had been ravaged by cancer. His professor told the group of students that this lady had written them a letter. She explained in the letter that she was a physician trained in neurology who 1 year ago felt that she had all of the time in the world and was beginning to think of retirement. She discussed her cancer and apologized for leaving her brain in such a mess. Then she left the students with a bit of wisdom." Remember that your first responsibility always is to care for your patients,and don't forget that you may learn more from them if you allow it than any professor can teach you. Always remember , above all else, to give them hope.
All the best, Dr. Ruth Ashland "

I still can see the very thin man whose body was very carefully dissected by myself and 3 other students. We were shocked when we found a soft ball size cancer mass in his chest. I recall that we knew so much about this mans body but nothing about the man who actually lived there.

My first physical exam on a real patient is still vivid in my memory. I was part of a 4 member medical student group assigned to do a physical on a frail older man. He was was very kind and put up with our inept questions and awkward exams. I can still see the white crystal material on his eyebrows. He died as we finished our exam. We later learned that the crystals were something called uremic frost. He had end stage kidney failure. There was no treatment for kidney failure at that time. I don't think any of us appreciated the reality of that moment in time until later as we matured as physicians.
Some things I learned from my first patient encounters is that our physical bodies are all much the same and we as physicians are pretty good at maintenance and repair . Getting to know and understand the person living in that body is the challenge that we all struggle with.

I also learned from my patients that we all have untapped strengths that that come to the surface when the chips are down and it is time to play the game. We as patient need those technical medical skills but we also need a little hope. I think we all need to remember Dr. Ashlands good advice,
"Always remember, above all else, to give them hope "
Tomorrow the other 3 articles discussing weight loss and the obesity paradox
Dr. Calder

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Your comments and questions are appreciated. David Calder,MD