Important MS1: An oxymoron?
Roshini Selladurai May 16, 2014
It’s been a week and a day since we finished our first year of med school. Pretty crazy! As my final post for the semester (not including the “MS1 recap” post that I just remembered I need to write…), I wanted to share about the last patient I saw during ICM (Intro to Clinical Medicine)…
We walked past the first patient in the room, went behind the curtain, and saw him lying in bed, staring straight ahead. I said his name (changed for obvious reasons), “William Johnson?” and he turned to face us. I instantly felt extremely uncomfortable. There was something about the way he looked at us that just seemed off. When he made eye contact, the uncomfortable feeling grew stronger.
As is often the case when I feel uncomfortable, my voice went up about an octave as I asked him, “So what brings you into the hospital today?” As usual, I said this as cheerfully as possible, but fully aware that there can be a fine line between being cheerful and being annoying in the hospital.
He looked me straight in the eyes and said, “I’m blind.”
I looked at my classmates and the two of them looked just as surprised as I felt. At least that explained why his gaze seemed a little “off.” It’s an uncanny feeling to have someone look you straight in the eyes, yet not see you. I had never experienced that before, and it was very disconcerting. His response had left me at a loss for words (a VERY rare occurrence, as anyone who knows me will agree!), but thankfully my classmate asked the follow-up question: “When did this start?”
He looked my friend straight in his eyes and said, “Last night.”
Whoa. Can you imagine going blind overnight? We asked him a few more questions and suddenly he leaned forward. In an attempt to be as honest as possible with y’all, I’ll tell you that I got nervous. We were standing really close to him, I had already felt uncomfortable, and suddenly he’s leaning towards us…I don’t know what I expected to happen, but I instinctively backed up a little. I hadn’t even noticed the bucket right next to his bed…until he began vomiting into it.
At this point, both of my classmates and I were standing in the corner, looking out the door to see if a nurse was coming (praise the Lord for nurses!). Because clearly, we had no idea what to do. Sure, we’d seen lots of patients over the year, but this guy was in a league of his own…and it was painfully obvious that we were out of our league. We whispered to each other, wondering if we should stay and continue asking questions to obtain the full “story” or if we should just leave the room and give the man some peace. I suggested we leave him alone. He was clearly not feeling well, we were only MS1s so all we could do is talk to him. We’re essentially playing dress up with our white coats…we don’t even wear a stethoscope for goodness sake–it’s not like we could actually HELP him, right?
And that’s something we often worried about when seeing patients. All we were capable of doing at this point was to talk to them. We were supposed to go in and ask the patient questions that they’ve undoubtedly already answered multiple times for more important people. Each patient helped us improve our history taking skills, but were we really helping them? Because on our end, we often felt like we were burdening people who had enough burdens of their own.
After his vomiting had ceased, he sat back in bed and said 5 words I’ll likely never forget:
“Are you guys still here?”
Full disclosure: Those words made me feel horrible for even suggesting that we leave the room. By focusing on the fact that all we could do is talk to the patient, I had completely disregarded the importance of that opportunity.
We quickly reassured him that we’re all still here and asked if he would mind answering more questions or if he would prefer we leave him alone. He said he’s fine with talking more and that we should stay.
And so we stayed. We asked more questions. We uncovered more of his story. We listened.
And that leads me to the most valuable lesson I learned this year during my patient encounters:
Being present is valuable, necessary, and helpful.
As first year medical students (MS1s), we had many people encourage us to press on through the intense studying by telling us that things will get better, one day we’ll feel useful, one day we’ll get to practice REAL medicine, one day we’ll FEEL like doctors instead of just looking like kids playing dress up.
But remember that all the patients you see in the hospital are usually pretty ill. They’re scared. His mind is going a million miles an hour imagining the worst case scenario. Or maybe her mind is tuning everyone and everything out after she was diagnosed with the worst case scenario. He’s wondering how he will tell his children. She’s wondering how she can afford to deal with this disease that’s taken her body as its hostage.
These patients have talked to multiple nurses, heard scary words from different physicians, undergone x-rays and CT scans and MRIs, had blood tests ordered, and feel overwhelmed with all the information and medical jargon they’ve heard.
And then in walks a first year medical student. The student has a smile on her face, a white coat that’s a little too big (furthering the notion that she’s playing dress up), and the knowledge that she knows very little “real medicine.” So, after giving her name and introducing herself as “a student doctor with IU health,” she cheerfully asks, “What brought you into the hospital?” and waits expectantly. The patient can recognize that she’s clearly not an important person in the hospital. The MS1 thinks she’s not important because…um, hello, she’s an MS1. But the patient recognizes her as unimportant in the eyes of the hospital not because she’s an MS1, but because she’s not in a hurry. The important people here are always in a hurry because…um, hello, they’re important. But this girl has way too much time to be important.
And so the patient encounter continues. The MS1 asks questions to obtain the history of the present illness (i.e. get details on what brought the patient into the hospital), doing her best to follow the CLOSER acronym (Characteristics, Location and radiation, Onset and duration, Symptoms associated with the concern, Exacerbating factors, Relieving factors). The patient answers the questions and enjoys a break from the medical jargon…mainly because the inexperienced MS1 doesn’t know much medical jargon.
So yes, the MS1 may not be very important in the hospital. She may not play a big role in determining the patient’s treatment (ok, let’s be real: she has no say whatsoever in what the patient eats, much less in how the patient is treated). She doesn’t have a stethoscope around her neck. She doesn’t have 2 important letters following her name. She isn’t getting paid to be here…no, no, on the contrary, she’s paying to be here. But not to fear, for one day things will get better. One day, the hospital will see her as important.
But to the patient, this MS1 is already important. The MS1 listens intently to the patient. The MS1 takes time to hear how the patient is feeling. The MS1 is young and inexperienced enough to still be excited about talking to a patient…while wearing a too-big white coat. But above all, the MS1 is important to the patient because the MS1 is present. She’s present in this time of uncertainty, this time of fear. She may not know what disease the symptoms are pointing to (ok, she may not even understand what some of the symptoms are), but she knows those symptoms are scaring the patient. And she’s here, listening, being present at this moment. And that makes her important.
So now that we’ve finished our first year of medical school and are a little closer to being “important,” I hope we all remember how we started our journey towards becoming a doctor. I hope we see the importance in what we’re doing right now. I hope we remember that staying with the patient and listening to them is important. I hope we never forget the importance of being present. I hope when the patient asks, “Are you guys still there?” we can assure him we are. Being present in the moment makes you important to that patient.
Be fully present with your patients.
Be fully present with your friends.
Be fully present with your family.
Because sometimes all people want is to know that you’re there.
And on that note, have a great summer, everyone!