Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.
Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.
Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.
His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?
“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.
“The cut is free. I’m still practicing.”
“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.
“Next?” Of all the people waiting in the barbershop, no one took a second glance.
“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.
“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”
I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.
“Caesar trim. Sides short. Front long,” his father called out.
“Thanks for giving me the opportunity.”
“No problem. We all have to start somewhere.”
“Hello,” came a quiet voice. I glanced up from my paperwork to find a young lady leaning in across the counter. Her wavy brown hair framed a shy smile. A white coat hardened her otherwise soft and subdued attire while the red tubing and metal instrument around her neck helped identify her.
“Hello. How are you?”
“I am good. How are you?”
“Not too bad. Can I help you with something?
“Yes. I am a second year medical student. I was sent up here for our clinical skills session to assess a patient and I was hoping, if you have time, to help me with a few points on my presentation.”
I stopped for a moment, unsure of myself. Could I help this student? Perhaps I am not the right one to ask. But what is the harm in trying?
“Tom, come take a look at this,” the attending beckons excitedly. I get up from the charting station and walk over to his computer.
A CT scan fills his screen with a very large, obvious abnormality. “This is one of the biggest I have seen in my career,” he says. The patient had developed not only a large mass but a rare one, causing all sorts of systemic anomalies. Given the extent, it would be inoperable.
As we proceed to the patient’s room, the doctor explains the clinical presentation of mass effect on the body. His eyes are wide and flicker with a fiery excitement. He can barely control the rate of his words as he gushes about the various pieces of the unique clinical puzzle in front of him.
“Are you excited?” he asks after he finishes. I reply that it is “interesting,” much to his displeasure. “How could you not be excited? You might not see this ever again in your life.”
But all I could think about was how this mass, this zebra on a CT scan would soon bring our patient to their untimely death.
Within, I watched the attending as he spoke to the patient and their family about the situation. He explained things with such professionalism, clarity and assurance that I could see no better way it could have gone.
Yet it continued to disturb me, his excitement in it all.
Joseph Addison, a poet said: “Everything that is new or uncommon raises a pleasure in the imagination, because it fills the soul with an agreeable surprise, gratifies its curiosity, and gives it an idea of which it was not before possessed.”
For my attending, who may have seen thousands upon thousands of patients with very similar presentations, this zebra case must have stirred up a renewed sense of adventure, a break from an otherwise regular routine of patients.
Perhaps, it is that hot flush of novelty, that infectious high of our peers that perpetuate our own behaviour.
Too often our fascinations show outwardly as our primary intent. In the process, we forget that the patient has a name, has a right to be treated with dignity, has an illness that still needs to be treated. In the process, we forget that the condition does not define the patient any more than he defines the condition.
It is a strange situation we find ourselves in, to be excited and captivated by our morbid curiosity; on some level, we must in order to learn and improve as clinicians; at the end of the day however, it must come at the expense of someone else’s health. For that, I must always consider the fine line that separates respectful and disrespectful learning.
“Pretty neat findings, eh?” He nudges me. I take a look back at the patient’s room. I watch as the family huddle in an emotional embrace as they come to terms with our news.
“Yeah. It is really interesting,” I mutter bleakly.
After weeks of studying, it had come down to this day: the surgery oral examination. Historically, it has remained one of the most challenging exams in third year. It covers a wide variety of subspecialties to great depth; of course, who can forget the intimidation factor of a face to face interrogation?
I went into the first station, sheer terror gripping tight my heart with icy fingers, knowing full well what merciless horrors senior students had suffered in this hour in years past. I hoped I was up to the job.
I was not prepared for what I was about to endure.
From the moment I was seated and the timer started, the questions lay siege. An unrelenting torrent that had me choking and drowning in my own words. The surgeons meticulously picked apart my answers and showed me how wrong some of my answers were.
It was a sorry sight indeed; the other stations were no better.
I felt embarrassed, shamed and defeated. I had not only come face to face with the expectations of the surgeon and fell well short, but I had come face to face with my own. Worse than the biting comments of a surgeon was knowing that I had let myself down.
Having said that, the entire exam took me to that space that is often talked about but not always explored: the space of the unknown. The surgeons today forced me inwards and ripped from the depths of my mind the large voids in my knowledge. And though the experience getting there was not a pleasant one, I must move past this and press onward with the hope that I can retrace my steps to this sacred place in my knowledge scape and rebuild.