“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.
The way I see it, the standards and recommendations of practice change from year to year, decade to decade. What does not change is the art of medicine, the ability to build a relationship with your patients.
If you can take away that from your training, you will do fine. The rest you can look up and read.
Recently, I had the great pleasure of working with a specialist. While I found him to be an excellent doctor and teacher of his field, he impressed me more with his mastery of the art of medicine.
Watching him work reminded me of the heart it takes to work with patients.
After spending a morning with him, I can honestly say without hesitation: I have never been more inspired about medicine.
There was nothing complicated or mysterious about his interactions with patients. There was no parlour tricks or unnatural question structure. It was just him, his patient, and the problem. His language was simple, his examples relevant, and his explanations honest.
We often talk about empathy as a tool to help us connect to a patient. In my hands, it is an embarrassingly clunky, yet unrefined hammer of “it must be frustrating,” or that “I see you are upset.” His was the precision cut scalpel that sliced to the core issues and emotions.
Patients simply opened up to and connected with him. And I, sitting in my seat, even felt the transference of emotions at times as well. It was a powerful and beautiful display of the art of medicine at work.
To his patients, it was an overwhelming sense of feeling human in the eyes of a stranger, to not feel like a bag of meat at the mercy of a probe and a blade. To him, it was just the way medicine had always been and would continue to be.
For me, it was the revelation of what it is to truly practice great medicine.
As I walked into the office, the strong smell of coffee and alcohol sanitizer wafted in the air. The walls were plastered with dedications and certificates, organized chronologically across its four walls, extending back well into the 1960s. The office was a mess, but that is of course a matter of perspective. To the doctor whom it belonged, it was organized chaos. Though a computer sat in the corner with the EMR humming on the screen, it was clear that this was a doctor who still preferred his paper files.
And the files lay everywhere.