The Lancet Student

Latest blog post:Clinic Day 1: I took an oath to at times do nothing.

This blog was submitted by mrosenstein on 24th June 2015.
Tagged with Medical Education; Primary Care; United States

In our first clinical placement at the Duke University School of Medicine, we spend one day per week listening to patients’ stories, asking for their list of medications, and listening to their heart sounds.  Yet, as we learn to crawl, we also learn to fly.  We begin having spent months standing next to life, fresh from the organs and neoplasia of pathology lab, having clutched beneath our gloves memoirs of providing human service as undergraduates.  Day 1 in the clinics, we are beckoning with excitement to again do something meaningful for another human being.  I was excited to master my craft, my stethoscope, and a physician’s seemingly routine efficacious ability to empower.

This experience has taught me that often, I will sit there.  In front of someone, someone in pain, someone who can’t get better, who won’t get better, who might and will die, or be depressed for months to come.  And I will be virtually and pragmatically helpless.  And I will sit there, and cringe at the details of an unjust life.  And I will cringe again, when our eyes meet and they cry too much pain for any one person.  And I will sit there when they allude to wanting to kill themselves, for reasons that are far from crazy, and far from their fault.  With a pencil, and notebook that has run out of pages.  

A few weeks ago, I sat with a single mother who sits alone with a nightly beer or vodka bottle, without money, without a job, who rightfully has little hope in consequence to injustice, to racial inequality, to social disparities.  She told me all was fine, and then she broke down in tears.  She shared how she had spent a lot of time thinking about death.  Every bone in my body told me I needed to get out of there, it was time to get my preceptor, Dr. Sheline.  I prayed Dr. Sheline had a new pill, a special shot, that gives people a peaceful home, and a stable supply of basic food to eat.

And I sat there, and I listened.  And I started to close my notebook.  And I asked myself what I was afraid of.  Afraid of the inevitable?  That I knew we wouldn’t be able to help her.  Was I afraid of coming out of anesthesia, coding at the realities of the world medical education shelters me from?  I sat there.  I couldn’t feel what she feels.  But for thirty minutes, I had the front row seat on her life.  And I wanted to leave, and told myself I had to leave.  And stopped, and sat, and listened.  

Reflecting, I took an oath, to at times do nothing.  Those thirty minutes were a portion of both mine, and her life.  For thirty minutes, she was safe, she was heard, we were just two human-beings.  And to my surprise she told me she felt better.  Her physiology, neurotransmitters, her body hadn’t been touched.  She hadn’t even been spoken to.  She observed the saccadic eye movement of a nodding head, of eyes that mirrored the water in hers.  I’m no Freud.  I did nothing new.  I sat there alone.  I sat there with her.  I sat there, and I listened.

She went home to a broken household, a child she can’t afford to support.  And there is no denouement; let’s be realistic, her life may be tough for a long time.  Yet, I walked out of clinic knowing that one person in this world listened to her.  And for a few seconds, when she saw me reopen my notebook, I believe she could tell someone cared.

Build it.  Build it with you eyes.  Build it with your acquiescence.  People will trust you, and tell you, and you – clinical knowledge aside, can make someone’s day, perhaps even their life.  You, the person beneath your white coat.  I’m starting to believe the mere act of being human needs to be accepted as a ubiquitous condition in itself.  The diagnostician comes to the bedside, to the exam table, with educated eyes, and yet he or she is vulnerable.  She – the well trained scientist - should be scared, be fearful, be nervous.  She should be curious, and not know.  She should be prepared to see someone whose experience may differ from hers, may shock her – and she should cry, remembering they were born, will die, and live a very much shared life.  The oath isn’t to a practice, it’s to a person. 

Matthew Rosenstein is a first year medical student at the Duke University School of Medicine, North Carolina, United States.