To infinity and beyond

The most surprising part of medical school is the actual patient interaction. Entering six weeks ago, I imagined that difficulty would lie in "mastering" the wealth of "medical information" (to blatantly borrow from a course name). However, I have found - so far - that the basic science of medicine is not conceptually difficult. (Ask me when I get to cardio physiology.) The difficulty lies in the patient in the sense that no two psyches are the same, and neither are your elbows. When you internalize that last notion, the number of permutations begins to take shape and I am once again Pascal declaring, “Le silence éternel de ces espaces infini m’effraie. [The eternal silence of infinite spaces terrifies me.]” (Side note: the hardest part so far of my dissection was the back of the neck. In that area, the skin is rather thick and separated from the cervical vertebrae. Peering between my midline incision, all I could see was a dark, empty crevice. People say the soul resides in the eyes or the heart. For me, it lies in the abyss at the base of your skull.)

To illustrate, we learned the musculoskeletal exam today. (Side note: I'm not sure I've ever had one performed on me.) It's indescribable how frightening the experience was. A simple task - walking my fingers along the clavicle to find the acromioclavicular joint - became enormous as the pads of my fingers lost themselves in the standardized patient's flesh. Was I palpating to hard? Am I even in the right spot? Is she laughing at me? Are my classmates? And then you strike gold and hope for greater acuity next time. I am hardly the first student to encounter these feelings. My point in writing about them is to give voice to their universality. Patients can fear us because of the knowledge we have, our unhindered access to their fates (good and bad). What they don't know is how frightening they can be. Today's standardized patient injected a fair amount of levity with her spontaneous endorsements of the benefits of paddle tennis to the 63 year-old body and curiosity in how physical landmarks on her body related to surgeries she had twenty years prior. In that last regard, she remininded me of my great aunt Ellen. (To know her is to love her.)