Finally, it's here. After two years of syllabi, slides, tests and exams, the theoretical becomes practical; the stories are now spoken, the patients are real.
"Third Year is an oral tradition" is a phrase I'll never forget from one of the doctors who interviewed me at UC San Diego two years ago. She meant that now, the spoken word, the story, interpersonal communication takes center stage. This is the stage of medical school that I have been waiting for and after my first rotation, it has not disappointed. Let's begin . . .
She had a sly, smile about her, like she was always thinking mischievous thoughts. Her movements were careful and measured. She was 84 years young and one of the first patients I talked to [to protect the privacy of all patients I refer to, I'll simply call her "Amanda"]. I thought I had her story all figured out, probably a life-long resident of Ann Arbor, coming in for check-up. How sweet. And how wrong! Amanda, it turns out had been all around the world as a nurse including Africa. I could tell in which era by the way she referred to Tanzania as Tanganyika (the colonial name). Her escapades included evacuating her entire family from a war-torn region of the Congo in about twenty minutes and driving across the border. But the stand-out moment of the appointment was when she bust out in Swahili and said that medications were "bei kali" (expensive). The last thing I was expecting to do at this appointment was chat in Swahili. Once again, my presumptions about labels and first assumptions were questioned. And that was just my first morning!
You would never know how much she had been through. A young patient is supposed to be essentially healthy, perhaps dealing with strep throat or a bad cold. In her 18 years, Carla (not her real name) had already had complications from orthopedic surgery, seizures, pneumonia and multiple other issues (or co-morbidities as we like to call them). Today, though it was not her physical issues that were on her mind. She is a vocal performance major in college and panic attacks have been part of the picture for her as well. As she described the challenge this presented for her, I saw an opportunity to interject. Having been given the go ahead from my preceptor, I told Carla about my own background in the performing arts and how the relentless expectation to perform at a high level and constantly being on the spot can wear on you. I shared how it takes stepping back and getting back in touch with what attracted you to the art in the first place, tapping back into the simple joy of performance, before the competition, the expectations and yes, the rejections. As I talked, Carla's mouth dropped. She was clearly not expecting to hear this perspective in the doctor's office (even though this was an Integrative Medicine visit). She had the expression someone gets when they feel someone understands their dilemma, not in a cerebral way, but in a "I've been there" way. I do wonder, though, who got more therapeutic value out of the encounter, her or me. I miss theatre, acting and performance. So when an an opportunity within medicine presents itself in this way, the resonance within me is vibrant. I feel the relationship element within medicine and theatre collide and it makes a glorious sound!
I just read a great play "Dead Man's Cell-Phone" by Sarah Ruhl. In the play she quotes Charles Dickens from "A Tale of Two Cities." in which he describes each human life as a "book of secrets." We each have a limited time to read each other's books, and then the books close. The process of learning and sharing secrets can be unnerving, so we package each other with labels and assumptions because otherwise, who knows what we may find . . . but if we do dare to open the book without presumption or preconception, then along with anything unsettling we may discover-because that is real- there is also a richness of experience in each life that is revelatory, challenging and often inspiring. And so, I await my next story . . .
[My goal in third year is to post at least once a week since there is so much more patient contact now. Neurology begins tomorrow- next post in a week!]