October 24, 2008

• Digging for answers in the final stretch

  With one week remaining until I take my boards, I have been poring over question after question like some grizzled old forty-niner trying to sift out little nuggets of knowledge, all the while not aware of the giant mountain at my back.

  In a sense, the boards, the last hurdle of my medical school career, are easy. Not easy in the sense that any idiot could pass them, for just like those gold miners of old, you had to stake out your area, and hope your instincts would lead you to a treasure trove. Rather, the boards are easy in the sense that every question stem smacks you in the face with clues leading to the right answer.

  Of course, in standardized exams, as in life, not all that glitters is gold. A stem might throw me several different lab results suggesting jaundice and gallbladder stones and then merely drop a hint that the patient is pale and has several petechia (spots) cluing me in to HELLP syndrome. Or give me a patient with a typical marfans build, long, skinny, heart problems, but then mention a downward lens dislocation that is almost pathognomonic for homocysteine deficiency. But in every question there is always at least one nugget of information that will help me find the vein (ha. ha.) I seek, the big payoff. I just have to know how to look for it.

  And it is slowly happening…I dont know that I will ever feel truly ready, but each day I come a little bit closer, do a little bit better, prove to myself that I do have the knowledge, these last several years have not been for naught.

  Because once I get out into the real world, I wont have these nice little inclusive histories all bundled up and presented to me by the patient. There will be no “doctor doctor, I have the following symptoms, can you tell me which one of these five diseases I have?” Despite the best efforts of webMD and google, most patients still can only come in and provide me with one or two options, and there is no guarantee that those aren’t just pyrite themselves.

  So why have I put myself through all this, why dont I bitch more? In a letter displayed in the library of congress, one goldminer reveals his motivation when he tells his cousin that: “I have left those that I love as my own life behind and risked everything and endured many hardships to get here. I want to make enough to live easier and do some good with, before I return.”

  That I think is a pretty good parallel of my med school experience thus far. The miner goes on to say of the others in his camp (or in my case med school)

  “Many, very many, that come here meet with bad success & thousands will leave their bones here. Others will lose their health, contract diseases that they will carry to their graves with them. Some will have to beg their way home, & probably one half that come here will never make enough to carry them back. But this does not alter the fact about the gold being plenty here, but shows what a poor frail being man is, how liable to disappointments, disease & death.”

  By this point some of you may be wondering whether or not the miner did indeed strike it rich or joined those who left their bones. Or you may be wondering how long I am going to push this metaphor between the gold rush and my med school experience. In answer to the second, not much longer

  As for the first, well we never find out, as we only have the one letter. And that is the entire gestalt of the medical profession right there…we are given a glimpse into a brief moment of your history, as much as we can take in of your story, and then all too often you are lost to us, consigned to the pages of history. But if I learn to do my job right, then in those few brief moments I can live a whole other lifetime. And that ultimately will be worth more to me than any gold. (which is good, because if healthcare keeps heading down the route it is now, there certainly wont be any-but thats a whole other post)

  Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

  -Almost Dr J

  • 2:28 am
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