“I am allergic to oxygen, water, air, food, and oh yes, people”, Dr. B remarked. He was hyperbolically repeating the words of one of his patients as he viewed a medical history. The paranoia that most patients feel after undergoing so many procedures is real. Some even diagnosed themselves with some deadly ailment before coming to see the doctor. It was a gloomy Tuesday morning as the summer’s simmering heat was quelled by the rain showers which does not seem to be holding back any of its potentials. I got to the general surgery office and we had about 14 patients on the schedule between 9am and 12pm. We saw patients within the age range of 17yrs to 73yrs old. The operating room is where I familiarize myself with surgical techniques, teamwork skills, and the human anatomy. On the other hand, in the exam room, it is just the doctor with critical thinking and people skills and the patient with concerns.

Patient A was in a wheelchair in the exam room. She seemed frail and her gait shuffled every other second. As Dr. B helped her to the bed for examination, she staggered and trod slowly until she made it up to the bed. The questions began to fire like action potential in neurons from Dr. B. After several questions, he then asked if she had pain above her navel or below it. He stressed that the answer is important in making the right diagnosis. She waved over her entire belly to indicate where she felt the pain. When asked to point to the pain, she initially pointed up and then later she pointed below. I could feel Dr. B getting frustrated. I think most patients don’t realize that physicians need the patients help in order to provide the highest quality care that they deserve. Being a physician is not a one-sided task; patients have to be engaged and responsible for their right diagnosis by being honest and exact in the best way possible.

After standing all morning long, I caught a break to study before returning to the room where I would be watching three consecutive colonoscopies. The coldness of that room would have taken me to my heels but I wanted to learn so I had to take it all in. Although I was just going to observe from the room corner, Dr. B showed me how to use the endoscope. The procedure felt gross to me until Dr. B started finding polyps in the colon of these patients. He clipped them off. Polyps are usually harmless but some could develop into cancer which can be deadly if not caught early. I thought to myself that maybe physicians’ bravery to withstand even the grossest things during their course of practice isn’t born out of some dauntless gene but out of the sincere desire to get positive outcomes that would lead to a patient’s overall wellbeing. After all, medical students do cringe sometimes during gross anatomy lab. Earlier in the day, we had seen patients who had intestinal diverticulitis (inflammation of the diverticula). So, during the colonoscopy, Dr. B showed me the diverticula on the monitor: they are small pouches in the colon.

The following day at the office, I was looking at the CAT scan of patient B who had a bilateral mastectomy. She had been undergoing chemotherapy and radiation but chose to stop it because the side effects were overwhelming. While analyzing CAT scan, Dr. B saw that the cancer had metastasized to her liver. She has masses in her liver which she knew not of. The oncologist should have discussed that with her so Dr. B refrained from addressing that issue during the examination but he strongly encouraged her to talk to her oncologist about her CAT scan result. Patient B’s fatigued eyes bore the pain that she has undergone and the slightest of hope she had struggled to gather. She asked the doctor if she could go back to work not knowing that another battle awaits her. I wish I had a magic wand. Nice people don’t deserve pain.

That same day, I was supposed to watch a surgery where the entire colon would be removed(colectomy) due to a patient’s poor decision making. He had developed a colon cancer which was caught very early and was advised to get it removed. He denied undergoing any surgery even after his daughters persuaded him to do something about it. Eventually, the cancer developed to the extent that it attached itself to the abdominal wall and protruded out of his belly. Now he has to get colectomy and have a colectomy bag attached to his abdomen so that all the waste can be disposed of. What I learned from this is that it is important to help patients understand their conditions and elucidate the imminent risk without sounding too forceful. Doctors tend to want the best for their patient while respecting their autonomy. This represents a dilemma that cannot be avoided during one’s course of practice. Yet, it is one of those things I guess, with time, doctors learn to grapple with. I cannot think of not worrying about a patient that makes a bad decision that could cost his/her life or quality of life.

The last day in the OR, I watched and participated another gall bladder removal surgery. I noticed that no two people are the same. The diagrams in the book are the same, however, in reality, one has to critically assess the anatomy of different patients. The gall bladder was detached by clipping cystic duct and cystic artery. If Dr. B had gone by the available heuristic, he wouldn’t have detected that the arteries were branched which made it two. He had clipped only one previously. Then thirty minutes later, I watched the removal of a breast tissue that had been marked by a pathologist for biopsy.

It was an incredible experience and over four days, I learned so much than I ever thought I would. My perspective towards medicine was shaped in a unique fashion. Seeing different facets of being a physician- the meritorious aspects, the dreary aspects, and the inevitable dilemma zone- made me appreciate the nobility and uniqueness of medicine. A physician could be cracking jokes with his staff to cutting a patient open to making life changing decisions for patients. Many times, I parallel my lab work on cell culture with treating patients: I had to make sure everything is sterile, make a treatment plan, execute my plan, and incubate the cells for optimal growth. This parallelism becomes faulty when I think of patients as having hearts, loved ones, dreams and aspirations, bucket list, and so on. My takeaway from this experience is that, in a broad sense, we as premeds are entering this profession to help people but, in a subtle sense, we are really interested in medicine to restore hope in people and guide them through the decision-making process regarding their health. When one stares at death straight in the eye due to an ailment, one looks out for help because one feels helpless. But, through the provision of help and compassionate care from physicians, the once staggered hope one has for living and in life is alleviated with renewed vigor.

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