Walking behind our registrar–white-coats, name badges, stethoscopes–we felt like superstars. The ward was packed and some people were standing against the walls as every seat available was seating four butt-cheeks already. Most of them ignored us, but some looked up as we walked by. Their expressions were a hesitant cross between automatic respect and reflex curiosity.
This lot are too young to be doctors, but they look like doctors. Are they doctors?
He led us past the nurse’s station, past a few curtained-off examination stations and into a small corner of the ward. Just as he began to speak, someone called him away for an important consult. We chatted away excitedly, wondering what he would teach us, musing about how much he resembled House.
When he returned he immediately launched in on his firm’s schedule, which nights would be call nights, what times we had to be around otherwise. Then he turned and walked away.
Stunned and unsure, we followed him to a countertop that had files neatly arranged like a fallen line of dominos.
“Divide into groups of two. Grab a file from the right side of the pile and work your way to the left.”
My clinical partner grabbed a file for us and we stood, awaiting further instruction.
Dr House-a-like turned to walk away but then paused to face us again.
“That’s your patient,” he said, his eyes pointing towards the file. “Call the name. Take them to an examination station. Take a history. Do a physical exam. Call me when you are ready to present.”
With that, he walked out.
“No way,” one of my clinical partners said, looking like he was expecting the doctor to return and say it was a joke. “He is serious.”
Being thrown in at the deep-end, it was either sink or swim. There was no time for orientations, and ward tours, and staff introductions. There was no time for him to demonstrate to us what was expected of us and how things were done in this ward. We were there to learn, but that learning would not be formal. All that mattered was that we were in the ward and thus were expected to make ourselves useful.
We floundered. We took patients to the wrong curtains, we called doctors for the wrong things. When we took histories, they were superficial where they needed to be deep and excessively detailed where there was no necessity. My partner and I forgot to examine our first patient and stood agape when the doctor asked us at the end of my presentation what physical signs I’d managed to ellicit. We missed a ridiculously textbook case of umbilical hernia because we were so focused on signs related to the patient’s history that we forgot to be thorough.
We fumbled. We bugged the doctor too often, we stood too long mid-history taking to figure out what next to ask. We presented a Neuro case to the Abdo surgeon because we thought the Nissen (fundoplication) from decades before was related to his lower back pain radiating down the legs. (No, it was quite obviously not.)
We followed. We imitated the S.I’s and the doctors. We watched and learned as our registrar explained in the most beautiful simplicity known to mankind how a patient who had suffered from ‘heartburn’ for over a decade actually had advanced gastric carcinoma and would probably end up with a Roux and Y, along with resection of other abdominal viscera due to unrelated pathology. We learned that something as simple as holding a gown up between the obese patient preparing for a rectal exam and the medical students shamelessly oggling the patient was an act of respect and acknowledged dignity in circumstances otherwise undignified.
We failed. All the while we thought we knew what being a doctor on this continent means, but we truly have no idea. Certain things we once considered basic human rights–lunch breaks, rest for your painful, swollen feet, bathroom breaks–we now know are mere luxaries. One of my partners walked in on a consult to ask if we could be excused for lunch since we would have a Clinical Skills Tut that would last all afternoon and no break between hospital and the Tut. The registrar patiently looked up from the patient’s chart and asked:
“Are there still patient files on the counter?”
“Good. You can leave when all patients have been seen to. ”
There were a lot of patients still.
Medicine is becoming real. It’s strange how I always used to think of some of the things we studied about in an almost abstract way. I didn’t even realize it until today when I was standing there, looking up a patient’s information on the system and wondering whether the gastroscopy would yield the results we were fearing it would. I was actually afraid. But not for myself and how totally out of depth I was. But rather for this other person who was as new to this world as I was but whose exit point would not be the start of an enriching journey but possibly the end of an all-too-short one.
We floundered, we fumbled, we followed and we failed. But it was one of the most significant days of my life. I quickly discovered how much we are expected to know, and how much we are expected to learn in a day. Suturing, IV-lines, injections–all learned in a day and all likely to be applied maximally over the course of the next month. Today, we were but fledglings. Someday, hopefully we will flourish.